PSYCHOTROPIC MEDICATION WITH CHILDREN: AN EVALUATION OF PROCEDURAL BIASES IN RESULTS OF REPORTED STUDIES

PEDIATRICS ◽  
1973 ◽  
Vol 51 (3) ◽  
pp. 513-517
Author(s):  
Stephen I. Sulzbacher
Keyword(s):  
Behavior Change ◽  
Research Design ◽  
Psychotropic Medication ◽  
Clinical Results ◽  
Psychotropic Medications ◽  
Treatment Plans

A review was conducted of 753 studies on the effects of drugs on learning or behavior in children published between January 1937 and March 1971. The studies were arranged in categories based on research design, measures of behavior change, and whether clinical results were reported as significant. The analysis of these studies suggests that research design and the measure of behavior change exert a biasing influence on the degree of reported efficacy of the psychotropic medications. These factors should be taken into account when interpretations of published reports are used to decide upon treatment plans with such medications.

scholarly journals Implementing an Interdisciplinary Committee to Reduce Psychotropic Drug and Increase Behavioral Intervention Use

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 306-306
Author(s):  
Lauren Hess Conrad ◽  
David Portman
Keyword(s):  
Psychotropic Drug ◽  
Behavioral Intervention ◽  
Psychotropic Medication ◽  
Behavioral Interventions ◽  
Psychotropic Medications ◽  
Interdisciplinary Treatment ◽  
Fiscal Year ◽  
Term Care ◽  
Care Plans ◽  
And Behavior

Abstract In Fiscal Year (FY) 2018, the Butler VA Health Care System’s Psychotropic Medication and Behavior Management Committee was identified as a Veterans Integrated Service Network 4 Best Practice. The goal of this committee is to reduce unnecessary psychotropic medication use and polypharmacy and to increase behavioral intervention implementation among Community Living Center (CLC) Veterans. This committee meets quarterly to review Psychotropic Drug Safety Initiative data, behaviors and behavior care plans, and all psychotropic medications prescribed to Veterans. Psychiatric diagnoses, changes to psychotropic medications, and appropriate behavioral interventions are discussed. Committee members take responsibility for action items in accordance with their discipline; documentation of recommendations are made in quarterly behavioral health assessments in CPRS; and follow-up on action items is completed at twice weekly interdisciplinary treatment team meetings, weekly behavior rounds, and/or as needed. From the first quarter (Q1) of FY16 to Q1 FY20, the Butler VA CLC has seen decreased prescriptions of 2 or more anticholinergics (6.6% to 0.80%), antihistamines (12.5% to 5.9%), benzodiazepines (24.7% to 11.0%), and benzodiazepines or sedative hypnotics (23.2% to 9.0%). While prescription of antipsychotic use has increased (Q1 FY20 = 23.8%), the committee will follow Long Term Care Institute guidelines for gradual dose reductions, behavioral interventions, and as needed psychotropic medication PRN use. This committee provides an interdisciplinary forum to discuss and implement beneficial changes to pharmacological and non-pharmacological interventions among all CLC Veterans. The committee is a valuable process for monitoring and reinforcing best practices that may be easily replicated across VA CLCs nationwide.

PRN Medication for Psychiatric Inpatients

1987 ◽  
Vol 32 (3) ◽  
pp. 199-203 ◽  
Author(s):  
John L. Craven ◽  
Peter M. Voore ◽  
George Voineskos
Keyword(s):  
Personality Disorder ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Teaching Hospital ◽  
Psychotropic Medication ◽  
Psychotropic Drugs ◽  
Psychiatric Inpatient ◽  
Psychiatric Inpatients ◽  
Psychotropic Medications ◽  
Inpatient Units

Little is known about the extent of the use of prn psychotropic medication in psychiatric inpatient units. A survey of the prn prescription and administration of psychotropic drugs in a psychiatric teaching hospital revealed that a large number of inpatients were prescribed and administered such drugs on a prn basis. Although 50% of the prescriptions were never administered, only 25% were actively discontinued by physicians. A diagnosis of personality disorder was the factor most frequently associated with the rate of prn prescriptions and of administrations. A large number of prn prescriptions had no instructions for indications, minimum time spacing between doses or maximum daily dosage. It is suggested that hospitals monitor the prn use of psychotropic medications in their inpatient units, and explore the reasons for such use. Psychotropic drug use on a prn basis should preferably be reserved for emergencies, and the instructions of prn prescriptions should be clear and detailed.

