Incidence and drug treatment of emotional distress after cancer diagnosis : a matched primary care case-control study

Notes This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License.Peer reviewedPublisher PD

Initiation of Psychotropic Medication after Partner Bereavement: A Matched Cohort Study

Background Recent changes to diagnostic criteria for depression in DSM-5 remove the bereavement exclusion, allowing earlier diagnosis following bereavement. Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists after bereavement. Aims To describe initiation of psychotropic medication in the first year after partner bereavement. Methods In a UK primary care database, we identified 21,122 individuals aged 60 and over with partner bereavement and no psychotropic drug use in the previous year. Prescribing (anxiolytic/hypnotic, antidepressant, antipsychotic) after bereavement was compared to age, sex and practice matched controls. Results The risks of receiving a new psychotropic prescription within two and twelve months of bereavement were 9.5% (95% CI 9.1 to 9.9%) and 17.9% (17.3 to 18.4%) respectively; an excess risk of initiation in the first year of 12.4% compared to non-bereaved controls. Anxiolytic/hypnotic and antidepressant initiation rates were highest in the first two months. In this period, the hazard ratio for initiation of anxiolytics/hypnotics was 16.7 (95% CI 14.7 to 18.9) and for antidepressants was 5.6 (4.7 to 6.7) compared to non-bereaved controls. 13.3% of those started on anxiolytics/hypnotics within two months continued to receive this drug class at one year. The marked variation in background family practice prescribing of anxiolytics/hypnotics was the strongest determinant of their initiation in the first two months after bereavement. Conclusion Almost one in five older people received a new psychotropic drug prescription in the year after bereavement. The early increase and trend in antidepressant use after bereavement suggests some clinicians did not adhere to the bereavement exclusion, with implications for its recent removal in DSM-5. Family practice variation in use of anxiolytics/hypnotics suggests uncertainty over their role in bereavement with the potential for inappropriate long term use

Trends in long-term prescribing of dependence forming medicines

Using patient-level primary care data to estimate the extent to which antidepressant medicines are prescribed to people continuously for long periods of time. Aim This descriptive research used patient-level primary care data to estimate the extent to which antidepressant medicines are prescribed to people continuously for long periods of time. The study also drew on survey data and data on the number of prescriptions dispensed. Findings - The number of antidepressant prescriptions dispensed each year in England doubled between 2008 and 2018 - Survey data show that the proportion of adults reporting use of antidepressants in the past year increased in the 1990s, and again between 2007 and 2014 - The average length of time that antidepressants are continuously prescribed to people for has increased over time. - Some types of antidepressants (for example, tricyclics and other antidepressants) tend to be prescribed for longer periods than other types (such as SSRIs). - In 2014, one in twelve prescribing periods for tricyclics and other antidepressants lasted for three years or more Methods The analyses in this report are descriptive and show the overall prevalence of long-term prescribing in each year. We used a sample of around 50,000 patients prescribed at least one antidepressant medicine between 2000 and 2017. This was drawn from the Clinical Practice Research Datalink (CPRD). The CPRD contains data about prescriptions issued by GPs (including the length and size of prescription) and characteristics of the patients prescribed to (such as their age, sex, and area where they live). Medicines were grouped for analysis into: tricyclics, selective serotonin reuptake inhibitors (SSRIs), and other ADMs. The length of individual prescriptions and continuous prescribing periods were derived using information on consultation dates, the quantity of tablets prescribed, and the numeric daily dose

Drug-drug interactions in repeat prescriptions at village dispensaries (bereg) in Malta

Inappropriate treatments and drug-drug interactions (DDIs) are known to occur in settings where repeat prescriptions are issued. In view of this, a study was carried out to document any such problematic drug prescribing and propose changes that would enhance patient safety. A random sample of 100 clients who requested a repeat prescription at a group of peripheral village dispensaries (bere©) in southern Malta was chosen and following anonymisation, the drugs requested for such prescriptions were entered into a database. A freely available online DDI checker was used in the analysis of the results and these were rechecked through the appropriate section of the British National Formulary. The resulting DDIs were then grouped according to type, potential effect or disease for which the drugs were used. A total of 255 DDIs were detected in the prescriptions of 53 clients. Drug combinations with a potential for increased hypotensive effect were the most common cause of DDIs (49.8%) in this sample, but other categories of DDIs were found. These included DDIs which could affect the management of diabetic patients (27.3%), patients on psychiatric treatment (7%) and anticoagulants (4.8%) as well as DDIs that affected serum potassium levels (2.2%). The results obtained indicate that DDIs are common at a number of peripheral village dispensaries in Malta, and these could affect disease management in some patients. Other DDIs can be potentially harmful. Awareness, knowledge and vigilance by the prescribers involved remains crucial to address the issues raised by DDIs. Suggestions for addressing these issues on an administrative level are proposed.peer-reviewe

