2,640 results on '"PSYCHOTROPIC MEDICATION"'
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2. Ten-year patterns of psychiatric medications dispensed to adolescent in Finland: Open dialogue-informed practice in Western Lapland as compared to practice in other Finnish regions
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Valtanen, Kari, Seikkula, Jaakko, Kurtti, Mia, Miettunen, Jouko, and Bergström, Tomi
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- 2024
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3. The use of the UKU side effect rating scale for adults with intellectual disabilities in a clinical sample
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Bakken, Trine Lise, Hellerud, Jane Margrete Askeland, Skaale, Svein Eirik, Augustin, Monica, and Elvehaug, Arne-Henrik
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- 2025
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4. Factors Associated with the Use of Psychotropic Medication in a Norwegian Community-Based Sample of Adults with Intellectual Disability.
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Pedersen, Erlend Refseth, Anke, Audny, Tessem, Silje Marie, Olsen, Monica Isabel, and Søndenaa, Erik
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PEOPLE with intellectual disabilities , *MENTAL illness , *MENTAL health screening , *MEDICATION abuse , *PSYCHIATRIC drugs - Abstract
BackgroundMethodResultsConclusionConcerns arise about overuse of psychotropic medication among people with intellectual disability. This study investigates occurrence of mental health problems, psychotropic medication use, and factors associated with the use of psychotropics in a Norwegian community-based sample.A cross-sectional community-based survey including 197 adults with intellectual disability. The POMONA-15 health indicators, the Aberrant Behavior Checklist-Community and the MPAS-Check were used for the assessment of factors associated with psychotropic medication use.A total of 39% (
n = 76) used psychotropic medication, 18% (n = 36) scored above cut-off on mental health screening and 23% (n = 45) reported mental health problems. Use of psychotropic medication was associated with older age, more severe intellectual disability, epilepsy, irritability and reported mental health problems.Psychotropic medication is still widely used, but antipsychotic drugs were used less frequently than previously reported. The use of psychotropics should be carefully evaluated, especially for populations with increased risk of adverse events. [ABSTRACT FROM AUTHOR] more...- Published
- 2025
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5. Comparing self‐report medication data from a longitudinal study on intellectual disability and national dispensing records.
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Gorman, A., Odalović, M., McCallion, P., Paul, A., Burke, É., MacLachlan, M., McCarron, M., Henman, M. C., Moran, M., O'Connell, J., Shankar, R., Ryan, C., and O'Dwyer, M.
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PATIENT compliance , *RESEARCH funding , *INTELLECTUAL disabilities , *LONGITUDINAL method , *STATISTICS , *DRUGS , *COMPARATIVE studies , *PSYCHIATRIC drugs , *SELF-perception - Abstract
Background: Medication data are a valuable resource in epidemiological studies. As the most common data collection method of medication data is self‐report, it is important to understand the accuracy of this in comparison with other methods such as dispensing records. The aim of this study was to compare the agreement between two different sources of medication data of older adults with intellectual disability (ID). Methods: Self‐report medication data were gathered from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing and linked to national pharmacy dispensing records. The kappa statistic was used to measure agreement between the two data sources for psychotropic medication. Results: The lowest agreement level was 'moderate' for the number of anxiolytics reported (kappa 0.56). The highest level of agreement was 'almost perfect' for the binary variable of antipsychotics (kappa 0.91). Other agreement results were 'substantial' or 'almost perfect'. Conclusions: Good agreement was found between the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing medication dataset and national dispensing records. Self‐report medication data appear to be a valid method of data collection in psychotropic medication use in adults with ID. [ABSTRACT FROM AUTHOR] more...
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- 2025
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6. Evaluation of routine health monitoring for metabolic disorders in patients with serious mental illness on psychotropic medications: a study from Ethiopia.
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Zeleke, Tirsit Ketsela, Teshome, Abel Hedato, Assefa, Meron Tademe, Chanie, Gashaw Sisay, and Abebe, Rahel Belete
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PEOPLE with mental illness , *MEDICAL personnel , *MENTAL illness , *PSYCHIATRIC drugs , *BLOOD lipids - Abstract
Background: Compared to the overall population, patients with mental health problems are more likely to experience concurrent physical illnesses, poorer health outcomes, and mortality. Psychotropic medications, which are the pillars in the management of mental health conditions, are associated with adverse effects such as weight gain, an increased level of glucose, and elevated circulating lipid levels, all of which contribute to metabolic disorders. Inadequate health monitoring may led to suboptimal interventions and worsening of these conditions. However, there is a lack of studies assessing routine health monitoring practices for metabolic disorders and their determinants among patients with serious mental illnesses taking psychotropic medications in Ethiopia. This study aimed to evaluate routine health monitoring for metabolic disorders and its determinants in patients with serious mental illnesses on psychotropic medications in Ethiopia. Method: A hospital based prospective follow-up study was conducted among patients with serious mental illness taking psychotropic medications who attended the outpatient psychiatry department at Debre Markos Comprehensive Specialized Hospital. Eligible participants were selected using a simple random sampling technique. Routine health monitoring was evaluated using guidelines and previous literature. Binary logistic regression was employed to identify the determinants of routine health monitoring, with statistical significance determined by a p-value of less than 0.05 and a 95% confidence interval (CI). Results: The overall routine health monitoring practice for metabolic disorders was found to be sub-optimal. Vital signs were the most commonly assessed parameters. Key determinants of routine health monitoring included participants aged 45 and above (AOR (95% CI): 2.82 (1.34–5.92), having social insurance (AOR (95% CI): 2.94 (1.86–4.64), availability of laboratory tests at the hospital (AOR (95% CI): 3.46 (2.16–5.55), and reporting of medication-related side effects (AOR (95% CI): 1.96 (1.21–3.17)). Conclusion: Routine health monitoring for metabolic disorders in patients with serious mental illnesses attending the outpatient psychiatry department was inadequate. Health care providers should give more attention to younger patients, those without health insurance, and who are not reported side effects. These findings provide crucial insights for improving routine health monitoring and promoting better health outcomes. [ABSTRACT FROM AUTHOR] more...
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- 2024
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7. Transitional challenges: Psychotropic medication and residential setting among young adults with intellectual disabilities.
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Houseworth, James, Tichá, Renáta, Pettingell, Sandra L., Stancliffe, Roger J., and Bershadsky, Julie
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MEDICAL prescriptions , *MENTAL health , *RESEARCH funding , *SEX distribution , *DESCRIPTIVE statistics , *UNCERTAINTY , *AGE distribution , *ANXIETY , *DISEASE prevalence , *INTELLECTUAL disabilities , *DEVELOPMENTAL disabilities , *SURVEYS , *PSYCHOSES , *TRANSITION to adulthood , *RESIDENTIAL care , *PSYCHIATRIC drugs , *DRUG utilization , *MENTAL depression , *ADULTS - Abstract
As youth with intellectual and developmental disabilities (IDD) are transitioning from the school systems and special education supports, many of them are moving into the adult service system (e.g., Vocational Rehabilitation, Home and Community‐Based Services). Thus, in addition to adolescence being a source of many psychological and behavioral needs, the change in service systems often leads to uncertainty and anxiety. Psychotropic medications tend to be used to treat challenging behavior and psychological conditions (e.g., depression, anxiety, psychosis). This study used National Core Indicators‐In‐Person Survey 2020–2021 data to explore the prevalence of psychotropic medication use among two groups of people with IDD: disability service users of transition age (18–25 years) and disability service users of adult age (26–45 years) and the role of residential settings (where one lives) as related to psychotropic medication use. The results indicated that adults (aged 26–45 years) are more likely to be prescribed psychotropic medications. This appears to be driven by the larger number of transition‐aged adults who still live with family, where prescription rates are much lower. Psychotropic drug use is an important issue due to its potential to lead to unintended negative consequences that affect health, social inclusion, and self‐determination if not carefully and effectively administered. [ABSTRACT FROM AUTHOR] more...
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- 2024
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8. What do people with intellectual disabilities, their family members and paid carers understand about psychotropic medication? A rapid review.
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Cavanagh, Dawn E., Caton, Sue, Rawles, Jodie, Runswick‐Cole, Katherine, Hatton, Chris, Chauhan, Umesh, and Hutchinson, Christine
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HEALTH literacy , *RESEARCH funding , *MEDICAL prescriptions , *DECISION making , *CAREGIVERS , *INTELLECTUAL disabilities , *SYSTEMATIC reviews , *LITERATURE reviews , *PSYCHIATRIC drugs , *CAREGIVER attitudes - Abstract
Background: People with intellectual disabilities are more likely to be prescribed psychotropic medication than the general population and are frequently prescribed multiple medications. Understanding people with intellectual disabilities and carer perspectives is essential to improving the quality of psychotropic medication prescribing and usage. Method: A rapid review explored people with intellectual disabilities' understanding of psychotropic medications, as well as family members and paid carers, and how this understanding can be improved. Results: Twenty‐one journal articles were included. Lack of understanding of medication was universal, with participants often unaware of adverse effects, alternatives, and rights around medication. There was also a lack of involvement in decision making for all participants. Some interventions aimed at people with intellectual disabilities or paid carers helped to improve knowledge. Conclusion: Evaluating how best to improve psychotropic medication understanding for people with intellectual disabilities, family members and paid carers should be a focus for future research. [ABSTRACT FROM AUTHOR] more...
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- 2024
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9. Interrupting the Cycle: Association of Parental Stress and Child/Youth Psychotropic Medication Nonadherence.
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Theall, Laura, Ninan, Ajit, Arbeau, Kim, Mannone, Jessica, and Stewart, Shannon L.
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PATIENT compliance , *PSYCHOLOGICAL stress , *PSYCHIATRIC drugs , *CHILDREN with developmental disabilities , *FAMILY relations , *WELL-being , *YOUTH health - Abstract
Efficacy of psychotropic medication depends in large part on successful adherence to prescribed regimens. This study investigated child/youth nonadherence in relation to family dynamics and informal support. The participants were 10,225 children and youth prescribed psychotropic medication and receiving services from 50 Ontario mental health agencies, assessed with the interRAI™ Child and Youth Mental Health (ChYMH) and ChYMH-Developmental Disability (ChYMH-DD) tools. Findings suggest a cycle of parental stress and child/youth medication nonadherence possibly leading to or even perpetuated by worsening psychiatric symptoms. Informal supports do not appear to moderate this cycle. While the present data cannot speak to causes of medication nonadherence in children/youth or where the cycle begins, the results are consistent with the extant literature calling for attention to parental wellbeing to support children/youth for optimal therapeutic benefits. Understanding home dynamics related to nonadherence can assist care planning that engages the family to achieve best possible child/youth outcomes. [ABSTRACT FROM AUTHOR] more...