scholarly journals An audit to look at the prescribing of psychotropic medication in the general adult inpatient setting in patients with emotionally unstable personality disorder

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S31-S31
Author(s):  
Declan Hyland ◽  
Charlie Daniels ◽  
Iulian Ionescu ◽  
Christina Houghton ◽  
Katie Goodier ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Psychotropic Medication ◽  
Psychotropic Medications ◽  
Inpatient Setting ◽  
Mood Stabiliser ◽  
Supportive Psychotherapy ◽  
Psychiatric Comorbidities ◽  
Prescribing Practice ◽  
Medication Prescribing ◽  
Emotionally Unstable Personality Disorder

AimsTo assess the frequency of prescription of psychotropic medication in patients with a primary diagnosis of emotionally unstable personality disorder (EUPD) following admission to Clock View Hospital, an inpatient unit in Mersey Care NHS Foundation Trust.MethodA retrospective analysis of the electronic (RiO) record of 50 patients discharged from Clock View Hospital between 1 January 2020 and 1 November 2020 was performed to assess prescribing practice.Twenty-five patients with a diagnosis of EUPD and no associated psychiatric comorbidities were included in the sample, as well as 25 patients with a diagnosis of EUPD and associated psychiatric comorbidities.Result80% of the 25 patients with EUPD and associated psychiatric comorbidities were prescribed psychotropic medication prior to admission to hospital (56% an antidepressant, 24% a mood stabiliser, 60% an antipsychotic and 8% a benzodiazepine). 64% of patients were prescribed two or more psychotropic medications. 28% were initiated on new psychotropic medications following admission. For four of the seven prescriptions commenced on psychotropic medication, prescribing practice was as advised in Mersey Care's EUPD guidelines.Of the 25 patients with EUPD and no associated psychiatric comorbidities, 96% of the patients were prescribed psychotropic medication prior to admission to hospital (56% an antidepressant, 20% a mood stabiliser, 72% an antipsychotic and 12% a benzodiazepine). 68% of patients were prescribed two or more psychotropic medications. Following admission, 28% of patients were initiated on new regular psychotropic medications. For five of the eight prescriptions for new psychotropic medication, prescribing practice was as advised in Mersey Care's EUPD guidelines.78% of the 50 patients were prescribed as required (PRN) psychotropic medication. In 21 patients, PRN medication was prescribed for longer than one week.ConclusionThere is a higher rate of prescribing of antipsychotic prescription in those EUPD patients with no psychiatric comorbidities compared to associated psychiatric comorbidities (72% vs 60%). Surprisingly, there was a lower rate of psychotropic polypharmacy in those with psychiatric comorbidities.Use of PRN psychotropic medication for longer than a week was higher in those patients with psychiatric comorbidities compared to those without psychiatric comorbidities (58% vs 50%). Benzodiazepines were overwhelmingly the most consistently prescribed PRN medication for patients with EUPD.One action to consider would be highlighting the importance of trialling psychologically-minded interventions and supportive psychotherapy prior to initiation of psychotropic medication. There also needs to be consideration to use of the sedative antihistamine promethazine as a first-line PRN medication for acute agitation.

scholarly journals Remote psychotropic medication advice for general practitioners: a quality improvement project

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S212-S213
Author(s):  
Emily Rackley ◽  
Rosemary King
Keyword(s):  
Confidence Interval ◽  
General Practitioners ◽  
Nurse Practitioners ◽  
Psychotropic Medication ◽  
Response Rate ◽  
Psychotropic Medications ◽  
Improvement Project ◽  
Email Address ◽  
Initial Survey ◽  
Relative Change

