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Background Methods Results Conclusions Antipsychotic and other psychotropic medication use is prevalent among community‐dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care (“the Partnership”) and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.Among community‐dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010–2017 Medicare fee‐for‐service claims using interrupted time series analyses across three periods (“Pre‐Partnership”: July 1, 2010 to March 31, 2012; “Post‐Partnership”: April 1, 2012 to January 31, 2015; “Five Star Quality Rating”: February 1, 2015 to December 31, 2017).We included 1,289,401 community dwellers with dementia contributing 26,609,697 person‐months. The mean age was 80 years, most were female (70%), approximately 80% were non‐Hispanic Whites, 10% were non‐Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre‐Partnership (β = −0.06, 95% CI: −0.08, −0.05) and post‐Partnership (β = −0.02, 95% CI: −0.02, −0.01). Post‐Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (β = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community‐dwelling older adults with dementia.These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community‐dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community‐dwellers with dementia. [ABSTRACT FROM AUTHOR]

Introduction Military Service Members, Veterans, and other patient populations who experience traumatic brain injury (TBI) may have increased risk of early neurodegenerative diseases relative to those without TBI history. Some evidence suggests that exposure to psychotropic medications may play a role in this association. The Long-term Impact of Military-relevant Brain Injury Consortium—Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) prospective longitudinal study provides an ideal setting to examine the effects of psychotropic medication exposure on long-term neurological health of those with and without mild TBI history. In this study, we sought to develop and pilot test a self-report electronic survey instrument to measure participants' psychotropic medication histories for use across LIMBIC-CENC study sites. Materials and Methods We developed a new survey instrument measuring psychotropic medication history and fielded it among Service Members and Veterans enrolled in a single site of the LIMBIC-CENC study to evaluate response rates and patterns, and to compare survey responses to prescription data extracted from participants' Veterans Affair (VA) records. Descriptive statistics estimated survey respondents' lifetime psychotropic medication exposures by their TBI history and other demographic and clinical characteristics of interest. We also compared survey responses to participants' VA outpatient prescription records to estimate sensitivity and negative predictive values (NPVs) for participants' self-reported medication exposures relative to this single prescription data source. Results Among 310 Veterans enrolled at the study site, 249 completed the survey (response rate = 80%), of whom 248 also had VA health records and were included in the analysis. Most (69%) had a history of mild TBI. Over three-fourths of survey respondents (78%) reported ever having used prescription opioids, 26% reported benzodiazepines, 50% reported muscle relaxants, 42% reported antidepressants, 13% reported non-benzodiazepine sedative-hypnotics, 15% reported stimulants, 7% reported mood stabilizers, and 6% reported antipsychotics. Veterans with, versus without, a history of mild TBI were more likely to self-report psychotropic medication history as well as have confirmed receipt of VA prescriptions for each medication class. Using VA records as a criterion standard, the sensitivity of the survey for detecting VA prescriptions ranged from 19% to 84%, while the NPVs ranged from 64% to 97%. Sensitivity and NPVs were similar for participants with, versus without, mild TBI history. Conclusions Service Members and Veterans may receive psychotropic medications from multiple sources over their lifetimes. Valid methods to examine and quantify these exposures among those with a history of TBI are important, particularly as we evaluate causes of neurodegenerative disorders in this population over time. The measurement of Veterans' lifetime psychotropic medication exposures using a self-report survey, in combination with health care records, holds promise as a valid approach, but further testing and refinement are needed. [ABSTRACT FROM AUTHOR]

In this retrospective cohort study, we compared neonatal and maternal outcomes after exposure of different psychopharmacological classes of drugs. Both psychiatric diseases and pharmacological treatment of these are associated with lower birth weights, lower APGAR scores, and NICU admission. Therefore, we tried to rule out the role of psychotropics as if no differences were found between pharmacological classes, the lower birthweights might not be attributable to these. We divided our groups in exposed to atypical antipsychotic drugs, Selective Serotonin Reuptake Inhibitors (SSRI), Tricyclic Antidepressants (TCA), benzodiazepines, and different combinations of psychotropic drugs. The last group included SSRIs combined with benzodiazepines, methylphenidate, lithium, and classic antipsychotic drugs. We used univariate regression analysis to see which factors from our rich dataset including pharmacological class, are associated with birth weight, APGAR scores, gestational age, and NICU admission. The significant associations from univariate analyses were further analyzed using ancova analysis or logistic regression where applicable. We found no clinically relevant differences in neonatal and maternal outcomes between the different exposed pharmacological classes. However, our dataset may have been too small to draw firm conclusions. [ABSTRACT FROM AUTHOR]