Current Concepts on Drug Abuse and Dependence

Drug addiction is a complex disease characterized by compulsive and uncontrollable desire to seek and consume the drug. In time, drug-related terminology has undergone many changes, arising from the deepening of the mechanisms of action, but also about the need for a greater precision in the definition. Drug dependence can be assigned not only to pharmacological effects of the drugs of abuse, but also to their interaction with each particular neurological and psychological constitution. The research on the neurobiological mechanisms of addiction processes allows both a better understanding of current pharmacotherapy and the development of new treatment strategies in drug abuse and dependence. In this review we intend to present the current concepts related to drug abuse and dependence

The pharmacist’s response to the needs of patients undergoing treatment with psychotropic medication

The usage of psychotropic (Table 1) medication is considerable world wide. In Malta, this can be attested to by the numerous studies that have been conducted by the University of Malta Department of Pharmacy (in conjuction with other institutions and individuals).peer-reviewe

Psychological, emotional and social impairments are associated with adherence and healthcare spending in type 2 diabetic patients: an observational study

OBJECTIVE: The aim of the present study was to assess the association among anxiety, depression, stress, social support and emotional abilities with adherence and healthcare spending in type 2 diabetic patients. PATIENTS AND METHODS: Sixty-four patients were enrolled and completed: Interpersonal Processes of Care (IPC), 20-item Toronto Alexithymia Scale (TAS-20), Rapid Stress Assessment Scale (RSAS), Morisky Medication Adherence Scale (MMAS-4), International Physical Activity Questionnaire (IPAQ)-Short Form and a socio-anamnestic questionnaire regarding also the healthcare spending. RESULTS: Mathematical linear regressions models were performed showing the predictive effects of: anxiety and social support scores (RSAS) on adherence levels (respectively p =. 019; p =. 016); adherence levels on anxiolytic use (p =.04); aggressiveness scores (RSAS) on the number of general check-ups (p =.031); TAS-20 and physician-patient communication (IPC) on the number of hospitalization days (respectively p=.001; p=.008); physician patient decision making (IPC) scores on physical activity (IPAQ) levels (p=.025); physical activity (IPAQ) on the number of medical examinations (p=.039). CONCLUSIONS: An association among psychosocial impairment, adherence and health- care spending was found. Future studies should investigate the effect of a brief psychological intervention in increasing adherence levels and reducing the healthcare spending in this clinical population

The role of biotransformation processes in mediating interactions between psychotropic drugs and natural products

Many patients are not aware that natural products such as fruit juices or plant infusions can cause significant interactions with several drugs, some of which can be dangerous, especially when the medical treatment is for neurological or psychiatric disorders. Among the most predisposed for interacting with drugs are citric juices, particularly grapefruit and plant infusions, especially St John`s wort (Hypericum perforatum). Understanding the mechanism and the frequency of this type of interaction helps to avoid it. The goal of this research was to identify and summarize the most relevant reports on interactions between psychotropic drugs and natural beverages, in order to raise awareness among physicians that they should invest more time in educating patients how to administer drugs properly, thus reducing the likelihood of such unwanted events. For the purpose of this study, an electronic search of PubMed database was conducted until September 2019. We concluded that natural beverage consumption along side medical treatment is a widespread practice and the main mechanism generating interactions is related to the functioning of biotransformation enzymes

Impulsivity in Sexual Trauma Survivors and their Use of Alcohol and Substances

Impulsivity in Sexual Trauma Survivors and their Use of Alcohol and Substances Kayla McLean, Dept. of Psychology, with Dr. Jasmin Vassileva, Depts. of Psychology and Psychiatry The current study investigates the associations of neurocognitive ‘choice’ impulsivity (delay discounting) and personality ‘trait’ impulsivity (UPPS Impulsive Behavior Scale) with alcohol and substance use among female college students reporting history of sexual trauma. Participants included 2476 students enrolled in the Spit for Science study of college student mental health at VCU. Bivariate correlations were used to examine the associations between lifetime use of alcohol and different types of drugs with delay discounting and trait impulsivity among female students reporting history of sexual trauma (N=688). The results revealed that only cannabis (r=0.10, p\u3c.05) and prescription stimulants (r=0.11, p\u3c.05) were significantly correlated with delay discounting, particularly of rewards of small magnitude. Emotion-related factors of the UPPS trait impulsivity (negative urgency, positive urgency, and sensation seeking), showed positive relationships with cannabis (r=0.34, p\u3c.01), opioids (r=0.27, p\u3c.05), stimulants (r=0.23, p\u3c.05), prescription sedatives (r=0.43, p\u3c.05) and prescription anxiolytics (r=0.43, p\u3c.05). These results may indicate substance use as a means of coping with the emotional effects of sexual trauma.https://scholarscompass.vcu.edu/uresposters/1324/thumbnail.jp