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1.
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
2.
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
3.
Psychiatr Prax ; 46(7): 388-393, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31284317

RESUMO

OBJECTIVE: Psychopharmaceuticals are often prescribed in nursing homes for elderly. Together with the general polypharmacy, the risk for adverse drug reactions and interactions is increased. METHODS: Medication data of 398 nursing home residents were analyzed. Guided interviews and focus groups were carried out with nurses, prescribing physicians and relatives. RESULTS: About 70 % of the residents received psychotropic drugs often with sedative properties. High work load, sociodemographic development and shortage of psychiatrists and neurologists had an influence on the prescription rates. CONCLUSION: Nurses and physicians need to be aware of possible adverse drug effects and interactions of psychotropics. The overall amount of psychopharmaceuticals prescribed in nursing homes should be reduced.


Assuntos
Instituição de Longa Permanência para Idosos , Casas de Saúde , Polimedicação , Psicotrópicos , Idoso , Alemanha , Humanos , Psicotrópicos/uso terapêutico
4.
Rev Assoc Med Bras (1992) ; 65(6): 870-879, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340319

RESUMO

This study aimed to assess the prevalence of medical and nonmedical use of psychiatric medication among undergraduate students of health sciences from a public university in Brasil. Another objective was to determine the frequency of nuclear morphological abnormalities in the buccal mucosa of students using psychiatric drugs. A cross-sectional study based on a Web survey was carried out with 375 health sciences undergraduate students from schools of Pharmacy, Physical Education, Nutrition, and Medicine. Additionally, spontaneous genetic damages in exfoliated cells of the buccal mucosa of 41 individuals by counting micronucleus (MN) and binucleated (BN) cells frequencies were evaluated. The results showed 76 (20.3%) of students reported the use of psychotropic drugs after enrolling in university. The majority of these students were from Pharmacy and Medicine programs, females, aged between 18-25 years old, nonsmokers, alcohol addicts, and with a family history of mental illness. In addition, Medical students, individuals with high-income, who live alone and are in the last period of the program are more likely to use psychotropic drugs. Moreover, exposure to psychiatric medication was able to increase the number of binucleated cells. These results provide evidence that the use of psychoactive drugs is increased in the academic context and may be related to the failure of the cell cycle.


Assuntos
Uso Indevido de Medicamentos/estatística & dados numéricos , Mucosa Bucal/efeitos dos fármacos , Mucosa Bucal/patologia , Psicotrópicos/uso terapêutico , Estudantes de Ciências da Saúde/estatística & dados numéricos , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Testes para Micronúcleos , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Universidades , Adulto Jovem
5.
Artigo em Russo | MEDLINE | ID: mdl-31156228

RESUMO

The relevance of the problem is determined by the growth of elderly population in the world and in Russia and by the increase in the frequency of non-psychotic mental disorders (non-PMD) in the structure of psychiatric diseases. The authors consider the current state of research in the field of non-PMD of old age, including neurotic disorders (ND). An analysis of the literature has shown that there is no convergent view on the ND of old age. As a consequence, there are contradictory views from researchers or psychiatric schools on the ND prevalence and morbidity. Attention is drawn to the insufficient diagnosis of non-PMD in the primary link of health care, difficulties of distinguishing ND from neurotic-like states, necessity in the clarification of the epidemiology of neuroses and efficiency of psychotherapeutic help. The use of resources of able-bodied people is important for the socio-economic development of the country.


Assuntos
Transtornos Mentais , Transtornos Neuróticos , Idoso , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Neuróticos/diagnóstico , Transtornos Neuróticos/tratamento farmacológico , Transtornos Neuróticos/epidemiologia , Prevalência , Psicotrópicos/uso terapêutico , Federação Russa/epidemiologia
6.
Nord J Psychiatry ; 73(6): 323-330, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31240984