Background: Pulmonary embolism (PE) is a serious and potentially lifethreatening condition that requires prompt diagnosis and treatment. Identifying risk factors and diagnostic markers can aid in the early detection and management of this condition. Methods: This case-control study examined 10,077 patients admitted to Shenzhen Kangning Hospital’s psychiatry facility in 2020. Among these, 65 patients were diagnosed with PE, including 50 new cases. After survival sampling for controls and age-and-gender matching, the study included 41 new PE cases and 41 age-and-gender-matched controls. Data on demographics, comorbidities, and medication use were extracted from electronic records. Conditional logistic regression analyses were performed to determine the association between each predictor and PE risk. Additionally, the sensitivity and specificity of the d-dimer diagnostic tool were assessed. Results: In univariable conditional logistic regression, active alcoholism was associated with a higher PE risk (OR=3.675, 95% CI 1.02–13.14, P=0.046). A history of physical restraint (OR=4.33, 95% CI 1.24–15.21, P=0.022) and chemical restraint (OR 4.67, 95% CI 1.34–16.24, p=0.015) also increased PE risk, as did benzodiazepine use (OR=3.33, 95% CI 1.34–8.30, P=0.010). Conversely, psychotropic medication before admission was associated with a lower risk of PE (OR=0.07, 95% CI 0.01–0.59, P=0.013). Stepwise multivariable forward conditional regression identified two subsets of psychiatric patients at higher risk of PE: new psychiatric cases without medication at admission who were chemically restrained, and cases without medication at admission who were started on antipsychotics and benzodiazepines. The d-dimer diagnostic tool, with an optimal threshold of 570 ng/ml determined by the Youden index (J statistic of 0.6098), showed a sensitivity of 73.17% and specificity of 87.80% for detecting PE, with an AUC of 0.833 (95% CI: 0.735–0.906). Conclusion: Our findings suggest that a history of restraint, alcoholism, and the use of antipsychotics and benzodiazepines are important predictors of PE in psychiatric inpatients. Conversely, psychotropic medications at admission may be linked to a lower PE risk. The d-dimer diagnostic tool shows good value for screening PE in psychiatric inpatients. These predictors and diagnostic markers could help clinicians identify high-risk patients and implement appropriate prevention strategies. [ABSTRACT FROM AUTHOR]

The objective was to analyze the relationship between depression and suicidal ideation and psychotropic drugs use during COVID-19 lockdown in adult population considering gender and age. The method used is a descriptive and non-probabilistic study, with a convenience sampling of 3780 participants (70.1% female), aged 18–64 years (M = 37.8). 18.3% participants presented depression and 5.1% exhibited suicidal ideation. The depression rate for female was double (21.4%) than male and 5 times higher (30.2%) for the youngest participants (18–24 years old) compared to oldest (55–64 years old), being this rate triple in suicidal ideation (9%). Depression correlated positively with tranquilizers and sleeping pills' consumption; and suicidal ideation did so with tranquilizers and sedatives. The rate of tranquilizer users was 8 times higher for severe depression compared to those who did not present depression, 5 times higher for sleeping pills, and 6 times higher for sedatives. The rate of tranquilizer users exhibiting suicidal ideation was more than triple than those who did not present suicidal ideation, between 3 and 4 times higher for sleeping pills, and almost 7 times higher for sedatives. The higher the level of depression and suicidal ideation during lockdown, the greater the consumption of psychotropic drugs. The consumption of psychotropic drugs should be monitored in people with depression and suicidal ideation during periods of crisis. [ABSTRACT FROM AUTHOR]

Psychoactive drugs have anticholinergic effects, which might cause constipation; however, probiotics and traditional Chinese medicine can resolve constipation. This study aimed to examine the effect of probiotics combined with traditional Chinese medicine, acupuncture point massage, and acupuncture point application on patients with intestinal solid heat constipation. We enrolled 200 patients, randomly divided into three intervention groups and a control group. Group 1 received probiotics combined with acupressure point massage and acupuncture point application; Group 2 received probiotics combined with acupressure point massage; Group 3 received probiotics combined with acupuncture point application, while the control group received routine treatment only. After intervention, the total effective rate of the intervention groups was higher than that of the control group (52%). The constipation symptom score in the intervention groups was lower than that in the control group, and the symptom score, defecation characteristics, and defecation time of group 1 were significantly lower than those of groups 2 and 3. The Bristol defecation trait, difficulty, time, and interval were better in the intervention groups than in the control group. Combining probiotics with traditional Chinese medicine, acupressure massage, and acupuncture point application can resolve intestinal solid heat constipation caused by psychoactive drugs. [ABSTRACT FROM AUTHOR]

The prevalence of obesity is increasing worldwide, resulting in various health issues such as hypertension, dyslipidemia, diabetes mellitus, heart disease, and a lower life expectancy. Importantly, several psychiatric disorders and the use of psychotropic medications have been linked to obesity, and the possible risk factors need further investigation. This study examined the prevalence of obesity and its associated factors using a self‐administered questionnaire. Participants were recruited from three outpatient clinics and individuals who met one or more of the ICD‐10 F0‐F9, G4 diagnoses were included. In total, 1384 participants completed the questionnaire about their lifestyle. Statistical analysis compared the demographic and clinical characteristics of the individuals who were obese (Body Mass Index: BMI ≥25) and those who were non‐obese (BMI <25). The results revealed that the factors associated with obesity in psychiatric outpatients were being male, prolonged treatment duration, eating out frequently, and use of both second‐ and first‐generation antipsychotics. The study emphasized the importance of closely monitoring BMI in individuals with multiple obesity‐related factors. [ABSTRACT FROM AUTHOR]

Background: Prader‐Willi syndrome (PWS) is commonly associated with intellectual disability, but also with a specific behavioural phenotype and a high predisposition to psychiatric comorbidity. This study examines the psychiatric care situation of people with PWS. Method: A structured online questionnaire was administered to carers of people with PWS living in Germany, asking about demographic, diagnostic and treatment parameters as well as personal experiences. Results: Of 77 people with PWS, 44.2% had at least one psychiatric comorbid diagnosis. The main reasons for seeking psychiatric care were emotional outbursts and aggressive behaviour. 34.9% reported that they were currently seeking psychiatric care without success. However, 32.5% of PWS had been treated with psychotropic medication, mainly antipsychotics. Conclusions: Psychiatric comorbidity appears to be undertreated in PWS, especially in the ambulatory setting. Uncertainty among mental health care providers may also lead to frequent off‐label use of psychotropic medications. [ABSTRACT FROM AUTHOR]