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- 2024
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10. Findings from an expert focus group on psychotropic medication deprescribing practices for children and youth with complex needs
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Laura Theall, Ajit Ninan, and Melissa Currie
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psychotropic medication ,deprescribing ,children and youth ,complex needs ,mental health ,Psychiatry ,RC435-571 ,Pediatrics ,RJ1-570 - Abstract
IntroductionPsychotropic medication can be effective at stabilizing emotional and behavioural disturbances associated with physiological processes in children and youth. When medication benefits, indication or adverse effects are queried, deprescribing should be considered. Current guidelines for deprescribing are mainly for adults/elderly and largely theoretical, not practical, especially for polypharmacy.MethodsAt a tertiary center for children and youth with complex emotional and behavioural needs, physicians on staff have expertise in conducting assessments of medication efficacy, side effect burden, and safety concerns. Deprescribing is routinely undertaken in the context of inpatient and outpatient services in partnership with children/youth and their families. A qualitative initiative leveraged the specialized deprescribing expertise of eight physicians (six psychiatrists and two pediatricians).ResultsEmerging themes were medication review, timing, a stepwise approach, and setting conditions (inpatient and outpatient), with recurring subcategories of patient/family engagement as well as the underlying importance of continuity of care with psychosocial/behavioural supports.DiscussionThe findings from this expert focus group serve as a step towards supporting prescribing clinicians in mindful deprescribing when medications are no longer in the best interest of young patients. more...
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- 2024
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11. Temporal trends in medication and service use patterns for mental health issues among men with prostate cancer.
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Tiruye, Tenaw, Hiwase, Mrunal, Charlick, Megan, O'Callaghan, Michael, Khalid, Ashna, Li, Ming, FitzGerald, Liesel M., Caughey, Gillian E., Ettridge, Kerry, Roder, David, and Beckmann, Kerri
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MEDICAL care use , *MENTAL health screening , *PROSTATE cancer , *PROSTATE cancer patients , *MENTAL health services , *CANCER diagnosis , *PSYCHIATRIC drugs - Abstract
Objective: Prostate cancer can significantly impact mental wellbeing, creating uncertainty and morbidity. This study described patterns of psychotropic medication and mental health service use, as a proxy measure for mental health problems, 5 years before and 5 years after prostate cancer diagnosis. Methods: Population‐based registry data were linked with Pharmaceutical Benefits Scheme and Medicare Benefits Schedule data for all prostate cancer patients diagnosed in South Australia between 2012 and 2020 (n = 13,693). We estimated the proportion and rates of psychotropic medication and mental health service use before and after diagnosis. Multivariable adjusted interrupted time series analyses (ITSA) were conducted to uncover temporal patterns. Results: Fifteen percent of men commenced psychotropic medications and 6.4% sought out mental health services for the first time after diagnosis. Psychotropic medication use rose from 34.5% 5 years before to 40.3% 5 years after diagnosis, including an increase in use of antidepressants (from 20.7% to 26.0%) and anxiolytics (from 11.3% to 12.8%). Mental health service use increased from 10.2% to 12.1%, with the increase mostly being general practice mental health visits (from 7.8% to 10.6%). Multivariable ITSA indicated a significant rise in medication and service utilisation immediately before and in the first 2 years following prostate cancer diagnosis. Conclusion: There is a clear increase in psychotropic medication use and mental health service use around the time of prostate cancer diagnosis. Mental health outcomes of men with prostate cancer may be improved with early mental health screening, particularly during the diagnosis process, to enable early intervention. [ABSTRACT FROM AUTHOR] more...
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- 2024
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12. Adverse childhood experiences and psychotropic medication prescription among cancer patients.
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Montague, Rachel, Canning, Sarah Elise, Thielking, Paul, and Qeadan, Fares
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MEDICAL prescriptions , *RESEARCH funding , *LOGISTIC regression analysis , *CANCER patients , *DESCRIPTIVE statistics , *CHI-squared test , *MANN Whitney U Test , *MULTIVARIATE analysis , *ODDS ratio , *PHYSICIAN practice patterns , *TUMORS , *DRUG prescribing , *DATA analysis software , *CONFIDENCE intervals , *SOCIAL support , *ADVERSE childhood experiences , *PSYCHIATRIC drugs - Abstract
This study aimed at identifying and characterizing adverse childhood experiences (ACEs) in a sample of cancer patients and subsequently evaluating the relationship between ACEs and prescription of psychotropic medication among them. Individuals with ACEs have a higher risk of mental health conditions and are more likely to be prescribed psychotropic medications. A sample of 178 adult patients receiving Supportive Oncology & Survivorship (SOS) services at Huntsman Cancer Hospital in Utah was obtained. ACEs and Brief Resilient Coping Scale (BRCS) questionnaires were administered confidentially. A multivariable mixed effect model, adjusting for sex, age, and insurance type while controlling for zip-codes clustering were employed. Compared to the prevalence of ACEs in the general population, from the CDC-Kaiser Permanente ACEs Study, we found no significant difference in the prevalence of people who had experienced an adverse childhood event (ACEs score > = 1) between our study of cancer patients and the CDC-Kaiser study (67.4% vs. 63.6%, p = 0.29372), but found a significant difference in the prevalence of people who had experienced severe adverse childhood experiences (ACES score > =4) (25.3% vs. 12.1%, p < 0.00001). Furthermore, this study reveals a significant association between an increase of one unit in the total ACEs score and the odds of psychotropic medication prescription in the past 12 months (OR: 1.233; 95% CI: 1.025, 1.483). Those with a total ACEs score of three or more were found to have 280% higher odds of being prescribed psychotropic medication compared to those with ACEs ≤ 2 (OR: 3.822; 95% CI: 1.404,10.407). A significant proportion of cancer patients have a history of ACEs, and thus trauma-informed care approach is essential during their treatment. [ABSTRACT FROM AUTHOR] more...
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- 2024
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13. Prevalence and determinants of psychotropic medication use in Poland.
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Pisarska, Agnieszka, Stokwiszewski, Jakub, and Moskalewicz, Jacek
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PSYCHIATRIC drugs ,SOCIODEMOGRAPHIC factors ,MENTAL illness ,COMPOSITE International Diagnostic Interview ,MENTAL depression ,ANTIDEPRESSANTS - Abstract
Aim. The aim of the study was to assess the prevalence of psychotropic medication use among adult population in Poland in past 12 months, and to analyse the relationship between psychotropic medication use and sociodemographic factors as well as mental health disorders experienced by respondents. Method. Composite International Diagnostic Instrument (WHO CIDI 3.0) was used in Polish survey of general population aged 18-64. Respondents were randomly selected from the population register. Ten thousand interviews were completed with a response rate of 50.4%. Results. In the general population, psychotropic medicines were used by almost 5% of the respondents in the past 12 months. These medicines were used more often by women, respondents from the oldest age group, with low level of education, retirees, unemployed, singles and residents of small and large cities. Among those experiencing mental health problems in the past 12 months, psychotropic medications were taken by up to 17% of the respondents. Pharmacological treatment was most often endorsed by over 40% of persons with symptoms of major depression and any mood disorders, while approximately 25% of respondents with major depression confirmed antidepressant use. Gender differences were small and mostly insignificant. Conclusions. The results indicate the need to improve access to mental health treatment and to better educate general practitioners (GPs) for appropriate diagnosing and treatment of mental health disorders. [ABSTRACT FROM AUTHOR] more...
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- 2024
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14. Off-label prescribing of psychotropics in a psychiatric patient population in Australia.
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Kyrios, Mietta, Levido, Jesse, Talbot, Daniel, and Harris, Anthony
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DRUG prescribing , *PEOPLE with mental illness , *SCHIZOAFFECTIVE disorders , *MEDICAL records , *GOVERNMENT agencies , *PSYCHIATRISTS - Abstract
Background: This study aimed to investigate the practice of off-label prescribing in both in- and outpatient psychiatry practice. Methods: One-hundred inpatient and 100 outpatient medical records from adult patients of an Australian psychiatry service from 2020 to 2021 were examined to determine the prevalence of off-label prescribing as defined by Therapeutic Goods Administration (TGA) indications, adherence to Royal Australian and New Zealand College of Psychiatrists (RANZCP) treatment guidelines, frequency of off-label prescription, and the quality of documentation and informed consent process. Results: Most prescribing events in both in- and outpatient settings were either on-label or off-label but consistent with RANZCP guidelines. Patients with a schizoaffective disorder diagnosis or displaying aggression were most likely to receive off-label prescriptions. There was no significant difference between in- and outpatient groups in the quality of documentation or consent process. Conclusions: In general, off-label prescribing across groups was common, but many decisions were then in line with RANZCP recommendations. That there is a discrepancy between clinical and regulatory bodies has implications for how off-label status is decided. [ABSTRACT FROM AUTHOR] more...
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- 2024
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15. Effectiveness of Psychotropic Medications in Children with Prenatal Alcohol and Drug Exposures: A Case Series and Model of Care.
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Ritfeld, Gaby J., Kable, Julie A., Holton, Jennifer E., and Coles, Claire D.
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PRENATAL drug exposure , *PRENATAL alcohol exposure , *PSYCHIATRIC drugs , *CONTINUOUS performance test , *FETAL alcohol syndrome - Abstract
Fetal Alcohol Spectrum Disorders affect up to 5% of the population, with additional children affected by prenatal drug exposures. The majority of these children display symptoms of ADHD and poor emotional dysregulation, a common reason for seeking psychiatric care. However, high prevalence of comorbid look-alike symptoms and limited availability of evidence-based treatments complicates psychiatric decision making in this population. The goal of the current study is to report on the effectiveness of psychotropic medications in a case series of 16 individuals with prenatal alcohol/drug exposure and propose a model for psychiatric care for this population. In addition to traditional subjective reports, an objective continuous performance test (T.O.V.A.®) was used to aid with guiding treatment. We found that T.O.V.A.®-scores improved on average from − 6.5 to − 2.9 with our psychiatric approach (p = 0.03). T.O.V.A.®-measurements were helpful in differentiating ADHD symptoms from comorbid symptoms and to guide decision-making on starting and changing medications. [ABSTRACT FROM AUTHOR] more...
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- 2024
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16. Parent Intention to Participate in an Online Intervention to Enhance Health Behavior Change Among Youth Treated with Psychotropic Medication Who are Overweight or Obese: An Application of the Theory of Planned Behavior.
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Richardson, Kathryn A., Punke, Elizabeth L. A., Dabrowski, Barbara S., Teply, Abby L., Walker, Johnathan, and McKibbin, Christine L.
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Youth with mental health disorders (MHD), particularly those who take psychotropic medications, are at increased risk of being overweight or obese (OW/OB) when compared to typical youth. Parents are important resources for interventions addressing OW/OB. However, parents of youth with MHD may face challenges that require interventions designed to address their needs. Prior to investing research funding in the development of interventions for this group, research is needed to understand factors associated with parents' decisions to enroll in these programs. The theory of planned behavior (TPB) provided a framework for examining parents' salient beliefs, direct attitudes, and intention to enroll in a hypothetical online healthy lifestyle intervention for their youth (ages 11–17) with OW/OB and treated with psychotropic medication. Parents who were enrolled in the study (n = 84) completed demographic questionnaires and a TPB questionnaire which was constructed for this study. A confirmatory factor analysis (CFA) of the direct attitude (i.e., attitude toward the behavior, subjective norm, perceived behavioral control) questions generally supported the three-factor model (i.e., RMSEA =.07, 90% CI.03–.11, p =.18; CFI =.96, SRMR =.06). Results from a multiple regression analysis demonstrated that direct attitudes predicted parent intention to participate in an online healthy lifestyle intervention for this sample of youth accounting for 84% of variance. In this preliminary study, the TPB appears to be a promising framework for understanding direct attitudes associated with parent intentions toward intervention participation in this population of youth. Interventions for parents of youth with OW/OB who are prescribed psychotropic medication should consider addressing these direct attitudes to improve intention. [ABSTRACT FROM AUTHOR] more...
