Potential interactions between psychotropic drugs and alcohol and tobacco dependence

Abstract The aim of this study was to identify and analyze the potential interactions between psychotropic drugs and alcohol and tobacco addiction. A cross-sectional study was carried out on secondary data collection in a Center for Psychosocial Care in Alcohol and Other Drugs. Subjects aged 18 years old and over, with alcohol and tobacco dependence, who were taking psychotherapies were included. Medical records with the most recent prescriptions were reviewed. Potential interactions between psychotropic drugs and alcohol and tobacco were analyzed using the Micromedex database and stratified according to clinical risks and mechanisms of action. The Pearson's Chi-square test was used to find significant associations between the variables of interest. The significance level was set at 5%. Between the 2010-2018 period, 2,322 subjects were treated at the care center. Of these, 1,020 fulfilled the inclusion criteria, out of whom 515 (50.5%) were dependent on alcohol and 310 (30.4%) were dependent on tobacco. We found 1,099 potential interactions between psychotropic drugs and alcohol and 160 potential interactions between psychotropic drugs and tobacco. In relation to alcohol dependence, psychotropic drugs interacted largely with moderate clinical risk, and pharmacokinetic mechanisms of action. In relation to tobacco dependence, high clinical risk interactions and pharmacodynamic mechanisms of action predominated.

Potential Psychotropic Drug Interactions among Drug-dependent People.

Using psychiatric drugs to treat drug dependence and its comorbidities is very common. The objective of this study was to analyze the interactions between prescribed drugs for patients treated at a specialized mental health-care center for persons who use drugs, located in the state of Santa Catarina, Brazil. A cross-sectional study was conducted on secondary data collected from 2010 to 2018. We reviewed the medical records of patients aged 18 years or older who took psychotropic drugs and had any type of substance dependence. The analysis of psychotropic drug interactions was conducted in three databases: Medscape, Drug Interactions Checker, and Micromedex. We included 1,022 of the 2,322 patients attending the care center during the study period. Psychotropic drug interactions were found in 779 (76.4%) study participants, and they presented 2,292 (100%) interactions, out of which 136 (6.0%) had minor clinical risk, 537 (23.4%) had moderate risk, and 1,619 (70.6%) had major risk for the patient, totaling 172 incompatible combinations between two psychotropic drugs. Of the total number of interactions, 128 were pharmacokinetic and 44 were pharmacodynamic. The high number of psychotropic drug interactions is a serious public health issue. Psychopharmacological treatment should be carefully addressed to be safe for the patient.

Caracterização de pacientes diabéticos tipo 2 em uso recente de insulina: estilo de vida e sintomas depressivos / Characterization of type 2 diabetic patients on recent insulin use: lifestyle and depressive symptoms

OBJETIVO: Caracterizar os portadores de diabete melito tipo 2 que iniciaram recentemente o uso de insulina de acordo com estilo de vida e sintomas depressivos. MÉTODO: Estudo transversal realizado com pacientes em uso recente de insulina, o qual foi determinado pelo cadastro realizado nas Estratégias de Saúde da Família de Tubarão-SC no período de janeiro de 2017 a agosto de 2018. Em visitas domiciliares, os pacientes responderam questões sobre estilo de vida, características da doença e o inventário de depressão de Beck (BDI). RESULTADOS: A amostra foi composta por 38 pacientes com predomínio do sexo masculino (57,9%), casados (65,8%) e brancos (89,5%), sendo a média de anos de estudo de 5,8±2,9. Foram considerados ativos fisicamente no tempo livre 13,2% e 47,4% faziam restrição de carboidratos. Apresentavam sobrepeso 65,8% e obesidade 34,2%. Os participantes receberam o diagnóstico de diabete melito tipo 2, em média, há 8,9±7,5 anos. Sobre os motivos que levaram ao uso de insulina, 92,1% mencionaram o descontrole da doença. Quanto à classificação de sintomas depressivos, 47,3% apresentaram alguma alteração psicológica, considerando o BDI ˃10. A presença de sintomas depressivos foi maior nas mulheres (p=0,014). CONCLUSÃO: Os pacientes com diabetes tipo 2 em uso recente de insulina apresentaram poucas mudanças no estilo de vida após o diagnóstico da doença. A maioria dos pacientes iniciou uso de insulina por descontrole da doença. A presença de sintomas depressivos foi maior nas mulheres e nos pacientes que relataram mudança da alimentação após o diagnóstico de diabete melito tipo 2.

AIMS: To characterize type 2 diabetes mellitus patients who have recently initiated treatment with insulin regarding lifestyle and depressive symptoms. METHODS: Cross-sectional study carried out with patients in recent use of insulin, which was determined by the register held in the family health strategy, from January 2017 to August 2018. In home visits, the patients answered questions about lifestyle and characteristics of the disease, and Beck's Depression Inventory. RESULTS: The sample consisted of 38 type 2 diabetic patients in recent use of insulin. There was a predominance of males (57.9%), married (65.8%) and white (89.5%), the average years of study being 5.8±2.9. 13.2% were considered physically active in leisure time, and only 47.4% were restricting carbohydrates. 65.8% were overweight and 34.2% were obese. The participants had type 2 diabetes mellitus diagnosis for 8.9±7.48 years on average. Regarding the reasons that led to the use of insulin, 92.1% mentioned the lack of control of the disease. As for the classification of depressive symptoms, 47.3% had some psychological alteration. We verified that the presence of depressive symptoms was more prevalent in women (p=0,014). CONCLUSION: Patients with type 2 diabetes on recent insulin use had few changes in lifestyle after being diagnosed with the disease. Most patients started using insulin due to lack of control of the disease. The presence of depressive symptoms was more prevalent in women and in patients who reported dietary changes after the diagnosis of type 2 diabetes mellitus.