Purchases of prescription drugs before an alcohol-related death : A ten-year follow-up study using linked routine data

Background: Physician's intention to prescribe drugs could potentially be used to improve targeting of alcohol interventions and enhanced disease management to patients with a high risk of severe alcohol-related harm within outpatient settings. Methods: Comparison of ten-year incidence trajectories of 13.8 million reimbursed purchases of prescription drugs among 303,057 Finnish men and women of whom 7490 ultimately died due to alcohol-related causes (Ale+), 14,954 died without alcohol involvement (Alc-), and 280,613 survived until the end of 2007. Results: 5-10 years before death, 88% of the persons with an Alc+ death had received prescription medication, and over two-thirds (69%) had at least one reimbursed purchase of drugs for the alimentary tract and metabolism, the cardiovascular system, or the nervous system. Among persons with an Alc+ death, the incidence rate (IR) for purchases of hypnotics, and sedatives was L38 times higher (95% confidence interval (C1):1.32,1.44) compared to those with an Alc death, and 4.07 times higher (95%C1:3.92,4.22) compared to survivors; and the IR for purchases of anxiolytics was 1.40 times higher (95%Ck1.34,1.47) compared to those with an Ale death, and 3.61 times higher (95%C1:3.48,3.78) compared to survivors. Conclusions: Using physician's intention to prescribe drugs affecting the alimentary tract and metabolism, cardiovascular system and nervous system could potentially be used to flag patients who might benefit from screening, targeted interventions or enhanced disease management. In particular, patients who are to be prescribed anxiolytics, hypnotics, and sedatives, and antidepressants may benefit from enhanced interventions targeted to problem drinking.Peer reviewe

The patterns in psychotropic drug prescriptions among older people with dementia:Lessons learned from Dutch long-term care practice

Most older people with dementia experience neuropsychiatric symptoms (NPSs). Psychotropic drugs are frequently prescribed to treat NPSs despite warnings from guidelines and publicity campaigns. Thus, this thesis aims to explore the patterns of psychotropic drug prescriptions in Dutch long-term care practice over the past decade. Firstly, we studied the patterns among community-dwelling older people with dementia during the course of dementia and during the COVID-19 pandemic using electronic health records from general practitioners. Additionally, we estimated the patterns among nursing home residents using secondary data from previous trials. Finally, we synthesised evidence for the success of withdrawing psychotropic drugs by introducing a new outcome variable, trial completion. The prescriptions of antipsychotics and antidepressants in community-dwelling older people with new-onset dementia increased during the five-year follow-up. This increase may prompt general practitioners to reconsider their prescribing habits. Furthermore, the unexpected decrease in psychotropic drug prescriptions during the first two years of the COVID-19 pandemic may reflect the neglect of NPSs during this period. In Dutch nursing homes, there has been a promising decline in antipsychotic prescriptions in recent years, although the prevalence of overall psychotropic drug prescriptions has remained high. Lastly, the synthesis of withdrawal trials indicates that over 80% of older people with dementia can withdraw antipsychotics and anti-dementia drugs within a three-month timeframe. In conclusion, the findings suggest room for improvement in prescribing practices of psychotropic drugs among both community general practitioners and elderly care physicians in nursing homes

Trajectories of mental health before and after old-age and disability retirement : a register-based study on purchases of psychotropic drugs

WOS:000308570400003OBJECTIVES: Retirement from paid work is a major life event facing increasingly large numbers of people in the coming years. We examined trajectories of mental health five years before and five years after old-age and disability retirement using data on purchases of psychotropic drugs. METHODS: The study included all employees from the City of Helsinki, Finland, retiring between 2000-2008 due to old age (N=4456) or disability (N=2549). Purchases of psychotropic drugs were analyzed in 20 3-month intervals before and after retirement using graphical methods and growth curve models. RESULTS: Old-age retirement was unrelated to purchases of psychotropic drugs. Among disability retirees, psychotropic medication tripled before retirement. The average increase was 0.95 [95% confidence interval (95% CI) 0.73-1.16] daily defined doses (DDD) 5-1.5 years before retirement; from 1.5 years until retirement it was 5.68 DDD (95% CI 5.33-6.03) for each 3-month interval. After disability retirement, purchases of antidepressants decreased on average by 0.40 DDD (95% CI 0.57-0.23) for each 3-month interval, those of hypnotics and sedatives increased by 0.30 DDD (95% CI 0.12-0.47), and no changes were seen for other psychotropic drugs. The changes before and after retirement were largest among those who retired due to mental disorders and those whose retirement had been granted as temporary. CONCLUSIONS: While no overall decrease in psychotropic medication after retirement was observed, purchases of antidepressants decreased after disability retirement. Long-term trajectories suggest that disability retirement might be prevented if mental health problems were tackled more efficiently earlier in the pre-retirement period.Peer reviewe