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- 2024
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17. Prader–Willi syndrome in a large sample from Spain: general features, obesity and regular use of psychotropic medication.
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González‐Domenech, P. J., Gurpegui, M., González‐Domenech, C. M., Gómez‐González, S., Rustarazo, A., Ruiz‐Nieto, V., Carretero, M. D., and Gutiérrez‐Rojas, L.
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PRADER-Willi syndrome , *CLINICAL medicine , *CROSS-sectional method , *LIFESTYLES , *HABIT , *BEHAVIOR disorders , *BODY mass index , *KEY performance indicators (Management) , *LOGISTIC regression analysis , *SYMPTOMS , *DESCRIPTIVE statistics , *LONGITUDINAL method , *HYPERPHAGIA , *STATISTICS , *COMPULSIVE skin picking , *COGNITION disorders , *ANTHROPOMETRY , *HYPERKINESIA , *OBESITY , *PSYCHIATRIC drugs , *DEMOGRAPHY , *PHYSICAL activity , *DISEASE complications - Abstract
Background: Prader–Willi syndrome (PWS), a genetically determined disorder, the most frequent cause of early onset obesity, is associated with physical and cognitive dysfunctions and behavioural disturbances; these disturbances are frequently treated with psychotropic medication. The aim of this cross‐sectional study was to describe the characteristics of the first large national sample of persons with PWS in Spain and analyse the relationships of those characteristics with key demographic and clinical factors, particularly with obesity and the regular use of psychotropic medication. Methods: Participants were recruited among all members of the Spanish Prader–Willi Association who agreed to take part in the study and fulfilled its inclusion criteria. Family and patient demographic features, family size and birth order, intelligence quotient (IQ), anthropometric measures, lifestyle habits, behavioural disturbances (with the Aberrant Behavior Checklist) and clinical data, as well as use of psychotropic drugs and their side effects (with the UKU scale), were collected in genetically confirmed cases of PWS. Bivariate and logistic regression analyses were used for determining the associations of demographic and clinical factors with both obesity and the regular use of psychotropic medication. Results: The cohort included 177 participants (aged 6–48 years), that is, 90 (50.8%) males and 87 (49.2%) females. Behavioural disturbances were present in a range of 75% to 93% of participants; psychotropic medication was prescribed to 81 (45.8%) of them. Number of siblings showed a direct correlation with IQ, especially among males, and inappropriate speech was more intense in only‐child females. Obesity was, in parallel, strongly associated with ascending age and with not being currently under growth hormone (GH) treatment. Participants taking any psychotropic medication were characterised by more frequent age ≥30 years, high level of hyperactivity and a psychiatric diagnosis. Conclusions: Characterisation of persons with PWS in Spain confirms their physical and behavioural phenotype and supports the long‐term application of GH therapy and the rational use of psychotropic medication. [ABSTRACT FROM AUTHOR] more...
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- 2024
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18. Psychotropic medication use among adolescents participating in three randomized trials of DBT
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Lars Mehlum, Joan Asarnow, Sudan Prasad Neupane, Pilar Santamarina-Perez, Mireia Primé-Tous, and Gabrielle A. Carlson
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Suicide ,Self-harm ,Adolescent ,Dialectical behaviour therapy ,Psychotropic medication ,Psychiatry ,RC435-571 - Abstract
Abstract Background Frequently presenting with symptoms of mood or anxiety disorders, substance abuse or borderline personality disorder, suicidal and self-harming adolescents often are prescribed psychotropic medication. Though such treatment may be warranted, recurrent suicidal and self-harming behaviour is often linked to emotion dysregulation where pharmacological treatment has weak empirical support. There is a need for more clinical research into the frequency, type and rationale for pharmacological treatment in this group. In this secondary analysis of three randomized clinical trials of dialectical behaviour therapy for adolescents, we report on psychotropic medication use in the respective samples at the time of recruitment, compare use of psychotropic medication across trials and describe sample characteristics that may be associated with possible differences in psychotropic medication. Findings Trials were conducted in Norway, the US and Spain (labelled the Oslo, US and Barcelona samples). At baseline, 86% of the Barcelona sample, 67% of the US sample and 12% of the Oslo sample were taking at least one psychotropic medication with antidepressants as the most frequent, followed by antipsychotics (72%, 22% and 1.3% respectively) and mood stabilizers (14.2%, 16.2% and 0%). In the Oslo sample there was a significant association between receiving a diagnosis of major depression and the likelihood of receiving antidepressants, but no such association was found in the Barcelona and US samples. The overall 7–8 times higher proportion of participants in the US and Barcelona samples treated with psychotropic medication could only partially be explained by differences between the samples in diagnostic profiles, symptom severity or level of dysfunction. Conclusions Highly prevalent in use among suicidal and self-harming adolescents with borderline features, psychotropic medication was still very unevenly prescribed across trials, differences not explained by differences in sample characteristics suggesting that current treatment practices are not fully empirically supported. We call for continued medical education and increased availability of evidence-based psychosocial interventions. more...
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- 2024
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19. Differential effects of healthcare worker burnout on psychotropic medication use and misuse by occupational level.
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Hoopsick, Rachel A., Las, Sylvia, and Sun, Rachel
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MEDICAL personnel , *MEDICATION abuse , *PSYCHIATRIC drugs , *PSYCHOLOGICAL burnout , *NURSES' aides , *HEALTH services administrators - Abstract
Purpose: Burnout has been well examined among physicians and other high-wage, high-autonomy healthcare positions. However, lower-wage healthcare workers with less workplace autonomy (e.g., medical assistants, nurses' aides) represent a substantial proportion of the workforce, but remain understudied. We aimed to examine the effects of burnout on psychotropic medication use and misuse and whether these effects differed by occupational level. Methods: In March 2022, we collected data from a diverse sample of US healthcare workers (N = 200) and examined the cross-sectional relationship between burnout and changes in prescribed psychotropic medication (i.e., starting, stopping, and/or having a change in the dose/frequency) during the COVID-19 pandemic. We also separately examined the relationship between burnout and psychotropic medication misuse (i.e., without a prescription, in greater amounts, more often, longer than prescribed, and/or for a reason other than prescribed). We stratified models by occupational level (prescribers/healthcare administrators vs. other healthcare workers). Results: Greater burnout was associated with higher odds of changes in prescribed psychotropic medication among prescribers/healthcare administrators (aOR = 1.23, 95% CI 1.01, 1.48), but not among other healthcare workers (aOR = 1.04, 95% CI 0.98, 1.10). Greater burnout was not associated with psychotropic medication misuse among prescribers/healthcare administrators (aOR = 0.96, 95% CI 0.82, 1.12) but was associated with increased odds of psychotropic medication misuse among other healthcare workers (aOR = 1.07, 95% CI 1.01, 1.14). Conclusions: Potential disparities in help-seeking and healthcare access might manifest in non-medical use of prescription drugs among some healthcare workers, which has implications for worker safety and well-being. [ABSTRACT FROM AUTHOR] more...
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- 2024
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20. Association of medication clusters and subsequent labor market marginalization in refugee and Swedish-born young adults with common mental disorders in Sweden.
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Chen, J., Mittendorfer-Rutz, E., Taipale, H., Rahman, S., Niederkrotenthaler, T., and Klimek, P.
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PSYCHIATRIC diagnosis , *CLUSTER analysis (Statistics) , *RESEARCH funding , *PSYCHOLOGY of refugees , *DESCRIPTIVE statistics , *REPORTING of diseases , *LABOR market , *LONGITUDINAL method , *CONFIDENCE intervals , *PSYCHIATRIC drugs , *PROPORTIONAL hazards models , *REGRESSION analysis , *PHARMACODYNAMICS - Abstract
Little is known about the association between common mental disorders (CMD) and labor market integration among refugee and Swedish-born young adults. Socially disadvantaged patients such as refugees are more likely to discontinue their medication use prematurely. This study aimed to identify clusters of individuals with similar psychotropic medication patterns; and examine the relationship between cluster membership with labor market marginalization (LMM) in refugee and Swedish-born young adults with CMD. The study uses a longitudinal matched cohort aged 18-24 years with CMD diagnoses from Swedish registers covering 2006–2016. Dispensed psychotropic medications (antidepressants, antipsychotics, anxiolytics, sedative-hypnotics, mood stabilizers) were collected one year before and after CMD diagnosis. Clusters of patients with similar time courses of prescribed dosages were algorithmically identified. The association of cluster membership with subsequent LMM, (long-term sickness absence, SA, disability pension, DP, or long-term unemployment, UE) was assessed using Cox regression. Among 12,472 young adults with CMD, there were 13.9% with SA, 11.9% with DP, and 13.0% with UE during a mean follow-up of 4.1 years (SD 2.3 years). Six clusters of individuals were identified. A cluster with a sustained increase in all medication types yielded the highest hazard ratio (HR [95% CI]) 1.69 [1.34, 2.13] for SA and 2.63 [2.05, 3.38] for DP. The highest HRs of UE give a cluster with a concentrated peak in antidepressants at CMD diagnosis (HR 1.61[1.18, 2.18]). Refugees and Swedish-born showed similar associations between clusters and LMM. To prevent LMM, targeted support and early assessment of CMD treatment are needed for individuals with a sustained increase in psychotropic medication after CMD diagnosis and for refugees in high-risk clusters for UE characterized by a rapid lowering of treatment dosages, which could be an indicator for premature medication discontinuation. [ABSTRACT FROM AUTHOR] more...
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- 2024
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21. STOMP during COVID-19: use of psychotropic medication in intellectual disabilities community services – pilot QI project.
- Author
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Zahid, Sadia, Rauf, Bushra, Lee, Rachel, Sheikh, Hafsa, Roy, Ashok, and Pathania, Rani
- Subjects
- *
INAPPROPRIATE prescribing (Medicine) , *STATISTICAL sampling , *SCIENTIFIC observation , *RETROSPECTIVE studies , *QUANTITATIVE research , *TRANQUILIZING drugs , *INTELLECTUAL disabilities , *PHYSICIAN practice patterns , *DRUG prescribing , *COVID-19 pandemic , *PSYCHIATRIC drugs , *HEALTH care teams - Abstract
Purpose: A quantitative observational study was conducted. The purpose of this study is to examine the continuing adherence to the stopping over-medication of people with intellectual disability and/or autism guidelines for a cohort of outpatients seen in the outpatients' clinics in the two teams who participated in this study to review the trend of psychotropic prescribing with a prescription indication along with the utilisation of non-pharmacological interventions. Design/methodology/approach: Data was retrospectively collected over a period of one year for patients sampled conveniently in the outpatient's clinic. The data was collected from two sites from psychiatric letters to the general practitioners (GPs), with the focus being psychotropic prescription indication and their adherence to British National Formulary limits, inclusion of a wider multi-disciplinary team or MDT (including nurses, psychologists and health support workers), use of Clinical Global Impression (CGI) scale for assessing medication side effects and response to treatment. Findings: Most of the patients had at least one review in the previous six months. Antipsychotics were the highest prescribed medications without an indication for their use (13.3%) followed by anxiolytics and other medications. CGI recording was suboptimal, with 26% of the patient population did not have medication side effects and effectiveness monitored through this method. In total, 41% of patients were open to community nurses followed by other disciplines. Originality/value: To the best of the authors' knowledge, this is an original article following the pilot study completed by the authors. [ABSTRACT FROM AUTHOR] more...
