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1.
Gesundheitswesen ; 82(1): 14-22, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31962367

RESUMO

AIM: The aims of this study were to create a scale for measuring the sedating and activating effects of drugs and to analyse if the total value of this scale correlates significantly with falls requiring medical treatment in dementia patients. Furthermore, prescription of drugs in nursing homes included in the PRISCUS-List, Anticholinergic Cognitive Burden List (ACB-List) and usage of psychotropic drugs were investigated. METHOD: This is a data analysis of a randomized controlled trial which tested the effects of a non-pharmacological multimodal activation therapy (MAKS®) in 139 patients with degenerative dementia in 5 nursing homes. At the beginning of the study, all prescribed drugs were rated on a five-tier scale by 2 pharmacologists based on the drugs' sedating or activating effects. The scale ranged from severely activating (+2) to severely sedating (- 2). The "central nervous system (CNS) depressant score" of each patient was calculated by summing up the scale value of all the medications they were taking. The correlation between CNS-depressant score and falls resulting in injuries within an observation period of 12 months was investigated by binary logistic regression analysis. RESULTS: Nearly 30% of the nursing home residents received drugs listed in the PRISCUS-list, 50% received drugs on the ACB-List, 55% took psychotropic drugs and 66% received at least 5 drugs. Sedating drugs were prescribed to 62% of patients. During the observation period, 36 out of 139 nursing home residents suffered falls and medical treatment was necessary. In multivariate analysis, the CNS-depressant score was associated significantly (p=0.045) with falls with resulting injuries. Increased sedation resulted in a higher number of fall incidents. CONCLUSIONS: The CNS-depressant score is a useful tool to describe the degree of sedation. Due to the significant association between sedation and falls resulting in injuries, the sedating medication of people suffering from dementia should be minimised as much as possible to reduce the risk of undesirable side effects.


Assuntos
Acidentes por Quedas , Demência , Hipnóticos e Sedativos , Psicotrópicos , Acidentes por Quedas/estatística & dados numéricos , Antagonistas Colinérgicos , Demência/tratamento farmacológico , Alemanha , Humanos , Hipnóticos e Sedativos/efeitos adversos , Casas de Saúde , Psicotrópicos/efeitos adversos
3.
Lancet ; 394(10209): 1668-1684, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668410

RESUMO

The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.


Assuntos
Monitoramento de Medicamentos/métodos , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Psicotrópicos/efeitos adversos , Saúde Pública/legislação & jurisprudência , Adolescente , Adulto , Comércio/legislação & jurisprudência , Coleta de Dados , Controle de Medicamentos e Entorpecentes/métodos , Feminino , Humanos , /legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Motivação , Psicotrópicos/classificação , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
4.
Clin Ter ; 170(6): e425-e426, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31696904

RESUMO

The practice of drug of abuse adulteration is changing. Currently, the risk of new adulteration practices involves New Psychoactive Substances (NPS), which can also be used as adulterants. In particular, the phenomenon of adulteration concerns fentanyl and its analogs, substances that can be toxic even if taken in very small quantities. The adulteration that involves NPS is creating a serious threat to the health of drug users, not only because of the pharmacological action but because of the increased toxicity of these new cutting agents.


Assuntos
Contaminação de Medicamentos , Psicotrópicos/efeitos adversos , Usuários de Drogas , Fentanila/efeitos adversos , Humanos
5.
Clin Ter ; 170(5): e337-e338, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31612189

RESUMO

In this letter, which is meant as a response to the letter titled "Sex enhancers: challenges, threats and the need for targeted measures", the Authors discuss the evolution of Chemsex phenomenon towards at least two directions: firstly, the use of psychoactive and non-psychoactive substances usually implicated in Chemsex, such as GHB/GBL, ketamine, mephedrone and other synthetic cathinones and erectile dysfunction medications, is currently accompanied by the use of illicit opioids, which have recently been indicated as a new serious health threat for consumers. In addition, as reported by the last European Drug report, the simultaneous use of illicit benzodiazepines with non-medical opioids misuse has also been observed. Secondly, strictly linked to the rising use of non-medical opioids is the risk of transition towards heroine followed by the adoption of risky injection practices frequently accompanied by high-risk sexual behaviors. In this sense, the current definition of the phenomenon as "the voluntary intake of certain psychoactive and non- psychoactive drugs in the context of sex parties and sexual intercourses with the intention of facilitating and/or enhancing the sexual encounter mostly among men who have sex with other men (MSM)" has been expanded to "heterosexual chemsex".


