The clinical course of individuals with 22q11.2 deletion syndrome converting to psychotic disorders: a long-term retrospective follow-up.

OBJECTIVES: This retrospective study aims to investigate the evolution and clinical course of psychotic disorders from three large international cohorts of individuals with 22q11.2 deletion syndrome (22q11.2DS) (Tel Aviv, Philadelphia, and Geneva). METHODS: We followed 118 individuals with 22q11.2DS from several years before the onset to several years after the onset of psychotic disorders. Data from structured baseline assessment of psychiatric disorders, symptoms of prodrome, indicators and types of psychotic disorders were collected. Additionally, cognitive evaluation was conducted using the age-appropriate Wechsler Intelligence Scale. Electronic medical records were reviewed for medication usage, occupational status, living situation, and psychiatric hospitalizations. RESULTS: At baseline evaluation, the most common psychiatric disorders were anxiety disorder (80%) and attention/deficit hyperactivity disorder (50%). The age of onset of prodromal symptoms and conversion to psychotic disorders were 18.6 ± 6.8 and 20.3 ± 7.2, respectively. The most common prodromal symptoms were exacerbation of anxiety symptoms and social isolation. Of the psychotic disorders, schizophrenia was the most common, occurring in 49% of cases. History of at least one psychiatric hospitalization was present in 43% of participants, and the number of psychiatric hospitalizations was 2.1 ± 1.4. Compared to the normalized chart, IQ scores in our cohort were lower after vs. before conversion to psychosis. Following conversion there was a decrease in the use of stimulants and antidepressants and an increase in antipsychotics use, and most individuals with 22q11.2DS were unemployed and lived with their parents. CONCLUSIONS: Our results indicate that 22q11.2DS psychosis is like non-22q11.2DS in its course, symptoms, and cognitive and functional impairments.

A Comparison of Knowledge, Attitude, and Practice (KAP) Between Private- and Government-Sector Pharmacists With Regard to Psychotropic Medications in Riyadh City.

Background Pharmacists play a significant role in patient care, and many patients consider them to be their primary source of information regarding medications. Therefore, pharmacists must have an adequate level of knowledge about psychotropic medications. This study aims to assess and compare the levels of knowledge, attitudes, and practices regarding psychotropic medications in governmental and private-sector pharmacists in Riyadh, Saudi Arabia. Methods An observational cross-sectional study was conducted, which included 355 pharmacists (governmental and private sector pharmacists). Each pharmacist was interviewed and asked to answer a structured questionnaire that consisted of four sections: demographic data, knowledge, attitude, and practice regarding psychotropic medications. Results Our findings indicate that the overall knowledge regarding psychotropic medications among private and government-sector pharmacists is insufficient. While 282 (79.4%) had insufficient knowledge, 20.6% of pharmacists had adequate knowledge regarding psychotropic medications, and good knowledge was detected among 29.1% of government-sector pharmacists compared to 18.1% of private-sector pharmacists (P = .033). Our results also revealed that 31.5% of the pharmacists felt comfortable with their knowledge of psychotropic agents. In addition, 18.9% of the pharmacists reported that they received adequate training on psychotropic medications (12.7% of the governmental group versus 20.7% of the private-sector group; P =.048). Conclusion The insufficient knowledge among pharmacists regarding psychotropic medications highlights the importance of providing more training programs and educational courses to improve pharmacists' knowledge about psychotropic medications in Saudi Arabia.

Psychotropic medication use pre and post-diagnosis of cluster B personality disorder: a Quebec's health services register cohort.