- Published
- 2024
- Full Text
- View/download PDF
22. Patterns in School-Based Mental Health Visits and Psychotropic Medication Prescribing Before and During the COVID-19 Pandemic.
- Author
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Benefield, Halei, Bettencourt, Amie, Lee, Melissa, and Vidal, Carol
- Abstract
School-based mental health programs (SBMHP) are vital to providing youth access to mental health services. This study aims to characterize changes in therapy encounters and psychotropic medication prescriptions in an urban SBMHP during the COVID-19 pandemic. We used electronic medical records to extract demographic, clinical, and utilization data from encounters through a SBMHP associated with an urban mid-Atlantic academic medical institution from September 2019 to September 2021. We compared encounter trends in the 3 months preceding the onset of the COVID-19 pandemic (December 2019—February 2020) and the first 3 months of the pandemic (March–May 2020). Using all data from the study period, we plotted encounter statistics and conducted an interrupted time series analysis to examine longitudinal trends in encounter type and attendance, psychotropic medication prescriptions by therapeutic indication, and medication dosage increase before and after schools closed due to COVID-19 pandemic-related restrictions. A total of 625 students with 25,641 encounters were included. Students had a median age of 11 years (range 5–18 years) and the majority identified as Black (57.9%), and non-Hispanic (74.4%). Average monthly encounter volume increased by 557% from March to May 2020 compared to the prior 3 months, 88.6% of which were video encounters, compared to 0% previously. In contrast, psychotropic medication prescriptions decreased by 7.4%. Medication dosage adjustments declined in the period after March 2020, when a state mandate to close schools was ordered due to COVID-19, with the most prominent decline being in ADHD medication prescriptions, which averaged 6 increases per month pre-pandemic versus 1 per month during the pandemic period. In this SBMHP, encounters increased during the pandemic period, primarily in video encounters, while psychotropic medication prescriptions, mostly ADHD medications, declined during the pandemic. Reasons for this decline warrant further study. [ABSTRACT FROM AUTHOR] more...
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- 2024
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- View/download PDF
23. Patterns and factors associated with the prescription of psychotropic medications after diagnosis of cancer in Chinese patients: A population‐based cohort study.
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Lam, Chun Sing, Lee, Chui Ping, Chan, Joey Wing Yan, and Cheung, Yin Ting
- Abstract
Purpose: Patients with cancer may be prescribed psychotropic medications to address their psychiatric symptoms and disorders. This study examined the patterns and factors associated with the prescription of psychotropics after cancer diagnosis using a population‐based database in Hong Kong. Methods: Patients who were diagnosed with malignant cancer and had no documented psychiatric diagnosis or psychotropic medications prior to cancer diagnosis, were included. Multivariable log‐binomial models were used to explore the associations between predictive factors and psychotropic medications use. Results: Among 9337 patients, 1868 patients (20.0%) were newly prescribed with psychotropic medications after cancer diagnoses, most commonly hypnotics (50.3%) and antidepressants (32.8%). About one‐third (31.4%) were prescribed chronic psychotropics (≥90 days). Approximately 48.3% of patients who were prescribed psychotropic medications received their prescriptions within 1 year after diagnosed with cancer. Only 18.6% of those prescribed psychotropic medications had a registered psychiatric diagnosis. Patients with multiple comorbidities (adjusted risk ratio[aRR] = 2.74; CI = 2.46–3.05) and diagnosed with oral (aRR = 1.89; CI = 1.52–2.35) or respiratory cancers (aRR = 1.62; CI = 1.36–1.93) were more likely to be prescribed psychotropics. Conclusions: The use of psychotropic medication is common (20%) among patients with cancer. Our findings highlight the importance of identification and documentation of psychiatric needs among patients with cancer. [ABSTRACT FROM AUTHOR] more...
- Published
- 2024
- Full Text
- View/download PDF
24. General practitioner perceptions and experiences of managing perinatal mental health: a scoping review
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Jacqueline Frayne, Sarah Seddon, Tamara Lebedevs, Talila Milroy, Beverly Teh, and Thinh Nguyen
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General practice ,Perinatal mental health ,Scoping review ,Psychotropic medication ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background General Practitioners (GPs) are involved in preconception, pregnancy, and postnatal care. Overall, mental health remains a significant contributor to disease burden affecting 1 in 4 pregnant women. Psychotropic medication prescribing occurs in almost 1 in 12 pregnancies, and appears to be increasing, along with the prevalence of mental health disorders in women of reproductive age. Perinatal mental health management is therefore not an unlikely scenario within their clinical practice. This scoping review aims to map current research related to GPs perceptions and experiences of managing perinatal mental health. Method A comprehensive search strategy using nine electronic databases, and grey literature was undertaken between December 2021 and February 2023. Relevant studies were sourced from peer review databases using key terms related to perinatal mental health and general practitioners. Search results were screened on title, abstract and full text to assess those meeting inclusion criteria and relevance to the research question. Results After screening, 16 articles were included in the scoping review. The majority focused on perinatal depression. Findings support that GPs express confidence with diagnosing perinatal depression but report issues of stigma navigating a diagnosis. Over the last two decades, prescribing confidence in perinatal mental health remains variable with concerns for the safety profile of medication, low level of confidence in providing information and a strong reliance on personal experience. Despite the establishment of perinatal guidelines by countries, the utilisation of these and other existing resources by GPs appears from current literature to be infrequent. Many challenges exist for GPs around time pressures, a lack of information and resources, and difficulty accessing referral to services. Conclusion Recommendations following this scoping review include targeted perinatal education programs specific for GPs and embedded within training programs and the development of practice guidelines and resources specific to general practice that recognises time, services, and funding limitations. To achieve this future research is first needed on how guidelines and resources can be developed and best delivered to optimise GP engagement to improve knowledge and enhance patient care. more...
- Published
- 2023
- Full Text
- View/download PDF
25. Navigating the Challenges: Predictors of Non-Adherence to Psychotropic Medications Among Patients with Severe Mental Illnesses in Ethiopia
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Zeleke TK, Birhane W, Gubae K, Kebede B, and Abebe RB
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severe mental illness ,psychotropic medication ,non-adherence ,ethiopia ,Medicine (General) ,R5-920 - Abstract
Tirsit Ketsela Zeleke,1 Worku Birhane,1 Kale Gubae,1 Bekalu Kebede,1 Rahel Belete Abebe2 1Department of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia; 2Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Tirsit Ketsela Zeleke, Tel +251919187613, Email teryketsela2018@gmail.com; tirsit_ketsela@dmu.edu.etBackground: Psychotropic medications, consisting of antidepressants, mood stabilizers, antipsychotics, and anxiolytics, are the pillars of managing mental illnesses. Since there is impairment in judgment, attitude, and stability in patients with severe mental conditions, they are vulnerable to non-adherence, which compromises treatment outcome. Nevertheless, a lack of studies investigating medication non-adherence and its predictors in severe mental illnesses patients in Ethiopia has been noticed. The purpose of this study was to evaluate the extent of non-adherence to psychotropic medication and its predictors in patients with severe mental illnesses in Ethiopia.Patients and Methods: A cross-sectional study was carried out among severely ill mental patients attending outpatient psychiatry department at Debre Markos Comprehensive Specialized Hospital. Stratified sampling strategy was used to enroll patients with a variety of mental diseases. The determinants of non-adherence were identified using logistic regression analysis. Statistical significance was determined by a p-value of < 0.05 and a 95% confidence range.Results: The prevalence of non-adherence to psychotropic medication was 50.9%. Missing regular follow-up [AOR (95% CI): 2.36 (1.24– 4.47)], current substance use [AOR (95% CI): 2.48 (1.44– 4.27)], negative attitude towards treatment [AOR (95% CI); 3.87 (2.26– 6.62)], experience of side effects [AOR (95% CI); 4.84 (2.74– 8.54)], medication use for more than 3 years [AOR (95% CI); 7.16 (3.93– 13.06)], and no family support [AOR (95% CI); 2.07 (1.19– 3.58)] were predictors of psychotropic medication non-adherence.Conclusion: This study generalized that most of the patients were non-adherent to their medications. Missing regular follow-up, current substance use, negative attitude towards treatment, experience of side effects, Medication use for more than 3 years and absence of family support were found to influence medication adherence of the patients. In order to correct patients’, caregivers’, and societal misconceptions regarding the significance of treatment adherence, we recommend the need to implement psycho-educational programs.Keywords: severe mental illness, psychotropic medication, non-adherence, Ethiopia more...
- Published
- 2023
26. Understanding childhood involvement with social services and mental health : a population-wide data linkage study
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McKenna, Sarah, Maguire, Aideen, O'Reilly, Dermot, and Donnelly, Michael
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Social services ,looked after children ,children in need ,care experienced ,mental health ,psychotropic medication ,self-harm ,suicidal ideation ,suicide ,psychiatric admission - Abstract
Background: Children known to social services are a vulnerable population in need of help or protection. Mental health is a vital indicator of the wellbeing of children known to social services. However, there are no UK population-level studies concerning the mental health of these children, and their subsequent mental health as adults. Aim: To examine the mental health of children and adults in Northern Ireland (NI) based on childhood exposure to social services, and to identify the sociodemographic and social care experiences associated with mental ill-health, exploring in particular level of social care exposure, reason for referral or placement in care, age at first referral or placement in care, number of referrals or care episodes, and care placement type. Methods: A longitudinal, population-wide database of individual-level information on all children known to social services between 1985 and 2015 in NI was created by linking children's social care, primary care, hospital admission, prescription medication, self-harm and ideation data, and death records. This dataset was used to conduct a series of cross-sectional and longitudinal quantitative analyses to determine the strength of association between level of childhood exposure to social services and mental ill-health in childhood and young adulthood, up to age 36 years. Involvement with social services was classified into four mutually exclusive groups based on highest level: i) no involvement; ii) referred but assessed as not in need (NIN) in every interaction with social services; iii) child in need (CIN); and iv) child in care (CIC). Additional analyses identified which individuals known to social services are most at risk of mental ill-health based on different social care experiences, and explored critical risk periods for mental ill-health during the transition to adulthood. Results: Likelihood of mental ill-health is elevated for all social care subgroups compared to peers never known to social services, and is highest in care experienced children and adults. Levels of mental ill-health are comparable between those assessed as a child in need, and those deemed not in need of any investigation, surveillance, or services. Children known to social services, and adults previously known, are more likely to receive psychotropic medication, present to an Emergency Department (ED) following an act of self-harm or thoughts of self-harm/suicide, or experience a psychiatric hospital admission compared to peers never known to social services. Children known to social services represent 49.5% of all children in NI that experienced mental ill-health in 2015. Young adults known to social services in childhood represent 40.9% of those who presented to ED with self-harm or ideation, 38.0% of those who experienced a psychiatric admission, and 39.7% of suicide deaths in NI during follow-up. For young adults known to social services in childhood, the period of transition to adulthood (i.e. in the years immediately after turning 18 years) is one of particular vulnerability to mental ill-health, particularly for care leavers. Likelihood of mental ill-health is higher with proximity to childhood social care involvement and subsequently declines over time, though it remains high in comparison to peers never known to social services. Social care experiences are associated with mental ill-health, and a strong indicator of mental ill-health across life stages is a higher number of referrals to social services in childhood. Conclusion: This study provides the first UK population-wide evidence that children known to social services at all tiers are a high risk group for mental ill-health, and this increased risk persists into adulthood. Those referred but assessed as not in need are a newly identified at risk group. Findings have already informed policy in NI, and will be useful in targeting resources and interventions to improve mental health. more...