Assuntos
/efeitos adversos , Psicotrópicos/efeitos adversos , Comportamento Sexual/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos , Adulto , Humanos , Masculino , Metanfetamina/efeitos adversos , Pessoa de Meia-Idade , Psicotrópicos/administração & dosagem , Saúde Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias , Inquéritos e Questionários
6.
Nervenarzt ; 90(11): 1125-1134, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31659372

RESUMO

Psychotherapy has been proven to be effective; however, this statement applies in particular to the "average patient" in randomized controlled trials. As a considerable proportion of patients do not show any benefits despite the constant development of new therapy methods and the mechanisms of action are still too little understood, innovative psychotherapy research has to address both problems. In addition, the idea of personalization that originated in somatic medicine or - from our point of view more appropriately - individualization or person-centering should be taken up. After providing an overview of further developments in psychotherapy beyond disorder-specific methods, this article presents an evidence- and process-based individualized and modular psychotherapy as a visionary goal of psychotherapeutic research: Beyond syndromes and disorders, as many biopsychosocial characteristics as possible and the processes and mechanisms underlying the mental problems should be analyzed and bundled in an individual comprehensive functional analysis. Based on this functional analysis, evidence-based techniques and modules should be selected. The individual response during the course of therapy should be continuously documented, so that feedback helps to determine the further therapeutic procedure. In order to pursue this vision, studies are needed that are oriented towards the individual patient, investigate the central mechanisms of action and generate large translational datasets. These should be analyzed by ideographic analyses and reduce the gap between research and practice, thus contributing to the paradigm of a practice research network, which is now consistently moving to the centre of research.


Assuntos
Psicoterapia , Psicotrópicos , Medicina Baseada em Evidências , Humanos , Psicoterapia/normas , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Resultado do Tratamento
8.
Adv Mind Body Med ; 33(3): 22-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31605602

RESUMO

Background: A 38-year-old, female with a history of GAD, MDD, AN, and PTSD wanted to taper her multiple medications in preparation for pregnancy. Benzodiazepine medications, such as Klonopin and Restoril; antidepressants, such as Effexor; and anticonvulsant medications, such as Lamictal, can be habit-forming, and withdrawal symptoms can occur upon discontinuation of use. Polypharmacy can be implicated in poor clinical outcomes, and a strategic and supported medication taper may improve those outcomes. Summary: After the primary MD unsuccessfully attempted to taper off the patient's psychotropic medications without lifestyle interventions, she was stabilized on a minimal regimen by an outside reproductive psychiatrist throughout her pregnancy. A second tapering was implemented by the primary MD after the patient had given birth and had established changes to her lifestyle. These lifestyle interventions included dietary changes, use of detoxification protocols, contemplative practices, and strategic supplement support in the setting of a powerful mindset shift. The patient experienced remarkable symptom remission after strategic discontinuation of medications through the addition of the lifestyle interventions. She also was able to heal the root-cause drivers of her psychiatric diagnoses. Currently she is symptom-free and medication-free after nearly 21 years. Conclusions: This case demonstrates the effectiveness of lifestyle interventions and psychospiritual support to enable dramatic clinical change without withdrawal syndrome after cessation of medication. More important, the initial failed tapering underpins the notion that a diligent meditation practice may be necessary to heal root-cause drivers of psychiatric symptoms and withdrawal syndrome. The results may serve to inform practitioners assisting patients who wish to discontinue benzodiazepine and other psychotropic medications or patients who would like to try a nonpharmaceutical approach as a first-line therapy.


