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

Psychotropic medication use among children in the child welfare system

Prior research demonstrates that children in the child welfare system are given psychotropic medication at rates approximately three times higher than children and adolescents in the general population. Using data from the second National Survey of Child and Adolescent Well-Being, authors Wendy Walsh and Marybeth Mattingly report that among children age 4 and older with a report of maltreatment, rates of psychotropic medication use are significantly higher in rural (20 percent) than urban areas (13 percent). Children age 4 and older with a maltreatment report in rural areas were significantly more likely to take more than one medication than children in urban areas. The significantly higher rates of psychotropic medication use among children in rural areas and the significantly higher rates of taking multiple medications point to the need among child welfare professionals in rural areas to closely monitor use. The results of the current analysis indicate that more information is needed about the complex decision-making process regarding medication use. This includes a need to better understand how pediatric clinicians make decisions, and the impact of community norms on medication use

Do antidepressants cure or create abnormal brain states?

Moncrieff and Cohen argue that psychotropic drugs create abnormal states that may co-incidentally relieve symptoms of mental illness

The alimentary impact of the hemp seed

Hemp seed and hemp seed oil can supply us with many important substances. Their essential fatty acid compositions are favourable, but they may contain non-psychotropic cannabinoids. Emerging data show that these components can influence the health status of the population beneficially. Some data also showed trace amounts of tetrahydrocannabinol in seed oils, the main psychotropic cannabinoid that is contraindicated.Our aim was to examine cannabinoids and fatty acid composition as well as metal and non-metal element compositions in products, like hemp seed oil and chopped hemp seed capsule.The cannabinoids were separated by thin layer chromatography. Fatty acid composition was determined with gas chromatography, and elements (Al, B, Ba, Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, P, Pb, S, Si, Sn, Sr, V, and Zn) were measured by inductively coupled plasma optical emission spectrometric method. Selenium was determined with polarographic analyser.Cannabinoids were not detectable by thin layer chromatography, so hemp seed oil, as well as the capsule, have no psychotropic adverse effect. Our data showed that hemp seed contains essential fatty acids close to the recommended ratio. The B and Se concentrations of the oils and the P concentration of the capsule are also relevant

Prevalence of Psychotropic Polypharmacy and Associated Healthcare Resource Utilization during Initial Phase of Care among Adults with Cancer in USA

Background: The use of psychotropic medications is not uncommon among patients with newly diagnosed cancer. However, the impact of psychotropic polypharmacy on healthcare utilization during the initial phase of cancer care is largely unknown. Methods: We used a claims database to identify adults with incident breast, prostate, lung, and colorectal cancers diagnosed during 2011–12. Psychotropic polypharmacy was defined as concurrent use of two or more psychotropic medication classes for at least 90 days. A multivariable logistic regression was performed to identify significant predictors of psychotropic polypharmacy. Multivariable Poisson and negative binomial regressions were used to assess the associations between psychotropic polypharmacy and healthcare utilization. Results: Among 5604 patients included in the study, 52.6% had breast cancer, 30.6% had prostate cancer, 11.4% had colorectal cancer, and 5.5% had lung cancer. During the year following incident cancer diagnosis, psychotropic polypharmacy was reported in 7.4% of patients, with the highest prevalence among patients with lung cancer (14.4%). Compared with patients without psychotropic polypharmacy during the initial phase of care, patients with newly diagnosed cancer with psychotropic polypharmacy had a 30% higher rate of physician office visits, an 18% higher rate of hospitalization, and a 30% higher rate of outpatient visits. The rate of emergency room visits was similar between the two groups. Conclusion: Psychotropic polypharmacy during the initial phase of cancer care was associated with significantly increased healthcare resource utilization, and the proportion of patients receiving psychotropic polypharmacy differed by type of cancer. Impact: Findings emphasize the importance of evidence-based psychotropic prescribing and close surveillance of events causing increased healthcare utilization among patients with cancer receiving psychotropic polypharmacy

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

Examining the Association Between Psychotropic Medication and Suicidal Desire and Risk

