[Melatonin and sleep disorders: Overview of literature and testing in psychiatric practice]. / Melatonine en slaapstoornissen: literatuuroverzicht en toetsing aan de psychiatrische praktijk.

BACKGROUND: Sleep disorders are a frequent problem with an important impact on the quality of life. Given its physiological properties, melatonin is often associated with sleep disorders and their treatment. In addition, melatonin has been recognized by the European Medicines Agency (ema) since 2007 for primary insomnia in adults over 55 years of age for a maximum of 13 weeks.
AIM: Analysis of the international literature on the indication statements and effectiveness of melatonin for sleep disorders and their testing against practical use.
METHOD: A narrative literature study in PubMed, Cochrane and Web of Science, supplemented with a retrospective study of prescribing behavior within a university psychiatric hospital.
RESULTS: The current evidence for the use of melatonin for insomnia and circadian arrhythmias is low. We also noted that the effectiveness of melatonin for the recognized indication of primary insomnia was questioned by some guidelines and that the various studies were also heterogeneous in terms of outcome measures, indication statements and formulated advice. In addition, only 19.6% of the requirements in the retrospective study met the official ema indication.
CONCLUSION: This study shows that melatonin is mainly used off-label. Overall, there appears to be limited effectiveness of melatonin, which has an impact on the indication statements.

Incidence and drug treatment of emotional distress after cancer diagnosis: a matched primary care case-control study.

BACKGROUND: Emotional distress is common in cancer patients. This study aimed to describe, in the year after a cancer diagnosis: the incidence of anxiety, depression and excessive alcohol use; the pattern of these diagnoses and treatment over time; and the nature and duration of the prescribed treatment. METHODS: A matched case-control study was conducted using routinely collected primary care data from 173 Scottish general practices. A presumptive diagnosis of emotional distress (anxiety, depression and/or excessive alcohol use) was based on prescription data or diagnostic code. Prescriptions for psychotropic drugs were described in terms of drug class, volume and treatment duration. RESULTS: In total, 7298 cancer cases and 14 596 matched-controls were identified. Overall, 1135 (15.6%) cases and 201 (1.4%) controls met criteria for emotional distress (odds ratio 13.7, 95% confidence interval 11.6-16.1). Psychotropic drugs were prescribed in the 6 months following initial cancer diagnosis for 1066 (14.6%) cases and 161 (1.1%) controls. The volume and duration of anxiolytic and antipsychotic prescribing was significantly different between cases and controls. CONCLUSION: This study quantified the higher incidence of new emotional distress in cancer patients in the first year post diagnosis. Clinicians should be aware of the possibility of emotional distress at any time in the year after cancer diagnosis.

[Medicine information for patients with a major depression at hospital discharge]. / Information sur les médicaments "sur mesure" pour des patients en etat dépressif. Rapport de thèse de doctorat.

This article provides an overview of several parts of a doctoral thesis on medicine information for patients with a major depression at hospital discharge. A review of the international literature showed that medicine information can increase knowledge and adherence. Inpatients would like to receive more information on the medicines prescribed. The GIPPOZ-study showed positive results on a few economic outcomes when a differentiated approach in providing information on antidepressants was applied. Follow-up calls of participants of the GIPPOZ-study yielded interesting qualitative findings on problems and perspective after discharge from hospital. The hospital pharmacists stressed the individual approach of patients during the GIPPOZ-study. Practice and health policy suggestions were formulated. Health care professionals should provide more information to patients on their medicines. Policy makers should guarantee a structure so that health care professionals can fulfill their role as provider of medication information.

Determinants of mental health stigma among pharmacy students in Australia, Belgium, Estonia, Finland, India and Latvia.