Assuntos
Antidepressivos/efeitos adversos , Estilo de Vida , Psicotrópicos/efeitos adversos , Síndrome de Abstinência a Substâncias , Adulto , Antidepressivos/uso terapêutico , Benzodiazepinas , Feminino , Humanos , Psicotrópicos/uso terapêutico , Síndrome de Abstinência a Substâncias/etiologia
9.
Forensic Sci Int ; 304: 109941, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31574421

RESUMO

In last years, international and national Institutions have been completely focused on the new psychoactive substances (NPS) phenomenon. Many contrast policies have been planned in order to control their spread. Even scientific entities, such as our Forensic Toxicology Division, have spent time and resources for NPS identification in biological (from clinical and forensic caseworks) and non-biological (seized material) samples. Last reports show a low prevalence of NPS across the Europe and Italy, while the classical drugs are still the main cause of drug-related deaths. In particular, a worrisome datum is represented by the increasing number of deaths due to heroin. Seen these statistics, is the NPS phenomenon overestimated? Is the interest in classical drugs decreased? Were we diverted by NPS?


Assuntos
Tráfico de Drogas/tendências , Psicotrópicos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Drogas Desenhadas/efeitos adversos , Toxicologia Forense , Humanos , /efeitos adversos
11.
Medicine (Baltimore) ; 98(37): e17101, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517840

RESUMO

BACKGROUND: Caregivers encounter serious and substantial challenges in managing hypertension in patients with subclinical or clinical borderline personality disorder (BPD). These challenges include therapeutic conflicts resulting from harmful drug-drug, and drug-disease interactions. Current guidelines provide no recommendations for concurrent psychotropic and antihypertensive treatment of hypertensive BPD patients who are at even greater cardiovascular risk. METHODS: We conducted a systematic literature review to assess the extent of available evidence on prevalence rates, cardiovascular risk factors, therapeutic conflicts, and evidence-based treatment recommendations for patients with co-occurring hypertension and BPD. Search terms were combined for hypertension and BPD in PubMed, MEDLINE, EMBASE, Cochrane, and PsycINFO databases. RESULTS: We included 11 articles for full-text evaluation and found a very high prevalence of hypertension and substantial cardiovascular risk in studies on co-occurring BPD and hypertension. However, we identified neither studies on harmful drug-drug and drug-disease interactions nor studies with treatment recommendations for co-occurring hypertension and BPD. CONCLUSIONS: Increased prevalence of hypertension in BPD patients, and therapeutic conflicts of psychotropic agents strongly suggest careful evaluation of treatment strategies in this patient group. However, no studies or guidelines recommend specific therapies or strategies to resolve therapeutic conflicts in patients with hypertension and BPD. This evidence gap needs attention in this population at high risk for cardiovascular disease.


Assuntos
Transtorno da Personalidade Borderline/complicações , Hipertensão/tratamento farmacológico , Psicotrópicos/efeitos adversos , Transtorno da Personalidade Borderline/tratamento farmacológico , Transtorno da Personalidade Borderline/psicologia , Interações de Medicamentos , Humanos , Hipertensão/psicologia , Prevalência , Psicotrópicos/uso terapêutico
12.
Geriatr Psychol Neuropsychiatr Vieil ; 17(3): 317-326, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31449050

RESUMO

This article aims to review evidence on pharmacologic treatments for the management of delusional symptoms in elderly patients with dementia. METHODS: We searched PubMed using the words 'delusion', 'dementia' and 'treatment' from January 2007 till November 2017. RESULTS: Non-pharmacologic interventions are first-line treatment. Acetyl-cholinesterase inhibitors have shown conflicting results in the treatment of delusions in dementia patients. However, donepezil may be particularly useful in the treatment of psychotic symptoms in Lewy body dementia (LBD). Antipsychotics are reserved for the treatment of severe symptoms. The highest level of evidence exists for risperidone, followed by olanzapine and quetiapine. Clozapine and pimavenserine are therapeutic options for Parkinson disease dementia and LBD. The duration of antipsychotic treatment should not exceed 6 weeks as per the French recommendations (Agence nationale pour la sécurité du médicament) and 4 months as per the American psychiatric association recommendations. In the event of failure to respond to the aforementioned treatments or as an alternative, antidepressants, in particularly citalopram can be considered. There is not enough evidence to recommend melatonine for the treatment of delusions in dementia patients, although it has been shown to improve behavioral symptoms of dementia in general. CONCLUSIONS: The choice of medication for the treatment of delusions in dementia patients should be tailored to each patient. The severity of the symptom and its related danger should be considered along with the patient's co-morbidities and the medication's potential adverse effect.