RESUMO

Background: Although cannabis use has been linked with schizophrenia in a dose-response pattern, to our knowledge, the relationship between cannabis and schizophrenia has rarely been reported in Asian population. Aim: We compared the clinical characteristics and psychotropic prescription patterns between cannabis users and non-users among Asian patients with schizophrenia. Moreover, we aimed to identify the independent correlates of cannabis use in these subjects. Methods: We performed the analysis of the data from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP), a collaborative consortium survey used to collate the prescription patterns for antipsychotic and other psychotropic medications in patients with schizophrenia in Asia. We included 132 schizophrenia patients in the group of lifetime cannabis use and 1756 in the group that had never used cannabis. A binary logistic model was fitted to detect the clinical correlates of lifetime cannabis use. Results: Adjusting for the effects of age, sex, geographical region, income group, duration of untreated psychosis, and Charlson comordity index level, a binary logistic regression model revealed that lifetime cannabis use was independently associated with aggressive behavior [adjusted odds ratio (aOR) = 1.582, 95% confidence interval (CI) = 1.006-2.490, p = .047] and with long-acting injectable antipsychotic treatment (aOR = 1.796, 95% CI = 1.444-2.820, p = .001). Conclusion: Our findings indicate a close link between lifetime cannabis use and aggressive behavior. The use of long-acting, injectable antipsychotics preferentially treats the aggressive behavior cannabis users among patients with schizophrenia in Asia, especially, the South or Southeast Asia.


Assuntos
Agressão , Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Cannabis/efeitos adversos , Fumar Maconha/efeitos adversos , Esquizofrenia/tratamento farmacológico , Adulto , Ásia/epidemiologia , Grupo com Ancestrais do Continente Asiático/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Fumar Maconha/epidemiologia , Fumar Maconha/psicologia , Razão de Chances , Psicotrópicos/administração & dosagem , Psicotrópicos/uso terapêutico , Esquizofrenia/epidemiologia , Inquéritos e Questionários
7.
BMC Health Serv Res ; 19(1): 272, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039784

RESUMO

BACKGROUND: The appropriateness of psychotropic prescriptions in the elderly is a major quality-of-care challenge at hospital. Quality indicators have been developed to prevent inappropriate psychotropic prescriptions. We aimed to select and automatically calculate such indicators, from the Bordeaux University Hospital information system, and to analyze the appropriateness of psychotropic prescription practices, in an observational study. METHODS: Experts selected indicators of the appropriateness of psychotropic prescriptions in hospitalized elderly patients, according to guidelines from the French High Authority for Health. The indicators were reformulated to focus on psychotropic administrations. The automated calculation of indicators was analyzed by comparing their measure to data collected from a clinical audit. In elderly patients hospitalized between 2014 and 2015, we then analyzed the evolution of the appropriateness of psychotropic prescription practices during hospital stay, using methods of visualization, and described practices by considering patients' characteristics. RESULTS: Two indicators were automated to detect overuse and misuse of psychotropic drugs. Indicators identified frequent inappropriate drug administrations, but practices tended to become more appropriate after quality-of-care improvement actions. In the majority of patients (85%), there was no inappropriate administration of psychotropic drugs during hospital stay; for the remaining 15% with at least one inappropriate administration, physicians tended to limit overuse or misuse during hospital stay. Inappropriate administrations were more frequent in patients suffering from psychiatric disorders, dependence and associated complications or morbidities. CONCLUSIONS: The automated indicators are structuring tools for the development of a drug prescription monitoring system. Inappropriate psychotropic administrations were limited by physicians during hospital stay; some inappropriate prescriptions might be explained by clinical characteristics of patients.


Assuntos
Prescrição Inadequada/prevenção & controle , Transtornos Mentais/tratamento farmacológico , Padrões de Prática Médica/normas , Psicotrópicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Auditoria Clínica , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Sistemas de Informação Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Padrões de Prática Médica/estatística & dados numéricos
8.
Internist (Berl) ; 60(6): 638-643, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31076796

RESUMO

People with rare diseases have a very high rate of mental and social stress. This results in specific tasks and problems in the psychosomatic care of patients. On the one hand, the physical and/or psychological symptoms of an undetected rare organic disease can be misdiagnosed as a psychosomatic disease, and the affected persons possibly receive psychotherapy that is not causally effective. On the other hand, mental diseases that require treatment can arise as a result of the effects of a rare disease. These should be diagnosed as such and treated with psychotherapy. If, in individual cases, both symptoms of a rare disease and symptoms of a psychosomatic disorder in the sense of comorbidity are present, neither one nor the other diagnosis should lead to a hasty termination of diagnostic efforts. Otherwise, misalignments can easily occur and the further diagnostic and therapeutic process can be permanently disturbed. Interdisciplinary team care interventions should therefore be developed further.


