RESUMEN
OBJECTIVE: In 2019, a regional survey of potentially inappropriate prescriptions (PIP) of psychotropic drugs in elderly psychiatric inpatients was carried out highlighting their inappropriate use in this population. The aim of this study was to assess the clinical relevance - defined as the provision of an appropriate and necessary treatment, chosen from other alternatives as being the most likely to produce the expected results for a given patient - of these prescriptions considered inappropriate according to current established criteria. MATERIAL AND METHOD: Patients aged over 75, or 64 to 75 and polypathological with at least one PIP of psychotropic drugs or drugs with a high anticholinergic burden, identified by an audit grid established on the basis of STOPP/STARTv2 criteria and the Laroche list on the prescription at 48h of hospitalization, were included. The weighing of the inappropriateness nature of the prescription (resistance to treatment, period of crisis, comorbidities ) was established by a pharmacist-psychiatrist pair on the entire computerized record of the current episode. The clinical relevance of the PIP and the overall prescription was rated as 0 (irrelevant), 1 (partially relevant) or 2 (relevant). RESULTS: Thirty-four patients were included. One hundred and twenty-five PIP of psychotropic drugs were noted: 50.4% concerned benzodiazepines and non-benzodiazepines anxiolytics (BZD/Z), 25.6% neuroleptics (NL), 12% antidepressants (ATD) and 12% drugs with a high anticholinergic burden. On one hand, 49.2% of PIP of BZD/Z, 50% of PIP of NL and 20% of PIP of ATD were considered irrelevant. On the other hand, 49.2% of PIP of BZD/Z, 31.3% of PIP of NL and 13.3% of PIP of ATD were considered partially relevant. Furthermore, 1.6% of PIP of BZD/Z, 18.8% of PIP of NL and 66.7% of PIP of ATD were considered relevant. For PIPs of drugs with a high anticholinergic burden, 80% were deemed irrelevant, 13.3% partially relevant and 6.7% relevant. In all, of the 34 drug prescriptions studied, three (8.8%) were considered irrelevant, 11 (32.4%) partially relevant and 20 (58.8%) clinically relevant. CONCLUSION: This study highlighted the clinical relevance of more than half the prescriptions considered inappropriate according to current PPI criteria in the elderly. It underlines the interest of a new PPI detection tool for elderly patients with psychiatric disorders.
RESUMEN
OBJECTIVE: Constipation is more common in patients with mental disorders than in the general population. However, its frequency in hospitalized patients, its association with drugs and how teams become aware of it and take care of it are not fully identified. METHOD: The retrospective study included 141 male and 127 female new patients admitted for routine treatment at France's largest psychiatric hospital between November 15 and December 11, 2017. A physician reviewed electronic medical records to diagnose constipation and record variables of interest: socio-demographic factors, diagnosis, drugs prescribed and taken. We calculated an anticholinergic impregnation score (AIS) for each patient by using a validated French scale. Patients were then classified into two groups by state of constipation defined by the physician. Univariate and multivariate analyses were used to study the frequency of constipation, factors associated with it and its management. RESULTS: The prevalence of constipation was 38% (95% CI 32-44). Associated factors were taking antipsychotics and the burden of anticholinergic treatment. On multiple regression analysis, the only remaining factor was anticholinergic treatment: AIS≥5 was associated with constipation (odds ratio 1.80 [95% CI 1.07-3.14], P=0.027). Only 44.0% of patients were prescribed a preventive laxative, systematically in half of the cases. Above all, only 11.2% were administered this laxative (i.e., 25% of that prescribed). Digestive transit was poorly recorded in the table of constants (34.7%). We found one case of sub-occlusion as a severe case. CONCLUSION: Constipation is common in psychiatric inpatients. The more the patient is prescribed drugs with a pronounced anticholinergic effect, the greater the risk. Alongside the preventive measures common to all psychiatric patients which must be promoted (concerning diet, physical activity, etc.), polymedication with this type of anticholinergic must be better monitored to prevent complications: prescription and administration of a preventive laxative, monitoring transit in the table of constants. Thus, a better knowledge of the subject and specific training are essential.