Assuntos
Delusões/tratamento farmacológico , Delusões/etiologia , Demência/complicações , Demência/tratamento farmacológico , Psicotrópicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Inibidores da Colinesterase/uso terapêutico , Delusões/psicologia , Demência/psicologia , Humanos , Psicotrópicos/efeitos adversos
13.
BMJ Case Rep ; 12(7)2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31326902

RESUMO

Kratom is a psychoactive herb that has stimulant properties at low doses and has opioid-like properties at higher doses. It has been used for centuries in southeast Asia as a stimulant but has gained increasing popularity as a substitute for opioids in western countries as it is easily available. As most cases of kratom use involve other drugs too, the Food and Drug Administration (FDA) has stopped short of restricting kratom due to difficulty in assessing the adverse effects of kratom alone. We present the case of a young healthy 35-year-old man who suffered a cardiac arrest due to kratom use with no other coingestants. He was subsequently intubated and found to have systolic dysfunction and small brain infarcts. Fortunately, he made a successful recovery and was discharged after a stay at thebehavioural health centre. Our case highlights the potential adverse effects of kratom and the need to regulate its use.


Assuntos
Infarto Encefálico/induzido quimicamente , Parada Cardíaca/induzido quimicamente , Mitragyna/envenenamento , Psicotrópicos/efeitos adversos , Adulto , Infarto Encefálico/terapia , Diagnóstico Diferencial , Parada Cardíaca/terapia , Humanos , Hipotermia Induzida , Masculino , Síndrome de Abstinência a Substâncias
14.
Codas ; 31(3): e20180111, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31271579

RESUMO

PURPOSE: to analyze the occurrence of psychiatric diagnosis and the use of psychotropics medications in subjects with vestibular complaints and to relate the presence of these conditions to the results of vestibulometry. METHODS: quantitative, observational, cross-sectional study with 131 patients, treated in a university hospital. They were submitted to anamnesis, visual inspection of the external ear canal, static and dynamic balance tests, Foam laser dynamic posturography and Computerized Vectoelectronystagmography. RESULTS: sample composed of 109 women and 22 men, with average age of 55 years and nine months. The most common type of dizziness was vertigo, with the presence of neurovegetative signals. A significant percentage of psychiatric complaint/diagnosis was observed, as well as the use of psychotropic medications, mainly serotonin uptake inhibitors, followed by benzodiazepines. There was a relation between the presence of psychiatric complaints with the female gender, alterations of the static balance and alterations in the Sensorial Organization Test positions III and VI. In the Vectoelectronystagmography, there was a relation between age and the presence of spontaneous nystagmus. CONCLUSION: There was a high occurrence of psychiatric complaint/diagnosis among patients with dizziness, with use of psychotropic medications substantially greater than the general population. The evaluation of postural balance revealed an association between anxiety/depression and alterations visual overload positions in the foam laser dynamic posturography. However, no relationship was found between these conditions and alterations in the Vectoelectronystagmography tests.


Assuntos
Tontura/induzido quimicamente , Transtornos do Humor/tratamento farmacológico , Equilíbrio Postural/efeitos dos fármacos , Psicotrópicos/efeitos adversos , Vertigem/induzido quimicamente , Testes de Função Vestibular/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/complicações , Psicotrópicos/classificação , Estudos Retrospectivos , Adulto Jovem
15.
PLoS One ; 14(5): e0216317, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048918

RESUMO

BACKGROUND: Intentional drug overdose is the most common method of self-harm. As psychiatric disorders are very common in self-harm patients, the medication used to treat these disorders can become the means for the self-harm act. The present study aimed at investigating an association between the use of prescribed medication (analgesics and antipyretics, anti-epileptics, antipsychotics, antidepressants and psychostimulants) as a method of self-harm and prescription rates of this medication in Flanders. We investigated the possible effect of gender, alcohol use during the self-harm act and a history of self-harm. METHODS: Data from the multicenter study of self-harm in Flanders between 2008 and 2013 were used. The significance of differences in percentages was calculated by GEE and the strength by odds ratios (OR). RESULTS: There was an increase in the odds of using antidepressants (0.8%) and antipsychotics (2%) among females when the rate of prescription increases. Analgesics and antipyretics (39.3/1,000) and antidepressants (124.9/1,000) were the most commonly prescribed drugs among females. Antidepressants (63.9/1,000) and antipsychotics (26.5/1,000) were the most commonly prescribed drugs among males. Antidepressants and analgesics and antipyretics were the most frequently used medications for self-harm. Analgesics and antipyretics during the self-harm act were more common among first-timers, while repeaters more commonly overdosed using antipsychotics and antidepressants. CONCLUSION: These findings suggest that the availability of medication via prescriptions plays an important role in the choice of the medication ingested during the self-harm act. Precautions are necessary when prescribing medication, including restrictions on the number of prescriptions and the return of unused medication to pharmacies after cessation of treatment. These issues should be a focus of attention in the education and training of physicians and pharmacists.


