Psychotropic Polypharmacy Among Youths With Serious Emotional and Behavioral Disorders Receiving Coordinated Care Services.

OBJECTIVE: The study examined differences in psychotropic polypharmacy among youths with serious emotional and behavioral disorders who received coordinated care services (CCS) that used a wraparound model and a matched sample of youths who received traditional services. METHODS: A quasi-experimental design compared psychotropic polypharmacy one year before and one year after discharge from CCS. The cohort was youths with serious emotional and behavioral disorders who were enrolled in CCS from December 2009 through May 2014. The comparison group was youths with serious emotional and behavioral disorders who received outpatient mental health services during the same time. Administrative data from Medicaid, child welfare, and juvenile justice services were used. A difference-in-difference analysis with propensity score matching evaluated the CCS intervention by time effect on psychotropic polypharmacy. RESULTS: In both groups, most youths were male, black, and 10-18 years old, with attention-deficit hyperactivity disorder (54%-55%), mood disorder (39%-42%), depression (26%-27%), and bipolar disorder (25%-26%). About half of each group was taking an antipsychotic. The percentage reduction in polypharmacy from one year before CCS enrollment to one year after discharge was 28% for the CCS group and 29% for the non-CCS group, a nonsignificant difference. CCS youths excluded from the analysis had more complex mental health needs and a greater change in polypharmacy than the CCS youths who were included in the analytic sample. CONCLUSIONS: Mental health care coordination had limited impact in reducing psychotropic polypharmacy for youths with less complex mental health needs. Further research is needed to evaluate the effect on psychotropic polypharmacy among youths with the greatest mental health needs.

[General pharmacology of Danhong injection].

OBJECTIVE: To investigate the effect of Danhong injection on the cardiovascular, the respiratory, and the nervous systems in animals. METHODS: Using the pressure transducer, tension transducer and subcutaneous electrodes connected to a multifunctional signal processor, the femoral artery pressure, respiratory curve and electrocardiogram were recorded, respectively, in dogs before and after administration of Danhong injection. The effect of the injection on spontaneous activities was observed in mice using a multifunctional mouse activity recorder. The effects were also observed on coordinated movements by recording tilt-board falling times of the mice and on hypnosis induced by subthreshold dose of pentobarbital sodium by observing the disappearance of righting reflex. RESULTS: Danhong injection caused slight decrease in systolic blood pressure without obviously affecting the heart rate, diastolic blood pressure and respiratory system of anesthetized dogs 30 min after intravenous Danhong injection at the dose of 2.4 g/kg, but at the doses of 1.2 and 0.6 g/kg.b.w, the injection did not produce any significant impact. The coordinated movement and spontaneous activity and pentobarbital sodium-induced hypnosis in mice were not obviously affected by the 3 doses of Danhong injection. CONCLUSION: Danhong injection does not affect the respiratory functions of the dogs and nervous system of mouse with the exception of the systolic pressure at the 3 doses.