RESUMEN
BACKGROUND: Pro re nata are frequent in psychiatry. The risks engendered by this treatment requires that their prescription and administration be made safer. The frequency of administration of pro re nata depends mainly on the nurse's clinical judgment. AIMS: Our first objective was to assess nurses' satisfaction about the quality of doctors' pro re nata prescriptions. Our second objective was to assess the nurses' self-reported practices for administering pro re nata treatments as written in the prescription. METHOD: Self-administered questionnaires were sent by the hospital's internal mail between November 13, 2014, and December 10, 2014 to all nurses in our psychiatric establishment in France. The questionnaire included multiple-choice questions and questions based on clinical vignettes. RESULTS: The response rate was 51.9% (124/239). Overall, 75.6% considered that the quality of the prescriptions in terms of dosage was satisfactory. However, regardless of the quality of the doctor's pro re nata prescription, nurses did not contact the doctor even when the prescription quality was poor. Unexpectedly, we found that 88.7% have administered medication "as needed" without a doctor's prescription and sometimes acted without consulting doctors. CONCLUSIONS: The nurses appeared globally satisfied with doctors' prescriptions of pro re nata medications. On the other hand, most administered some medications without any prescription, that is, illegally. Physicians must be rigorous in the quality of their PRN prescriptions. At the same time, nurses must comply with the medical prescription or contact the physician if the quality of the PRN prescription appears poor.
Asunto(s)
Trastornos Mentales , Psiquiatría , Humanos , Trastornos Mentales/tratamiento farmacológico , Salud Mental , Encuestas y Cuestionarios , AutoinformeRESUMEN
OBJECTIVES: Drug-induced hypersalivation is a frequent drug adverse event of psychotropic drugs. This excess salivary pooling in the mouth can cause an impairment of a patient's quality of life leading to low rates of medication adherence. The optimal management of hypersalivation is thus crucial to improve patient care. To date, no recommendations for limiting drug-induced hypersalivation have been published. In this study, we conducted a systematic review to investigate the effectiveness of interventions aimed at reducing drug-induced hypersalivation. METHODS: Treatment of drug-induced sialorrhea based on case reports and clinical studies were sought in May 2021 from PubMed, Google Scholar and Science Direct (keywords : « treatment ¼, « hypersalivation ¼, « induced ¼, « drug ¼, « clozapine ¼). Articles published between 1966 to May 2021 on the treatment of drug-induced hypersalivation were included in this study. RESULTS: Sixty-seven articles were selected in this narrative review. First, patient education associated with non-drug related management are essential to improve the compliance to drugs inducing hypersalivation. The non-drug related management should be initiated with an increase in the frequency of swallowing with chewing gum. In the case of ineffectiveness, the dosage of drug responsive of sialorrhea can be adjusted according to the patient's response and his/her medical history (i.e. reducing the dose or splitting the daily dose). Finally, if the problem persists, a symptomatic treatment can be added according to the type of sialorrhea (diurnal or nocturnal), preferred galenic by patient, tolerance and availability of drugs. Several drugs have been tested to reduce hypersalivation induced by clozapine (61/67), risperidone (3/67), quetiapine (2/67) and aripiprazole (2/67). Among the 63 articles targeting a specific corrective treatment, anticholinergic agents were most described in the literature (41 cases out of 63) with atropine, glycopyrrolate and scopolamine (6/41 each). Other agents were described as clinically effective on hypersalivation: dopamine antagonists (9/63) with amisulpride (5/9), alpha-2-adrenergic agonists (5/63) with clonidine (3/5), botulinic toxin (4/63), and terazosine, moclobemide, bupropion and N-acetylcysteine (for each 1/63). CONCLUSIONS: In the case of drug-induced hypersalivation, after failure of non-drug therapies and dosage optimization of the causative treatment, an anticholinergic drug can be initiated. In case of insufficient response, the different treatments presented can be used depending on the galenic form, tolerance and access to those medications. The assessment of the risk-benefit balance should be systematic. The heterogeneity of the studies, the little knowledge about the pharmacological mechanism of saliva flow modulation and the unavailability of corrective drugs are different factors contributing to the complexity of therapeutic optimization.
