RESUMEN
AIM: Analyze prescriptions in public hospital psychiatric practice. METHODS: Psychiatric and somatic prescriptions were analyzed a given day regarding their indication, dosage, treatment duration, and prescription scheme. Consultants were individually asked for the reasons of off-label prescriptions. RESULTS: Five thousand eighty-six lines of prescription were recorded for 495 patients, showing a total of 34% off-label prescriptions, including 43.5% for psychiatric medications and 22.7% for somatic medications. Psychiatric medications: 22.3% were off-label for indication, 13.1% for dosage, 4.5% for treatment duration, and 6.2% for prescription scheme. (off-label prescriptions for indication: 12.1% without clonazepam - which delivery have been restricted by the end of 2011). Somatic medications: respectively 4.5%, 14.9%, 4.8% and 12.5%. CONCLUSIONS: Percentage of off-label prescriptions for indication of psychiatric medications was clearly less than percentages published in the literature (other percentages are new). While most of off-label prescriptions were made in accordance with clinical reports in the literature, some others were not.
Asunto(s)
Uso Fuera de lo Indicado/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Medicamentos bajo Prescripción/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Etiquetado de Medicamentos , Femenino , Hospitales Psiquiátricos , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Medicamentos bajo Prescripción/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: The self-medication hypothesis is commonly put forward to explain the high prevalence of smoking in psychiatric patients. However, studies supporting the self-medication hypothesis have most often been carried out on chronic patients stabilized by antipsychotics. AIM: Given that antipsychotics tend to erase psychiatric symptoms, the present study was undertaken on acutely ill patients usually receiving no medications, or on whom medications are ineffective. METHODS: Participants were 492 consecutively hospitalized patients. They were evaluated the day of their hospitalization with the Brief Psychiatric Rating Scale (BPRS, 18 items). Urinary cotinine and creatinine were measured the morning following their hospitalization. The urinary cotinine/creatinine ratio and the cotinine/creatinine/number of cigarettes smoked per day ratio (nicotine extraction index) were calculated for each patient. RESULTS: The positive symptoms subscale of the BPRS significantly correlated with smoking, whereas other BPRS subscales did not. In patients with mood disorder, the nicotine extraction index correlated with the positive symptoms, activation and hostility subscales, but not with the negative symptoms subscale. Analyses of individual BPRS items using the cotinine/creatinine ratio measure showed that smoking is positively associated with "unusual thought content" and "grandiosity" items and negatively associated with "guilt feeling", "depressed mood" and "motor retardation". Analyses of individual BPRS items using the nicotine extraction index showed a positive association only with "unusual thought content" and "grandiosity" items. Patients with schizophrenia extract more nicotine from cigarettes than other patients. CONCLUSION: In acutely ill psychiatric patients, smoking is linked with positive symptoms and not with negative symptoms.
Asunto(s)
Alcoholismo/psicología , Trastornos del Humor/psicología , Psicología del Esquizofrénico , Automedicación , Fumar/psicología , Enfermedad Aguda , Antipsicóticos/uso terapéutico , Apatía , Escalas de Valoración Psiquiátrica Breve , Cotinina/orina , Creatinina/orina , Hospitalización , Humanos , Trastornos Mentales/tratamiento farmacológico , Nicotina/uso terapéutico , Productos de TabacoRESUMEN
BACKGROUND: Asking psychiatric in-patients about their drug consumption is unlikely to yield reliable results, particularly where alcohol and illicit drug use is involved. The main aim of this study was to compare spontaneous self-reports of drug use in hospitalized psychiatric patients to biological measures of same. A secondary aim was to determine which personal factors were associated with the use of tobacco, alcohol, and illicit drugs as indicated by these biological measures. METHODS: The consumption of substances was investigated using biological measures (urine cotinine, cannabis, opiates, cocaine, amphetamines and barbiturates; blood carbohydrate-deficient transferrin [CDT] and gamma-glutamyl transferase [GGT]) in 486 consecutively admitted psychiatric patients, one day following their hospitalization. Patients' self-reports of alcohol, tobacco and illicit drugs consumption were recorded. Socio-professional and familial data were also recorded. RESULTS: The results show a low correlation between biological measures and self-reported consumption of alcohol and illicit drugs. Fifty-two percent of the patients under-reported their consumption of illicit drugs (kappa=.47). Patients with schizophrenia and personality disorders were more likely to disclose their illicit drug consumption relative to patients suffering from mood disorders and alcohol dependence. Fifty-six percent of patients underreported alcohol use, as evaluated by CDT (kappa=.2), and 37% underreported when using the CDT+GGT measure as an indicator. Smoking appeared to be reported adequately. In the study we observed a strong negative correlation between cannabis use and age, a strong correlation between tobacco and cannabis use, and correlations between tobacco, cannabis and alcohol consumption. CONCLUSION: This study is the first to compare self-reports and biological measures of alcohol, tobacco and illicit drug uses in a large sample of inpatients suffering from various categories of psychiatric illnesses, allowing for cross-diagnosis comparisons.