- Published
- 2022
27. Association of mental health diagnosis with race and all‐cause mortality after a cancer diagnosis: Large‐scale analysis of electronic health record data
- Author
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Chen, William C, Boreta, Lauren, Braunstein, Steve E, Rabow, Michael W, Kaplan, Lawrence E, Tenenbaum, Jessica D, Morin, Olivier, Park, Catherine C, and Hong, Julian C
- Subjects
Health Services and Systems ,Nursing ,Health Sciences ,Cancer ,Mental Health ,Clinical Research ,Health Disparities ,Minority Health ,Good Health and Well Being ,Adult ,Cohort Studies ,Electronic Health Records ,Humans ,Neoplasms ,Retrospective Studies ,distress ,electronic health record ,mental health ,psychooncology ,psychotropic medication ,Oncology and Carcinogenesis ,Public Health and Health Services ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Public health - Abstract
BackgroundDisparity in mental health care among cancer patients remains understudied.MethodsA large, retrospective, single tertiary-care institution cohort study was conducted based on deidentified electronic health record data of 54,852 adult cancer patients without prior mental health diagnosis (MHD) diagnosed at the University of California, San Francisco between January 2012 and September 2019. The exposure of interest was early-onset MHD with or without psychotropic medication (PM) within 12 months of cancer diagnosis and primary outcome was all-cause mortality.ResultsThere were 8.2% of patients who received a new MHD at a median of 197 days (interquartile range, 61-553) after incident cancer diagnosis; 31.0% received a PM prescription; and 3.7% a mental health-related visit (MHRV). There were 62.6% of patients who were non-Hispanic White (NHW), 10.8% were Asian, 9.8% were Hispanic, and 3.8% were Black. Compared with NHWs, minority cancer patients had reduced adjusted odds of MHDs, PM prescriptions, and MHRVs, particularly for generalized anxiety (Asian odds ratio [OR], 0.66, 95% CI, 0.55-0.78; Black OR, 0.60, 95% CI, 0.45-0.79; Hispanic OR, 0.72, 95% CI, 0.61-0.85) and selective serotonin-reuptake inhibitors (Asian OR, 0.43, 95% CI, 0.37-0.50; Black OR, 0.51, 95% CI, 0.40-0.61; Hispanic OR, 0.79, 95% CI, 0.70-0.89). New early MHD with PM was associated with elevated all-cause mortality (12-24 months: hazard ratio [HR], 1.43, 95% CI, 1.25-1.64) that waned by 24 to 36 months (HR, 1.18, 95% CI, 0.95-1.45).ConclusionsNew mental health diagnosis with PM was a marker of early mortality among cancer patients. Minority cancer patients were less likely to receive documentation of MHDs or treatment, which may represent missed opportunities to identify and treat cancer-related mental health conditions. more...
- Published
- 2022
28. Psychotropic Medication and Psychosocial Service Use Among Transition Age Youth With Autism Spectrum Disorder.
- Author
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Plourde, Emma R., Ali, Mir M., and West, Kristina D.
- Subjects
AUTISM spectrum disorders ,PSYCHIATRIC drugs ,SINGLE-payer health care ,LOGISTIC regression analysis - Abstract
People with autism spectrum disorder (ASD) experience high rates of psychotropic medication utilization and barriers to psychosocial services, yet limited literature explores use of these services and the association between a mental health condition (MH) and use. Using national multipayer claims data, this study estimates a multinomial logistic regression model to discern psychotropic medication and psychosocial service use among transition age youth (TAY) with ASD (12-26 years; N = 52,083) compared to a matched cohort of those without ASD (12-26 years; N = 52,083). Approximately one-third of TAY with ASD and no MH condition receive only psychotropic medication and the likelihood of using both psychosocial services and medication is higher only when TAY with ASD have a co-occurring MH condition. [ABSTRACT FROM AUTHOR] more...
- Published
- 2024
- Full Text
- View/download PDF
29. Medicine use in people with intellectual disabilities: a Finnish nationwide register study.
- Author
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Nurminen, F., Rättö, H., Arvio, M., Teittinen, A., Vesala, H. T., and Saastamoinen, L.
- Subjects
- *
CONFIDENCE intervals , *PSYCHIATRIC drugs , *AGE distribution , *MEDICAL care costs , *SEX distribution , *COMPARATIVE studies , *DRUGS , *DESCRIPTIVE statistics , *LOGISTIC regression analysis , *ODDS ratio , *INTELLECTUAL disabilities - Abstract
Background: People with intellectual disability (ID) are a vulnerable group in our society; many of them depend on other people for assistance in their everyday lives. Compared with the general population, people with ID have poorer general health and, therefore, need more healthcare services and use more medicines. The aim of this study is to define the population of all Finnish people with ID using administrative data and to compare their medicine use and expenditure on medicines to those of the age‐matched and sex‐matched controls. Methods: People with ID and their age‐matched and sex‐matched controls (1:1) were extracted from nationwide healthcare and social allowance registers. Administrative register data on all prescription medicine purchases in 2019 were used to determine the prevalence of medicine use in both groups on a general level and by medicine categories. The differences in the prevalence of medicine use between the two groups were analysed using the logistic regression model. In addition, we studied the total expenditure on reimbursable medicine purchases covered by the National Health Insurance between people with ID and control group. Results: The subpopulation of people with ID consisted 37 196 individuals, of whom 82.7% purchased prescription medicines in 2019. The corresponding share of individuals purchasing prescription medicines in the control group was 70.3%. The differences in the prevalence of medicine use between the two populations were highest in the younger age groups (0–6, 7–12 and 13–17). In the study population, 28.1% (OR = 12.28; 95% CI: 11.54–13.07) of the people used antipsychotics, making it the most used medicine category in people with ID. In the control group, 3.3% of people used antipsychotics. Compared with the control group, the use of antiepileptics, drugs for constipation, mineral supplements and anxiolytics was four to seven times higher among people with ID. Furthermore, the median expenditure on medicine use among people with ID was four times higher than in the control group. Conclusions: Compared with the control group, people with ID used more medicines, especially psychotropics, and their expenditure on medicine use was higher. [ABSTRACT FROM AUTHOR] more...
- Published
- 2023
- Full Text
- View/download PDF
30. General practitioner perceptions and experiences of managing perinatal mental health: a scoping review.
- Author
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Frayne, Jacqueline, Seddon, Sarah, Lebedevs, Tamara, Milroy, Talila, Teh, Beverly, and Nguyen, Thinh
- Subjects
PRECONCEPTION care ,GENERAL practitioners ,MENTAL health personnel ,MENTAL health ,MENTAL illness ,CHILDBEARING age ,WOMEN'S mental health - Abstract
Background: General Practitioners (GPs) are involved in preconception, pregnancy, and postnatal care. Overall, mental health remains a significant contributor to disease burden affecting 1 in 4 pregnant women. Psychotropic medication prescribing occurs in almost 1 in 12 pregnancies, and appears to be increasing, along with the prevalence of mental health disorders in women of reproductive age. Perinatal mental health management is therefore not an unlikely scenario within their clinical practice. This scoping review aims to map current research related to GPs perceptions and experiences of managing perinatal mental health. Method: A comprehensive search strategy using nine electronic databases, and grey literature was undertaken between December 2021 and February 2023. Relevant studies were sourced from peer review databases using key terms related to perinatal mental health and general practitioners. Search results were screened on title, abstract and full text to assess those meeting inclusion criteria and relevance to the research question. Results: After screening, 16 articles were included in the scoping review. The majority focused on perinatal depression. Findings support that GPs express confidence with diagnosing perinatal depression but report issues of stigma navigating a diagnosis. Over the last two decades, prescribing confidence in perinatal mental health remains variable with concerns for the safety profile of medication, low level of confidence in providing information and a strong reliance on personal experience. Despite the establishment of perinatal guidelines by countries, the utilisation of these and other existing resources by GPs appears from current literature to be infrequent. Many challenges exist for GPs around time pressures, a lack of information and resources, and difficulty accessing referral to services. Conclusion: Recommendations following this scoping review include targeted perinatal education programs specific for GPs and embedded within training programs and the development of practice guidelines and resources specific to general practice that recognises time, services, and funding limitations. To achieve this future research is first needed on how guidelines and resources can be developed and best delivered to optimise GP engagement to improve knowledge and enhance patient care. [ABSTRACT FROM AUTHOR] more...
- Published
- 2023
- Full Text
- View/download PDF
31. Receptor-Independent Therapies for Forensic Detainees with Schizophrenia–Dementia Comorbidity.
- Author
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Sfera, Adonis, Andronescu, Luminita, Britt, William G., Himsl, Kiera, Klein, Carolina, Rahman, Leah, and Kozlakidis, Zisis
- Subjects
- *
NEUROBEHAVIORAL disorders , *OLANZAPINE , *OLDER people , *MEDICAL care , *PEOPLE with mental illness , *GRAY matter (Nerve tissue) , *AMISULPRIDE , *ARIPIPRAZOLE - Abstract
Forensic institutions throughout the world house patients with severe psychiatric illness and history of criminal violations. Improved medical care, hygiene, psychiatric treatment, and nutrition led to an unmatched longevity in this population, which previously lived, on average, 15 to 20 years shorter than the public at large. On the other hand, longevity has contributed to increased prevalence of age-related diseases, including neurodegenerative disorders, which complicate clinical management, increasing healthcare expenditures. Forensic institutions, originally intended for the treatment of younger individuals, are ill-equipped for the growing number of older offenders. Moreover, as antipsychotic drugs became available in 1950s and 1960s, we are observing the first generation of forensic detainees who have aged on dopamine-blocking agents. Although the consequences of long-term treatment with these agents are unclear, schizophrenia-associated gray matter loss may contribute to the development of early dementia. Taken together, increased lifespan and the subsequent cognitive deficit observed in long-term forensic institutions raise questions and dilemmas unencountered by the previous generations of clinicians. These include: does the presence of neurocognitive dysfunction justify antipsychotic dose reduction or discontinuation despite a lifelong history of schizophrenia and violent behavior? Should neurolipidomic interventions become the standard of care in elderly individuals with lifelong schizophrenia and dementia? Can patients with schizophrenia and dementia meet the Dusky standard to stand trial? Should neurocognitive disorders in the elderly with lifelong schizophrenia be treated differently than age-related neurodegeneration? In this article, we hypothesize that gray matter loss is the core symptom of schizophrenia which leads to dementia. We hypothesize further that strategies to delay or stop gray matter depletion would not only improve the schizophrenia sustained recovery, but also avert the development of major neurocognitive disorders in people living with schizophrenia. Based on this hypothesis, we suggest utilization of both receptor-dependent and independent therapeutics for chronic psychosis. [ABSTRACT FROM AUTHOR] more...