Asunto(s)
Antipsicóticos , Clozapina , Sialorrea , Femenino , Humanos , Masculino , Sialorrea/inducido químicamente , Sialorrea/tratamiento farmacológico , Clozapina/uso terapéutico , Calidad de Vida , Amisulprida/efectos adversos , Escopolamina/uso terapéutico , Antagonistas Colinérgicos/efectos adversos , Antipsicóticos/efectos adversosRESUMEN
AIM: Psychotropic drugs remain frequently prescribed in elderly people. Some of them are classified as « inappropriate ¼ because they could increase the risk of adverse drug reactions. The aim of this study is to evaluate the prevalence of exposure to potentialy inappropriate psychotropic drugs (PIPs) in the elderly living in nursing home residents (EHPAD) in West Occitanie area. METHODS: We carried out a retrospective study on the cohort of PAAPI program (Personne âgée et amélioration des prescriptions inappropriées) participating in PAAPI program set up in West Occitanie in 2016 including 3095 patients during 2 years. PIPs were identified by the list EU(7)PIM and completed with the guidelines mailed by the National Drug Safety Agency. We measured the prevalence of exposure to PIPs in this population. RESULTS: The majority of the residents (n=2301, 74.4%) were female of the average age was 87.1±8.1 years and. The prevalence of exposure to psychotropic drugs was about 77.5% with an average of 1.6 prescription lines per patient (±1,1). We found antidepressants (36.5% of PIP) with mainly paroxetine (37.3% of antidepressants PIP), followed by venlafaxine (32.8%), hypnotics and sedatives (26.6% of PIP) with zopiclone with inappropriate dose (59.4% of hypnotics PIP), anxiolytics (25.8% of PIP) with alprazolam (37.9% of anxiolytics PIP), followed by bromazepam (16%) and antipsychotics (11.2% of PIP) with cyamemazine (100% of inappropriate prescription) followed by aripiprazole and haloperidol (respectively 100% and 14.7% of inappropriate prescription). CONCLUSION: According to our data, third of elderly people in Nursing Homes were exposed to a PIP suggesting that guidelines about psychotropic drugs prescription are not well followed. Then, information campaign of healthcare professionnals could be useful to improve psychotropic drug prescription in the elderly population.
Asunto(s)
Ansiolíticos , Bromazepam , Anciano , Anciano de 80 o más Años , Alprazolam , Antidepresivos , Aripiprazol , Prescripciones de Medicamentos , Femenino , Haloperidol , Humanos , Hipnóticos y Sedantes , Prescripción Inadecuada , Masculino , Paroxetina , Psicotrópicos/efectos adversos , Estudios Retrospectivos , Clorhidrato de VenlafaxinaRESUMEN
OBJECTIVES: The objective was to describe the trends in the consumption of narcotic drugs, substances related to narcotic drugs (SAS) and psychotropic drugs between a French hospital and a Quebec hospital between 2013 and 2017. METHODS: This is a retrospective descriptive study. The consumption data was obtained from the pharmacy management software and was extracted by financial year (January 1st, 2013 to December 31st, 2017 for the French hospital and April 1st, 2013 to March 31st, 2018 for the Quebec hospital). For each drug considered to be narcotics, SAS and psychotropic drugs in France or subject to the legislation on designated substances in Quebec, we identified the quantities consumed from 2013 to 2017. The data werepresented according to the following therapeutic classes: opioids (N02A), other analgesics (N02B), anxiolytics (N05B), hypnotics and sedatives (N05C), general anesthetics (N01A), psychostimulants (N06B), androgens (G03B) and antagonists peripheral opioid receptors (A06A). The data were expressed as a defined daily dose (DDJ) for 1000 patient-days (PDs). RESULTS: In the French hospital, the consumption of narcotics, SAS and psychotropic drugs varied from 676 to 560 DDJ per 1000 PDs between 2013 and 2017. While it varied from 1019 to 756 DDJ per 1000 PDs between 2013 and 2017 in the Quebec hospital. In 2017, the most widely used therapeutic classes in French hospitals were, in decreasing order, anxiolytics (211 DDJ per 1000 PDs) (i.e. alprazolam), opioids (205 DDJ per 1000 PDs) (i.e. tramadol, morphine injectable) and hypnotics and sedatives (64 DDJ per 1000 PDs) (i.e. midazolam injectable). In Quebec hospitals, the three therapeutic classes the most used in 2017 were, in decreasing order, opioids (314 DDJ per 1000 PDs) (i.e. hydromorphone injectable, morphine injectable), anxiolytics (221 DDJ per 1000 PDs) (i.e. clobazam) and hypnotics and sedatives (108 DDJ per 1000 PDs) (i.e. midazolam injectable). CONCLUSION: This study notes a decrease in the consumption of opioids and other substances in both the French and Quebec establishments between 2013-2017. More work is needed to better describe the differences observed between the profile of each establishment. This is why monitoring consumption trends, therapeutic indications and preventive measures are essential.