BACKGROUND: Healthcare professionals commonly exhibit negative attitudes toward people with mental disorders. Few international studies have sought to investigate the determinants of stigma. OBJECTIVE: To conduct an international comparison of pharmacy students' stigma towards people with schizophrenia, and to determine whether stigma is consistently associated with stereotypical attributes of people with schizophrenia. METHOD: Students (n = 649) at eight universities in Australia, Belgium, India, Finland, Estonia and Latvia completed a seven-item Social Distance Scale (SDS) and six items related to stereotypical attributes of people with schizophrenia. RESULTS: Mean SDS scores were 19.65 (+/- 3.97) in Australia, 19.61 (+/- 2.92) in Belgium, 18.75 (+/- 3.57) in India, 18.05 (+/- 3.12) in Finland, and 20.90 (+/- 4.04) in Estonia and Latvia. Unpredictability was most strongly associated with having a high social distance in Australia (beta = -1.285), the perception that people will never recover in India (beta = - 0.881), dangerousness in Finland (beta = -1.473) and the perception of being difficult to talk to in Estonia and Latvia (beta = -2.076). Unpredictability was associated with lower social distance in Belgium (beta = 0.839). CONCLUSION: The extent to which students held stigmatizing attitudes was similar in each country, however, the determinants of stigma were different. Pharmacy education may need to be tailored to address the determinants of stigma in each country.

[How to improve the continuity of pharmacotherapy at hospital admission and discharge]. / Comment optimiser la continuité du traitement médicamenteux entre l'hôpital et le domicile?

The continuity of pharmacotherapy is of vital importance when patients move from one health care setting to another. Unfortunately, this continuity is not always guaranteed. The aim of this study is to propose solutions to enhance the continuity of pharmacotherapy at hospital admission and discharge. The study consists of a systematic review of the international literature and an analysis of seamless care initiatives in seven selected countries; a summary of Belgian data on problems as well as solutions with regard to continuity of care; a quantification of the extent of medication changes as a result of a hospital stay in Belgium; and a qualitative analysis of the perception of Belgian health care professionals (HCPs) on approaches to improve seamless care. The literature review yielded 15 papers of sufficient quality. However, this review did not generate definitive conclusions on the clinical impact and the cost-effectiveness of interventions aiming to enhance the continuity of pharmacotherapy. The most important initiatives that have been put in practice in foreign countries include the development and implementation of guidelines for HCPs; national information campaigns; education of HCPs; and the development of information technologies as to share patient and prescription data between settings of care. For Belgium, 66 seamless care initiatives were identified. The high number and variety of projects show the interest for this topic as well as the involvement of various HCPs from diverse settings in the development of solutions. Based on this research, and the solutions discussed in the focus groups, the following elements are proposed to enhance the continuity of pharmacotherapy: a national guideline governing the continuity of pharmacotherapy; a national campaign to sensitize HCPs and patients in this area; the availability of a comprehensive and up to date medication list for each patient; and electronic healthcare infrastructure that facilitates sharing of information.

Medication information for Flemish inpatients with major depression: evaluation and construct validity of the Consumer Information Rating Form.

BACKGROUND AND OBJECTIVES: Evaluating the quality of written medication information is a major topic of concern when patient pamphlets are developed. The objective of this study is to evaluate a patient pamphlet on selective serotonin reuptake inhibitors (SSRIs) by calculating Flesch-Douma readability scores and by applying the Consumer Information Rating Form (CIRF) to Flemish inpatients with major depression taking SSRIs. METHODS: The pamphlet was evaluated by calculating Flesch-Douma readability scores. The study enrolled patients with major depression taking SSRIs. Patient received a SSRI pamphlet and completed a self-administered structured questionnaire consisting of the adapted CIRF and the Hospital Anxiety and Depression Scale. Construct validity was explored by means of factor analysis and Cronbach's alpha. RESULTS AND DISCUSSION: The Flesch-Douma readability scores showed that the pamphlet was easy to read, had much interest in the reader and was very popular. The sample of 96 patients consisted of doubtful/definite cases in terms of anxiety (10.65 +/- 4.90) and doubtful cases in terms of depression (8.91 +/- 5.23). Using the CIRF, patients assigned positive scores to comprehensibility, utility and design quality of the pamphlet. Factor analysis on the original CIRF confirmed the three original factors (P < 0.001). Cronbach's alpha of factors ranged from 0.69 to 0.83. CONCLUSION: The SSRI pamphlet is of good quality. Our study supported the construct validity of the CIRF to Flemish inpatients with major depression.