Polypharmacy in psychiatric inpatients: Data from amsp (arzneimittelsicherheit in der psychiatrie), a european pharmacovigilance system

2011 ◽  
Vol 26 (S2) ◽  
pp. 591-591
Author(s):  
A. Konstantinidis ◽  
M. Letmaier ◽  
R. Grohmann ◽  
P. Stephan ◽  
R. Engel ◽  
...  
Keyword(s):  
Psychotropic Drugs ◽  
Routine Clinical Practice ◽  
High Rate ◽  
Pharmacovigilance System ◽  
Psychotropic Agents ◽  
Icd 10 ◽  
Positive Results ◽  
Study Center ◽  
Diagnosis Age ◽  
Age And Sex

IntroductionPsychotropic polypharmacy is widely used in routine clinical practice although there is still a substantial deficit in established knowledge about combination and augmentation treatments. Polypharmacy is related with a higher risk of adverse drug reactions and incompliance.MethodsOn two reference days per hospital and per year, the following data are recorded for all patients on the wards under AMSP surveillance: all drugs applied on that day with the daily dosage for psychotropic drugs, ICD diagnosis, age, and sex. Data is stored at the study center in Munich. We evaluated data from 2000 (N = 5669) and 2007 (N = 8346).ResultsFrom 2000 to 2007 inpatient prescriptions including three or more drugs increased significantly from 59.4% to 69.3% (chi2: 144.913; df:1; p < 0.001). Furthermore the percentage of inpatients being prescribed three or more psychotropics increased significantly from 36.5% in 2000 to 47.97% in 2007 (chi2: 180.01; df:1; p < 0.001).Investigating further, which inpatients, diagnosed according to ICD-10, tend to be treated with more than two psychotropics, we found that this was more common in inpatients, who had an F2., F3. or F9. ICD-10 diagnosis. Especially inpatients with a bipolar disorder (F31.) showed an extremely high rate for psychotropic polypharmacy with three or more psychotropic drugs, with rates of 63,8% in 2000 and 75,2% in 2007.ConclusionPolypharmacy is still gaining ground. Our results show that psychotropic agents are commonly used in combination; therefore further studies evaluating assumable positive results of psychotropic combinations are needed.

Bipolar treatment in everyday practice - the European perspective; data from the international AMSP program

2011 ◽  
Vol 26 (S2) ◽  
pp. 2027-2027
Author(s):  
A. Konstantinidis ◽  
R. Grohmann ◽  
M.E. Friedrich ◽  
W. Greil ◽  
S. Kasper
Keyword(s):  
Bipolar Disorder ◽  
Valproic Acid ◽  
Bipolar Depression ◽  
Lithium Carbonate ◽  
European Perspective ◽  
Time Period ◽  
Median Dosage ◽  
Psychotropic Agents ◽  
Diagnosis Age ◽  
Age And Sex

In the last decade new psychotropic agents have been licensed for the treatment of bipolar depression and mania. We wanted to evaluate if this led to changes in psychotropic prescriptions for bipolar-inpatients over the time-period from 2000 to 2007.On two reference-days per hospital and per year, the following data are recorded for all patients on the wards under AMSP surveillance: all drugs applied on that day with the daily dosage for psychotropic drugs, ICD-diagnosis, age, and sex. In our analysis we evaluated data from 2000 (N = 210) and 2007 (N = 383).We found a decrease of psychotropic monotherapy from 13.8% in 2000 to 4.7% in 2007. The percentage of inpatients receiving 5 or more psychotropics increased significantly from 10.95% in 2000 to 22.19% in 2007 (chi2: 11.199, df:1, p < 0.001). Furthermore we found a significant decrease of prescriptions for one or two psychotropics (38.89% to 16.38%) in bipolar-depressed-inpatients, but not in bipolar-hypo/manic-inpatients (chi2: 17.929, df:1, p < 0.001). The most frequently prescribed psychotropic in bipolar depression in 2000 was lithium-carbonate (median-dosage: 675 mg/day) and in 2007 valproic-acid (median-dosage: 1000 mg/day). In bipolar hypo-/mania the most commonly prescribed psychotropic in 2000 was again lithium-carbonate (median-dosage: 675 mg/day) and in 2007 valproic-acid (median-dosage: 1500 mg/day). The most frequently prescribed combinations were those of cbamazepine with lithium-carbonate (4.76%) in 2000 and of valproic-acid with quetiapine (8.88%) in 2007.In our bipolar sample polypharmacy increased over the years. Further studies evaluating the safety of this polypharmacy, as well as putative effects of psychotropic combination-treatment in bipolar disorder are needed.