The primary aim of this study was to examine the relationship between components of suicidal desire and psychotropic medication. Specifically, the usage of psychotropic medication, the usage of specific classes of psychotropic medications and the amount of psychotropic medication utilized and differences in feelings of perceived burdensomeness, thwarted belongingness and overall suicide risk were examined. The present study utilized pre-collected data consisting of 225 patients with substance use disorder undergoing residential treatment for substance dependence. It was posited that individuals utilizing psychotropic medications would exhibit higher mean levels of thwarted belongingness, perceived burdensomeness, and suicide risk relative to individuals not utilizing psychotropics and that individuals utilizing multiple psychotropic medications would exhibit higher suicidal desire and risk than individuals utilizing zero or one psychotropic medication. Additionally, it was posited that individuals utilizing antipsychotics would exhibit higher suicidal desire and risk than individuals utilizing any other type of psychotropic medication. For all hypotheses it was posited that such effects would occur above and beyond severity of psychopathology and substance use. Results indicated a significant difference in suicide risk between individuals utilizing a psychotropic and individuals not utilizing a psychotropic. Additional exploratory analyses indicated a significant difference in levels of perceived burdensomeness between individuals utilizing an antidepressant and individuals utilizing any other type of psychotropic besides an antidepressant. Overall, results suggest that the use of psychotropic medication may increase the risk for suicide. These findings highlight the need for routine suicide risk assessments for patients utilizing psychotropic medications

Antipsychotic Drug Use: Managing Cardiometabolic and Cost Effects

Across the US, 30%, or approximately one third of people meet the criteria for at least one mental illness.1 Of those with severe mental illness (SMI), namely schizophrenia and bipolar disorder, the mortality rate is more than twofold compared to the general population.2 The cardiovascular risk factors that contribute to cardiovascular related deaths, including metabolic disease and type II diabetes, are not only modifiable, but staggeringly higher for those with SMI.3 Though antipsychotic drug prescription is the standard protocol for SMI treatment, such drug effects on cardiovascular risk factors and related deaths exacerbate the much higher mortality rate for the severely mentally ill population. Due to both the prevalence of SMI and the physical comorbidities that it entails, analysis of healthcare costs associated with this population are an essential part of general health and policy improvement for the U.S. Therefore, a breakdown of the healthcare costs of this population requires not only acknowledgment of the modes of treatment for mental illness specifically, but also the identification and cost-analysis of the commonly associated physical comorbidities. This is especially important considering SMI is almost always considered chronic, and many SMI patients qualify for either Medicare, Medicaid, or both. Certain gaps in coverage can lead to lack of preventive care, exacerbating the cost burden. From a clinician’s perspective, assessing relevant scientific studies and reviews to change the relationship between primary care and psychiatry is necessary to dampen the high mortality rate of the SMI population. From a policy-maker’s perspective, analyzing the cause and effect balance between managing costs of care directed at the SMI itself against the adjunct costs from physical comorbidity calls for a change in the structure of therapeutic care and how the SMI population accesses primary care. The Collaborative Care model is a health care model that unifies psychiatric, behavioral, and primary care to support the mental, behavioral, and physical health of patients. By supporting holistic healthcare, the high cost of care for the SMI population will be diminished. The model includes four parts: patient-centered care, populationbased care, measurement-based treatment to target, and evidence-based care. Swapping oral antipsychotics with injectable versions will be especially cost-effective by improving adherence rates, and thus, reducing institutionalization and other hospitalizations. By enforcing the Collaborative Care model through community health center interventions, clinicians and policy makers will be able to work together to effectively leverage the health of the SMI population while eroding the high health care expenditure that this population currently imposes on states

Mental health nurses’ medicines management role: a qualitative content analysis

Aim: This study explores medicines management role undertaken by mental health nurses (MHN) in a wide variety of clinical specialisms and contexts. Method: Ten MHNs were interviewed and audiotaped. Qualitative content analysis of the transcribed interviews was undertaken. Results: These findings evidenced the wide ranging skills and knowledge the MHN utilizes when psychotropic medication is prescribed, and how they engage with service users and other practitioners. Four themes emerged that illustrated how the participants undertook such interventions: Medicines management in context; Managing time; Knowledge and skill used; Collaboration with other healthcare providers. Medicines management thus needs a greater emphasis in order for the for service users from the drugs they are prescribed achieves the optimum outcome