Background: Cluster B personality disorders (PDs) are considered some of the most severe mental health conditions. Scarce evidence exists about the real-world utilization of psychotropics for cluster B PD individuals. Objective: We aimed to uncover trends and patterns of psychotropic medication use among individuals diagnosed with cluster B PD in the year before and after their diagnosis and to identify factors associated with medication use in a large cohort of individuals newly diagnosed with cluster B PDs. Methods: We conducted a population-based observational study using Quebec's health services register. We identified Quebec residents aged ≥14 years and insured with the provincial drug plan with a first diagnosis of cluster B PD recorded between April 1, 2002, and March 31, 2019. Cluster B PD was defined with ICD-9/10 diagnostic codes. We retrieved all claims for the main psychotropic medication classes: antipsychotics, antidepressants, anxiolytics, mood stabilizers, and attention-deficit/hyperactivity disorder (ADHD) medications. We calculated the proportion of individuals exposed to these medication classes and analyzed trends over the years using robust Poisson regression models, adjusting for potential confounders. We used robust Poisson regression to identify factors associated with medication class use. Results: We identified 87,778 new cases of cluster B PD, with a mean age of 44.5 years; 57.5% were women. Most frequent psychiatric comorbidities in the five years before cluster B PD diagnosis were depression (50.9%), anxiety (49.7%), and psychotic disorders (37.5%). Most individuals (71.0%) received at least one psychotropic during the year before cluster B PD diagnosis, and 78.5% received at least one of these medications in the subsequent year. The proportion of users increased after the diagnosis for antidepressants (51.6-54.7%), antipsychotics (35.9-45.2%), mood stabilizers (14.8-17.0%), and ADHD medications (5.1-5.9%), and remained relatively stable for anxiolytics (41.4-41.7%). Trends over time showed statistically significant increased use of antipsychotics and ADHD medications, decreased use of anxiolytics and mood stabilizers, and a stable use of antidepressants. Conclusion: Psychotropic medication use is highly prevalent among cluster B PD individuals. We observed an increase in medication use in the months following the diagnosis, particularly for antipsychotics, antidepressants, and mood stabilizers.

Psychiatric Diagnoses, Medication, and Service Use Among Patients Who Receive Emergency Care for Inflammatory Bowel Diseases.

This study examined relative psychiatric burden among patients who presented to the emergency department once or more than once for inflammatory bowel disease visits. Results highlight the need for integration of psychiatric and gastrointestinal care among high-risk inflammatory bowel disease patients.

Evergreening of Psychiatric Medications: A Systemic Literature Review of Strategies, Case Examples, and the Implications of Cost.

Evergreening consists of multiple ways that pharmaceutical companies extend patent protection and prolong profitability of brand name drugs past patent expiration. In psychotropic medications, these strategies do not necessarily make more effective drugs, and often increase drug prices, which can result in lower access and utilization. There has not been a systematic literature review of evergreening strategies for psychiatric medications. Based on such a review, 11 strategies were identified and relevant examples were provided. Four case examples of commonly used psychiatric medications indicated evergreen prices 3 to 211 times the cost of the original medication, and the evergreen costs ranging from $132.00 to $10,125.24 higher than the original cost on an annual basis. The higher cost of evergreening medications can create inefficiencies and waste in healthcare resulting in lower-quality patient care. Healthcare providers, patient advocates, health insurance companies, and policy-makers should be aware of these practices to improve healthcare systems.

A Peer-to-Peer, Longitudinal Reproductive Psychiatry Educational Curriculum for Obstetrics/Gynecology Residents.

OBJECTIVE: Pregnant patients with psychiatric diagnoses are commonly advised to stop their psychiatric medications. Few studies assess the knowledge of, attitude toward, or comfort levels of obstetrics and gynecology (OB/GYN) residents in managing psychiatric conditions, which carry adverse and potentially life-threatening risks to mother and fetus. A gap remains between evidence advocating for active psychopharmacological treatment during pregnancy and implementation of curricula targeting OB/GYN physicians in mental health. The authors' goals are to assess the knowledge, attitude, and comfort that OB/GYN residents have toward assessing and managing active psychiatric conditions in pregnant/postpartum women and to develop an educational, case-based intervention targeting these conditions in the perinatal/postpartum period. METHODS: Eight perinatal/postpartum psychiatric topics were developed into interactive cases designed for OB/GYN residents. Two weeks before the curriculum administration, OB/GYN residents were surveyed on prior knowledge in, attitudes toward, and comfort levels in assessing and discussing psychiatric conditions in pregnant patients. The assessment was administered again after the intervention to assess its effectiveness. RESULTS: Pre- (N = 19) and post-intervention (N = 15) surveys of residents were analyzed. Most residents (94%) felt it was both important and their responsibility to discuss mental health conditions with pregnant patients. Comfort levels with counseling psychiatric patients increased for all eight topics after the educational intervention was implemented, with statistically significant increases (p < 0.05) for five of the topics. CONCLUSIONS: OB/GYN residents feel responsible for caring for pregnant patients with psychiatric illness, and case-based interventions offer an interactive, helpful tool for increasing residents' knowledge and comfort level in treating this patient population.

