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The prescribing of psychotropic drugs in mental health services in Trinidad
Moore,Shelley; Jaime,Lazara K. Montane; Maharajh,Hari; Ramtahal,Indar; Reid,Sandra; Ramsewak,Feroza Sircar; Maharaj,Mala;
Revista Panamericana de Salud Pública , 2002, DOI: 10.1590/S1020-49892002000900010
Abstract: objective. to describe, analyze, and interpret patterns of psychotropic drug prescribing in new psychiatric patients attending psychiatric outpatient clinics in the caribbean island of trinidad. design and methods. this was a cross-sectional study of psychotropic drug prescribing by psychiatrists for 132 new psychiatric outpatients who were seen at the outpatient clinics surveyed and who were entering the mental health system during the period of research, november 1998 through february 1999. results. a single patient could be prescribed more than one psychotropic drug. antidepressant drugs were the class of psychotropic drugs most prescribed (79 of 132 patients, 59.8%), followed by antipsychotic drugs (67 of 132 patients, 50.8%). tricyclic antidepressants (tcas) were the antidepressants most prescribed (58 of the 79 patients), mainly amitriptyline (53 of the 58). fluoxetine was the only selective serotonin reuptake inhibitor (ssri) prescribed (21 of the 79 patients prescribed antidepressants). of the 67 patients receiving antipsychotic drugs, phenothiazines accounted for 41 of those 67, including trifluoperazine (14 of the 41) and thioridazine (13 of the 41). the individual antipsychotic most prescribed was sulpiride (21 of the 67 patients). anticholinergic drugs were prescribed to 20 of the 132 patients (15.1%). eighty-three of the patients were prescribed more than one drug concomitantly (either more than one psychotropic or a combination of psychotropic(s) and nonpsychotropic(s)). prescription by ethnicity, age, and gender coincided with the morbidity rates encountered in these patients. the prescribing of ssris to persons of african or east indian ethnicity was significantly lower than it was for persons of mixed heritage. conclusions. the prescription patterns of psychotropic drugs in trinidad revealed the psychiatrists' preferences for traditional psychotropic drugs, the moderate use of anticholinergic drugs, and polypharmacy in some cases, with probable pred
The prescribing of psychotropic drugs in mental health services in Trinidad  [cached]
Moore Shelley,Jaime Lazara K. Montane,Maharajh Hari,Ramtahal Indar
Revista Panamericana de Salud Pública , 2002,
Abstract: Objective. To describe, analyze, and interpret patterns of psychotropic drug prescribing in new psychiatric patients attending psychiatric outpatient clinics in the Caribbean island of Trinidad. Design and Methods. This was a cross-sectional study of psychotropic drug prescribing by psychiatrists for 132 new psychiatric outpatients who were seen at the outpatient clinics surveyed and who were entering the mental health system during the period of research, November 1998 through February 1999. Results. A single patient could be prescribed more than one psychotropic drug. Antidepressant drugs were the class of psychotropic drugs most prescribed (79 of 132 patients, 59.8%), followed by antipsychotic drugs (67 of 132 patients, 50.8%). Tricyclic antidepressants (TCAs) were the antidepressants most prescribed (58 of the 79 patients), mainly amitriptyline (53 of the 58). Fluoxetine was the only selective serotonin reuptake inhibitor (SSRI) prescribed (21 of the 79 patients prescribed antidepressants). Of the 67 patients receiving antipsychotic drugs, phenothiazines accounted for 41 of those 67, including trifluoperazine (14 of the 41) and thioridazine (13 of the 41). The individual antipsychotic most prescribed was sulpiride (21 of the 67 patients). Anticholinergic drugs were prescribed to 20 of the 132 patients (15.1%). Eighty-three of the patients were prescribed more than one drug concomitantly (either more than one psychotropic or a combination of psychotropic(s) and nonpsychotropic(s)). Prescription by ethnicity, age, and gender coincided with the morbidity rates encountered in these patients. The prescribing of SSRIs to persons of African or East Indian ethnicity was significantly lower than it was for persons of mixed heritage. Conclusions. The prescription patterns of psychotropic drugs in Trinidad revealed the psychiatrists' preferences for traditional psychotropic drugs, the moderate use of anticholinergic drugs, and polypharmacy in some cases, with probable predisposition to adverse drug reactions. Given our results and based on the evaluation of individual patients, consideration should be given to a broader use of the newer antidepressants (SSRIs) and antipsychotics. Unless justified, polypharmacy should be avoided.
