Patterns of psychotropic medication prescribing and potential drug-hormone interactions among transgender and gender-diverse adults within 2 years of hormone therapy.

BACKGROUND: Transgender and gender-diverse (TGD) people have a high prevalence of psychotropic medication use, yet knowledge about the patient-level psychotropic medication burden is limited. TGD patients may take hormone therapy to meet their gender expression goals. Potential drug-hormone interactions exist between psychotropic medications and hormone therapy, requiring increased knowledge about psychotropic medication use for TGD adults undergoing hormone therapy. OBJECTIVES: The objective of this study was to examine the extent of psychotropic medication polypharmacy in a cohort of TGD adults within 2 years of starting hormone therapy. We also characterized potential drug-hormone interactions and the association with psychotropic polypharmacy. METHODS: Retrospective cross-sectional analysis of patients with ≥1 transgender health-related visit (2007-2017) in the University of Washington Medical System (Seattle, WA). Eligible patients had ≥1 psychotropic medication including antidepressants, antipsychotics, mood stabilizers, and sedative-hypnotics ordered within 2 years of starting hormone therapy (testosterone or estradiol with or without spironolactone, progesterone, finasteride, or dutasteride). We defined psychotropic polypharmacy as ≥2 psychotropic medication orders with overlapping treatment durations for at least 90 days and characterized potential drug-hormone interactions (Lexicomp, Hudson, OH). We descriptively summarized patients with and without polypharmacy (frequencies and percentages) and compared drug-hormone interactions using chi-square or Fishers exact tests (P < 0.05 considered significant). RESULTS: A total of 184 patients had ≥1 psychotropic medication order within 2 years of hormone therapy; 68 patients (37.0%) had psychotropic polypharmacy. The most frequent type of psychotropic polypharmacy was antidepressant+sedative-hypnotic (18 of 68, 26.5%). More patients had a potential drug-hormone interaction among those with psychotropic polypharmacy (23 of 68, 33.8%) versus those without (8 of 116, 6.9%, P < 0.001). CONCLUSION: Among TGD patients on psychotropic medications within 2 years of hormone therapy, one-third had psychotropic polypharmacy. Most polypharmacy types appeared to align with mental health treatment guidelines. The number of patients with a potential drug-hormone interaction was significantly higher among those with polypharmacy. Prospective studies are needed to characterize drug-hormone interactions.

Modafinil Induced Psychosis in a Patient with Bipolar 1 Depression.

Modafinil has been used as an adjunctive medication in the treatment of bipolar 1 depression with reported success. Case reports have been published demonstrating modafinil induced mania in bipolar patients and modafinil induced psychosis in schizophrenic patients. To our knowledge, we report the only case of modafinil induced psychosis in a patient with bipolar depression treated with both mood stabilizers and antipsychotics. In addition, it is the quickest onset to psychosis (2 days) at the lowest dosage of modafinil (100 mg/day) reported in the literature. Although favorable outcomes using modafinil for treatment of bipolar depression have been reported in literature, clinicians should remain cautious of the potential to rapidly induce psychosis with modafinil at low dosages in patients with bipolar depression despite being treated with mood stabilizers and antipsychotics.

Vortioxetine (brintellix): a new serotonergic antidepressant.

Vortioxetine (Brintellix): a new serotonergic antidepressant.

Alcohol attitudes and behaviors among faculty at U.S. schools and colleges of pharmacy / Actitudes y comportamientos sobre el alcohol entre académicos de las escuelas y facultades de farmacia en Estados Unidos