Beyond Binary Narratives of Mental Health Advocacy: Latent Profiles of Mental Health Activists and Advocates With Lived Experience.

OBJECTIVE: In this article, the authors used data from a national survey of mental health activists and advocates (MHAAs) with lived experience of psychiatric disabilities to investigate attitudes toward psychiatric care. METHODS: The authors distributed a survey, developed by a team led by researchers who were also service users, to both mainstream and more critical advocacy groups and networks (N=547 participants), and they analyzed the data by using latent class analysis (LCA). Four survey variables regarding beliefs about involuntary hospitalization, assisted outpatient treatment, medication, and diagnosis were used to generate latent subgroups. The authors explored associations between key survey variables and latent classes with chi-square tests and analysis of variance. RESULTS: LCA indicated an optimal six-class solution. The classes existed on a spectrum of positions, ranging from highly favorable views of traditional psychiatric practices to highly critical views, with classes in the middle representing distinct profiles of attitudes toward treatment and diagnosis. Significant between-group differences were found for participants' psychiatric treatment histories, motivations to engage in activism and advocacy, and views about mental health care and advocacy priorities. CONCLUSIONS: Findings reveal considerable heterogeneity among MHAAs and challenge binary narratives of mental health advocacy.

Epidemiological characteristics and hospitalization trajectories prior to suicide in Galicia between 2013 and 2016.

INTRODUCTION: Addressing suicide requires an understanding of regional patterns of epidemiology, with health variables being central. However, the clinical profile of people who commit suicide has received little attention. The objectives of this study were to analyze the sociodemographic, clinical, and forensic characteristics of persons who committed suicide in Galicia between 2013 and 2016, analyze suicide mortality rates, and identify trajectories of hospitalizations and associated variables. MATERIAL AND METHODS: A population study was carried out on the 1354 people who died by suicide in Galicia. RESULTS: The most common profile was a retired man, 57.9 years old (SD=18.5), from an urban and inner area. 43.6% had been previously hospitalized, 41.6% had been diagnosed with physical disorders, and 26.8% with mental disorders. 48.2% had been prescribed psychiatric medications and 29.6% had received outpatient psychiatric care. The highest prevalence of death by suicide (27.5%) was in 2014, with the predominant method being hanging (59.1%). The average raw rate was 12.3/100,000. Three trajectories of hospitalizations emerged: 94.83% had experienced few hospitalizations; 2.95% an increasing pattern; and 2.22% a decreasing pattern. These trajectories were associated with number of psychiatric appointments, prescription of psychiatric medications, and diagnoses of physical and mental disorders. CONCLUSIONS: These findings are crucial for detection and prevention.

Supraventricular Tachycardia Ablation and Its Effects on Anxiety Medications.

BACKGROUND: Patients with true paroxysmal supraventricular tachycardia (PSVT) are frequently misdiagnosed with panic or anxiety disorders due to similar symptoms of palpitations, light-headedness, dyspnea, or chest discomfort. Unrecognized PSVT can lead to unnecessary management with anxiety medications. Treatment of PSVT with catheter ablation may lead to a reduction in anxiety medications.  Methods: A total of 175 patients underwent successful PSVT ablation between January 1, 2010 and December 31, 2020. We examined symptoms at presentation, psychiatric medications prior to PSVT ablation, comorbidities, and psychiatric medications at three months post-ablation.  Results: Fifteen percent of patients who underwent successful PSVT ablation were being treated with psychiatric medications and included in the final study population. The most common symptoms were palpitations (80.77%), followed by dizziness (42.31%), and shortness of breath (34.62%). The average number of medications prior to ablation was 1.42 and decreased to 1.08 at three months post-ablation (p = 0.04). The average number of selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other anxiolytics also decreased but was not statistically significant. CONCLUSION:  In patients with anxiety and PSVT, catheter ablation reduced the average number of psychiatric medications.