Assuntos
Transtornos Psicofisiológicos , Medicina Psicossomática , Doenças Raras , Estresse Psicológico/complicações , Humanos , Transtornos Mentais/terapia , Equipe de Assistência ao Paciente , Transtornos Psicofisiológicos/classificação , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/terapia , Psicoterapia , Psicotrópicos/uso terapêutico , Doenças Raras/diagnóstico , Doenças Raras/terapia
9.
J Manag Care Spec Pharm ; 25(5): 555-565, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039063

RESUMO

BACKGROUND: Psychotropic polypharmacy is not uncommon among cancer patients and may contribute to the increased direct health care cost burden in this population. OBJECTIVE: To estimate average direct health care costs in the year following cancer diagnosis among cancer patients receiving psychotropic polypharmacy compared with those without psychotropic polypharmacy, using a multivariable analysis framework. METHODS: A retrospective cross-sectional study was conducted among patients aged 18 years and older diagnosed with the most commonly occurring cancers (breast, prostate, lung, and colorectal) in the United States during 2011-2012 using the deidentified Optum Clinformatics Data Mart commercial claims database. Psychotropic polypharmacy was defined as concurrent use of 2 or more psychotropic medications for at least 90 days. Direct health care costs in the year following cancer diagnosis were estimated as total medical payments made by the health plans and were derived from claims files. A generalized linear regression model with log-link function and gamma distribution was used to model average direct health care costs, controlling for baseline patient demographic and clinical covariates. RESULTS: Average annual direct health care costs for cancer patients with psychotropic polypharmacy ($53,497; SD $72,590) were higher than those without psychotropic polypharmacy ($38,255; SD $59,844), with an unadjusted average cost difference of $15,242 (P < 0.0001). In the adjusted regression model, the average difference in costs shrunk to $5,888 but remained notable. When examined by type of cancer, average direct health care costs for all cancer patients with psychotropic polypharmacy were significantly higher than those for patients without psychotropic polypharmacy, except for colorectal cancer patients. CONCLUSIONS: Overall health care costs were higher among cancer patients with psychotropic polypharmacy compared with those without psychotropic polypharmacy. Our findings support the need for future research to better understand the benefits and risks of psychotropic polypharmacy, given its potential to cause adverse health outcomes and avoidable health care utilization and costs for this vulnerable patient population. DISCLOSURES: This study was funded by the American Association of Colleges of Pharmacy (AACP) New Investigator Award mechanism, which was received by Vyas. Aroke was partially supported by the AACP grant for conducting data analysis of the study. Kogut is partially supported by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health and the AACP. The authors report no conflicts of interest. An abstract of this study was presented as a poster at the American Association of Colleges of Pharmacy Annual Meeting on July 22, 2018, in Boston, MA.


Assuntos
Transtornos de Adaptação/tratamento farmacológico , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Neoplasias/economia , Psicotrópicos/economia , Transtornos de Adaptação/economia , Transtornos de Adaptação/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Neoplasias/terapia , Polimedicação , Psicotrópicos/uso terapêutico , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
10.
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
11.
Psychiatr Danub ; 31(1): 18-25, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30948685