An Updated Analysis of Psychotropic Medicine Utilisation in Older People in New Zealand from 2005 to 2019

Background: Psychotropic medicine utilisation in older adults continues to be of interest because of overuse and concerns surrounding its safety and efficacy. Objective: This study aimed to characterise the utilisation of psychotropic medicines in older people in New Zealand. Methods: We conducted a repeated cross-sectional analysis of national dispensing data from 1 January, 2005 to 31 December, 2019. We defined utilisation using the Anatomical Therapeutic Chemical classification defined daily dose system. Utilisation was measured in terms of the defined daily dose (DDD) per 1000 older people per day (TOPD). Results: Overall, the utilisation of psychotropic medicines increased marginally by 0.42% between 2005 and 2019. The utilisation increased for antidepressants (72.42 to 75.21 DDD/TOPD) and antipsychotics (6.06–19.04 DDD/TOPD). In contrast, the utilisation of hypnotics and sedatives (53.74–38.90 DDD/TOPD) and anxiolytics decreased (10.20–9.87 DDD/TOPD). The utilisation of atypical antipsychotics increased (4.06–18.72 DDD/TOPD), with the highest percentage change in DDD/TOPD contributed by olanzapine (520.6 %). In comparison, utilisation of typical antipsychotics was relatively stable (2.00–2.06 DDD/TOPD). The utilisation of venlafaxine increased remarkably by 5.7 times between 2005 and 2019. The utilisation of zopiclone was far greater than that of other hypnotics in 2019. Conclusions: There was only a marginal increase in psychotropic medicines utilisation from 2005 to 2019 in older adults in New Zealand. There was a five-fold increase in the utilisation of antipsychotic medicines. Continued monitoring of psychotropic medicine utilisation will be of interest to understand the utilisation of antidepressants and antipsychotic medicines during the coronavirus disease 2019 pandemic year.</p

Birth Defects Res

BackgroundOral clefts (OC) are among the most common congenital malformations and can have a large impact on the life of the affected individual. Research findings regarding the psychological and psychosocial consequences of OC are inconclusive.MethodsUsing Danish nationwide registers we investigated redeemed prescriptions of psychotropic medication 1996\u20132012 and visits to psychiatrists and psychologists 1996\u20132011 among individuals born with non-syndromic OC in Denmark 1936\u20132009 and a comparison cohort of individuals without OC. This includes 8,244 individuals with OC and 82,665 individuals without OC.ResultsCox-regression analysis revealed 12% (95%CI: 7%\u201316%) increased risk of using any psychotropic medication for individuals with OC. When examining by cleft type, higher risks for medication use were observed in individuals with cleft lip and palate (CLP) or cleft palate only (CP). The largest increased relative risk was found for use of antipsychotics and stimulants for individuals with CP followed by use of antipsychotics for individuals with CLP. We found increased risk of visits to psychiatrists for individuals with CP and no increased risk for visits to psychologists for either group.ConclusionsThis study indicates that a small group of individuals with non-syndromic OC, in particular those with palatal involvement, have greater risk of using psychotropic medications. Elevated use was however also observed among younger individuals with cleft lip only. There seems to be only a modest increase in visits to health professionals for psychological reasons. Undiagnosed syndromes, e.g. 22q11 deletion syndrome, may however contribute to an overestimation of the associations.R01 DD000295/DD/NCBDD CDC HHS/United StatesR01 DE020895/DE/NIDCR NIH HHS/United States2018-07-03T00:00:00Z28402064PMC5568049vault:2441

The use of antidepressants, anxiolytics, sedatives and hypnotics in Europe: focusing on mental health care in Portugal and prescribing in older patients