AimsOur first aim was to first find out how confident general practitioners were about referring in to the Gloucester Recovery Team and managing psychotropic medications. Our second aim was to then improve general practitioner's self-rated scores of confidence in managing psychotropic medication whilst also improving general practitioner's satisfaction with waiting times for patient's referred to the Gloucester Recovery Team.MethodWe planned to introduce an email address for GPs to use to seek medication and diagnostic advice for patients known to and not known to the Recovery Team. We initially introduced this for the ‘Team 2’ catchment area consisting of five practices within Gloucester. These were then read and replied to by the Team 2 consultant, Dr Ikram, as appropriate. A further survey was then sent out.. These results provided both quantitative ordinal data through a likert scale, which was then transformed into binomial data, such as those scoring ‘extremely confident’ ‘very confident’ ‘somewhat confident’ vs ‘not so confident’ and ‘not confident at all’ which is then compared using relative risk.ResultOur response rate for our initial survey was 8 general practitioners, and for our follow-up survey 1 general practitioner and 2 nurse prescribers. Confidence in continuing psychotropic medications increased from 7 out of the 8 (78%) stating somewhat confident to extremely confident to 3 out of the 3 (100%) after the introduction of the email; a relative change of 1.14 (95% confidence interval 0.87-1.48 p = 0.318). Confidence in initiating psychotropic medications increased from 4 out of the 8 (50%) stating somewhat confident to extremely confident to 2 out of the 3 (66%) after the introduction of the email; a relative change of 1.33 (95% confidence interval 0.46-3.84 p = 0.594).ConclusionAnalysing the qualitative data showed the email address was used for a variety of requests and advice including: 1) A capacity assessment, 2) Initiating medications for depression and anxiety, 3) Medications during pregnancy, 4) Medication for those with Intellectual Disability, 5) Switching medication, 6) Medications for poor sleep and 7) Mood stabilising medication.This change appeared to be well received, however the response rate was very low which makes full analysis difficult. We also included nurse practitioners working in primary mental health in our second survey, whereas the initial survey was only sent to GPs. This initiative was also only started for 5 of the GP practices within Gloucester, and there may be a different knowledge base/confidence amongst the other practices.

Narratives of Research Design

2020 ◽  
pp. 40-72
Author(s):  
Jennifer Lynne Bird ◽  
Eric T. Wanner
Keyword(s):  
Physical Therapy ◽  
Patient Education ◽  
Research Design ◽  
New Technology ◽  
Medical Clinic ◽  
Working Together ◽  
Treatment Plans ◽  
Positive Outlook

The authors explain the design of a survey that provides a new technology for physical therapy clinicians to use while treating patients. The survey dovetails knowledge from the fields of writing and medicine to provide a resource for patient education. In a medical clinic, a patient is asked to numerically rate how he or she feels; however, the new survey discussed not only looks at how patients feel numerically, but also how they subjectively feel using writing. This survey is a new tool that encourages communication between patients and clinicians, makes patients more aware of what they are feeling when they write down responses, and helps clinicians adjust treatment plans when they read what the patients write. Through writing, patients become accountable for their actions and increase their education. The authors focus on the connections among writing, positive outlook, and healing, as well as the lessons they learned from working together and discussing their fields of expertise.

scholarly journals The Potential Utility of Pharmacogenetic Testing in Psychiatry

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Kathryn R. Gardner ◽  
Francis X. Brennan ◽  
Rachel Scott ◽  
Jay Lombard
Keyword(s):  
Genetic Testing ◽  
Patient Outcomes ◽  
Healthcare Costs ◽  
Clinical Utility ◽  
Psychiatric Patients ◽  
Psychotropic Medications ◽  
Pharmacogenetic Testing ◽  
Wide Range ◽  
Treatment Plans ◽  
Varied Response

Over the last decade, pharmacogenetics has become increasingly significant to clinical practice. Psychiatric patients, in particular, may benefit from pharmacogenetic testing as many of the psychotropic medications prescribed in practice lead to varied response rates and a wide range of side effects. The use of pharmacogenetic testing can help tailor psychotropic treatment and inform personalized treatment plans with the highest likelihood of success. Recently, many studies have been published demonstrating improved patient outcomes and decreased healthcare costs for psychiatric patients who utilize genetic testing. This review will describe evidence supporting the clinical utility of genetic testing in psychiatry, present several case studies to demonstrate use in everyday practice, and explore current patient and clinician opinions of genetic testing.