High Rate of Negative Results of Tuberculin and QuantiFERON Tests Among Individuals With a History of Positive Skin Test Results

2006 ◽  
Vol 27 (5) ◽  
pp. 436-441 ◽  
Author(s):  
Lloyd N. Friedman ◽  
Esther R. Nash ◽  
June Bryant ◽  
Susan Henry ◽  
Julia Shi ◽  
...  
Keyword(s):  
Skin Test ◽  
Significant Proportion ◽  
High Rate ◽  
Negative Group ◽  
Tuberculosis Screening ◽  
Positive Skin ◽  
Screening Programs ◽  
History Of ◽  
Positive Results

Objectives.To evaluate individuals at high risk for tuberculosis exposure who had a history of a positive tuberculin skin test (TST) result in order to determine the prevalence of unsuspected negative TST results. To confirm these findings with the QuantiFERON-TB test (QFT), an in vitro whole-blood assay that measures tuberculin-induced secretion of interferon-γ.Methods.This survey was conducted from November 2001 through December 2003 at 3 sites where TST screening is regularly done. Detailed histories and reviews of medical records were performed. TSTs were placed and read by 2 experienced healthcare workers, and blood was drawn for QFT. Any subject with a negative result of an initial TST during the study (induration diameter, <10 mm) underwent a second TST and a second QFT. The TST-negative group comprised individuals for whom both TSTs had an induration diameter of <10 mm. The confirmed-negative group comprised individuals for whom both TSTs yielded no detectable induration and results of both QFTs were negative.Results.A total of 67 immunocompetent subjects with positive results of a previous TST were enrolled in the study. Of 56 subjects who completed the TST protocol, 25 (44.6%; 95% confidence interval [CI], 31.6%-57.6%) were TST negative (P<.001). Of 31 subjects who completed the TST protocol and the QFT protocol, 8 (25.8%; 95% CI, 10.4%-41.2%) were confirmed negative (P<.005).Conclusions.A significant proportion of subjects with positive results of a previous TST were TST negative in this study, and a subset of these were confirmed negative. These individuals' TST status may have reverted or may never have been positive. It will be important in future studies to determine whether such individuals lack immunity to tuberculosis and whether they should be considered for reentry into tuberculosis screening programs.

All-Cause Mortality of Hospital-Treated Borderline Personality Disorder: A Nationwide Cohort Study

2020 ◽  
Vol 34 (6) ◽  
pp. 723-735 ◽  
Author(s):  
Jesper N⊘rgaard Kjær ◽  
Robert Biskin ◽  
Claus Vestergaard ◽  
Povl Munk-J⊘rgensen
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mortality Rate ◽  
Borderline Personality ◽  
High Rate ◽  
Standardized Mortality Ratio ◽  
Central Research ◽  
Emergency Rooms ◽  
Icd 10 ◽  
Mortality Ratio

Patients with borderline personality disorder (BPD) are known to present frequently in emergency rooms, and they have a high rate of suicide. The mortality rate of patients with BPD is still unclear. The Danish Psychiatric Central Research Register and The Danish Register for Causes of Death were used to identify patients with a first-ever diagnosis of BPD (ICD-10: F60.31) from 1995 through 2011 together with time and cause of death. A total of 10,545 patients with a BPD diagnosis were followed for a mean time of 7.98 years. A total of 547 deaths were registered. The standardized mortality ratio of patients with BPD compared to the general population was 8.3 (95% CI [7.6, 9.1]). More than three inpatient admissions per year or a comorbid diagnosis of substance use disorder correlated with a higher mortality rate. The increased mortality rate in patients with BPD treated in secondary care emphasizes that it is a severe mental disorder.

Low Rate of False-Positive Results with Use of A Rapid HIV Test

2002 ◽  
Vol 23 (6) ◽  
pp. 335-337 ◽  
Author(s):  
Cassandra D. Salgado ◽  
Heidi L. Flanagan ◽  
Doris M. Haverstick ◽  
Barry M. Farr
Keyword(s):  
Enzyme Immunoassay ◽  
False Positive ◽  
Diagnostic System ◽  
Rapid Test ◽  
Occupational Exposures ◽  
High Rate ◽  
Negative Results ◽  
Hiv Test ◽  
Rapid Hiv Test ◽  
Positive Results