RESUMO

Psychiatric consultation and evaluation is an important part of candidate selection for organ transplantation. Psychiatric assessment of patients undergoing transplantation procedure is done in pre- and post-transplantation periods, each one having its specifics. In the pre-transplantation period it is crucial to assess the patient's therapeutic adherence and the ability of understanding the treatment. The main prediction factor for short and long-term success is medical compliance for which thorough clarification of psychosocial support is needed. Symptoms of psychological exhaustion due to physical illness should be distinguished from psychiatric disorders. If a patient has a history of psychiatric illness, the risks of exacerbation or recurrence of a disease need to be evaluated. Pharmacokinetic and pharmacodynamics of psychotropic drugs resulting from to organ failure should be considered when deciding on treatment. Psychiatric assessment of the organ donor aims to clarify the psychological suitability and motivation. There are specific aspects of liver, kidney, heart and lung transplantation to keep in mind. Understanding psychosexual development is particularly important to children, before transplantation, as is the assessment of every family member. The consultation concludes with an overall evaluation of the patient's psychosocial strengths and limitations and recommended interventions to optimize the candidacy for transplantation. In the post-transplantation period potential psychological problems or psychiatric disorders must be identified and treated accordingly, in addition to psychiatric side effects of immunosuppressive therapy. The use of psychotropic drugs in the post-transplantation period requires knowledge of medication interactions. Overall, psychiatrists perform multiple roles in the transplantation team. The psychiatrists' goals are to meet the psychological needs of both patients and potential donors, evaluate candidates and to help other medical experts on the team with understanding underlying psychological mechanisms triggered by serious medical conditions and procedures. Finally, the most important purpose is optimal organ recruitment and recovery.


Assuntos
Transtornos Mentais , Psiquiatria , Psicotrópicos , Criança , Família , Humanos , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Encaminhamento e Consulta
12.
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
13.
Artigo em Inglês | MEDLINE | ID: mdl-30813406

RESUMO

One of the most common neurodevelopmental disorders worldwide is autism spectrum disorder (ASD), which is characterized by language delay, impaired communication interactions, and repetitive patterns of behavior caused by environmental and genetic factors. This review aims to provide a comprehensive survey of recently published literature on ASD and especially novel insights into excitatory synaptic transmission. Even though numerous genes have been discovered that play roles in ASD, a good understanding of the pathophysiologic process of ASD is still lacking. The protein⁻protein interactions between the products of NLGN, SHANK, and NRXN synaptic genes indicate that the dysfunction in synaptic plasticity could be one reason for the development of ASD. Designing more accurate diagnostic tests for the early diagnosis of ASD would improve treatment strategies and could enhance the appropriate monitoring of prognosis. This comprehensive review describes the psychotropic and antiepileptic drugs that are currently available as effective pharmacological treatments and provides in-depth knowledge on the concepts related to clinical, diagnostic, therapeutic, and genetic perspectives of ASD. An increase in the prevalence of ASD in Gulf Cooperation Council countries is also addressed in the review. Further, the review emphasizes the need for international networking and multidimensional studies to design novel and effective treatment strategies.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/genética , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/tratamento farmacológico , Diagnóstico Precoce , Humanos , Oriente Médio/epidemiologia , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Plasticidade Neuronal/efeitos dos fármacos , Plasticidade Neuronal/genética , Psicotrópicos/farmacologia , Psicotrópicos/uso terapêutico , Fatores de Risco , Transmissão Sináptica/efeitos dos fármacos , Transmissão Sináptica/genética
14.
Rev Med Suisse ; 15(643): 631-635, 2019 Mar 20.
Artigo em Francês | MEDLINE | ID: mdl-30892842

RESUMO

Bariatric surgery is considered an effective treatment against obesity. This intervention and the subsequent weight loss can affect several pharmacokinetic parameters leading to a possible need of dosing adjustment. Despite an increasing number of bariatric interventions, clinical recommendations are often based on theoretical principles and expert opinions. Because reliable clinical and biological parameters for adjusting psychotropic drug are not available, the use of therapeutic drug monitoring needs to be advised as a useful approach. However, it is not currently possible to predict the effect of bariatric surgery on psychotropic blood levels, and due to their important inter-individual variability, preoperative medication blood levels should be measured to ensure an adequate postoperative dosing adaptation.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Psicotrópicos , Humanos , Obesidade Mórbida/cirurgia , Período Pós-Operatório , Psicotrópicos/uso terapêutico , Perda de Peso
15.
Ther Drug Monit ; 41(2): 174-179, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30883511