Medical and nonmedical use of psychiatric medications among medical students in Riyadh, Saudi Arabia.

Introduction: Psychiatric medication use has increased recently among college students. This includes antidepressants, opioids, stimulants, analgesics, sedatives, and anxiolytics, which could be self-administered without medical supervision. Objectives: To determine the prevalence of medical and nonmedical use of psychiatric prescription medications and its correlation with academic performance, demographic data as well as the motives for the nonmedical use. Methods: A cross-sectional study aims to assess the psychiatric medication use with or without prescription with the motives behind it, and demographic data of the students at medical colleges in Riyadh, Saudi Arabia. Results: A total of 1268 responded to the questionnaire. 251 (20%) of the participants reported using some psychiatric medications in their lifetime, while 191 (15%) participants used some psychiatric medications in the last 12 months. Antidepressants were most used in the surveyed population 144 (57%), followed by opioids/pain relief medications 62 (24%) and anxiolytics 39 (15%). Only 44 surveyed students (3.5%) reported nonmedical use of these psychiatric medications. As for the motives of nonmedical use, the greatest portion reported to use it for "relax or relieve tension" 12 (29%), followed by "relieve pain caused by other health problems" 8 (20%), and "medication to get through the day" 6 (15%). Conclusion: Nonmedical use of psychiatric medications among medical students in Riyadh is several times lower than reports by other researchers. Future research should focus on collecting more participants who are using medications without prescription and conduct cross-cultural studies to examine factors contributing to such low rates of illicit psychiatric medication use.

Mental health in patients with asthma: A population-based case-control study.

BACKGROUND: This study's objectives were to compare the prevalence of mental disorders and consumption of psychiatric medications in asthmatic subjects with non-asthmatic controls and identify risk factors associated with psychiatric conditions. METHODS: This was an epidemiological case-control study based on the 2020 European Health Survey in Spain self-reported data. Each asthmatic subject was paired with a non-asthmatic control. Study variables included demographics, use of healthcare services, comorbidities, and risky behaviours were compared. RESULTS: There were 22,072 participants in the survey; 1151 cases and 1151 controls were selected. The prevalence of mental disorders (25.5% versus 13.4%; p < 0.001) and consumption of psychiatric medications (25.8% versus 15.6%; p < 0.001) were higher in cases than controls. In asthmatic subjects, female gender (OR 1.814; p = 0.001), age over 80 years (OR 2.558; p = 0.002), poor self-rated health (OR 2.047; p < 0.001), visits to a psychologist (OR 10.854; p < 0.001) and chronic pain (OR 1.938; p < 0.001) were independently associated with mental disorder diagnoses. Meanwhile, female sex (OR 1.710; p < 0.001), age over 80 years (OR 3.802; p < 0.001), poor self-rated health (OR 2.482; p < 0.001), visits to a psychologist (OR 2.694; p < 0.001) and chronic pain (OR 1.494; p = 0.012) were risk factors independently associated with psychiatric medication consumption. CONCLUSIONS: The prevalence of psychiatric conditions were higher in asthmatic subjects. Female gender, older age, worse self-rated health, visits to a psychologist and chronic pain were associated with psychiatric conditions in asthmatic subjects.

Recent Stressful Life Events in Euthymic Major Depressive Disorder Patients: Sociodemographic and Clinical Characteristics.