Assuntos
Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Medicamentos sob Prescrição/efeitos adversos , Psicotrópicos/efeitos adversos , Tentativa de Suicídio , Adulto , Bélgica/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Medicamentos sob Prescrição/administração & dosagem , Psicotrópicos/administração & dosagem , Fatores Sexuais
16.
Psychopharmacology (Berl) ; 236(9): 2713-2724, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31044290

RESUMO

BACKGROUND: The main psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), can impair driving performance. Cannabidiol (CBD), a non-intoxicating cannabis component, is thought to mitigate certain adverse effects of THC. It is possible then that cannabis containing equivalent CBD and THC will differentially affect driving and cognition relative to THC-dominant cannabis. AIMS: The present study investigated and compared the effects of THC-dominant and THC/CBD equivalent cannabis on simulated driving and cognitive performance. METHODS: In a randomized, double-blind, within-subjects crossover design, healthy volunteers (n = 14) with a history of light cannabis use attended three outpatient experimental test sessions in which simulated driving and cognitive performance were assessed at two timepoints (20-60 min and 200-240 min) following vaporization of 125 mg THC-dominant (11% THC; < 1% CBD), THC/CBD equivalent (11% THC, 11% CBD), or placebo (< 1% THC/CBD) cannabis. RESULTS/OUTCOMES: Both active cannabis types increased lane weaving during a car-following task but had little effect on other driving performance measures. Active cannabis types impaired performance on the Digit Symbol Substitution Task (DSST), Divided Attention Task (DAT) and Paced Auditory Serial Addition Task (PASAT) with impairment on the latter two tasks worse with THC/CBD equivalent cannabis. Subjective drug effects (e.g., "stoned") and confidence in driving ability did not vary with CBD content. Peak plasma THC concentrations were higher following THC/CBD equivalent cannabis relative to THC-dominant cannabis, suggesting a possible pharmacokinetic interaction. CONCLUSIONS/INTERPRETATION: Cannabis containing equivalent concentrations of CBD and THC appears no less impairing than THC-dominant cannabis, and in some circumstances, CBD may actually exacerbate THC-induced impairment.


Assuntos
Condução de Veículo , Canabidiol/efeitos adversos , Cognição/efeitos dos fármacos , Dronabinol/efeitos adversos , Fumar Maconha/efeitos adversos , Vaping/efeitos adversos , Adulto , Condução de Veículo/psicologia , Canabidiol/administração & dosagem , Cognição/fisiologia , Estudos Cross-Over , Método Duplo-Cego , Dronabinol/administração & dosagem , Feminino , Alucinógenos/administração & dosagem , Alucinógenos/efeitos adversos , Humanos , Masculino , Fumar Maconha/psicologia , Psicotrópicos/efeitos adversos , Vaping/psicologia , Adulto Jovem
17.
Med Clin North Am ; 103(4): 629-650, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078197

RESUMO

The use of psychotropic drugs during pregnancy and breastfeeding remains a controversial topic. There are several reasons for the controversy, ranging from the misperception that pregnancy is protective against mental illness, to the notion that women should be "pure" during pregnancy and avoid all extraneous substance use, and finally, to the stigma and misunderstanding of psychiatric illness and underestimation of how serious it can be. Fortunately, the currently available data are reassuring for most psychiatric medications-properly controlled studies indicate little to no risk for most (but not all) psychiatric medications.