- Published
- 2023
- Full Text
- View/download PDF
32. „Deprescribing“ in DGPPN-S3-Leitlinien – eine systematische Analyse
- Author
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Seitz, Selina, Hasan, Alkomiet, Strube, Wolfgang, Wagner, Elias, Leucht, Stefan, and Halms, Theresa
- Published
- 2024
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33. Violence Caused by Prescription Medication
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Eikelenboom-Schieveld, Selma J. M., Fogleman, James C., Martin, Colin R., editor, Preedy, Victor R., editor, and Patel, Vinood B., editor
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- 2023
- Full Text
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34. Mental Skills Training for Endurance Sports
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Carter, Jennifer E., Norman, Joshua L., and Miller, Timothy L., editor
- Published
- 2023
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35. Prevalence of psychotropic and opioid prescribing among hospice beneficiaries in the United States, 2014–2016
- Author
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Gerlach, Lauren B, Kales, Helen C, Kim, Hyungjin Myra, Zhang, Lan, Strominger, Julie, Covinsky, Kenneth, Teno, Joan, Bynum, Julie PW, and Maust, Donovan T
- Subjects
Pharmacology and Pharmaceutical Sciences ,Biomedical and Clinical Sciences ,Behavioral and Social Science ,Clinical Research ,Neurosciences ,Good Health and Well Being ,Aged ,80 and over ,Analgesics ,Opioid ,Antipsychotic Agents ,Cross-Sectional Studies ,Drug Prescriptions ,Female ,Hospice Care ,Humans ,Male ,Medicare ,Medicare Part D ,Practice Patterns ,Physicians' ,Prevalence ,Psychotropic Drugs ,United States ,hospice ,psychotropic medication ,symptom management ,Medical and Health Sciences ,Geriatrics ,Biomedical and clinical sciences ,Health sciences ,Psychology - Abstract
Background/objectivesPsychotropic and opioid medications are routinely prescribed for symptom management in hospice, but national estimates of prescribing are lacking. Changes in Medicare hospice payment in 2014 provide the first opportunity to examine psychotropic and opioid prescribing among hospice beneficiaries, and the factors associated with use of specific medication classes.DesignCross-sectional analysis of a 20% sample of traditional and managed Medicare with Part D enrolled in hospice, 2014-2016.SettingBeneficiaries enrolled in the Medicare hospice benefit.ParticipantsMedicare beneficiaries ≥65 newly enrolled in hospice between July 1, 2014 and December 31, 2016 (N = 554,022).Main outcomePrevalence of psychotropic and opioid medication prescribing by class and factors associated with prescribing.Results70.3% of hospice beneficiaries were prescribed a psychotropic and 63.3% were prescribed an opioid. The most common psychotropic classes prescribed were: benzodiazepines (60.6%), antipsychotics (38.3%), antidepressants (18.4%), and antiepileptics (10.2%). Lorazepam (56.4%), morphine (52.8%), and haloperidol (28.6%) were received by the most beneficiaries. Prevalence of any psychotropic and opioid prescription was highest among beneficiaries who were female (76.7%), non-Hispanic white (76.6%), and those with cancer (78.9%). Compared to white beneficiaries, non-Hispanic black beneficiaries were less likely to receive nearly every class of medication, with significantly lower odds of receiving opioids (64.1% vs 57.9%; AOR 0.75, 95% CI 0.72-0.77) and benzodiazepines (61.6% vs 52.2%; AOR 0.66, 95% CI 0.64-0.68). Differences were seen across hospice diagnosis; those with cancer were more likely to receive opioids, benzodiazepines, and antipsychotics but less likely to receive antidepressants and antiepileptics.ConclusionsPsychotropic and opioid medications are frequently prescribed in hospice. Observed variations in prescribing across race and ethnicity may reflect disparities in prescribing as well as patient preferences for care. Further work is important to understand factors driving prescribing given limited studies surrounding medication prescribing in hospice. more...
- Published
- 2021
36. Psychologists' responses to medication concerns
- Author
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Childs, Helen
- Subjects
Psychologists ,Medication concerns ,Psychotropic medication ,Minoritised ethnic backgrounds ,Psychosis-related diagnoses - Abstract
Section A: Presented here, is a systematic review of the literature detailing the experiences of taking psychotropic medication in service users from minoritised ethnic backgrounds with psychosis-related diagnoses. Eleven qualitative studies are discussed and critically appraised. The review synthesises findings under six main categories; medication helping versus negative effects; coercion; "They're quite happy to just hand out pills"; surrender versus disengaging; the need for cultural understandings alongside medication; and family support for versus opposition to medication. The review provides some initial evidence which suggests negative experiences of medication (predominant in the papers), although not specific to ethnicity per se, are more likely to be compounded if service users are a member of a minoritised ethnic group. Future research would benefit focusing on the voices of service users from minoritised ethnicities looking directly at this issue and investigating how clinicians might respond to service users who wish to challenge their current treatment. Section B: Presented here, is a study exploring psychologists' experience of responses to concerns about the medication of service users given a psychosis-related diagnoses. Guided by a critical realist grounded theory methodology, the constructed model identified 43 sub-categories organised within six main categories: Observing Coercion; 'Walking the Tight Rope'; 'Listen' or 'Shut Down'; Service Users 'Stuck in the Middle'; Teams, People and Relationships; Economic Climate and Societal Discourses. Findings highlight some of the dilemmas participants experienced regarding medication and is important in its acknowledgement of how difficult it can be to negotiate these dilemmas. The results indicate the need to improve shared decision making with service users, to offer increased support in the withdrawal of medication, and to help teams feel able to take more positive risks in relation to prescribing. more...
- Published
- 2021
37. Inflammation and damage-associated molecular patterns in major psychiatric disorders
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Fernanda Endler Valiati, Jacson Gabriel Feiten, Luiza Paul Géa, Érico de Moura Silveira Júnior, Ellen Scotton, Marco Antonio Caldieraro, Giovanni Abrahão Salum, and Marcia Kauer-Sant’Anna
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Psychiatric disorders ,inflammation ,DAMPs ,HSP70 ,psychotropic medication ,Psychiatry ,RC435-571 - Abstract
Abstract Background Emerging evidence indicates that inflammation plays an important role as a mechanism underlying mental disorders. However, most of the research on inflammatory mechanisms focuses on serum levels of interleukins and very few studies have investigated molecules that initiate and expand innate immune pathways such as damage-associated molecular patterns (DAMPs). Objectives This study investigated the levels of DAMPs among patients diagnosed with major depressive disorder (MDD), bipolar disorder (BD) I and II, schizophrenia (SCZ), and generalized anxiety disorder (GAD). We quantified serum levels of heat shock proteins (HSPs) 70 and 60 and of S100 calcium-binding protein B (S100B). Methods Serum levels of HSP70, HSP60, and S100B were assessed in a sample of participants with psychiatric disorders (n = 191) and a control group (CT) (n = 59) using enzyme-linked immunosorbent assay (ELISA). Results Serum HSP70 concentrations were significantly higher in the MDD group compared to the CT, SCZ, and BD groups. The GAD group had higher concentrations of HSP70 than the SCZ group. Exploring associations with medications, lithium (p = 0.003) and clozapine (p = 0.028) were associated with lower HSP70 levels. Approximately 64% of the sample had DAMPs levels below the limits of detection indicated by the respective ELISA kit. Conclusion This was the first study to assess DAMPs levels in a transdiagnostic sample. Our preliminary findings suggest that HSP70 may be associated with MDD pathophysiology. Medications such as lithium and clozapine were associated with lower HSP70 levels in BD and SCZ groups, respectively. Therefore, it is worth mentioning that all participants were medicated and many psychotropic drugs exert an anti-inflammatory effect, possibly reducing the signs of inflammation. more...
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- 2023
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38. Mental Health Disorders and Psychotropic Medication: Prevalence and Related Characteristics Among Individuals in Foster Care.
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McLeigh, Jill D., Malthaner, Lauren Q., Tovar, Madeline C., and Khan, Mohsin
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PSYCHIATRIC epidemiology , *STATISTICS , *PSYCHIATRIC drugs , *CONFIDENCE intervals , *AGE distribution , *MULTIVARIATE analysis , *RETROSPECTIVE studies , *ACQUISITION of data , *HEALTH status indicators , *RACE , *FISHER exact test , *PRIMARY health care , *SEX distribution , *T-test (Statistics) , *NEUROPSYCHOLOGICAL tests , *DRUG prescribing , *SYMPTOMS , *MEDICAL records , *DESCRIPTIVE statistics , *PHYSICIAN practice patterns , *SOCIODEMOGRAPHIC factors , *FOSTER home care , *MENTAL health services - Abstract
This study sought to provide prevalence data for mental health (MH) diagnoses and psychotropic medication prescriptions among individuals in foster care and to examine their relationships with physical health status, maltreatment type, placement type, and demographic variables. Data were retrieved from electronic health records for 3,067 patients seen at integrated pediatric primary care clinics serving individuals in care. Descriptive and bivariate statistics for presence of MH diagnoses and psychotropic medication prescription were calculated. Multivariable zero-inflated negative binomial regressions were used to assess relationships. Half (50.0%) of patients had at least one MH diagnosis; trauma and stressor-related (31.5%) and attention deficit hyperactivity (22.6%) disorders were most common. 27.8% of patients were prescribed at least 1 psychotropic medication. Complex chronic physical health, having 1 and 2 or more maltreatment exposures, and being 6–11 and 12–20 years of age had significantly higher rates of having a MH diagnosis while being female, Black, Hispanic, and other race were significantly associated with lower rates. Patients with at least 1 MH diagnosis that had complex chronic physical health status, experienced sexual abuse, and were 6–11 and 12–20 years of age had significantly higher rates of psychotropic medication prescription while shelter and kinship placement and female gender were significantly associated with lower rates. Findings suggest that initial and ongoing MH screening is vital for individuals in care so that appropriate interventions can be offered. Results support implementing strategies designed to increase access to MH services for this population, such as integrated care and child psychiatry consult programs. [ABSTRACT FROM AUTHOR] more...