BACKGROUND: Stressful life events (SLE) may influence the illness course and outcome. This study aimed to characterize socio-demographic and clinical features of euthymic major depressive disorder (MDD) outpatients with SLE compared with those without. METHODS: The present sample included 628 (mean age=55.1 ± 16.1) currently euthymic MDD outpatients of whom 250 (39.8%) reported SLE and 378 (60.2%) did not. RESULTS: After univariate analyses, outpatients with SLE were most frequently widowed and lived predominantly with friends/others. Moreover, relative to outpatients without SLE, those with SLE were more likely to have a family history of suicidal behavior, manifested melancholic features, report a higher Coping Orientation to the Problems Experienced (COPE) positive reinterpretation/growth and less likely to have a comorbid panic disorder, residual interepisodic symptoms, use previous psychiatric medications, and currently use of antidepressants. Having a family history of suicide (OR=9.697; p=≤.05), history of psychotropic medications use (OR=2.888; p=≤.05), and reduced use of antidepressants (OR=.321; p=.001) were significantly associated with SLE after regression analyses. Mediation analyses showed that the association between current use of antidepressants and SLE was mediated by previous psychiatric medications. CONCLUSION: Having a family history of suicide, history of psychotropic medications use, and reduced use of antidepressants is linked to a specific "at risk" profile characterized by the enhanced vulnerability to experience SLE.

Medication by Proxy: The Devolution of Psychiatric Power and Shared Accountability to Psychopharmaceutical Use Among Soldiers in America's Post-9/11 Wars.

With the United States military stretched thin in the "global war on terror," military officials have embraced psychopharmaceuticals in the effort to enable more troops to remain "mission-capable." Within the intimate conditions in which deployed military personnel work and live, soldiers learn to read for signs of psychopharmaceutical use by others, and consequently, may become accountable to those on medication in new ways. On convoys and in the barracks, up in the observation post and out in the motor pool, the presence and perceived volatility of psychopharmaceuticals can enlist non-medical military personnel into the surveillance and monitoring of medicated peers, in sites far beyond the clinic. Drawing on fieldwork with Army personnel and veterans, this article explores collective and relational aspects of psychopharmaceutical use among soldiers deployed post-9/11 in Iraq and Afghanistan. I theorize this social landscape as a form of "medication by proxy," both to play on the fluidity of the locus of medication administration and effects within the military corporate body, and to emphasize the material and spatial ways that proximity to psychopharmaceuticals pulls soldiers into relationships of care, concern and risk management. Cases presented here reveal a devolution and dispersal of biomedical psychiatric power that complicates mainstream narratives of mental health stigma in the US military.

Pharmaceutical Creep: U.S. Military Power and the Global and Transnational Mobility of Psychopharmaceuticals.

In 2006, the United States Department of Defense developed for the first time official criteria for the use of psychopharmaceuticals "in theater"-in the physical and tactical spaces of military operations including active combat. Based on fieldwork with Army soldiers and veterans, this article explores the transnational and global dimensions of military psychopharmaceutical use in the post-9/11 wars. I consider the spatial, material, and symbolic dimensions of what I call "pharmaceutical creep"-the slow drift of psychopharmaceuticals from the civilian world into theater and into the military corporate body. While pharmaceutical creep is managed by the U.S. military as a problem of gatekeeping and of supply and provisioning, medications can appear as the solution to recruitment and performance problems once in theater. Drawing on soldiers' accounts of medication use, I illuminate the possibilities, but also the frictions, that arise when routine psychopharmaceuticals are remade into technologies of global counterinsurgency.

Rating of the Effectiveness of 26 Psychiatric and Seizure Medications for Autism Spectrum Disorder: Results of a National Survey.