Introduction: Organic molecules that bind to cannabinoid receptors are known as cannabinoids. These molecules possess pharmacological properties similar to those produced by Cannabis sativa L. High‐performance liquid chromatography (HPLC) and ultra‐performance liquid chromatography (UPLC, also known as ultra‐high‐performance liquid chromatography, UHPLC) have become the most widely used analytical tools for detection and quantification of phytocannabinoids in various matrices. HPLC and UPLC (or UHPLC) are usually coupled to an ultraviolet (UV), photodiode array (PDA), or mass spectrometric (MS) detector. Objective: To critically appraise the literature on the application of HPLC and UPLC (or UHPLC) methods for the analysis of phytocannabinoids published from January 2020 to December 2023. Methodology: An extensive literature search was conducted using Web of Science, PubMed, and Google Scholar and published materials including relevant books. In various combinations, using cannabinoid in all combinations, cannabis, hemp, hashish, C. sativa, marijuana, analysis, HPLC, UHPLC, UPLC, and quantitative, qualitative, and quality control were used as the keywords for the literature search. Results: Several HPLC‐ and UPLC (or UHPLC)‐based methods for the analysis of phytocannabinoids were reported. While simple HPLC‐UV or HPLC‐PDA‐based methods were common, the use of HPLC‐MS, HPLC‐MS/MS, UPLC (or UHPLC)‐PDA, UPLC (or UHPLC)‐MS, and UPLC (or UHPLC)‐MS/MS was also reported. Applications of mathematical and computational models for optimization of protocols were noted. Pre‐analyses included various environmentally friendly extraction protocols. Conclusion: During the last 4 years, HPLC and UPLC (or UHPLC) remained the main analytical tools for phytocannabinoid analysis in different matrices. HPLC and UPLC (or UHPLC) are versatile analytical tools for the analysis of phytocannabinoids. This review critically appraises the literature on the application of HPLC and UPLC (or UHPLC) methods for the analysis of phytocannabinoids published from January 2020 to December 2023. During this period, HPLC and UPLC (or UHPLC) remained the main analytical tools for phytocannabinoid analysis. Applications of mathematical and computational models for optimization of protocols were noted. Pre‐analyses included various environmentally friendly extraction protocols. [ABSTRACT FROM AUTHOR]

Background: Many patients with depressive disorders use antidepressants longer than clinically indicated. Long-term use of antidepressants is associated with high individual and societal costs. Patients often perceive antidepressant discontinuation as challenging. Aim: To understand patients' expectations about discontinuation, to document their experiences with long-term use and discontinuation, and to identify factors that can help or hinder discontinuation. Design and setting: Qualitative study using semi-structured interviews via telephone with adult patients in Germany. Method: We interviewed 32 patients with remitted major depressive disorder and long-term antidepressant use. We analysed transcripts with content analysis aided by MAXQDA to derive thematic categories. Results: Patients expected to eliminate side effects or regain independence after discontinuation. Such positive expectations were perceived as facilitators and motivated patients' wish to discontinue antidepressants. However, patients also had negative expectations such as recurrence or discontinuation symptoms. Patients' negative expectations were often fuelled by previous negative experiences, which persisted despite a wish to stop antidepressants, and hindered discontinuation. Most patients perceived antidepressants as being effective, but experienced side effects and further problems. Patients felt inadequately informed about treatment duration and methods for discontinuation. Further barriers and facilitators included a stable environment, availability of support, and treatment information. Conclusion: Patients prefer to discontinue antidepressants within structured frameworks that provide information and support. Identified facilitators and barriers may help optimise appropriate use and discontinuation of antidepressants in routine practice. Promoting functional expectations and specifying individualised approaches to minimise dysfunctional expectations, adapted to patients' previous experiences, appear to be especially important. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is a major global burden and a leading cause of premature death among patients with severe mental illness. Over time, research and clinical practice have paid increased attention to the impact of psychiatric medications on cardiac repolarization. In a resource-limited setting, it is common for psychotropic medications to be initiated and maintained in an outpatient setting without baseline or follow up ECG. This study evaluated the determinants and predictors of QT abnormalities among patient taking psychotropic drugs. We conducted a cross-sectional study in a population of 150 psychiatric patients on psychotropics and 75 controls. We studied the effects of various psychotropic drugs on QT dispersion (QTd) and corrected QT interval (QTc) as well as correlation with the types and dosages of psychotropic drugs used. All the subjects had detailed clinical examination and resting electrocardiogram (ECG) at 25 mm/sec done. QTc was determined using Bazett formula and QTd was determined by subtracting shortest from longest QT in 12-lead ECG. The prevalence of prolonged QTc and QTd as well as the mean QTc and QTd were significantly higher in patients than the control group. The mean QTc was significantly higher in patient on typical antipsychotics compared to those on atypical antipsychotics. Age, heart rate and antipsychotic dose in chlorpromazine equivalent were predictors of QTc with the heart rate being the most powerful predictor among them. Psychotropic drugs use is associated with QTc and QTd prolongation with age, heart rate and antipsychotic dose as predictors of QTc. [ABSTRACT FROM AUTHOR]