Background:Occupational exposure to human immunodeficiency virus (HIV) is an important threat to healthcare workers. Centers for Disease Control and Prevention guidelines recommend prompt institution of prophylaxis. This requires (1) immediate prophylaxis after exposure, pending test results that may take more than 24 hours in many hospitals; or (2) performance of a rapid test. The Single Use Diagnostic System (SUDS)® HIV-1 Test is used to screen rapidly for antibodies to HIV type 1 in plasma or serum, with a reported sensitivity of more than 99.9%. We used this test from January 1999 until September 2000, when it was withdrawn from the market following reports claiming a high rate of false-positive results.Methods:We reviewed the results of postexposure HIV testing during 21 months.Results:A total of 884 SUDS tests were performed on source patients after occupational exposures (883 negative results, 1 reactive result). The results of repeat SUDS testing on the reactive specimen were also reactive, but the results of enzyme immunoassay and Western blot testing were negative. A new specimen from the same patient showed a negative result on SUDS testing. This suggested a specificity of 99.9%. In the 4 months after SUDS testing was suspended, there was 1 false-positive result on enzyme immunoassay for 1 of 132 source patients (presumed specificity, 99.2%).Conclusion:Use of the SUDS test facilitated rapid and accurate evaluation of source specimens, obviating unnecessary prophylaxis.

Treatment versus Enhancement

2018 ◽  
pp. 392-394
Author(s):  
S. Nassir Ghaemi
Keyword(s):  
Psychotropic Drugs ◽  
The Body ◽  
Therapeutic Interventions ◽  
Disease Models ◽  
Biomedical Model ◽  
Psychological Traits ◽  
Medication Treatment ◽  
Functional Loss ◽  
Psychotropic Agents ◽  
The Individual

The concept of “treatment” is based on a “biomedical” model of disease. In this model, illness represents a breakdown of the physical constituents of the body, leading to a functional loss of a capacity to perform typical activities of the organism. The proponent of the “enhancement” approach to the therapy of depression comes at the problem from other disease models. Any of the alternative non-biomedical models imply the conclusion that therapeutic interventions in depression should seek to enhance the functioning of the individual, rather than simply to permit redress of loss of functioning. Therefore, besides using psychotropic drugs for treatment of symptoms, many patients and clinicians seek psychotropic drugs to enhance normally variable psychological traits. This enhancement approach to practice appears to be most active in relation to the use of amphetamines to heighten attention, energy, and libido, as well as to lose weight. The use of psychotropic agents for such nonmedical uses raises some ethical questions, as well as contradicting the Hippocratic tradition of focusing medication treatment on diseases.

scholarly journals Newborn Screening for Cystic Fibrosis by Use of a Multiplex Immunoassay

2010 ◽  
Vol 56 (3) ◽  
pp. 445-450 ◽  
Author(s):  
Barbara A Lindau-Shepard ◽  
Kenneth A Pass
Keyword(s):  
Cystic Fibrosis ◽  
Newborn Screening ◽  
Screening Program ◽  
Pancreatic Disease ◽  
High Rate ◽  
Dna Testing ◽  
Second Tier ◽  
Sample Set ◽  
Positive Results ◽  
Immunoreactive Trypsinogen

Abstract Background: Since its beginnings, newborn screening for cystic fibrosis (CF) using an assay for immunoreactive trypsinogen (IRT) has been plagued by a high rate of false-positive results (screen positive, diagnosis negative), despite attempts to reduce this rate by use of altered cutoffs and second-tier DNA testing. IRT exists as 2 isoforms: IRT1 and IRT2, with IRT2 being more closely aligned with pancreatic disease, including CF. Assay standardization between programs is a continuing problem because the IRT assays currently in use variously recognize either 1 or both isoforms. Here we report the development of a multiplexed assay for both forms of IRT simultaneously. Methods: Using 2 different Luminex bead sets, we developed assays for each IRT isoform separately and then combined them. Using the sum of IRT1 and IRT2 values (IRT1+IRT2), we compared the results with a CF kit currently in use. Results: In a sample set consisting of 16 cases confirmed positive for CF, we established a cutoff at &gt;97 μg/L total IRT. Seven of 8 carriers with 1 CF mutation screen-positive by the standard method were also screen-positive by IRT1+IRT2. Of 32 cases screen-positive by standard IRT, 11 were screen-negative by IRT1+IRT2. None of these 11 cases had CF mutations identified by the screening program. Conclusions: These data indicate that the multiplex method with specificity for 2 isoforms of IRT has performance comparable to that of a standard IRT method and the advantage of improved standardization by detection of the 2 isoforms.

scholarly journals Assessment of Campylobacter fetus subsp. venerealis molecular diagnosis using clinical samples of bulls

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Marta Filipa Silva ◽  
Ana Duarte ◽  
Gonçalo Pereira ◽  
Luísa Mateus ◽  
Luís Lopes-da-Costa ◽  
...  
Keyword(s):  
False Positive ◽  
Bacterial Species ◽  
Venereal Disease ◽  
High Rate ◽  
Clinical Samples ◽  
Campylobacter Fetus ◽  
Subspecies Level ◽  
Geographical Regions ◽  
Pcr Assays ◽  
Positive Results