OBJECTIVE: The objective of this study was to provide an evaluation of the benefits and adverse effects (AEs) of psychiatric and seizure medications commonly used for individuals with autism spectrum disorder (ASD). METHODS: As part of the National Survey on Treatment Effectiveness for Autism, we report ratings of 26 psychiatric and seizure medications by 505 participants. Each medication was rated with a standardized scale for overall benefits, overall AEs, and specific symptoms affected. The frequency of use and net perceived benefit (overall benefit minus overall AE) are reported. RESULTS: Most medications were rated as having a slightly greater benefit than AE. Six medications (lamotrigine, oxcarbazepine, clonidine, guanfacine, buspirone, and sertraline) had benefit ratings that were more than twice their adverse rating. Conversely, some medications had slightly negative net benefit ratings (worse AEs than benefits on average), including Adderall, Paroxetine, Quetiapine, Olanzapine, and Topiramate. However, there were wide variations in individual ratings of benefit and AEs, suggesting that clinical response to medications was highly variable, so these scores simply represent averages. A ranking of the top medications (those with the highest net perceived benefit) for each of 18 different symptoms is provided, which may provide some clinical guidance as to which medications may be most worth considering for a given symptom. A comparison of the survey results with the results of clinical trials shows generally good agreement in terms of medication benefits with some differences; in some cases the differences are because the clinical trials did not assess all of the symptoms assessed by this survey. CONCLUSIONS: It is hoped that physicians and their patients will find the survey results useful in selecting the most promising medications for a given symptom, and also for monitoring for likely benefits and AEs, especially for medications for which few or no studies have been carried out in ASD populations.

A systematic approach for developing a corpus of patient reported adverse drug events: A case study for SSRI and SNRI medications.

"Psychiatric Treatment Adverse Reactions" (PsyTAR) corpus is an annotated corpus that has been developed using patients narrative data for psychiatric medications, particularly SSRIs (Selective Serotonin Reuptake Inhibitor) and SNRIs (Serotonin Norepinephrine Reuptake Inhibitor) medications. This corpus consists of three main components: sentence classification, entity identification, and entity normalization. We split the review posts into sentences and labeled them for presence of adverse drug reactions (ADRs) (2168 sentences), withdrawal symptoms (WDs) (438 sentences), sign/symptoms/illness (SSIs) (789 sentences), drug indications (517), drug effectiveness (EF) (1087 sentences), and drug infectiveness (INF) (337 sentences). In the entity identification phase, we identified and extracted ADRs (4813 mentions), WDs (590 mentions), SSIs (1219 mentions), and DIs (792). In the entity normalization phase, we mapped the identified entities to the corresponding concepts in both UMLS (918 unique concepts) and SNOMED CT (755 unique concepts). Four annotators double coded the sentences and the span of identified entities by strictly following guidelines rules developed for this study. We used the PsyTAR sentence classification component to automatically train a range of supervised machine learning classifiers to identifying text segments with the mentions of ADRs, WDs, DIs, SSIs, EF, and INF. SVMs classifiers had the highest performance with F-Score 0.90. We also measured performance of the cTAKES (clinical Text Analysis and Knowledge Extraction System) in identifying patients' expressions of ADRs and WDs with and without adding PsyTAR dictionary to the core dictionary of cTAKES. Augmenting cTAKES dictionary with PsyTAR improved the F-score cTAKES by 25%. The findings imply that PsyTAR has significant implications for text mining algorithms aimed to identify information about adverse drug events and drug effectiveness from patients' narratives data, by linking the patients' expressions of adverse drug events to medical standard vocabularies. The corpus is publicly available at Zolnoori et al. [30].

Drug-Drug Interaction Assessment and Identification in the Primary Care Setting.

BACKGROUND: Drug-drug interactions (DDIs) are ubiquitous, harmful and a leading cause of morbidity and mortality. With an aging population, growth in polypharmacy, widespread use of supplements, and the rising opioid abuse epidemic, primary care physicians (PCPs) are increasingly challenged with identifying and preventing DDIs. We set out to evaluate current clinical practices related to identifying and treating DDIs and to determine if opportunities to increase prevention of DDIs and their adverse events could be identified. METHODS: In a nationally representative sample of 330 board-certified family and internal medicine practitioners, we evaluated whether PCPs assessed DDIs in the care they provided for three simulated patients. The patients were taking common prescription medications (e.g. opioids and psychiatric medications) along with other common ingestants (e.g. supplements and food) and presented with symptoms of DDIs. Physicians were scored on their ability to inquire about the patient's medications, investigate possible DDIs, evaluate the patient, and provide treatment recommendations. We scored the physicians' care recommendations against evidence-based criteria, including overall care quality and treatment for DDIs. RESULTS: Average overall quality of care score was 50.5% ± 12.0%. Despite >99% self-reported use of medication reconciliation practices and tools, physicians identified DDIs in only 15.3% of patients, with 15.5% ± 20.3% of DDI-specific treatment by the physicians. CONCLUSIONS: PCPs in this study did not recognize or adequately treat DDIs. Better methods are needed to screen for DDIs in the primary care setting.