Abstract Modern intensive care has improved survival rates, but emerging evidence suggests a high prevalence of post-intensive care unit (ICU) health problems, including post-traumatic stress disorder, depression and anxiety. These symptoms may have a detrimental effect on quality of life and increase mortality. The primary objective of this study is to examine the extent of initiation of antidepressant medication among ICU survivors and identify the factors associated with its usage. The secondary objective is to investigate whether the use of these medications is linked to an increased mortality. The nationwide study cohort included 125,130 ICU survivors admitted between 2010 and 2017. Within the first 3 months after ICU discharge, 7% of patients initiated antidepressant medication, by 1 year 15.5% had started medication. We found no tendency to a decrease during the 2-year follow-up period. Factors associated with antidepressant use included middle age, female sex, psychiatric and somatic comorbid conditions, substance dependence, higher illness severity, and longer ICU stay. Antidepressant users had a higher mortality rate, and deaths due to external causes and suicide were more frequent in this group. This study emphasizes the importance of detecting and addressing depression in ICU survivors to improve their quality of life and reduce mortality rates.

Abstract Background The COVID-19 pandemic has had a significant impact on mental health, with evidence suggesting an enduring mental health crisis. Studies worldwide observed increased usage of antidepressants, anxiolytics, and hypnotics during the pandemic, notably among young people and women. However, few studies tracked consumption post-2021. Our study aimed to fill this gap by investigating whether the surge in the number psychotropic drug consumers in France persisted 2 years after the first lockdown, particularly focusing on age and gender differences. Methods We conducted a national retrospective observational study based on the French national insurance database. We retrieved all prescriptions of anxiolytics, hypnotics, and antidepressants dispensed in pharmacies in France for the period 2015–2022. We performed interrupted time series analyses based on Poisson models for five age classes (12–18; 19–25; 26–50; 51–75; 76 and more) to assess the trend before lockdown, the gap induced and the change in trend after. Results In the overall population, the number of consumers remained constant for antidepressants while it decreased for anxiolytics and hypnotics. Despite this global trend, a long-term increase was observed in the 12–18 and 19–25 groups for the three drug classes. Moreover, for these age classes, the increases were more pronounced for women than men, except for hypnotics where the trends were similar. Conclusions The number of people using antidepressants continues to increase more than 2 years after the first lockdown, showing a prolonged effect on mental health. This effect is particularly striking among adolescents and young adults confirming the devastating long-term impact of the pandemic on their mental health.

INTRODUCTION: The readability of a text can be measured objectively using a series of mathematical formulas. Patients' proper understanding of a drug's effects and side effects is essential for treatment compliance in psychiatry. This study aimed to measure the readability level of the package leaflets of psychotropic drugs currently used in Turkey and to determine at what average age and education level were appropriate. METHODS: Four main psychotropic drug groups, which are thought to be used more frequently in adult psychiatry, were included in this study. The most recent package leaflets of the drugs in these groups were obtained from the official websites of the Ministry of Health, the Turkish Medicines and Medical Devices Agency (https: //www.titck.gov.tr/kubkt) and the relevant companies in the market, and their readability level was determined. The formulas developed by Ateşman and Bezirci-Yılmaz were used to evaluate readability levels in this study. RESULTS: The average Ateşman readability points were determined to be 48.2. From this, it was understood that an education at the level of the 13th-15th grade was necessary for the readability of the package leaflets. The average Bezirci-Yilmaz readability points were determined to be 13.2, indicating that an education at the level of 13th grade, or further education, was necessary for the readability of the package leaflets. DISCUSSION AND CONCLUSION: The level of education required for readability of the psychotropic drug package leaflets was seen to be extremely high when the average level of education in Turkey was considered. Improving package leaflets' readability can reduce patients' concerns about psychotropic drugs by facilitating their understanding of the treatment. It can increase treatment compliance, thereby helping the recovery of mental health.

Abstract In December 2022, the Ministry of Health, Labour and Welfare (MHLW) of Japan issued and implemented the guideline for evaluating the effects of psychotropic drugs on motor vehicle driving performance. This guideline recommends the use of a tiered approach to assess clinically meaningful driving impairment. It is noted that adverse events cannot be solely explained by pharmacokinetics, as the onset and duration of these events vary. Among these adverse events, those affecting alertness, such as drowsiness caused by psychotropic drugs on driving performance, are more frequently observed during initial treatment stages and dose escalation. Hence, when evaluating the effects of psychotropic drugs on driving performance, it becomes crucial to assess the persistence of clinically meaningful impairment. Therefore, the MHLW guideline, developed by the authors, emphasizes the need to assess the temporal profile of adverse events affecting driving in all clinical trials. Additionally, the guideline states that when conducting driving studies, the timing of multiple dosing should consider not only the pharmacokinetics of the investigational drug but also its tolerance.