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- 2023
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39. A Longitudinal Analysis of Concerning Psychotropic Medication Regimens Among Adolescents in Foster Care.
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Palmer, Lindsey, Herd, Toria, Swanson, Ann Shun, Felt, John, and Font, Sarah
- Abstract
To provide a population-based examination of psychotropic medication use before and after entry into foster care (FC), with special attention on the use of concerning medication regimens: polypharmacy, stimulants, and antipsychotics. Using linked administrative Medicaid and child protective service data from Wisconsin, we follow a cohort of early adolescents ages 10–13 years who entered FC between June 2009 and December 2016 (N = 2,998). Descriptive statistics and Kaplan Meyer survival curves illustrate the timing of medication. Cox proportional hazard models identify hazard of outcomes (new medication, polypharmacy, antipsychotic, and stimulant medication) during FC. Separate models were run for adolescents with and without a psychotropic medication claim in the six months before FC. Overall 34% of the cohort entered with a pre-existing psychotropic medication, accounting for 69% of adolescents with any psychotropic medication claim during FC. Similarly, the majority of adolescents with polypharmacy, antipsychotics or stimulants during FC entered with those prescriptions. Among youth with pre-entry medication, rates of polypharmacy (56%), antipsychotic (50%) and stimulants (64%) were high. Among adolescents who entered FC with no prior medication, placement disruptions (30 days before or after) predicted new medication. Although a great deal of attention - and policies - have focused on youth in care, there is high reliance on psychotropic medications within the broader population of maltreated adolescents, indicating a need for timely and accurate re-assessment of current and past medications upon entry. Adolescents should also be actively involved in their own health care. [ABSTRACT FROM AUTHOR] more...
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- 2023
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40. Psychotropic medication use in treatment-seeking youth with eating disorders.
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Gorrell, Sasha, Lebow, Jocelyn, Kinasz, Kathryn, Mitchell, James E, Goldschmidt, Andrea B, Le Grange, Daniel, and Accurso, Erin C
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Humans ,Antipsychotic Agents ,Psychotropic Drugs ,Psychotherapy ,Adolescent ,United States ,Female ,Male ,Feeding and Eating Disorders ,adolescents ,anorexia nervosa ,bulimia nervosa ,eating disorders ,psychotropic medication ,Brain Disorders ,Eating Disorders ,Mental Health ,Pediatric ,Clinical Research ,Evaluation of treatments and therapeutic interventions ,Management of diseases and conditions ,7.3 Management and decision making ,6.1 Pharmaceuticals ,Mental health ,Clinical Sciences ,Psychology ,Clinical Psychology - Abstract
ObjectivePsychotropic medication use in youth with eating disorders (EDs) is poorly understood despite high co-occurrence of psychiatric disorders. This study examined characteristics associated with medication use in treatment-seeking youth with EDs.MethodYouth up to age 18 reported on medication use when presenting to an academic medical center outpatient ED service in the United States. Data presented were collected between 1998-2015.ResultsThe sample (N = 604) was predominantly female (90.6%) with a mean age of 15.3 years (SD = 2.3). Approximately one-third (30%, n = 173) were taking psychotropic medications (40%, n = 70, were taking multiple medications). Antidepressant use was most common (26%, n = 152), followed by atypical antipsychotics (8%, n = 43). Adjusting for co-occurring psychiatric disorders, non-Hispanic Whites who had received prior treatment (psychotherapy, hospitalization) were significantly more likely to be using medication. Longer illness duration and prior treatment were associated with greater antidepressant use. For atypical antipsychotics, prior hospitalization was associated with greater use.ConclusionsFindings confirm moderate psychotropic medication use among young patients with EDs despite a lack of clarity regarding optimally effective pharmacologic interventions in this population. Pharmacological trials examining the efficacy of medications for young patients with EDs are warranted to inform future prescribing practice. more...
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- 2020
41. Losing a child to adolescent cancer: A register‐based cohort study of psychotropic medication use in bereaved parents
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Emma Hovén, Lisa Ljungman, Josefin Sveen, Charlotte Skoglund, Gustaf Ljungman, Rickard Ljung, and Anna Wikman
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adolescence ,bereavement ,cancer ,parents ,psychotropic medication ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Purpose To investigate the short‐ and long‐term risk of psychotropic medication use in parents who lose a child to cancer diagnosed in adolescence. Methods This is a Swedish nationwide register‐based study including 184 bereaved mothers and 184 bereaved fathers of 184 children diagnosed with cancer in adolescence. Logistic regression analyses, adjusted for sociodemographic characteristics and history of mental health problems, were performed to estimate risk of a prescription of psychotropic medication (anxiolytics, hypnotics/sedatives, antidepressants) in cancer‐bereaved parents from 1 year before to 5 years after the child's death, with a general population sample of non‐bereaved parents (n = 3291) as referents. Results At the year of the child's death, 28%–36% of mothers and 11%–20% of fathers had a prescription of anxiolytics, hypnotics/sedatives or antidepressants. The corresponding percentages for non‐bereaved mothers and fathers were 7%–12% and 4%–7%, respectively. Compared to non‐bereaved mothers, bereaved mothers showed higher odds of prescriptions from 1 year before up to four (anxiolytics) and 5 years (hypnotics/sedatives and antidepressants) after the child's death. Bereaved fathers showed higher odds than non‐bereaved fathers of prescriptions from 1 year before up to the year of (anxiolytics and hypnotics/sedatives) and 1 year after (antidepressants) the child's death. No differences in odds between bereaved and non‐bereaved fathers were found at 2 years after the child's death. Being unmarried, born outside Sweden, and having a history of mental health problems were associated with higher odds of prescribed medications. Conclusions Indicative of mental health problems of clinical importance, cancer‐bereaved parents had a higher prevalence of use of psychotropic medication. A decrease in medication use was evident with time, but still at 5 years after the child's death mothers displayed a higher use while fathers showed no difference to non‐bereaved fathers after 2 years. more...
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- 2023
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42. Primary care visits due to mental health problems and use of psychotropic medication during the COVID-19 pandemic in Finnish adolescents and young adults
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Ilari Kuitunen, Mikko M. Uimonen, Ville T. Ponkilainen, and Ville M. Mattila
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COVID-19 ,Mental health ,Psychotropic medication ,Epidemiology ,Adolescence ,Pediatrics ,RJ1-570 ,Psychiatry ,RC435-571 - Abstract
Abstract Background Social restrictions due to COVID-19 have impacted the everyday life of adolescents and young adults, with increased levels of stress and anxiety being reported. Therefore, we report primary care visits due to mental health problems and the use of psychotropic medication in Finland. Methods We conducted a nationwide register-based study and included primary care visits with mental health problems (F*-class ICD-10 diagnosis) for patients aged 15–24 years. We calculated incidence for visits and used incidence rate ratios (IRR) for comparisons. Psychotropic medication purchases for patients aged 13–24 years were included. Annual psychotropic medication user prevalence per 1000 was calculated and prevalence rate ratios (PRR) with 95% confidence intervals (CI) were used for comparisons. The years 2020 and 2021 were compared to the pre-pandemic reference year 2019. Results A total of 396534 visits to primary care due to mental health problems were included. Annual visit incidences per 1000 were 151.7 in 2019, 193.6 in 2020, and 306.7 in 2021, indicating a 28% (IRR 1.28, CI 1.27–1.29) increase from 2019 to 2020 and a 102% (IRR 2.02, CI:2.01–2.04) increase from 2019 to 2021. Highest reported increases in 2020 were sleeping disorders (IRR 1.79, CI 1.72–1.87) and anxiety disorders (IRR 1.39, CI 1.37–1.42). Prevalence of antidepressant use increased by 25% (PRR 1.25, CI 1.23–1.26) in 2021. An increase was also seen in the use of antipsychotics (+ 19%, PRR 1.19. CI 1.16–1.21). Conclusions The COVID-19 pandemic increased the need for mental health services and medication among Finnish adolescents and young adults. Our health care system needs the capacity to manage the increased number of visits, and we must be better prepared for future crises. more...
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- 2023
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43. Deprescribing psychotropic medicines for behaviours that challenge in people with intellectual disabilities: a systematic review
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Danielle Adams, Richard P. Hastings, Ian Maidment, Chetan Shah, and Peter E. Langdon
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Deprescribing ,Intellectual disabilities ,Psychotropic medication ,Behaviours that challenges ,Psychiatry ,RC435-571 - Abstract
Abstract Background Clear evidence of overprescribing of psychotropic medicines to manage behaviours that challenges in people with intellectual disabilities has led to national programmes within the U.K. such as NHS England’s STOMP to address this. The focus of the intervention in our review was deprescribing of psychotropic medicines in children and adults with intellectual disabilities. Mental health symptomatology and quality of life were main outcomes. Methods We reviewed the evidence using databases Medline, Embase, PsycINFO, Web of Science, CINAHL and Open Grey with an initial cut-off date of 22nd August 2020 and an update on 14th March 2022. The first reviewer (DA) extracted data using a bespoke form and appraised study quality using CASP and Murad tools. The second reviewer (CS) independently assessed a random 20% of papers. Results Database searching identified 8675 records with 54 studies included in the final analysis. The narrative synthesis suggests that psychotropic medicines can sometimes be deprescribed. Positive and negative consequences were reported. Positive effects on behaviour, mental and physical health were associated with an interdisciplinary model. Conclusions This is the first systematic review of the effects of deprescribing psychotropic medicines in people with intellectual disabilities which is not limited to antipsychotics. Main risks of bias were underpowered studies, poor recruitment processes, not accounting for other concurrent interventions and short follow up periods. Further research is needed to understand how to address the negative effects of deprescribing interventions. Trial registration The protocol was registered with PROSPERO (registration number CRD42019158079) more...
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- 2023
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44. Central hypothyroidism related to antipsychotic and antidepressant medications: an observational study and literature review
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Frederick Keen, Anuja Chalishazar, Kelly Mitchem, Alan Dodd, and Atul Kalhan
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central hypothyroidism ,antipsychotics ,antidepressants ,psychotropic medication ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Objective: To investigate the final diagnosis and clinical outcome of pati ents referred to endocrinology in our district general hospital with biochemi cal isolated central hypothyroidism (CeH), and whether there is an association between this biochemical picture and treatment with antidepressant and antipsychotic med ications. Methods: We performed a retrospective observational study of patients r eferred to endocrinology with unexplained biochemical isolated CeH over a 5-year period. Results: Of the 29 patients included in the study, 4 were found to have a partially empty or empty sella and 1 to have a bulky pituitary gland whic h was deemed to be an incidental radiological finding. No patients had any clinically significant pathology. On reviewing their medications, 18/29 (62%) were found to be on ps ychotropic medications. Conclusions: Our study suggests a relationship between patients on psychotr opic medications and biochemical isolated CeH, an association only described in a very limited amount of literature prior to this. The mechanism behind this may be suppression of TSH secretion via antagonism of the dopamine-ser otoninergic pathway. Determining a correlation between psychotropic medications and isolated CeH could lead to the avoidance of further radiological investigations an d unnecessary anxiety for patients. However, a larger observational study is needed to pr ovide further evidence to support/refute our finding. more...