Clinical Utility of Definitive Drug⁻Drug Interaction Testing in Primary Care.

Drug⁻drug interactions (DDIs) are a leading cause of morbidity and mortality. New tools are needed to improve identification and treatment of DDIs. We conducted a randomized controlled trial to assess the clinical utility of a new test to identify DDIs and improve their management. Primary care physicians (PCPs) cared for simulated patients presenting with DDI symptoms from commonly prescribed medications and other ingestants. All physicians, in either control or one of two intervention groups, cared for six patients over two rounds of assessment. Intervention physicians were educated on the DDI test and given access to these test reports when caring for their patients in the second round. At baseline, we saw no significant differences in making the DDI diagnosis (p = 0.071) or DDI-related treatment (p = 0.640) between control and intervention arms. By round two, providers who accessed the DDI test performed significantly better in making the DDI diagnosis (+41.6%) and performing DDI-specific treatment (+12.2%) than in the previous round, and were 9.8 and 20.4 times more likely to diagnose and identify the DDI (p < 0.001 for all). The introduction of a definitive DDI test significantly increased identification, appropriate management, and counseling of DDIs among PCPs, which has the potential to improve clinical care.

A Estratégia Gestão Autônoma da Medicação e a Inserção da (A)normalidade no Discurso da Cidadania / Autonomous Medication Management Strategy and the Introduction of (Ab)normalities in the Discourse of Citizenship / La Estrategia Gestión Autónoma de la Medicación y la Inserción de la (A)normalidad en el Discurso de la Ciudadanía

Este trabalho tem por objetivo geral analisar as formas de compreensão e exercício da cidadania pelos sujeitos envolvidos com a implementação da estratégia Gestão Autônoma da Medicação (GAM) na macrorregião referente à 4ª Coordenadoria Regional de Saúde do Estado do RS. Como objetivos específicos pretende descrever as relações de saber e poder em torno dos medicamentos psiquiátricos que produzem o agrupamento de ativistas do Guia GAM, bem como pensar os modos pelos quais as anormalidades passaram a ocupar o discurso da normalidade no exercício político. Pela abordagem participante do tipo apoio, esta pesquisa reuniu gestores, profissionais, acadêmicos e usuários, em rodas de conversas para troca de experiências sobre estratégia GAM. Os encontros e o conteúdo dos guias GAM do usuário e do moderador foram analisados pela perspectiva arqueogenealógica de Michel Foucault. Discutiu-se o campo de forças estabelecido pelos pesquisadores na liberdade dos envolvidos para constituição de um sujeito crítico da saúde mental, assim como as práticas de conscientização, de fazer ouvir e falar para a formação do ativismo do usuário. Conclui-se que o exercício da cidadania na saúde mental passa pela afirmação da vulnerabilidade psiquiátrica do sujeito e da problematização da normalidade pela inserção da anormalidade neste campo discursivo....(AU)