Asunto(s)
Ansiolíticos , Analgésicos Opioides , Francia/epidemiología , Hospitales , Humanos , Hipnóticos y Sedantes , Midazolam , Derivados de la Morfina , Narcóticos , Psicotrópicos/uso terapéutico , Quebec/epidemiología , Estudios RetrospectivosRESUMEN
The use of psychotropics during the COVID-19 pandemic has raised two questions, in order of importance: first, what changes should be made to pharmacological treatments prescribed to mental health patients? Secondly, are there any positive side effects of these substances against SARS-CoV-2? Our aim was to analyze usage safety of psychotropics during COVID-19; therefore, herein, we have studied: (i) the risk of symptomatic complications of COVID-19 associated with the use of these drugs, notably central nervous system activity depression, QTc interval enlargement and infectious and thromboembolic complications; (ii) the risk of mistaking the iatrogenic impact of psychotropics with COVID-19 symptoms, causing diagnostic error. Moreover, we provided a summary of the different information available today for these risks, categorized by mental health disorder, for the following: schizophrenia, bipolar disorder, anxiety disorder, ADHD, sleep disorders and suicidal risk. The matter of psychoactive substance use during the pandemic is also analyzed in this paper, and guideline websites and publications for psychotropic treatments in the context of COVID-19 are referenced during the text, so that changes on those guidelines and eventual interaction between psychotropics and COVID-19 treatment medication can be reported and studied. Finally, we also provide a literature review of the latest known antiviral properties of psychotropics against SARS-CoV-2 as complementary information.
Asunto(s)
Tratamiento Farmacológico de COVID-19 , Humanos , Pandemias , Psicotrópicos/efectos adversos , SARS-CoV-2RESUMEN
A inclusão dos cuidados em Saúde Mental na Atenção Primária tem ocorrido em diversos países, incluindo o Brasil, para suprir a existência de uma lacuna assistencial. A integração dos serviços é apontada como necessária, mas ao mesmo tempo um grande desafio. O objetivo deste estudo foi realizar a análise exploratória das práticas discursivas sobre o uso dos medicamentos psicotrópicos e das abordagens não farmacológicas para superação de eventos negativos da vida. As entrevistas realizadas com médicos que trabalham na saúde da família, sobre a prática clínica nos cuidados primários em saúde mental, compuseram o corpus da pesquisa. Os dados foram tratados a partir dos pressupostos da análise do discurso. As descrições analíticas foram construídas a partir dos enunciados identificados na formação discursiva da medicalização da vida. Os resultados da análise evidenciaram o pluralismo terapêutico dos psicotrópicos e seus efeitos, com o uso menos frequente das abordagens não farmacológicas; a prescrição exclui tramas sociais mais amplas, captura a potência da vida modulando os comportamentos individuais e coletivos, para que a convivência seja assegurada e legitimada, para garantir o pretenso bem comum.
Inclusion of mental health care into primary care has occurred in several countries, including Brazil, to tackle the lack of assistance. The integration of services is seen as necessary, but at the same time a major challenge. The aim of this study was to conduct an exploratory analysis of discursive practices on the use of psychotropic drugs and non-pharmacological approaches to overcome negative life events. Interviews conducted with physicians working in family health on the clinical practice of primary mental health care made up our research corpus. Data were analyzed based on the assumptions of discourse analysis. The analytical descriptions were built based on the statements identified in the discursive formation of the medicalization of life. The results of the analysis showed the therapeutic pluralism of psychotropics and their effects, less frequently using non-pharmacological approaches. Prescription excludes broader social plots, captures the power of life by modulating individual and collective behavior, so that social life is assured and legitimized, thus ensuring the alleged common good.