Weight Gain, Obesity, and Psychotropic Prescribing  [PDF]
Nikhil Nihalani,Thomas L. Schwartz,Umar A. Siddiqui,James L. Megna
Journal of Obesity , 2011, DOI: 10.1155/2011/893629
Abstract: A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment with these agents. There is newer literature looking at the etiology of this weight gain and the potential treatments being used to alleviate this side effect. The authors undertook a comprehensive literature review in order to present epidemiology, etiology, and treatment options of weight gain associated with antipsychotics, mood stabilizers, and antidepressants. 1. Introduction Weight gain is a major health problem in the United States and is a common adverse effect associated with many psychiatric drugs used to treat depression, anxiety, bipolar disorder, and schizophrenia. Clearly the new, second generation antipsychotics have gathered much press and literature about thier profound effects on weight gain and the development of metabolic disorders. Class action law suits have been filed and settled against drug manufacturers, and the FDA has issued cautions about these serious side effects with this class of medications. Psychiatric prescribers are well aware of this side effect profile of antipsychotics but also note weight gain to be associated with a majority of other commonly used psychiatric medications. Induction of weight gain and obesity often contributes towards psychotropic medication nonadherence. This can lead to relapse and hospitalization. Weight gain clearly contributes to medical comorbidity [1, 2]. Currently prescribed psychotropics (antipsychotics, antidepressants, and mood stabilizers) may cause 2–17?kg of weight gain over the course of clinical treatment [3–6]. Unfortunately, there are only a very few psychotropics associated with weight loss [7–9]. This paper will briefly review the epidemiology, possible etiology, and available treatment options for psychotropic-induced weight changes. In a novel format, the authors will present brief clinical cases to help convey information about typical patient scenarios and management strategies. 2. Weight Gain due to Psychotropics Case 1 HA is a 22-year-old female suffering from depressive disorder and social anxiety disorder. She had failed to respond to an initial SSRI antidepressant (paroxetine) and was subsequently placed on an SNRI. She had a partial response to this agent and developed a minimal 1-2?kg weight gain. An approved second generation antipsychotic (aripiprazole) was added for her resistant symptoms and after 6 weeks of treatment she
Psychotropic Drug Prescribing Trends in Bahrain: Implications for Sexual Functions  [PDF]
Khalid A. J. Al-Khaja, Reginald P. Sequeira, Mohammed K. Al-Haddad, Adel R. Al-Offi
International Journal of Clinical Medicine (IJCM) , 2012, DOI: 10.4236/ijcm.2012.34054
Abstract: Treatment-emergent sexual dysfunction is a frequent adverse effect of many psychotropic drugs. We have analyzed the prescribing trends and the likelihood of psychotropic-associated sexual dysfunction in outpatients with depression or other psychotic disorders treated by psychiatrists. A retrospective prescription audit was conducted at the Psychiatric Hospital, the only psychiatric facility in Bahrain that offers both inpatient and outpatient services. Psychotropic associated sexual dysfunction was graded as negligible (0), moderate (2+), moderately severe (3+) and uncertain (U) for antidepressants, and for antipsychotics as no effect (0), very low (1+), moderate (2+), moderately severe (3+) and uncertain (U) effect. As antidepressant monotherapy, a significant trend towards prescribing selective serotonin reuptake inhibitors (SSRIs; 3+) and selective norepinephrine reuptake inhibitors (SNRIs; 3+) in females, and tricyclic antide-pressants (TCAs; 2+) in males was apparent. Atypical antidepressant mirtazapine (0) monotherapy was rarely prescribed. Mirtazapine with SSRIs or SNRI was the most often prescribed combinations followed by TCAs with other antidepressants. Risperidone (0 to 3+), an atypical antipsychotic, was the most popular antipsychotic prescribed to augment antidepressants; there was no gender-based difference. Clozapine (0) and olanzapine (1+) were rarely prescribed to augment antidepressant therapy. In Bahrain, the psychotropic prescribing trends suggest that there is a need to optimize drug therapy to achieve the therapeutic goal with minimal adverse impact on sexual function.