Attitudes toward Psychotropic Medications

2012 ◽  
Vol 110 (2) ◽  
pp. 475-476 ◽  
Author(s):  
Stephanie A. Fife ◽  
Kay E. Ketzenberger ◽  
James N. Olson
Keyword(s):  
Substance Abuse ◽  
Psychotropic Medication ◽  
Psychotropic Medications ◽  
Attitudes And Beliefs ◽  
Psychiatric Outpatients ◽  
Negative Attitudes ◽  
Beliefs About Medicines ◽  
Attitude Inventory ◽  
Drug Attitude Inventory ◽  
Buprenorphine Treatment

Attitudes and beliefs towards psychotropic medication were evaluated among psychiatric outpatients, patients receiving buprenorphine treatment for substance abuse, and a group who reported never having used psychotropic medications (non-users). The Drug Attitude Inventory scale and the Beliefs about Medicines Questionnaire General were used to assess attitudes and beliefs of 49 participants. Non-users exhibited more negative attitudes and beliefs toward psychotropic medication than both psychiatric groups.

Placebos in Clinical Trials of Psychotropic Medication

1997 ◽  
Vol 42 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Donald Addington ◽  
Richard Williams ◽  
Yvon Lapierre ◽  
Nady El-Guebaly
Keyword(s):  
Clinical Trials ◽  
Side Effects ◽  
High Risk ◽  
Psychotropic Medication ◽  
Psychotropic Drugs ◽  
Placebo Response ◽  
Response Rates ◽  
Psychotropic Medications ◽  
Placebo Controls

This paper represents the position of the Canadian Psychiatric Association on the ethical and scientific issues related to the use of placebos in the evaluation of new psychotropic drugs. The position taken by the Association is that new psychotropic medications must be shown to be effective and must be weighed against the best current interventions. Placebo controls may be appropriate under certain circumstances, even when an established intervention is effective. These include situations in which placebo response rates are high, variable, or close to response rates for effective therapies. Placebo controls arc also appropriate when established interventions cany a high risk of side effects or are effective against only certain symptoms of the disorder.

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

2021 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Psychotropic Medication ◽  
Qualitative Data ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n=31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n=27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medication, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

scholarly journals Trends in Psychotropic Medication Prescriptions in Urban China From 2013 to 2017: National Population-Based Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Lu Xu ◽  
Xiaozhen Lv ◽  
Huali Wang ◽  
Qingjing Liu ◽  
Shuzhe Zhou ◽  
...  
Keyword(s):  
Psychotropic Medication ◽  
Developed Countries ◽  
Population Based ◽  
Psychotropic Medications ◽  
Urban China ◽  
Mood Stabilizers ◽  
World Health ◽  
Population Based Study ◽  
National Population ◽  
Adhd Medications

Purpose: Psychotropic medications are commonly used for treating mental disorders; however, there is currently no study on how commonly they are used in China. This study reported the trends in psychotropic medications prescriptions in urban China.Methods: A national population-based study was conducted using the China Health Insurance Research Association database to estimate the period prescription prevalence of 11 major classes of psychotropic medications annually during 2013–2017. The World Health Organization Anatomical Therapeutic Chemical (ATC) classification codes were used to identify psychotropic medications.Results: The prescription prevalence of any psychotropic medication increased from 8.110% (8.106–8.114%) in 2013 to 11.362% (11.357–11.366%) in 2017. The prescription prevalence of six classes increased significantly during 2013–2017, including sedatives-hypnotics (from 3.177 to 5.388%), anxiolytics (from 1.436 to 2.200%), antiepileptic drugs (from 1.416 to 2.140%), antipsychotics (from 0.809 to 1.156%), antidepressants (from 0.891 to 1.045%), and psycholeptic polypills (from 0.682 to 0.866%). The prescription prevalence of antidementia drugs increased from 0.069 to 0.122%, and mood stabilizers increased from 0.029 to 0.037%, although not statistically significant. The prescription prevalence of nootropic drugs, attention deficit hyperactivity disorder (ADHD) medications and drugs used in the treatment of addictive disorders was largely stable. Psychotropic medication prescription increased with age for all classes except for ADHD medications and mood stabilizers.Conclusion: Increasing trends in prescription prevalence were observed for most classes of psychotropic medications in urban China, although the prevalence was still lower than that in most developed countries. Further research is warranted to explore the potential treatment gap between China and most developed countries.

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