L'inclusion des soins de santé mentale dans l'attention primaire se développe dans divers pays, y compris au Brésil, pour combler l'existence d'une lacune assistancielle. L'intégration des services est considérée comme nécessaire, mais également comme un défi. L'objectif de cette étude a été de réaliser l'analyse exploratoire des pratiques discursives sur l'usage des médicaments psychotropes et des approches non pharmacologiques pour surmonter les événements négatifs de la vie. Les entretiens réalisés avec les médecins travaillant en santé familiale à propos de la pratique clinique dans les soins primaires de santé mentale ont composé le corpus de la recherche. Les résultats de l'analyse ont mis en évidence le pluralisme thérapeutique des psychotropes et leurs effets, avec l'usage moins fréquent des approches non pharmacologiques. La prescription exclut des trames sociales plus amples, capture la puissance de la vie en modulant les comportements individuels et collectifs pour que la vie sociale soit assurée et légitimée, pour garantir le prétendu bien commun.
La inclusión de la atención en salud mental en el ámbito de la atención primaria se ha dado en varios países, entre ellos Brasil, para suplir la existencia de un vacío asistencial. La integración de los servicios se considera como necesaria y, al mismo tiempo, como un gran desafío. El objetivo de este estudio fue realizar un análisis exploratorio de las prácticas discursivas sobre el uso de medicamentos psicotrópicos y sobre los abordajes no farmacológicos para superar los eventos negativos de la vida. Las entrevistas a médicos, que trabajan en salud familiar, sobre la práctica clínica en salud mental dentro de la atención primaria, constituyeron el corpus de la investigación. Los datos fueron tratados a partir de los postulados del análisis del discurso. Las descripciones analíticas se construyeron a partir de las declaraciones identificadas en la formación discursiva de la medicalización de la vida. Los resultados del análisis mostraron el pluralismo terapéutico de los psicotrópicos y sus efectos, con un uso menos frecuente de abordajes no farmacológicos, la prescripción excluye tramas sociales más amplias, capta la potencia de la vida modulando os comportamientos individuales y colectivos, para garantizar y legitimar la coexistencia y garantizar el supuesto bien común.
RESUMEN
Geriatric Psychiatry in Nursing Homes in the Canton Basel-Stadt - The View of General Practitioners Abstract. Background: This cross-sectional study intends to examine the potential need for an outpatient geronto-psychiatric service and evaluates GPs' views of the frequency of psychiatric symptoms among residents of nursing homes in the canton of Basel-Stadt, Switzerland. Results: Nine out of ten (89 %) see a need for a geronto-psychiatric service. Two thirds (58,9 %) of them prefer a service available during office hours. GPs estimate that 63 % of their nursing home residents suffer from psychiatric symptoms (dementia in 60 %, depression in 23 %, sleep disorders in 11 %). Antipsychotics are prescribed most often (in 50,6 %). Discussion: GPs in the canton of Basel-Stadt see a need for an outpatient geronto-psychiatric service. Psychiatric symptoms are common among residents of nursing homes.
Asunto(s)
Médicos Generales , Psiquiatría Geriátrica , Anciano , Estudios Transversales , Humanos , Casas de Salud , SuizaRESUMEN
Psychiatric signs and symptoms occur frequently in individuals with central nervous system diseases. Inadequately treated, these comorbid conditions affect patient rehabilitation, compliance with treatment and quality of life. Their management poses a major challenge given the variable efficacy and safety profiles of available psychotropic drugs and increased risk of drug interaction. This review aims to summarize the existing literature on the prescription of psychotropic drugs for management of psychiatric disorders among persons with central nervous system's diseases.