Abstract Background There is a global perception that psychotropic utilization in children and adolescents is increasing, especially with the onset of COVID-19 pandemic. Available literature data on paediatric psychotropic medication prescriptions in Italy are limited to one or few regions and not updated. The aim of this study was to provide updated data on psychotropic prescriptions referred to the whole Italian paediatric population, as overall and by subgroups of medications and to evaluate if the COVID-19 pandemic during 2020 had an impact on prescription rates. Methods A descriptive study on psychotropic drug utilization in children and adolescents (

Objective: To describe the psychotropic drug deprescription process in older patients of a geriatric psychiatry outpatient clinic. Methods: We conducted a quasi-experimental study of people aged < 60 years who were treated at Hospital São Lucas` Geriatric Psychiatry Outpatient Clinic, which is affiliated with Pontifícia Universidade Católica doRio Grande do Sul, Brazil. Data on 150 older people were collected from March 2021 to August 2022 and were evaluated by the pharmacists. The inclusion criteria were age < 60 years, being a patient of the hospital`s Geriatric Psychiatry Outpatient Clinic, use of at least one psychotropic drug, and agreeing to participate in the study. Those unable to report their medicationsand those who only came to the first appointment were excluded. Results: Overall, deprescription of at least one psychotropic drug was indicated in 61.3% (n = 92) of the participants, andit was effectively implemented in 68.5% (n = 63) of this group. Deprescribing, which was more frequent in the youngest age group (60-69 years) (p = 0.049), was indicated for 37.4% (n = 136) of psychotropic drugs, 67.6% (n = 92) of which were effectively deprescribed. The main classes indicated for deprescription were hypnotics and sedatives (90.0% n = 18) and anxiolytics(73.3%; n = 11). Conclusions: At least 1 psychotropic drug was indicated for deprescription in the majority of the patients, and in most cases it was effectively implemented. One-third ofthe prescribed psychotropic drugs were indicated for deprescription, and more than half were successfully deprescribed.

Aims Methods Results Conclusion Alzheimer's disease and related diseases (ADRD) is a progressive and inexorable disease. In France, acetylcholinesterase inhibitors and memantine were reimbursed for subjects with ADRD, until 2 modifications of their reimbursement rate (2012, 2018). We aimed to study the consequences of these measures on ADRD subjects' healthcare use.We analysed data from the FRA‐DEM cohort, including subjects with presumed incident ADRD identified since 2011 in the French health insurance system. We studied the healthcare use of subjects identified with incident ADRD in 2011, 2013, 2015, 2017 and 2019, notably the annual number of defined daily doses of various psychotropic groups. We performed 2 multivariate multinomial logistic regressions with the subcohort year as the dependent variable.In total, 165 120 subjects were included. A progressive decrease in exposure to antidementia drugs was observed between 2011 and 2019. Consultations with private neurologists or psychiatrists, and exposure to risperidone, antidepressants and benzodiazepines increased in the 2019 subcohort, following the 2018 reimbursement withdrawal. Meanwhile, the use of nursing/allied healthcare and emergency care increased over the subcohort years, whereas we observed a decrease in general practitioner consultations.These results suggest increases in private neurologist or psychiatrist consultations and exposure to recommended drugs after the reimbursement withdrawal, contrary to the fears expressed. However, antidementia drug exposure decreased long before the reimbursement modifications, probably due to the growing evidence of the modest effect of these drugs, and exposure to benzodiazepines increased after the reimbursement withdrawal. [ABSTRACT FROM AUTHOR]

In December 2022, the Ministry of Health, Labour and Welfare (MHLW) of Japan issued and implemented the guideline for evaluating the effects of psychotropic drugs on motor vehicle driving performance. This guideline recommends the use of a tiered approach to assess clinically meaningful driving impairment. It is noted that adverse events cannot be solely explained by pharmacokinetics, as the onset and duration of these events vary. Among these adverse events, those affecting alertness, such as drowsiness caused by psychotropic drugs on driving performance, are more frequently observed during initial treatment stages and dose escalation. Hence, when evaluating the effects of psychotropic drugs on driving performance, it becomes crucial to assess the persistence of clinically meaningful impairment. Therefore, the MHLW guideline, developed by the authors, emphasizes the need to assess the temporal profile of adverse events affecting driving in all clinical trials. Additionally, the guideline states that when conducting driving studies, the timing of multiple dosing should consider not only the pharmacokinetics of the investigational drug but also its tolerance. [ABSTRACT FROM AUTHOR]

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Post-traumatic stress disorder (PTSD) is a disabling psychiatric condition with a worldwide prevalence between 6% and 9%, and more common in the female than in the male sex. The aim of this paper is to review and comment on the different factors that might explain the discrepancies in the pharmacological management of women and men. The available literature shows that there exists a vulnerability of women to develop PTSD that may depend on neurobiological as well as environmental/cultural factors. These variables might influence the clinical picture, the outcome and the response to specific treatments, given their consequences on the pharmacokinetics of commonly prescribed drugs. Women suffering from PTSD are more prone to consult and receive more prescriptions of psychotropic drugs than men. However, it is evident that the particular stages of a women's life such as pregnancy or breastfeeding might require a specific evaluation and care. It is necessary to explore the pharmacokinetics of compounds highlighting sex-related differences, and their safety during pregnancy and lactation. Taking care of differences between women and men should represent a main focus of research, while being a primary target towards a really tailored pharmacological treatment of PTSD. [ABSTRACT FROM AUTHOR]

Introduction: The influence of psychotherapy duration on common mental disorder (CMD) outcomes remains a topic of ongoing debate. Whereas most research has focused on CMD symptom change, the evidence on the psychotherapy duration of subsequent CMD‐related work disability and the change in psychotropic drug purchases is scarce. Methods: We used a register‐based cohort representing 33% of the Finnish population. The participants included working‐age individuals (N = 12,047, 76% women, mean age = 36) who initiated long‐term psychotherapy, between 2014 and 2017. They were followed from 2011 to 2021 and psychotherapy duration ranged from less than a year to over 3 years. We used an interrupted time series design to analyze the psychotherapy duration‐dependent changes in CMD‐related work disability (primary outcome, operationalized as depression or anxiety‐related sickness absence, SA, days) and the annual number of psychotropic drug purchases or distinct drugs purchased (secondary outcomes). Results: There were no differences in the levels of work disability or drug purchases before the psychotherapy. We observed a decreasing level and trend in all outcomes across all psychotherapy duration groups. The largest decline in level was observed in the <1‐year duration group (88% decline for SA and 43%–44% for drug purchases) while the smallest decline was in the 3+ years duration group (73% for SA and 27% for drug purchases). Conclusion: Work disability outcomes and duration varied among individuals, even with similar initial mental health‐related work disability or use of auxiliary psychotropic treatments. Compared to longer psychotherapy, shorter psychotherapy was associated with sharper improvements. [ABSTRACT FROM AUTHOR]