This paper aims to analyze the understandings and exercise of citizenship of subjects involved in the implementation of the GAM strategy in the macro-region of the 4th Regional Healthcare Coordination of Rio Grande do Sul. Its specific objectives are to describe the relations of knowledge and power around the psychiatric medications which the group of GAM activists is built upon, as well as to reflect on how abnormalities were introduced in the discourses of normality in the political exercise. Through a support participant observation, this study gathered managers, professionals, scholars and users in conversation circles to exchange experiences on GAM strategy. Both the meetings and the content of GAM user guide and moderator guide were analyzed based on the archeogenealogical perspective of Michel Foucault. The force field established by researchers considering the individuals' freedom to constitute a critical subject of mental health was discussed in this study, as well as the awareness practices of listening and speaking in building user activism. It can be concluded that the exercise of citizenship in mental health involves stating the psychiatric vulnerability of the subject and problematizing the principles of normality by introducing the abnormality in this discursive field....(AU)

Este trabajo tiene como objetivo analizar las formas de comprensión y practica de la ciudadanía por parte de los sujetos involucrados en la implementación de la estrategia Gestión Autónoma de la Medicación (GAM) en la macro-región de la 4ª Coordinación Regional del Departamento de Salud del Estado de Rio Grande do Sul. Como objetivos específicos pretende describir las relaciones de saber y poder en torno a los medicamentos psiquiátricos que producen la agrupación de activistas de la Guía GAM, así como pensar los modos por los cuales las anormalidades pasaron a ocupar el discurso de la normalidad en el ejercicio político. Por el abordaje participante del tipo apoyo, esta investigación reunió a gestores, profesionales, académicos y usuarios, en ruedas de conversaciones para intercambio de experiencias sobre estrategia GAM. Los encuentros y el contenido de las guías GAM del usuario y del moderador fueron analizados por la perspectiva arqueogenalógica de Michel Foucault. Se discutió el campo de fuerzas establecido por los investigadores en la libertad de los involucrados para la constitución de un sujeto crítico de la salud mental, así como las prácticas de concientización, de hacer oír y hablar para la formación del activismo del usuario. Se concluye que el ejercicio de la ciudadanía en la salud mental pasa por la afirmación de la vulnerabilidad psiquiátrica del sujeto y de la problematización de la normalidad por la inserción de la anormalidad en este campo discursivo....(AU)

Impact of psychiatric medication co-exposure on Neonatal Abstinence Syndrome severity.

BACKGROUND: Among opioid-exposed infants, psychiatric medication co-exposure is common. Our objective was to compare Neonatal Abstinence Syndrome (NAS) outcomes based on individual psychiatric medication co-exposures. METHODS: A retrospective study of 744 opioid-exposed mother-infant dyads from a single institution was performed. Mothers on pharmacotherapy with methadone or buprenorphine at delivery were included. Data were collected on maternal demographics, psychiatric medication use, and NAS outcomes, including any medication treatment, adjunctive medication treatment, length of hospital stay (LOS), and opioid treatment days. The extent to which individual psychiatric medication and polypharmacy exposure were associated with NAS outcomes was assessed using multivariable regression. RESULTS: Fifty-four percent of the mothers were on ≥1 psychiatric medication, with 32% on ≥2 or psychiatric medications (polypharmacy group). In adjusted models, polypharmacy exposure was associated with longer LOS (ß = 4.31 days, 95% CI 2.55-6.06) and opioid treatment days (ß = 3.98 days, 95% CI 2.24-5.72) and more treatment with adjunctive medication for NAS (aOR = 2.49, 95% CI 1.57-3.95). Benzodiazepines were associated with longer LOS (ß = 4.94, 95% CI 2.86-7.03) and opioid treatment days (ß = 4.86, 95% CI 2.61-6.75), and more adjunctive medication treatment (aOR = 2.57, 95% CI 1.49-4.42). Gabapentin was associated with longer LOS (ß = 2.79, 95% CI 0.54-5.03), more NAS medication treatment (aOR = 2.96, 95% CI 1.18-7.42) including more adjunctive medications (aOR = 1.92, 95% CI 1.05-3.53). CONCLUSION: For infants of mothers with OUD who are also on concurrent psychiatric medications, polypharmacy was associated with worse NAS severity. When medically indicated, limiting use of multiple psychiatric medications, particularly benzodiazepines and gabapentin, during pregnancy should be considered to improve NAS outcomes.