Asunto(s)
Trastornos Mentales , Calidad de Vida , Sistema Nervioso Central , Interacciones Farmacológicas , Humanos , Trastornos Mentales/tratamiento farmacológico , Psicotrópicos/uso terapéuticoRESUMEN
The 2019-20 coronavirus pandemic (SARS-CoV-2; severe acute respiratory syndrome coronavirus 2) has dramatic consequences on populations in terms of morbidity and mortality and in social terms, the general confinement of almost half of the world's population being a situation unprecedented in history, which is difficult today to measure the impact at the individual and collective levels. More specifically, it affects people with various risk factors, which are more frequent in patients suffering from psychiatric disorders. Psychiatrists need to know: (i) how to identify, the risks associated with the prescription of psychotropic drugs and which can prove to be counterproductive in their association with COVID-19 (coronavirus disease 2019), (ii) how to assess in terms of benefit/risk ratio, the implication of any hasty and brutal modification on psychotropic drugs that can induce confusion for a differential diagnosis with the evolution of COVID-19. We carried out a review of the literature aimed at assessing the specific benefit/risk ratio of psychotropic treatments in patients suffering from COVID-19. Clinically, symptoms suggestive of COVID-19 (fever, cough, dyspnea, digestive signs) can be caused by various psychotropic drugs and require vigilance to avoid false negatives and false positives. In infected patients, psychotropic drugs should be used with caution, especially in the elderly, considering the pulmonary risk. Lithium and Clozapine, which are the reference drugs in bipolar disorder and resistant schizophrenia, warrant specific attention. For these two treatments the possibility of a reduction in the dosage - in case of minimal infectious signs and in a situation, which does not allow rapid control - should ideally be considered taking into account the clinical response (even biological; plasma concentrations) observed in the face of previous dose reductions. Tobacco is well identified for its effects as an inducer of CYP1A2 enzyme. In a COVID+ patient, the consequences of an abrupt cessation of smoking, particularly related with the appearance of respiratory symptoms (cough, dyspnea), must therefore be anticipated for patients receiving psychotropics metabolized by CYP1A2. Plasma concentrations of these drugs are expected to decrease and can be related to an increase risk of relapse. The symptomatic treatments used in COVID-19 have frequent interactions with the most used psychotropics. If there is no curative treatment for infection to SARS-CoV-2, the interactions of the various molecules currently tested with several classes of psychotropic drugs (antidepressants, antipsychotics) are important to consider because of the risk of changes in cardiac conduction. Specific knowledge on COVID-19 remains poor today, but we must recommend rigor in this context in the use of psychotropic drugs, to avoid adding, in patients suffering from psychiatric disorders, potentially vulnerable in the epidemic context, an iatrogenic risk or loss of efficiency.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Trastornos Mentales/tratamiento farmacológico , Pandemias , Neumonía Viral , Psicotrópicos/uso terapéutico , Factores de Edad , Antivirales/efectos adversos , Antivirales/uso terapéutico , Biotransformación , COVID-19 , Enfermedades Cardiovasculares/inducido químicamente , Comorbilidad , Continuidad de la Atención al Paciente , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Citocromo P-450 CYP1A2/metabolismo , Interacciones Farmacológicas , Fiebre/inducido químicamente , Francia/epidemiología , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Trastornos Mentales/inducido químicamente , Trastornos Mentales/epidemiología , Preparaciones Farmacéuticas/provisión & distribución , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Psicotrópicos/administración & dosificación , Psicotrópicos/efectos adversos , Psicotrópicos/farmacocinética , Trastornos Respiratorios/inducido químicamente , Medición de Riesgo , SARS-CoV-2 , Cese del Hábito de Fumar , Evaluación de Síntomas , Tratamiento Farmacológico de COVID-19RESUMEN
French recommendations have been proposed for psychotropics use and possible adaptations during the SARS-CoV-2 epidemic. Between uncertainties linked to the lack of data and speculations about possible benefits of psychotropics against the coronavirus, we propose here elements allowing to base the pharmacotherapeutic decisions potentially useful in Covid+ patients with psychiatric disorders.
Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Reposicionamiento de Medicamentos , Pandemias , Neumonía Viral/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Ansiolíticos/efectos adversos , Ansiolíticos/uso terapéutico , Antivirales/efectos adversos , Antivirales/farmacología , Betacoronavirus/efectos de los fármacos , COVID-19 , Comorbilidad , Infecciones por Coronavirus/epidemiología , Disnea/inducido químicamente , Disnea/etiología , Humanos , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/uso terapéutico , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Neumonía Viral/epidemiología , Psicotrópicos/efectos adversos , Psicotrópicos/farmacología , Respiración/efectos de los fármacos , Medición de Riesgo , SARS-CoV-2 , Tratamiento Farmacológico de COVID-19RESUMEN
CONTEXT: Electro-convulsive therapy (ECT) is the most effective treatment for treatment resistant mood disorders and catatonia. ECT also appears to be an effective treatment in combination with clozapine in the context of treatment resistant schizophrenia spectrum disorders. Although increasingly codified (guidelines on indications, contraindications, methods of implementation), the practice of ECT still lacks consensual protocols. The concomitant use of psychotropic and/or non-psychotropic medication is a common situation when ECT treatment is considered. To our knowledge, there is to date no summary of studies or case reports in France, nor any proposal for guidelines concerning the management of medication of the patient to whom ECT sessions are offered. Indeed, several particularities must be considered. This article proposes to specify for each pharmacological class the possible interaction between ECT and medication. A first section of this article will be devoted to non-psychotropic treatments, and a second section to psychotropic treatments. A practical summary table is also provided. METHOD: A review of the literature was conducted including all articles published prior to January 2019 referenced in Pub Med database, combining research with Medical Subject Headings "Electroconvulsive Therapy" and each following pharmacological class: "Cardiovascular Agents" "Bronchodilator Agents" "Bronchoconstrictor Agents" "Theophylline" "Anticoagulants" "Hypoglycemic Agents" "Insulin" "Potassium" "Benzodiazepines" "Valproic Acid" "Carbamazepine" "Lamotrigine" "Lithium" "Antidepressive Agents" "Antipsychotic Agents". RESULTS: After reading the titles, abstracts and whole articles, then searching for additional articles in the references, 50 articles were selected. A summary table summarizing the main risks and proposing a course of action has been produced. DISCUSSION: It is essential to take into account the specificity and the different physiological mechanisms involved in the ECT treatment in order to adjust the associated pharmacological treatments. The prescription for each molecule should be reviewed when ECT treatment is initiated.
Asunto(s)
Fármacos del Sistema Nervioso Central/uso terapéutico , Terapia Electroconvulsiva , Guías de Práctica Clínica como Asunto/normas , Psicotrópicos/administración & dosificación , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Catatonia/epidemiología , Catatonia/terapia , Fármacos del Sistema Nervioso Central/clasificación , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Terapia Combinada/normas , Contraindicaciones , Interacciones Farmacológicas/fisiología , Quimioterapia Combinada/efectos adversos , Quimioterapia Combinada/métodos , Terapia Electroconvulsiva/efectos adversos , Terapia Electroconvulsiva/métodos , Terapia Electroconvulsiva/normas , Humanos , Trastornos del Humor/epidemiología , Trastornos del Humor/terapia , Pautas de la Práctica en Medicina/normas , Psicotrópicos/efectos adversosRESUMEN
Increased consumption of psychotropic drugs has been noted in Brazil and other Western countries in the last few decades for different reasons. The objective of this study was to understand the lived experience of individuals who used psychotropic drugs to cope with the problems faced in daily life. A qualitative study guided by hermeneutic phenomenology was carried out. In-depth interviews were conducted. The experience was grouped into two themes: experience of using psychotropic and the search for non-pharmacological approaches. Psychotropics were considered necessary for regaining a point of equilibrium when the problems faced were recognized as having a high degree of difficulty. In some cases, the drugs were perceived as insufficient for solving the problem, leading or not to the search for alternatives to deal with the difficulty.
O aumento do consumo de psicotrópicos tem sido observado no Brasil e em outros países ocidentais nas últimas décadas, por diferentes razões. O objetivo deste estudo foi compreender a vivência de indivíduos que utilizaram psicotrópicos para lidar com os problemas enfrentados no cotidiano. Um estudo qualitativo guiado pela fenomenologia hermenêutica foi realizado, agrupando-se o resultado em dois temas: experiência com o uso dos psicotrópicos e busca por abordagens não farmacológicas. Os psicotrópicos foram considerados necessários para recuperar um ponto de equilíbrio quando se reconheceram os problemas enfrentados como tendo alto grau de dificuldade. Em alguns casos, os fármacos foram percebidos como insuficientes para solucionar o problema, levando ou não à busca de alternativas para lidar com as dificuldades.
