The role of an anesthesiologist in the pandemic of uncontrolled use of psychotropic drugs

In the modern world, the number of people using various psychotropic drugs increases every day. The situation that has been described in recent decades associated with the use of narcotic and not criminalized substances in international literature as the OPIOID + (plus) crisis. According to statistics, over the past few years, officially registered deaths from drug overdose have exceeded 70,000 in the United States. Leading causes were synthetic opioids, psychostimulants, and cocaine. This includes prescription opioids, opiates, benzodiazepines, and antidepressants. All aforementioned drugs are used in combination with each other, with alcohol or psychotropic marijuana. For humans, biological, social, and psychological factors are cause the initiation of psychoactive drugs. Due to the lack of a well-functioning medical care system for patients with chronic pain, doctors of all specialties treat pain. In this article, we consider the current situation with mind-altering drugs and apply the role of the anesthesiologist in reducing the growth rate of the opioid pandemic.

Treatment induced Mood Switching in Affective Disorders

Many patients under treatment for mood disorders, in particular patients with bipolar mood disorders, experience episodes of mood switching from one state to another. Various hypotheses have been proposed to explain the mechanism of mood switching, spontaneously or induced by drug treatment. Animal models have also been used to test the role of psychotropic drugs in the switching of mood states. We examine the possible relationship between the pharmacology of psychotropic drugs and their reported incidents of induced mood switching, with reference to the various hypotheses of mechanisms of mood switching.

UTILIZAÇÃO DE PSICOFÁRMACOS E SINTOMAS DE ANSIEDADE E DEPRESSÃO EM ESTUDANTES UNIVERSITÁRIOS DE LAGARTO/SE DURANTE A PANDEMIA DA COVID-19

Introdução: A pandemia causada pela COVID-19 pode provocar impactos na saúde mental dos universitários, devido a fatores como suspensão das aulas presenciais e a sobrecargas do ensino online, assim objetivou-se quantificar o número de estudantes universitários com ansiedade e depressão provável relacionando com o uso de psicofármacos durante a pandemia. Métodos: Estudo transversal, descritivo e quantitativo aprovado pelo CEP (CAAE: 37453920.0.0000.5546). Foi aplicado um questionário online para verificação dos sintomas de depressão (Questionário Sobre Saúde do Paciente; PHQ-2) e ansiedade (Escala de Transtorno geral de Ansiedade; GAD-2), e sobre o uso de psicofármacos e perfil sociodemográfico de estudantes de graduação da Universidade Federal de Sergipe (UFS) de Lagarto-SE. Resultados: Dos 99 participantes, 48,5% foram classificados com ansiedade provável (GAD-2 ≥ 3) e 37,4% com depressão provável (PHQ-2 ≥ 3), enquanto que 33,3% (n=33) apresentaram depressão e ansiedade provável, simultaneamente. Destes 10,1% (n=10) faziam uso de psicofármacos. Uma quantidade significativa de pessoas que não fazem uso de psicofármacos apresentou sintomas de ansiedade (47,2%, n=42) e de depressão (33,7%, n=30). Conclusão: A grande maioria dos estudantes foi avaliada com depressão ou ansiedade provável, entretanto, uma pequena porcentagem faz uso de psicofármacos, podendo sugerir outras formas de tratamentos ou a falta de tratamento. Assim é sugerido que os mesmos procurem por apoio psicológico para avaliações adicionais. ABSTRACT Introduction: The pandemic caused by COVID-19 can cause impacts on the mental health of university students, due to factors such as suspension of in-person classes and overload of online teaching, so the objective was to quantify the number of university students with anxiety and depression likely related to the use of psychotropic drugs during the pandemic. Methods: Cross-sectional, descriptive, and quantitative study approved by CEP (CAAE: 37453920.0.0000.5546). An online questionnaire was applied to check the symptoms of depression (Questionnaire on Health of the Patient; PHQ-2) and anxiety (General Anxiety Disorder Scale; GAD-2), and on the use of psychotropic drugs and the sociodemographic profile of undergraduate students of the Federal University of Sergipe (UFS) in Lagarto-SE. Results: Of the 99 participants, 48.5% were classified with probable anxiety (GAD-2 ≥ 3) and 37.4% with probable depression (PHQ-2 ≥ 3), while 33.3% (n=33) presented depression and likely anxiety. Of these 10.1% (n=10) were using psychotropic drugs. A significant number of people who do not use psychotropic drugs had symptoms of anxiety (47.2%, n=42) and 33.7% (n=30) of depression. Conclusion: The vast majority of students were assessed with probable depression and anxiety, however, a small percentage uses psychotropic drugs, which may suggest other forms of treatment or lack of treatment. Thus, it is suggested that they look for psychological support for further evaluations.

Effects of Recovery-Orientation on the Use of Forced Medication and Maximum Daily Drug Dose: The “Weddinger Modell”

Objective: The aim of the present study was to analyze the effects of the implementation of the Recovery-orientated psychiatric care concept “Weddinger Modell” on the incidence of forced medication, the total number of forced medication incidents per affected case, the maximum dose of a singular forced medication and the maximum voluntary daily drug dose of different psychotropic drugs administered during an inpatient stay.Methods: This retrospective case-control study included 234 patients. A pre/post-comparison of patients on two acute psychiatric wards before (control group, n = 112) and after (intervention group, n = 122) the implementation of the Weddinger Modell in 2010 was performed. Patient data was selected at two reporting periods before and at two reporting periods after 2010.Results: No significant differences were found in the incidence of forced medication and the total number of forced medications. A significant reduction of the maximum forced medication dose of haloperidol in the intervention group was seen. Furthermore, the analysis of the intervention group showed a significant reduction of the maximum voluntary daily drug doses of clozapine, haloperidol and risperidone.Discussion: The results indicate that the implementation of the Weddinger Modell had no effect on the incidence of forced medication, but it can help to improve the approach to psychotropic drugs. Despite the reduction of mechanical coercive measures by the model, as shown in a previous study, there is no increase in forced medications or administered drug doses. Focus on Recovery helps in reducing coercion in acute psychiatric care.