Asunto(s)
Alcoholismo/psicología , Drogas Ilícitas , Trastornos Mentales/psicología , Fumar/psicología , Detección de Abuso de Sustancias , Trastornos Relacionados con Sustancias/psicología , Revelación de la Verdad , Adolescente , Adulto , Alcoholismo/epidemiología , Alcoholismo/orina , Comorbilidad , Cotinina/orina , Femenino , Humanos , Drogas Ilícitas/orina , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/orina , Persona de Mediana Edad , Trastornos de la Personalidad/epidemiología , Trastornos de la Personalidad/psicología , Trastornos de la Personalidad/orina , Esquizofrenia/epidemiología , Esquizofrenia/orina , Psicología del Esquizofrénico , Fumar/epidemiología , Fumar/orina , Estadística como Asunto , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/orina , Transferrina/análogos & derivados , Transferrina/metabolismo , gamma-Glutamiltransferasa/sangreRESUMEN
Oral liquid drugs have many advantages in psychiatry (compliance, facility of administration) but they may be origin of medicinal iatrogenics (dose error). Since 2001, chemistry of Paul Guiraud's hospital (Villejuif) has developed recommendations about this galenic form and measured every two years practices evolution and respect of recommendations. In 2005, we analysed 601 prescriptions (100%) and collected 215 questionnaires (60% of answers). This study confirms the large prescription of oral liquid forms and the necessity to improve recommendations diffusion. The chemistry in collaboration with the cares department has produced a booklet of drugs administration, a poster and has set up information meetings with medical and nursery teams. The aim of this study is to evaluate nurse practices about preparation and administration of oral liquid drugs. It is part of a global process to accredit and secure the drug use process.
Asunto(s)
Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/enfermería , Soluciones Farmacéuticas/uso terapéutico , Psicotrópicos/administración & dosificación , Psicotrópicos/uso terapéutico , Adulto , Anciano , Formas de Dosificación , Composición de Medicamentos , Prescripciones de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicotrópicos/efectos adversos , Encuestas y CuestionariosRESUMEN
INTRODUCTION: There is little information available about the real content of cannabis consumed in France. OBJECTIVE: To assess the chemical content, including adulterants and contaminants, and potency of cannabis samples obtained from end-users. METHODS: Samples of resins considered by users to produce "unusual" effects were collected from habitual consumers and chemically analyzed. RESULTS: Thirty-seven samples were obtained. Average THC content was 8.8%. The effects reported by users were consistent with the THC content. Apart from an unidentified fatty substance found in two samples, no adulteration was found. DISCUSSION: This study, which relied on volunteers, enabled us to collect samples considered abnormal by experienced users. It did not confirm the numerous anecdotes of adulteration. CONCLUSION: We suggest that this study should be widened to monitor the current chemical contents of cannabis derivatives available in France. The impact of providing users with the results remains to be evaluated.