(1) Background: Mental disorders are a growing concern in the 21st century. The most prevalent common mental disorders include depression and anxiety. It is predicted that half of the population will at some point in their lives experience one or more mental disorders. Although common mental disorders are highly prevalent, some of the most significant related problems are the wide treatment gap and the excessive use of antidepressants, anxiolytics and sedatives/hypnotics, especially among older patients. (2) Methods: This study aimed to analyze mental health care in Portugal, with a focus on the consumption of antidepressants, anxiolytics, sedatives and hypnotics among older patients. (3) Results: The use of antidepressants, anxiolytics, sedatives and hypnotics has increased overall across Europe. In Portugal, a downward trend of sedatives and hypnotics consumption can be observed. Anxiolytics and antidepressants, on the other hand, have been increasing. Patients aged ≥60 years old consume more than half of the aforementioned drugs. (4) Conclusions: Mental health policies should be designed to improve the conscientious use of antidepressants, anxiolytics, sedatives and hypnotics, particularly among older adults.publishe

Shift work and use of psychotropic medicine:A follow-up study with register linkage

OBJECTIVE: This study aimed to investigate a prospective association between shift work and use of psychotropic medicine. METHODS: Survey data from random samples of the general working population of Denmark (N=19 259) were linked to data from national registers. Poisson regression was used for analyses of prospective associations between shift work and redeemed prescriptions of psychotropic medicine. Prevalent cases were excluded at baseline. In secondary analyses, we tested differential effects on subsets of psychotropic medicine and, cross-sectionally, we studied correspondence between estimates based on psychotropic medicine and self-reported mental health. According to the protocol we interpret results from the secondary analyses following the principles for nested hypothesis testing, if the primary analyses reject the null-hypothesis, and otherwise we regard it as hypothesis generating exploratory analyses. RESULTS: In the primary analysis, the rate ratio for incidence of psychotropic medicine among shift workers was 1.09 (95% confidence interval 0.99–1.21). Results from the secondary analyses suggested increased incidence of use of hypnotics, sedatives and antidepressants and decreased incidence of use of anxiolytics. Cross-sectional analysis suggested increased risk for use of psychotropic medicine (all kinds), but not for poor self-rated mental health. CONCLUSIONS: Results did not support that working in shifts to the extent that is currently practiced in Denmark is associated with an increased incidence of overall psychotropic medicine use. Future studies should test, whether there is a differential incidence for different drugs among shift workers as suggested by the secondary analyses and how psychotropic medicine use and mental health are related

Psychotropic medication use among elderly nursing home residents in Slovenia: cross-sectional study

Aim To determine the prevalence of psychotropic medication prescribing in elderly nursing home residents in Slovenia and to explore the residents’, physicians’, and nursing home characteristics associated with prescribing. Methods In a cross-sectional study, we collected the data for 2040 nursing home residents aged 65 years and older in 12 nursing homes in Slovenia between September 25 and November 30, 2006. Prescribed medications lists were retrieved from patients’ medical records. Psychotropic medications were coded according to Anatomical Therapeutic Chemical Classification 2005, which we adjusted for the purposes of the study. Multivariate logistic regression analysis was performed to determine the residents’, physicians’, and nursing home characteristics associated with prescribing. Results Residents were from 65 to 104 years old (median, 83 years) and 1606 (79%) of them were female. A total of 970 (48%) residents had dementia and 466 had depression (23%). In 1492 (73%) residents, at least one psychotropic medication was prescribed. Nine hundred sixty residents were prescribed hypnotics and sedatives (47%), 572 (28%) antipsychotics, 460 (23%) antidepressants, and 432 (21%) anxiolytics. Residents’ characteristics associated with psychotropic medication use were female sex (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.03-1.80), age (OR, 0.97; 95% CI, 0.95-0.98), permanent restlessness (OR, 2.54; 95% CI, 1.71-3.78), dementia (OR, 1.76; 95% CI, 1.33-2.34), depression (OR, 5.51; 95% CI, 3.50-7.58), and the number of prescribed medications (OR, 1.29; 95% CI, 1.23-1.35). Of physicians’ characteristics (sex, age, specialization in general practice, years of working experiences as a general practitioner, and years of experiences working in a nursing home), male sex was associated with psychotropic medication prescribing (OR, 1.80; 95% CI, 1.17-2.76). Conclusion Frequency of psychotropic medication prescribing in elderly nursing home residents in Slovenia is high and is comparable to Western European countries. Our next step should be optimizing the prescribing in patients with the highest prescription rate