Abstract Background Campylobacter fetus subsp. venerealis (Cfv) is the pathogen responsible for Bovine Genital Campylobacteriosis (BGC), a venereal disease of cattle associated with impaired reproductive performance. Although several PCR assays were developed to identify this pathogen, most of them are still poorly evaluated in clinical samples. This study evaluated real-time PCR assays for Cfv detection in preputial samples of bulls (n = 308). Results The detection at the subspecies level (Cfv) compared four assays: two targeting ISCfe1 and two targeting parA gene. The detection at the species level (C. fetus) considered an assay targeting the nahE gene and a commercial kit for C. fetus identification. At the subspecies level, assays directed either to different targets (parA and ISCfe1), or to the same target (ISCfe1 or parA), showed a high percentage of disagreeing results. All samples positive at the subspecies level (n = 169) were negative in C. fetus detection assays, which strongly suggests the horizontal gene transfer of ISCfe1 and parA to other bacterial species. This was confirmed by microbiological isolation of three Campylobacter portucalensis strains responsible for false positive results. Sequences with a high level of identity with ISCfe1 and parA gene of Cfv were identified in C. portucalensis genome. Conclusions Overall, this study reveals that PCR assays solely directed to a subspecies target originate a high rate of false positive results, due to the presence of parA and ISCfe1 homologous sequences in other bacterial species, namely of the genus Campylobacter. Although the specificity of these methods may be higher if applied to bulls from herds with clinical features of BGC or in other geographical regions, current PCR diagnosis should couple subspecies and species targets, and further research must be envisaged to identify Cfv specific molecular targets.

scholarly journals Balantidiasis, a zoonotic protozoan infection, in cattle and domestic pigs

2019 ◽  
Vol 1 (17) ◽  
Author(s):  
T. R. Paul ◽  
N. Begum ◽  
M. Shahiduzzaman ◽  
M. S. Hossain ◽  
S. S. Labony ◽  
...  
Keyword(s):  
The Other ◽  
High Rate ◽  
Dilution Technique ◽  
Adult Cattle ◽  
Balantidium Coli ◽  
Protozoan Infection ◽  
Faecal Samples ◽  
High Prevalence ◽  
Opportunistic Protozoa ◽  
Age And Sex

Background: Balantidium coli, is a common -opportunistic protozoa of man and animals which causes gastroenteritis. A study was conducted to ascertain the prevalence of balantidiasis in cattle and pig irrespective of age and sex. Methods: In total, 200 faecal samples (150 cattle and 50 pigs) were collected during July to December, 2016 in Mymensingh district, Bangladesh and Modified Stoll’s Ova dilution technique was used to screen the faecal samples for B. coli under microscope. The cysts or trophozoites of B. coli were identified based on the morphological features using standard keys. Results: B. coli cysts and/or trophozoites were detected in 103 samples (51.5%), where comparatively high prevalence was observed in cattle (54.7%) than pig (42.0%). Prevalence of balantidiasis was significantly high in adult cattle (70.4%) compared to that of young (40.5%) and calves (31.3%) while the piglet (65.0%) showed high prevalence than the grower (31.3%) and adult (21.4%). In cattle, high rate of infection was recorded in female (58.8%) than male cattle (45.8%) which was statistically insignificant. On the other hand, high rate of infections was recorded in male pigs (54.5%) than female pigs (32.1%). Conclusion: In conclusion, the present study revealed high circulation of B. coli in cattle and pig in Mymensingh district, which poses potential threats to both animal and public health.

scholarly journals Prevalence of insomnia in elderly and drug prescriptions

2014 ◽  
Vol 5 (1) ◽  
pp. 5-12
Author(s):  
Consuelo Ibañez ◽  
Diego R. Dueñas ◽  
Mª Rosa Sánchez-Waisen
Keyword(s):  
Older People ◽  
Sleep Disorders ◽  
Psychotropic Drugs ◽  
Well Being ◽  
The Elderly ◽  
Medical Comorbidity ◽  
High Demand ◽  
Health And Well Being ◽  
Very High ◽  
Diagnosis Age

Sleep disorders are very frequent in the elderly and it affects health and well-being of older people. Some authors estimate that the prevalence of insomnia in the elderly is very high, close to 60%. Sleep disorders in the elderly are frequent and it causes high demand for care. Some authors think that it will affect a lot in health of older people and those who take care of them. This could bring an increase of institutionalization. With this work we wanted to measure prevalence of insomnia in those chronic and psychogeriatric patients who are in nursing-homes, and which psychotropic drugs are prescribed for control it. In addition, we have studied if there is significant relationship between psychiatric diagnosis, neurologic diagnosis, age or sex, medical comorbidity, and the presence of insomnia.

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