RESUMO

BACKGROUND: Despite the obvious potential of Therapeutic Drug Monitoring (TDM) as a tool to optimize psychopharmacotherapy, especially treatment with mood-stabilizing, antidepressant and antipsychotic drugs, acceptance of TDM as a routine tool is still limited. A serious scientific argument against the regular use of TDM is the lack of evidence for a concentration-dependent clinical effect. The aim of this review was to highlight methodological problems leading to poor or even negative concentration-effect relationships and to show how therapeutically effective concentrations of psychoactive drugs can be determined using routine TDM databases. METHODS: Reports on concentration-effect relationships of psychoactive drugs were analyzed with regard to applied methods. From routine TDM databases of patients who had been treated with antidepressant or antipsychotic drugs and whose improvement was measured by the clinical global impressions scale, mean and median drug concentrations were calculated and compared with reference ranges recommended by TDM guidelines. RESULTS: Few fixed-dose studies with adequate design and data analysis demonstrated a correlation between drug concentration and clinical effect for psychoactive drugs. Most studies, however, mostly retrospective analyses of TDM databases, failed to find significant concentration-effect relationships because of flexible dosing. They were not suitable for the determination of therapeutically effective drug concentrations. Using TDM databases of antidepressant and antipsychotic drug concentrations in blood of patients who were categorized as responders by the clinical global impressions score, the interquartile ranges of drug concentrations (25th-75th percent range) can be shown to be very close to the therapeutic reference ranges recommended in guidelines for TDM in psychiatry. CONCLUSIONS: This review provides a discussion on why simple correlation analyses of psychoactive drug concentrations in blood and clinical effects are obsolete for flexible-dose studies or TDM databases. TDM databases, however, can and should be used to calculate drug concentrations in blood of patients who had responded to the drugs. Interquartile ranges can be regarded and used as preliminary therapeutic reference ranges.


Assuntos
Monitoramento de Medicamentos/métodos , Psicotrópicos/sangue , Valores de Referência , Humanos , Psicotrópicos/uso terapêutico
16.
J Affect Disord ; 249: 112-120, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30771641

RESUMO

BACKGROUND: Suicide prevention is a core task in mental health services. Our objective was to determine whether Collaborative Assessment and Management of Suicidality (CAMS) reduced suicidal thoughts and behaviors and mental health distress more effectively than treatment as usual (TAU) in a heterogeneous patient population within specialized mental health care services. METHODS: In this observer-blinded pragmatic randomized controlled trial participants who scored 13 or above on Beck's Scale for Suicide Ideation-Current (BSSI-C) were included from seven in- and outpatient units. Primary outcome was suicidal ideation (BSSI-C). Secondary outcomes were mental health distress measured by the Outcome Questionnaire-45, and suicidal behaviors measured by the Suicide Attempt Self-Injury Count. Patients were assessed at baseline and after 6 and 12 months. RESULTS: The final intent-to-treat analyses included 78 participants (mean age 35.9 years, SD = 14.5, 41 females). The majority were depressed (65%), had a secondary diagnosis (73%) and 32% suffered from borderline personality disorder or borderline traits. After 6 months, CAMS participants reported lower levels of suicidal ideation compared to TAU (ß = -4.29, 95% CI = -8.32 to -0.27, p = .036). Larger changes in mental health distress were observed for CAMS participants after 6 months (ß = -11.87, 95% CI = -22.99 to -0.76, p = .036) and 12 months (ß = -13.70, 95% CI = -24.88 to -2.51, p = .017). LIMITATIONS: The modest sample size rendered the trial unable to detect small between-group differences. CONCLUSIONS: CAMS reduced suicidal ideation and mental health distress more efficiently than TAU in a heterogeneous patient population within specialized care.


Assuntos
Psicoterapia , Psicotrópicos/uso terapêutico , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Adulto , Transtorno da Personalidade Borderline/psicologia , Depressão/psicologia , Gerenciamento Clínico , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Método Simples-Cego , Tentativa de Suicídio/psicologia , Inquéritos e Questionários
17.
J Autism Dev Disord ; 49(6): 2291-2303, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30706350

RESUMO

Individuals with autism spectrum disorder (ASD) have higher rates of co-occurring diagnoses and use of psychotropic medication prescriptions than people with other developmental disabilities. Few studies have examined these trends in samples of people with intellectual and developmental disabilities (IDD) with and without ASD. Using a random sample of 11,947 adult IDD service users from 25 states, co-occurring diagnoses and psychotropic medication use were compared for those with and without ASD. Regardless of diagnosis, individuals with ASD had higher percentages of psychotropic medication use. Controlling for co-occurring condition, age, gender, and ID level, a diagnosis of ASD predicted number of medications used. Further research is needed to understand why individuals with ASD are prescribed more medication, more often, than similarly functioning groups of individuals without ASD.