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- 2023
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45. Structured monitoring of psychotropic medication in university hospital child psychiatry in Finland
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Kirsi Kakko, Riina Pesonen, Leena Pihlakoski, Raili Salmelin, and Reija Latva
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psychotropic medication ,monitoring ,guidelines ,children ,child psychiatry ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Introduction: The use of psychotropic medications has emerged in children, but the monitoring practices are diverse. With the aim of systematizing psychotropic medication practices in children, the Medication Unit was launched at the department of child psychiatry of Tampere University Hospital (TAUH) in February 2021. Aims and methods: The aim of this retrospective patient report-based study was to examine the performed psychotropic medication monitoring in the Medication Unit between 1 February and 31 December 2021. Results: The median age of the study patients (n = 57) was 10.7 years and 77% were males. The most common medications at the first visit to the Medication Unit were methylphenidate (44%) and risperidone (23%). Performed somatic monitoring followed the medication group-specific guidelines well, but target symptom reporting and dialogue concerning adverse effects was not as systematic. Conclusion: The monitoring of psychotropic medications in the Medication Unit was well executed, systematic and followed the local guidelines well. During this study, co-operation with the nursing staff, clearly defined tasks, predefined protocols and proper facilities probably benefitted the monitoring. Further studies on strategies to improve psychotropic medication practices within the child psychiatric service system are needed. more...
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- 2022
46. Motor synchronization and impulsivity in pediatric borderline personality disorder with and without attention-deficit hyperactivity disorder: an eye-tracking study of saccade, blink and pupil behavior.
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Calancie, Olivia G., Parr, Ashley C., Brien, Don C., Huang, Jeff, Pitigoi, Isabell C., Coe, Brian C., Booij, Linda, Khalid-Khan, Sarosh, and Munoz, Douglas P.
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ATTENTION-deficit hyperactivity disorder ,BORDERLINE personality disorder ,EYE tracking ,INTERSTIMULUS interval ,RESPONSE inhibition ,PUPIL diseases - Abstract
Shifting motor actions from reflexively reacting to an environmental stimulus to predicting it allows for smooth synchronization of behavior with the outside world. This shift relies on the identification of patterns within the stimulus - knowing when a stimulus is predictable and when it is not - and launching motor actions accordingly. Failure to identify predictable stimuli results in movement delays whereas failure to recognize unpredictable stimuli results in early movements with incomplete information that can result in errors. Here we used a metronome task, combined with video-based eye-tracking, to quantify temporal predictive learning and performance to regularly paced visual targets at 5 different interstimulus intervals (ISIs). We compared these results to the random task where the timing of the target was randomized at each target step. We completed these tasks in female pediatric psychiatry patients (age range: 11-18 years) with borderline personality disorder (BPD) symptoms, with (n = 22) and without (n = 23) a comorbid attention-deficit hyperactivity disorder (ADHD) diagnosis, against controls (n = 35). Compared to controls, BPD and ADHD/BPD cohorts showed no differences in their predictive saccade performance to metronome targets, however, when targets were random ADHD/BPD participants made significantly more anticipatory saccades (i.e., guesses of target arrival). The ADHD/BPD group also significantly increased their blink rate and pupil size when initiating movements to predictable versus unpredictable targets, likely a reflection of increased neural effort for motor synchronization. BPD and ADHD/BPD groups showed increased sympathetic tone evidenced by larger pupil sizes than controls. Together, these results support normal temporal motor prediction in BPD with and without ADHD, reduced response inhibition in BPD with comorbid ADHD, and increased pupil sizes in BPD patients. Further these results emphasize the importance of controlling for comorbid ADHD when querying BPD pathology. [ABSTRACT FROM AUTHOR] more...
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- 2023
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47. Sedative administration in Spanish hospitals in the context of perinatal loss: findings from a mixed-methods study.
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Cassidy, Paul Richard, Gordo, Ángel, Olza, Ibone, and Cassidy, Jillian
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RESEARCH methodology , *PERINATAL death - Abstract
This article explores the contexts, processes and motivations behind the administration of sedatives (minor tranquilisers) in the time around perinatal loss. Using a mixed methods design, an online survey of 796 women and 13 narrative interviews were conducted. The participants had experienced a stillbirth or termination of pregnancy from 16 weeks or a neonatal death in Spanish hospitals. The quantitative (univariate and CHAID decision-tree) and qualitative (narrative-linguistic) analysis found that sedative administration was pervasive across care contexts and appears to be naturalised despite contradicting practice recommendations. Sedative administration was associated with emotional control and avoidance of loss, lack of accompaniment and on occasion with managing disruptive patients. Lack of informed consent was very common, with little explanation of side-effects prior to administration. In the participants' narratives, health professionals tended to construct sedatives as benign, but for some women the effects were counterproductive to loss and grief and related to persistent regrets about decisions. The study concludes that, in the context of perinatal loss, sedative administration was highly integrated into the fabric of medicalised care. As a socio-political and cultural practice underscored by gender-based care dynamics, there seems to be an imbalance between benefit and risk to women's welfare. [ABSTRACT FROM AUTHOR] more...
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- 2023
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48. A PERTURBAÇÃO DE DÉFICE DE ATENÇÃO E HIPERATIVIDADE EM CRIANÇAS E ADOLESCENTES: REVISÃO BIBLIOGRÁFICA.
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RODRIGUES, SABINA, FERNANDES FONSECA, CECÍLIA MARIA, ARAÚJO, ANDRÉ R. T. S., and GEANINI, MARIA LEONOR SALICIO
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- *
LITERATURE reviews , *PROGNOSIS , *ATTENTION-deficit hyperactivity disorder , *DRUG therapy , *BIBLIOGRAPHIC databases , *PSYCHIATRIC drugs - Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common mental disorders worldwide. Given the children and adolescents individual needs, it is essential to understand this disorder in its characterization, etiology and treatment. This literature review intends to systematize and organize the best scientific evidence about this disorder, including characterization, epidemiology, diagnosis and treatment. A bibliographic research was carried out within Scopus, Scielo, Pubmed, Web of Science databeses as well Google Scholar, and the INFARMED website has been consulted. The research was carried out by using the combination of keywords: Attention-Deficit/Hyperactivity Disorder, etiology, diagnosis, comorbidities, psychotropic medication and non-pharmacological treatment. Scientific studies were selected between the years 2003 and 2021, as well as studies in Portuguese and English. It was found that beyond the importance of an early diagnosis, it is importante to identify the presence of comorbidity too, in order not to deteriorate the disease prognosis. Scientific advances have demystified the etiology of ADHD resulting from factors related to diet, being mainly attributed to the genetic component. The pharmacological treatment is mainly performed with psychotropic medications, but the institution of a nonpharmacological treatment proved to be extremely important, concomitantly, to be more effective and safe. It was concluded that it is extremely important to continue to carry out studies in order to improve the diagnosis criteria and the guidelines for establishing the pharmacological treatment, with a view to a personalised treatment for each child or adolescent. [ABSTRACT FROM AUTHOR] more...
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- 2023
49. Experiences of decision making about psychotropic medication during pregnancy and breastfeeding in women living with severe mental illness: a qualitative study.
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Frayne, J., Ellies, R., and Nguyen, T.
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MATERNAL health services , *PSYCHIATRIC drugs , *PATIENT autonomy , *PATIENT decision making , *INTERVIEWING , *PATIENTS' attitudes , *QUALITATIVE research , *BREASTFEEDING , *PSYCHOLOGY of women , *DECISION making , *INTERPROFESSIONAL relations , *COMMUNICATION , *DRUGS , *HEALTH , *INFORMATION resources , *DESCRIPTIVE statistics , *RESEARCH funding , *THEMATIC analysis , *PATIENT compliance , *MENTAL illness , *LITHIUM , *PREGNANCY - Abstract
Purpose: The aim of this study was to explore the experiences of women living with severe mental illnesses making decisions about psychotropic medication use in pregnancy and breastfeeding, and what helped or hindered the decision-making process. Methods: We report on a qualitative study from 12 women who attended the pregnancy service between May 2018 and June 2019. Interviews occurred at 4–6 weeks postpartum on women with severe mental illnesses, which was nested within a larger mixed-methods study. Results: Three main themes were elicited from the participants' transcriptions and included (i) the decision-making process with subthemes of shared decision-making, consistency and complete care, collaboration and clear communication, and challenges of managing medication; (ii) how information is given, with subthemes of information delivery and communication breakdown; and (iii) breastfeeding dilemmas with subthemes of lithium and breastfeeding choice and autonomy regarding breastfeeding on medication. Conclusion: Findings offer understanding of patients' experiences in the decision-making and use of psychotropic medication during pregnancy and breastfeeding. Women living with severe mental illnesses, such as bipolar and psychosis, face difficult medication decisions due to uncertainty around use in pregnancy, potentially causing conflict with their dual role as both persons with a diagnosed mental illness but also new mothers. The clinician needs to provide comprehensible and concise information, giving space for a woman's voice to be heard to guide them from a position of hesitancy to one of assurance. Collaboration within a multidisciplinary team and external care providers combined with consistency of care assists this process. [ABSTRACT FROM AUTHOR] more...
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- 2023
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50. Lifestyle behaviors, metabolic disturbances, and weight gain in psychiatric inpatients treated with weight gain-associated medication.
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Simon, Maria S, Barton, Barbara, Zagler, Anja, Engl, Katharina, Rihs, Leonora, Glocker, Catherine, and Musil, Richard
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EMOTIONAL eating , *WEIGHT gain , *METABOLIC disorders , *FOOD habits , *SWEETNESS (Taste) , *BODY weight - Abstract
Many psychiatric patients suffer from overweight/obesity and subsequent metabolic disturbances, where psychotropic medication is one of the main contributors. However, the magnitude of weight gain ranges individually, which leads to questioning the role of other contributors like lifestyle factors. The present study investigated several lifestyle factors among psychiatric inpatients, their relation to biological factors, and their predictive capability for weight gain during treatment. Using a naturalistic observational study design, psychiatric inpatients of all diagnoses were followed for 4 weeks from the start of treatment with weight gain-associated medication. N = 163 participants entered the study. Lifestyle factors were assessed by patient self-report questionnaires. Body weight change over time was calculated relative to baseline body weight. Our study provides three main findings: (1) Obesity and/or metabolic syndrome (metSy) were associated with emotional eating (disinhibition), craving for fast food and sweets, and weight cycling. (2) Patients without metSy and normal BMI experienced increased sweets craving (also for women), a more positive attitude towards drugs, and an improvement of affect (also for men). (3) Sex, presence of metSy and/or drug dosage interacted with disinhibition change, sweets craving change (trend), and fast food craving change to predict weight change over time. Furthermore, drug attitude change interacted with BMI, drug dosage, and presence of metSy to predict weight change. Lifestyle factors, especially eating behaviors, are related to metabolic disturbances and predict weight gain in interaction with clinical parameters. [ABSTRACT FROM AUTHOR] more...
- Published
- 2023
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