Objective: In psychiatry, polypharmacy or high psychotropic drug doses increase adverse drug event (ADE) prevalence. However, the full relationship between polypharmacy and ADEs is unclear, and few studies have evaluated dose equivalents for psychotropic drugs for ADEs. Thus, we conducted a retrospective analysis to clarify the effects of polypharmacy and chlorpromazine (CP)‐, diazepam (DAP)‐, and imipramine‐ equivalent doses on all ADEs in inpatients. Methods: Psychiatric inpatients in a Japanese hospital from April 1, 2016 to March 31, 2018, were enrolled. ADE severity and causality were assessed. Multiple logistic regression analyses were performed to evaluate ADE risk factors. Results: Among 462 patients analyzed, out of 471 patients enrolled, 145 (31.4%) experienced ADEs. The causality assessment determined that "possible" was 96.5%. The most common ADEs were nervous system disorders (35%). Multiple logistic regression analyses indicated an increase in ADE prevalence with the number of drugs used (≥5; p = 0.026); CP‐equivalent dose (p = 0.048); and endocrine, nutritional, and metabolic disorders (p = 0.045). DAP‐equivalent dose; infectious and parasitic diseases; and injury, poisoning, and consequences of other external causes decreased ADE prevalence (p = 0.047, 0.022, and 0.021, respectively). Conclusions: Avoiding polypharmacy in psychiatric inpatients and adjusting drug regimens to safe equivalent doses could reduce ADEs during hospitalization. [ABSTRACT FROM AUTHOR]

Purpose: This longitudinal study aimed to examine the trends in antipsychotics, antidepressants, anxiolytics, and hypnotics/sedatives consumption in Croatia over a 10-year period (2012–2021). The study also assessed whether the COVID-19 pandemic had an impact on the yearly consumption of psychotropic drugs. Methods: Data were collected from Croatian Agency for Medicinal Products and Medical Devices (HALMED) and presented as defined daily doses per 1000 inhabitants per day (DDD/TID). The consumption before (2012–2019) and during the COVID-19 pandemic (2020–2021) was compared with interrupted time series analysis. Results: There was an increase in total consumption of analyzed psychotropic drugs in Croatia between the years 2012 and 2021, from 115.47 DDD/TID in 2012 to 155.50 DDD/TID in 2021. An increasing trend was observed in the consumption of all 4 analyzed groups of medicines (antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants). Anxiolytics accounted for 59% (68.29/115.47 DDD/TID), and hypnotics and sedatives for 8.5% (9.76/115.47 DDD/TID) of total consumption in 2012. At the end of a 10-year period, hypnotics and sedatives represented 12% (19.05/155.50 DDD/TID) and anxiolytics 54% (83.53/155.50 DDD/TID) of psychotropic drugs consumption. The total consumption of psychotropic drugs was not significantly different before and during COVID-19 pandemic (estimate ± standard error = 5.029 ± 6.899, t = 0.729, P = 0.490). Conclusion: Croatia had a high, continuously increasing consumption of psychotropic drugs. National anxiolytics consumption was one of the highest globally, while consumption of antidepressants was rather low compared to other high-income countries. The COVID-19 pandemic did not seem to influence the yearly utilization of psychotropic drugs in Croatia. [ABSTRACT FROM AUTHOR]

The authors sought to provide updated estimates of the proportion of psychotropic medications prescribed by different medical providers. This pooled cross-sectional study used data from the Medical Expenditure Panel Survey (2016–2019). Nationally representative estimates of the percentages of all psychotropic medications prescribed by each provider type were calculated, and analyses stratified by medication type, insurance type, and age were conducted. Data from 58,547 psychotropic prescriptions reported by 7,693 unique individuals were analyzed. More than 60% of psychotropic medications were prescribed by providers other than psychiatrists (33.5%) or psychologists (2.2%), such as general practitioners, nurse practitioners, and physician assistants. This distribution varied significantly by medication, insurance, and patient age. Most psychotropic medication prescribing occurs in primary care; however, notable differences by medication, insurance, and age were observed, suggesting areas for future research. [ABSTRACT FROM AUTHOR]

Psychotropic drugs (PDs) include anxiolytics, sedatives and hypnotics, antidepressants, and antipsychotics, and they are available as medicines with different safety profiles. Given Portugal's high anxiolytic consumption and the rising prevalence of mental disorders, safety monitoring is crucial. This study aimed to analyze the individual case safety reports (ICSR) of suspected adverse drug reactions (ADRs) related to PDs, obtained through spontaneous reporting, and recorded in the Portuguese National Pharmacovigilance System between January 2017 and December 2021. This observational and retrospective study analyzed the ICSRs of suspected ADRs to PDs. Most reports pertained to female individuals (67.78%) between 18 and 64 years of age (63.71%). The pharmaceutical industry was the primary source of these reports (62.16%). Antidepressants were responsible for most ICSRs (61.90%). At least one serious ADR was recorded in 58.44% of the reports, and 43.84% of ADRs evolved into "cure". The most-observed ADRs were nausea (10.92%), dizziness (10.70%), and off-label use (10.30%). In the causality assessment, 45.49% of ADRs were classified as "possible", and only 4.96% were classified as "definitive". The current analysis helps to strengthen the safety evidence for PDs. In the future, some measures could be implemented to improve the use of and/or access to PDs, as well as to reinforce the rate of suspected ADR reports within the community, contributing to the safety data available. [ABSTRACT FROM AUTHOR]