Assuntos
Transtorno do Espectro Autista/tratamento farmacológico , Transtorno do Espectro Autista/epidemiologia , Deficiências do Desenvolvimento/tratamento farmacológico , Deficiências do Desenvolvimento/epidemiologia , Serviços de Saúde/tendências , Psicotrópicos/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno do Espectro Autista/psicologia , Deficiências do Desenvolvimento/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
18.
Drug Alcohol Depend ; 197: 28-36, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30769263

RESUMO

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) frequently co-occurs with Substance Use Disorders (SUDs). Standard ADHD pharmacotherapies are not effective in patients with this comorbidity and cognitive behavioral therapy (CBT) has not been tested in this population. This RCT aimed to compare the efficacy of Integrated CBT (CBT/Integrated) directed at adult ADHD and SUD with CBT directed at SUD only (CBT/SUD) in patients with SUD and ADHD (SUD + ADHD). METHODS: Randomized clinical trial among 119 SUD + ADHD patients in a SUD treatment center. CBT/Integrated consisted of 15 individual sessions of motivational therapy, coping skills training and relapse prevention for SUD, and training of planning skills, problem-solving skills and dealing with emotions for ADHD. CBT/SUD consisted of 10 individual SUD treatment sessions only. Primary outcome was ADHD symptom severity according to the ADHD rating scale (ARS) at post-treatment. Secondary outcomes included ADHD symptom severity after two-month follow-up, and treatment response (≥30% ADHD symptom reduction), substance use, depressive or anxiety symptoms, and quality of life at post-treatment and follow-up. RESULTS: CBT/Integrated was more effective than CBT/SUD in the reduction of ADHD symptoms post-treatment: ARS = 28.1 (SD 9.0) vs. 31.5 (SD 11.4) (F = 4.739, df = 1, 282, p = .030; d = 0.34). At follow-up, CBT/Integrated still resulted in lower ARS scores than CBT/SUD, but the difference was not significant at the 0.05 level. For other secondary outcomes, including substance use, no significant between-group differences were present. CONCLUSIONS: Compared to regular SUD cognitive behavioral therapy, integrated cognitive behavioral therapy resulted in a significant extra improvement in ADHD symptoms in SUD + ADHD patients.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Terapia Cognitivo-Comportamental/métodos , Psicotrópicos/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Terapia Combinada , Comorbidade , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento
19.
Psychopharmacology (Berl) ; 236(5): 1411-1432, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30806744

RESUMO

The human gut contains trillions of symbiotic bacteria that play a key role in programming different aspects of host physiology in health and disease. Psychotropic medications act on the central nervous system (CNS) and are used in the treatment of various psychiatric disorders. There is increasing emphasis on the bidirectional interaction between drugs and the gut microbiome. An expanding body of evidence supports the notion that microbes can metabolise drugs and vice versa drugs can modify the gut microbiota composition. In this review, we will first give a comprehensive introduction about this bidirectional interaction, then we will take into consideration different classes of psychotropics including antipsychotics, antidepressants, antianxiety drugs, anticonvulsants/mood stabilisers, opioid analgesics, drugs of abuse, alcohol, nicotine and xanthines. The varying effects of these widely used medications on microorganisms are becoming apparent from in vivo and in vitro studies. This has important implications for the future of psychopharmacology pipelines that will routinely need to consider the host microbiome during drug discovery and development.


Assuntos
Antidepressivos/farmacologia , Antipsicóticos/farmacologia , Microbioma Gastrointestinal/efeitos dos fármacos , Psicotrópicos/farmacologia , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Microbioma Gastrointestinal/fisiologia , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/psicologia , Microbiota/efeitos dos fármacos , Microbiota/fisiologia , Psicotrópicos/uso terapêutico
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