Au cours des dernières décennies, on a observé l'augmentation de la consommation de médicaments psychotropes au Brésil et dans d'autres pays occidentaux pour différentes raisons. L'objectif de cette étude est de comprendre le vécu d'individus qui ont utilisé les psychotropes pour faire face aux problèmes de la vie quotidienne. Une étude qualitative, guidée par la phénoménologie herméneutique, a été réalisée. Le résultat a été divisé en deux thèmes: l'expérience découlant de l'usage de psychotropes et la recherche d'approches non pharmacologiques. Les psychotropes ont été considérés nécessaires pour récupérer un point d'équilibre lorsque les problèmes vécus ont été reconnus comme ayant un degré élevé de difficulté. Dans certains cas, les médicaments se sont révélés insuffisants pour résoudre le problème, entraînant ou pas la recherche d'alternatives pour faire face aux difficultés.
En las últimas décadas y por diferentes razones, se ha observado en Brasil y en otros países occidentales un aumento en el consumo de psicotrópicos. El objetivo de este estudio fue comprender la vivencia de individuos que utilizaron psicotrópicos para enfrentar los problemas del día a día. Se realizó un estudio cualitativo dirigido por la fenomenología hermenéutica. El resultado fue agrupado en dos temas: experiencia con el uso de los psicotrópicos y la búsqueda de enfoques no farmacológicos. Los psicotrópicos fueron considerados necesarios para recuperar un punto de equilibrio cuando los problemas enfrentados fueron reconocidos como problemas de alto grado de dificultad. En algunos casos, los fármacos fueron percibidos como insuficientes para solucionar el problema, llevando o no a la búsqueda de alternativas para enfrentar las dificultades.
In den letzten Jahrzehnten wird ein steigender Konsum von Psychotropika in Brasilien und in anderen westlichen Ländern festgestellt, der auf verschiedenen Faktoren beruht. Ziel dieser Untersuchung war es, die Lebensweise von Personen zu verstehen, die psychotropische Medikamente benutzen, um Alltagsprobleme zu meistern. Basierend auf der hermeneutischen Phänomenologie wurde dazu eine qualitative Untersuchung durchgeführt. Das Ergebnis wurde in zwei Themen eingeteilt: Erfahrungen mit der Benutzung von Psychotropika und die Suche nach nicht-pharmakologischen Ansätzen. Die Psychotropika wurden als notwendig betrachtet, um ein Gleichgewicht wiederherzustellen, wenn Probleme mit hohem Schwierigkeitsgrad zu meistern waren. In einigen Fällen wurden diese als unzureichend empfunden, was zur Suche nach Alternativen führte, um mit diesen Problemen umzugehen.
RESUMEN
An elderly person's use of alcohol can conceal undernutrition, cognitive decline due to dementia or depression. Caregivers have an important role to play with these patients in distress. It is necessary to help them regain their self-esteem and to support their will to live to restore the relationship with others.
Asunto(s)
Trastornos Relacionados con Alcohol/terapia , Anciano , Trastornos Relacionados con Alcohol/etiología , Humanos , Psicotrópicos , Trastornos Relacionados con Sustancias/etiología , Trastornos Relacionados con Sustancias/terapiaRESUMEN
PURPOSE: There are differences between recommendations and practice in the pharmacological treatment of acute mania. OBJECTIVE: The objective was to assess conformity of the anti-manic prescription between national recommendations (Haute Autorité de santé [French health authority, HAS] and "résumé des caractéristiques du produit" [product characteristics, RCP]) and clinical practice. METHODS: We observed the drug prescriptions of in-patients for a manic episode. The main outcome measure was the concordance rate with the recommendations of the drugs prescriptions at the 48th hour. The secondary outcome repeated the same process with the hospital discharge statement of switches, associations, the presence of symptomatic and antidepressant treatments. RESULTS: Sixty-six episodes were included, 40 patients (60%) had a prescription complies with RCP recommendations H48 and 46 patients (70%) to HAS. These rates fall at hospital discharge. CONCLUSIONS: Off-label prescriptions, drug combinations and choices of not listed molecules are the most common reasons for non-conformity.
Asunto(s)
Antipsicóticos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Adhesión a Directriz , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We have conducted in two nursing homes a survey to study the impact of meprobamate's withdrawal, at the beginning of 2012, in terms of extent of prescribing to others psychotropic drugs and occurrence of adverse events. After meprobamate's withdrawal, 65 % of residents did not receive alternative medication and within three months after meprobamate stopping, adverse events (drowsiness, falls and hospitalization) decreased while agitation did not increase.