Prescribing of psychotropic medications to the elderly population of a Canadian province: a retrospective study using administrative databases  [PDF]
Silvia Alessi-Severini,Matthew Dahl,Jennifer Schultz,Colleen Metge,Colette Raymond
PeerJ , 2015, DOI: 10.7717/peerj.168
Abstract: Background. Psychotropic medications, in particular second-generation antipsychotics (SGAs) and benzodiazepines, have been associated with harm in elderly populations. Health agencies around the world have issued warnings about the risks of prescribing such medications to frail individuals affected by dementia and current guidelines recommend their use only in cases where the benefits clearly outweigh the risks. This study documents the use of psychotropic medications in the entire elderly population of a Canadian province in the context of current clinical guidelines for the treatment of behavioural disturbances.
International variation in antipsychotic prescribing for schizophrenia: Pooled results from the research on East Asia psychotropic prescription (reap) studies  [PDF]
Hiroto Ito, Yasuyuki Okumura, Teruhiko Higuchi, Chay Hoon Tan, Naotaka Shinfuku
Open Journal of Psychiatry (OJPsych) , 2012, DOI: 10.4236/ojpsych.2012.224048
Abstract: Objective: To identify updated trends in antipsychotic prescribing patterns in patients with schizophrenia in East Asia. Methods: Using the data from the 2001, 2004, and 2008 Research on East Asia Psychotropic Prescription (REAP) studies, we compared the proportions of acute inpatients (stay <6 months), new long-stay patients (6 months to 3 years), and old long-stay patients (≥3 years), the rates of excessive dosing (more than chlorpromazine 1,000 mg equivalent) and polypharmacy (the coprescription of more than 1 antipsychotic). Findings: While the proportion of long-term inpatients increased over time in Chinese mainland and Taiwan, it decreased in Japan, Singapore and Hong Kong. The proportion of acute inpatients receiving more than one drug was highest in Singapore, followed by Japan, Korea and Chinese Mainland. Two-drug combination therapy was especially high in Singapore. Korea had the highest rate of excessive dosing followed by Japan and Hong Kong. While the rates of both polypharmacy and excessive dosing decreased significantly over time in Japan, polypharmacy increased significantly in Chinese Mainland and Taiwan and excessive dosing increased significantly in Korea and Hong Kong. Conclusion: Our results suggest that the change in antipsychotic prescribing patterns, including excessive dosing and polypharmacy, varied among the participating East Asian countries/areas.
Demographic and Clinical Features and Prescribing Patterns of Psychotropic Medications in Patients with the Melancholic Subtype of Major Depressive Disorder in China  [PDF]
Yu-Tao Xiang, Gang Wang, Chen Hu, Tong Guo, Gabor S. Ungvari, Amy M. Kilbourne, Kelly Y. C. Lai, Tian-Mei Si, Qi-Wen Zheng, Da-Fang Chen, Yi-Ru Fang, Zheng Lu, Hai-Chen Yang, Jian Hu, Zhi-Yu Chen, Yi Huang, Jing Sun, Xiao-Ping Wang, Hui-Chun Li, Jin-Bei Zhang, Helen F. K. Chiu
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0039840
Abstract: Background Little has been known about the demographic and clinical features of the melancholic subtype of major depressive disorder (MDD) in Chinese patients. This study examined the frequency of melancholia in Chinese MDD patients and explored its demographic and clinical correlates and prescribing patterns of psychotropic drugs. Methods A consecutively collected sample of 1,178 patients with MDD were examined in 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide. The cross-sectional data of patients’ demographic and clinical characteristics and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. The diagnosis of the melancholic subtype was established using the Mini International Neuropsychiatric Interview (MINI). Medications ascertained included antidepressants, mood stabilizers, antipsychotics and benzodiazepines. Results Six hundred and twenty nine (53.4%) of the 1,178 patients fulfilled criteria for melancholia. In multiple logistic regression analyses, compared to non-melancholic counterparts, melancholic MDD patients were more likely to be male and receive benzodiazepines, had more frequent suicide ideations and attempts and seasonal depressive episodes, while they were less likely to be employed and receive antidepressants and had less family history of psychiatric disorders and lifetime depressive episodes. Conclusions The demographic and clinical features of melancholic MDD in Chinese patients were not entirely consistent with those found in Western populations. Compared to non-melancholic MDD patients, melancholic patients presented with different demographic and clinical features, which have implications for treatment decisions.