Assuntos
Aleitamento Materno , Transtornos Mentais/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Psicofarmacologia/normas , Psicotrópicos/uso terapêutico , Feminino , Humanos , Comportamento do Lactente/efeitos dos fármacos , Recém-Nascido , Gravidez , Psicotrópicos/efeitos adversos , Transtornos Puerperais/tratamento farmacológico , Estados Unidos
18.
Psychiatry Res ; 276: 151-159, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31085419

RESUMO

OBJECTIVE: To assess the reversibility of weight gain associated with psychotropic medications in children. METHODS: A retrospective cohort study was conducted using an ambulatory electronic medical records database. Individuals under 18 years of age were identified if they were initiating a new course of second generation/atypical antipsychotics (SGA) or mood stabilizers (MS) following a bipolar disorder diagnosis and subsequently discontinued treatment within 24 months of treatment initiation. RESULTS: Of the 297 children who had experienced positive BMI percentile increase (mean±SD: 8.71±11.94) during the treatment of SGA and/or MS, treatment discontinuation led to an average of 1.88 (±13.41) unit decrease in BMI percentile during a 12-month period since the treatment discontinuation. Repeated measure mixed model analysis showed that the reduction of BMI percentile after treatment discontinuation was neither associated with the treatment regimens patients previously received, nor associated with time since the treatment discontinuation. The three statistically significant predictors were baseline BMI percentile, BMI percentile gained during the treatment, and comorbid substance abuse disorder. CONCLUSION: Children with bipolar disorder were able to lose a fraction of weight gained during pharmacotherapy after the treatment discontinuation, however, their BMI percentile may not return to the prior treatment level within a year post-medication discontinuation.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Psicotrópicos/efeitos adversos , Ganho de Peso/efeitos dos fármacos , Adolescente , Transtorno Bipolar/fisiopatologia , Índice de Massa Corporal , Peso Corporal , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Suspensão de Tratamento
19.
J Psychosoc Nurs Ment Health Serv ; 57(4): 9-12, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30933297

RESUMO

Pharmacogenetic testing to aid in making decisions about prescribing medications was approved by the U.S. Food and Drug Administration in 2005 and gradually became a common practice. However, an innovation that was thought to help individualize prescribing psychotropic medications with fewer trials and errors soon became a disappointment to clinicians. Current pharmacogenetic testing assesses how the liver metabolizes drugs through the cytochrome p 450 system; however, much of the variability in how a drug affects an individual also relies on the pharmacodynamics of the drug (i.e., the specific ways the drug changes the body). The current article discusses the advantages and disadvantages of pharmacogenetic testing to aid in prescribing psychotropic medications. [Journal of Psychosocial Nursing and Mental Health Services, 57(4), 9-12.].


Assuntos
Monitoramento de Medicamentos/métodos , Farmacogenética , Testes Farmacogenômicos , Psicotrópicos , Testes Genéticos/métodos , Humanos , Serviços de Saúde Mental , Enfermagem Psiquiátrica , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Estados Unidos , United States Food and Drug Administration
20.
Psychiatry Res ; 275: 366-372, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31003063

RESUMO

Harmful drug-drug interactions (DDI) frequently include psychiatric drugs. Drug interaction database programs are viewed as a primary tool to alert physicians of potential DDI, but may provide different results as there is no standard to define DDI. This study compared the category of potential DDI provided by 6 commercial drug interaction database programs (3 subscription, 3 open access) for 100 drug interaction pairs. The pairs involved 94 different drugs; 67 included a psychiatric and non-psychiatric drug, and 33 included two psychiatric drugs. The category assigned to the potential DDI by the 6 programs was compared using percent agreement and Fleiss' kappa interrater reliability measure. The overall percent agreement for the category of potential DDI for the 100 drug interaction pairs was 66%. The Fleiss kappa overall interrater agreement was fair. The kappa agreement was substantial for interaction pairs with any severe category rating, and fair for interaction pairs with any major category rating. The category of potential DDI for drug interaction pairs including psychiatric drugs often differs among drug interaction database programs. Modern technology allows easy access to several interaction database programs. When assistance from a drug interaction database program is needed, the physician should check more than one program.


Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Serviços de Informação sobre Medicamentos/estatística & dados numéricos , Interações de Medicamentos , Psicotrópicos/efeitos adversos , Humanos , Reprodutibilidade dos Testes
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