Introduction: Mood stabilisers and other psychotropic drugs can lead to serious adverse drug events (ADEs). However, the incidence remains unknown.We aimed to (a) determine the incidence of serious ADEs in patients with bipolar or schizoaffective disorders, (b) explore the role of lithium exposure, and (c) describe the aetiology. Methods: This study is part of the LiSIE (Lithium--Study into Effects and Side Effects) retrospective cohort study. Between 2001 and 2017, patients in the Swedish region of Norrbotten, with a diagnosis of bipolar or schizoaffective disorder, were screened for serious ADEs to psychotropic drugs, having resulted in critical, post-anaesthesia, or intensive care. We determined the incidence rate of serious ADEs/1,000 person-years (PY). Results: In 1,521 patients, we identified 41 serious ADEs, yielding an incidence rate of 1.9 events per 1,000 PY. The incidence rate ratio (IRR) between ADEs with lithium present and causally implicated and ADEs without lithium exposure was significant at 2.59 (95% CI 1.20--5.51; p = 0.0094). The IRR of ADEs in patients <65 and ≥65 years was significant at 3.36 (95% CI 1.63--6.63; p = 0.0007). The most common ADEs were chronic lithium intoxication, oversedation, and cardiac/blood pressure-related events. Discussion: Serious ADEs related to treatment of bipolar (BD) or schizoaffective disorder (SZD) were uncommon but not rare. Older individuals were particularly at risk. The risk was higher in individuals exposed to lithium. Serum lithium concentration should always be checked when patients present with new or unclear somatic symptoms. However, severe ADEs also occurred with other mood stabilisers and other psychotropic drugs. [ABSTRACT FROM AUTHOR]

Background: Clozapine (CLO) is a very effective antipsychotic, whose use is associated with dose-dependent risk of complications. Due to high interindividual variability in CLO metabolism, there is a need to identify factors affecting the blood concentrations of CLO and its active metabolite, norclozapine (NCLO). Methods: A total of 446 blood samples (collected from 233 women and 213 men, aged from 18 to 77 years) were included in this study and analyzed for CLO and NCLO concentrations. The patients were treated at a psychiatric hospital in Warsaw in the years 2016-2021. Serum CLO and NCLO concentrations were determined with high-performance liquid chromatography coupled to UV. Results: The following factors were shown to increase serum CLO and NCLO levels: higher CLO dose (p < 0.001), female sex (p < 0.001), nonsmoker status (p < 0.001), the use of more than two additional psychotropic drugs (only in the case of CLO; p = 0.046), concomitant use of beta-blockers (for CLO p = 0.049; for NCLO p < 0.001), and older age (for CLO p < 0.001; for NCLO p = 0.011). Despite the use of CLO at daily doses within the recommended range (200-450 mg), the evaluated serum CLO and NCLO levels were within the therapeutic ranges in only 37% and 75% of cases, respectively, with 5.6% of cases exceeding the CLO toxicity threshold. Discussion: The use of CLO at recommended doses does not guarantee achieving therapeutic concentrations of CLO or NCLO. Women and nonsmokers were at the highest risk of having toxic CLO levels. [ABSTRACT FROM AUTHOR]

Objective: The readability of a text can be measured objectively using a series of mathematical formulas. Patients' proper understanding of a drug's effects and side effects is essential for treatment compliance in psychiatry. This study aimed to measure the readability level of the package leaflets of psychotropic drugs currently used in Turkey and to determine at what average age and education level were appropriate. Method: Four main psychotropic drug groups, which are thought to be used more frequently in adult psychiatry, were included in this study. The most recent package leaflets of the drugs in these groups were obtained from the official websites of the Ministry of Health, the Turkish Medicines and Medical Devices Agency (https://www.titck.gov.tr/kubkt) and the relevant companies in the market, and their readability level was determined. The formulas developed by Atejman and Bezirci-Yilmaz were used to evaluate readability levels in this study. Results: The average Atejman readability points were determined to be 48.2. From this, it was understood that an education at the level of the 13th-15th grade was necessary for the readability of the package leaflets. The average Bezirci-Yilmaz readability points were determined to be 13.2, indicating that an education at the level of 13th grade, or further education, was necessary for the readability of the package leaflets. Discussion: The level of education required for readability of the psychotropic drug package leaflets was seen to be extremely high when the average level of education in Turkey was considered. Improving package leaflets' readability can reduce patients' concerns about psychotropic drugs by facilitating their understanding of the treatment. It can increase treatment compliance, thereby helping the recovery of mental health. [ABSTRACT FROM AUTHOR]