Improving the Appropriateness of Antipsychotic Prescribing for Behavioral and Psychological Symptoms of Dementia (BPSD): A Pilot Study of the Psychotropic Use Monitoring (PUM) Program  [PDF]
Kai Zhen Yap, Ee Heok Kua, Sui Yung Chan, Joyce Yu-Chia Lee
Open Journal of Psychiatry (OJPsych) , 2014, DOI: 10.4236/ojpsych.2014.42020
Abstract:

In nursing homes, antipsychotic prescribing decisions (APDs) for managing behavioral and psychological symptoms of dementia (BPSD) depend on the nursing staff’s feedback. Inappropriate APDs can result in the lack of timeliness, objectivity and important clinical information when nursing staff’s feedback on residents’ behavior and pharmacotherapy outcomes. Currently, there are no reported interventions for improving psychiatrists’ APDs through nursing staff’s monitoring and feedback processes. This one-group pre-and-post pilot study aimed to evaluate the feasibility and impact of implementing a newly-developed Psychotropic Use Monitoring (PUM) program for improving the appropriateness of APDs in a 50-bed dementia ward of a nursing home. The PUM intervention involved 16 pharmacist-trained nursing staff, who monitored and reported residents’ BPSD changes and psychotropic side effects for 24 weeks, while carrying out their routine care duties. A face-to-face interview was then administered to determine the nursing staff’s perceptions of PUM. Data of 51 residents were collected from hardcopy individual patient records to evaluate the changes in APDs and the number of resident falls before and after implementing PUM. The nursing staff reported increases in their knowledge, awareness, confidence, and actual frequency of monitoring for side effects, as well as their ability in differentiating and managing BPSD (p < 0.05). After PUM, there was a significant increase in the number of APDs due to side effect-related reasons (4 versus 16) (p < 0.031). Although not significant, the number of APDs with no documented reasons (5 versus 9) and the number of resident falls (7 versus 15) appeared to be lesser after PUM. This study demonstrated the nursing staff’s positive participation in PUM intervention, specifically in monitoring and feedback of side effects. Furthermore, a potential exists for PUM to encourage more judicious APDs, which may be useful in settings with heavy patient load, limited human resources and dependence on foreign nursing staff from differing cultural backgrounds.

Specialist prescribing of psychotropic drugs to older persons in Sweden - a register-based study of 188 024 older persons
Gunilla Martinsson, Ingegerd Fagerberg, Lena Wiklund-Gustin, Christina Lindholm
BMC Psychiatry , 2012, DOI: 10.1186/1471-244x-12-197
Abstract: Data concerning drug treatment for older persons from 2006 to 2008 was gathered from the Swedish Prescribed Drug Register. Mental disorders, defined as affective, psychotic and anxiety disorders (ICD-10 F20-42) were evaluated in order to identify associated drugs. Included was a total of 188 024 older individuals, who collectively filled 2 013 079 prescriptions for the treatment of mental disorders. Descriptive analyses were performed, including frequency distribution and 95% CI. The competence of the prescribers was analyzed by subdividing them into five groups: geriatricians, psychiatrists, general practitioners (GPs), other specialists, and physicians without specialist education.GPs represented the main prescribers, whereas geriatricians and psychiatrists rarely prescribed drugs to older persons. Benzodiazepines and tricyclic antidepressants were the most commonly prescribed drugs. Women were prescribed drugs from geriatricians and psychiatrists to a greater extent than men.This study examined the prescription of psychotropic drugs to older persons. Physicians specialized in older persons’ disorders and mental health were rarely the prescribers of these drugs. Contrary to clinical guidelines, benzodiazepines and tricyclic antidepressants were commonly prescribed to older persons, emphasizing the need for continuous examination of pharmaceutical treatment for older persons. The results indicate a future need of more specialists in geriatrics and psychiatry.The world is facing a demographical shift in which the older population will increase. It is thus fair to assume that the prevalence of disorders that are common among older persons will also increase. Studies have shown that mental disorders are prevalent among the old [1-3], even when dementia disorders are excluded [4,5]. The treatment of mental disorders (i.e. affective, psychotic and anxiety disorders) in older persons is a complex task and can be affected by a variety of factors, including pharmacokinetic
Weight Gain, Obesity, and Psychotropic Prescribing  [PDF]
Nikhil Nihalani,Thomas L. Schwartz,Umar A. Siddiqui,James L. Megna
Journal of Obesity , 2011, DOI: 10.1155/2011/893629
Abstract: A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment with these agents. There is newer literature looking at the etiology of this weight gain and the potential treatments being used to alleviate this side effect. The authors undertook a comprehensive literature review in order to present epidemiology, etiology, and treatment options of weight gain associated with antipsychotics, mood stabilizers, and antidepressants.
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