Despite attempts to control college-aged drinking, binge and underage drinking continues at colleges and universities. Although often underutilized, faculty have the potential to influence students’ behaviors and attitudes towards drinking. Little information is available pertaining to college faculty drinking patterns, views on drinking, or their influence on college drinking. What little information is available predates the economic crisis, mandates for increased alcohol education, and the American Pharmacists Association’s call for increased alcohol awareness in pharmacists. Objectives: This study was designed to determine alcohol use patterns and viewpoints among faculty at U.S. colleges of pharmacy, in particular, to identify alcohol practices among faculty, use of alcohol with their students, mentioning alcohol in classroom as a social norm, and perceived drinking norms within their colleagues. Methods: Following Institution Review Board approval, 2809 invitations were emailed to U.S. pharmacy faculty for this survey-based study. The survey consisted of demographic questions, the World Health Organization Alcohol Use Disorders Identification Test (AUDIT), and questions pertaining to personal and institution attitudes on drinking and on drinking with students. Results: More than 96% of 753 respondents had a total AUDIT score <8. Males and preceptors were more likely to have higher AUDIT scores. More than 75% of faculty reported never drinking with students. Conclusion: In order to help pharmacy students address the extent of their alcohol use and misuse, pharmacy faculty must address their own use, along with their own and their institutions attitudes and behaviors towards alcohol use (AU)

A pesar de los intentos de control de la ingesta de alcohol en las facultades, la juerga y la bebida entre menores continúa en facultades y universidades. Aunque a menudo infrautilizados, los académicos tienen la posibilidad de influenciar las actitudes y comportamientos de los estudiantes sobre la bebida. Hay poca información disponible sobre los hábitos de bebida de los académicos, visión de la bebida, o su influencia sobre la bebida en las facultades. La poca información disponible anterior a la crisis económica recomienda aumentar la educación sobre el alcohol y la Asociación de Americana de Farmacéuticos pide un aumento de la concienciación sobre el alcohol entre los farmacéuticos. Objetivos: Este estudio fue diseñado para determinar los patrones de uso de alcohol y los puntos de vista de los académicos en las facultades de farmacia de Estados Unidos, en particular, identificar las prácticas con el alcohol entre académicos, el uso de alcohol con sus estudiantes, menciones al alcohol en clases como hábito social, y hábitos percibidos sobre el alcohol con sus colegas. Métodos: Después de la aprobación del Comité de Investigación de la Institución, se enviaron por correo 2809 invitaciones a académicos de farmacia de Estados Unidos para esta encuesta. El cuestionario comprendía preguntas demográficas, el World Health Organization Alcohol Use Disorders Identification Test (AUDIT) y preguntas relativas a actitudes personales y de la institución sobre el beber y el beber con estudiantes. Resultados: Más del 96% de los 753 respondentes tenían una puntuación total en el AUDIT de <8. Los hombres y los preceptores tenían puntuaciones AUDIT mayores. Más del 75% de los académicos reportaron no beber nunca con estudiantes. Conclusión: Para ayudar a los estudiantes de farmacia a afrontar el extendido uso y abuso del alcohol, los académicos de farmacia deben afrontar su propio uso, así como sus actitudes y comportamientos y las de sus instituciones sobre el consumo de alcohol (AU)

Alcohol attitudes and behaviors among faculty at U.S. schools and colleges of pharmacy.

UNLABELLED: Despite attempts to control college-aged drinking, binge and underage drinking continues at colleges and universities. Although often underutilized, faculty have the potential to influence students' behaviors and attitudes towards drinking. Little information is available pertaining to college faculty drinking patterns, views on drinking, or their influence on college drinking. What little information is available predates the economic crisis, mandates for increased alcohol education, and the American Pharmacists Association's call for increased alcohol awareness in pharmacists. OBJECTIVE: This study was designed to determine alcohol use patterns and viewpoints among faculty at U.S. colleges of pharmacy, in particular, to identify alcohol practices among faculty, use of alcohol with their students, mentioning alcohol in classroom as a social norm, and perceived drinking norms within their colleagues. METHODS: Following Institution Review Board approval, 2809 invitations were emailed to U.S. pharmacy faculty for this survey-based study. The survey consisted of demographic questions, the World Health Organization Alcohol Use Disorders Identification Test (AUDIT), and questions pertaining to personal and institution attitudes on drinking and on drinking with students. RESULTS: More than 96% of 753 respondents had a total AUDIT score <8. Males and preceptors were more likely to have higher AUDIT scores. More than 75% of faculty reported never drinking with students. CONCLUSIONS: In order to help pharmacy students address the extent of their alcohol use and misuse, pharmacy faculty must address their own use, along with their own and their institutions attitudes and behaviors towards alcohol use.