Mental health has become a significant public health problem that impacts both economic and social development, with severe mental disorders (SMDs) being the top priority. Over recent years, Beijing, China, has introduced several policies to reduce the economic burden on patients with mental health disorders. The aim of this study was to investigate the current status and composition of patients' medical expenses following the introduction of multiple medical policies, explore the factors that may impact the utilisation of medical services and provide a reference and basis for subsequent policy improvements. Multistage sampling was used to select a representative study population. A retrospective survey was used to collect patient information and data on medical expenses in 2019. Descriptive statistics were applied to analyse the current status of patients' medical expenses, and a two-part model was used to examine the factors influencing healthcare utilisation and to model predicted expenses. Among 4940 participants, the average outpatient expenses of patients with SMD who incurred medical expenses were 8373.61 Yuan, and the average hospitalisation expenses were 81,594.05 Yuan. The out-of-pocket expenses were 29.22% of outpatient expenses and 8.13% of inpatient expenses. Factors such as age, household status, economic status, marital status, participation in the Community Free-Medication Service (CFMS) and the type of disease diagnosed influenced the differences in medical expenses and utilisation of services. The medical expenses of patients with SMD in Beijing are high, but a number of introduced policies have effectively reduced these costs for patients. Future studies should focus on the impact of factors such as age, economic status, participation in the CFMS and the type of disease diagnosed on medical expenses. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of potential drug–drug interactions involving psychotropics prescribed by dentists, and dispensed by the public healthcare system, as well as to describe the severity and level of evidence of those interactions in the state of Minas Gerais, Brazil. Materials and Methods: We conducted data analysis from pharmaceutical claims in which dental patients received systemic psychotropics in 2017. Data from the Pharmaceutical Management System provided the drug dispensing history of the patients, allowing the identification of those on concomitant medication use. The outcome was the occurrence of potential drug–drug interactions, which were detected according to IBM Micromedex®. Independent variables were the patient's sex, age, and the number of drugs used. Descriptive statistics was performed using SPSS v. 26. Results: Overall, 1480 individuals were prescribed psychotropic drugs. The prevalence of potential drug–drug interactions was 24.8% (n = 366). The total of 648 interactions was observed and, most of which were of major severity (n = 438, 67.6%). Most interactions occurred in female individuals (n = 235; 64.2%), with 46.0 (±17.3) years‐old, concurrently taking 3.7 (±1.9) drugs. Conclusion: A substantial proportion of dental patients presented potential drug–drug interactions, mostly of major severity, which might be life‐threatening. [ABSTRACT FROM AUTHOR]

BackgroundHospitalizations among people with dementia (PWD) may precipitate behavioral changes, leading to the psychotropic medication use despite adverse outcomes and limited efficacy. We sought to determine the incidence of new psychotropic medication use among community-dwelling PWD after hospital discharge and, among new users, the proportion with prolonged use.MethodsThis was a retrospective cohort study using a 20% random sample of Medicare claims in 2017, including hospitalized PWD with traditional and Part D Medicare who were 68 years or older. The primary outcome was incident prescribing at discharge of psychotropics including antipsychotics, sedative-hypnotics, antiepileptics, and antidepressants. This was defined as new prescription fills (i.e., from classes not used in 180 days preadmission) within 7 days of hospital or skilled nursing facility discharge. Prolonged use was defined as the proportion of new users who continued to fill newly prescribed medications beyond 90 days of discharge.ResultsThe cohort included 117,022 hospitalized PWD with a mean age of 81 years; 63% were female. Preadmission, 63% were using at least 1 psychotropic medication; 10% were using medications from ≥3 psychotropic classes. These included antidepressants (44% preadmission), antiepileptics (29%), sedative-hypnotics (21%), and antipsychotics (11%). The proportion of PWD discharged from the hospital with new psychotropics ranged from 1.9% (antipsychotics) to 2.9% (antiepileptics); 6.6% had at least one new class started. Among new users, prolonged use ranged from 36% (sedative-hypnotics) to 63% (antidepressants); across drug classes, prolonged use occurred in 51%. Predictors of newly initiated psychotropics included length of stay (≥median vs. ConclusionsHospitalized PWD have a high prevalence of preadmission psychotropic medication use; against this baseline, discharge from the hospital with new psychotropics is relatively uncommon. Nevertheless, prolonged use of newly initiated psychotropics occurs in a substantial proportion of this population.

Medicine counterfeiting is a worldwide problem affecting all therapeutic areas. The analysis of such products is sometimes a scientific challenge, since their chemical composition is unknown and might be very different from the one of the original product. While some counterfeited drug products are quite easy to detect, others are close in composition with the genuine products. The health consequences of counterfeit medicines are appalling since these products can contain the =rong chemical composition, impurities or toxic compounds, and be manufactured and stored in dreadful conditions that do not even respect the basic hygienic conditions. Providing reliable analytical tools is therefore necessary for an efficient fight against the phenomenon. In this study, the analysis of counterfeits of psychotropic drugs presenting a rare closeness in composition to the genuine drugs will be described. It will be exposed how the choice of reliable analytical strategy and tools is decisive for the correct authentication of such pharmaceuticals. The results of classical methods like High-Performance Liquid Chromatography (HPLC) will be presented. Then the contribution of vibrational spectroscopy and imaging tools, including spectral imaging and Near infrared (NIR) spectroscopy, and spectral imaging, will be described, as well as Gas Chromatography coupled with Mass Spectrometry (GC–MS), 1H Nuclear Magnetic Resonance (NMR), 3D microscopy as support for the physical analysis, and finally X-ray fluorescence spectroscopy (XRF) as an elemental analysis technology. The results of the forensic analysis will also reveal analytical links between the counterfeit cases, providing useful information for law enforcement investigations.