Non-psychiatrist prescriptions within the Brazilian National Health System represents a risk to patients in the use of psychotropic pharmacotherapies

This cross-sectional study collected data from the Brazilian National Health System (NHS) patients’ that filled their psychotropic prescriptions in NHS owned pharmacies. The study aimed to identify oversights in psychotropic prescriptions leading to insecure therapeutic. Patients in use of at least one psychotropic drug in 12 months were identified by a retrospective data search and considered for the study. After examining 15,001 patients in use of psychotropic medicines, 7,440 met the inclusion criterion. The majority of patients were women (67.1%), 54.2% of prescriptions analysed over the studied period presented multiple medicines including one psychotropic, and 54.7% cursing with psychotropic monotherapy. In 92.7% of cases, only one medicine was dispensed and prescriptions from psychiatrists represented only 17.6% of cases. In terms of safety, 9.5% of patients had at least one potential drug interaction of clinical significance, and 71.5% of elder patients had at least one drug that was potentially inappropriate for their age group use. These findings suggest urgency in integrating patients’ medical records information to pharmacotherapy history at the pharmacy computer technology applied for dispensing, reducing harm to patients in the use of psychotropic drugs.

Analysis on the Application Effect of Psychological Counseling for COVID-19 Patients

The COVID-19 outbreak is a global emergency. The consequences of the pandemic were numerous. Mental health and psychosocial support services have been severely impacted by the COVID-19 pandemic. Innovative solutions such as tele-consultations, digital self - help platforms, novel approaches to ensure supply of psychotropic medicines, and task sharing/shifting for basic psychosocial support, are being used to defeat service disruptions and maintain care for those with psychological conditions.

Impact of the introduction of falls risk assessment toolkit on falls prevention and psychotropic medicines’ utilisation in Walsall: an interrupted time series analysis

ObjectiveTo determine the impact of the introduction of a falls risk assessment toolkit (FRAT) in a UK medical centre on the number and cost of non-elective admissions for falls and psychotropic medication utilisation.DesignInterrupted time series analysis quantifying the number and cost of non-elective admissions for falls and primary care use data for Rushall Medical Centre before and after the implementation of FRAT at July 2017.SettingData on the monthly number and cost of non-elective admissions for falls and number of referrals and assessment to the falls service were provided by Walsall Clinical Commissioning Group. Primary care prescribing cost and volume data for Rushall Medical Centre was derived from the Openprescribing.net website for prescriptions dispensed between April 2015 and November 2018.Primary and secondary outcome measuresThe number and cost of non-elective admissions for falls and number of referrals and assessment to the falls service, and the volume of utilisation of psychotropic medicines.ResultsFollowing the implementation of FRAT at Rushall Medical Centre in July 2017, the number of non-elective admissions for falls decreased at a rate of 0.414 admissions per month (p<0.033, 95% CI –0.796 to –0.032). The utilisation of psychotropic medications (alimemazine, citalopram, escitalopram, fluoxetine, mirtazapine, olanzapine and risperidone) decreased. The expenditure on psychotropic medications prescribed/used at Rushall Medical Centre decreased by at least £986 per month (p<0.001, 95% CI –2067 to –986).ConclusionsThe implementation of FRAT at Rushall Medical Centre was associated with a reduction in the number of non-elective admissions for falls. Assessment of these patients together with deprescribing of psychotropic medications resulted in a reduction in the number of non-elective admissions for falls and associated costs.

Off-label prescribing of quetiapine in south locality crisis teams

AimsThe audit was carried out to determine the frequency of off label prescribing of quetiapine and compliance with standards within Trust Policy (UHM PGN 02 PPT PGN 08) – Physical Health Monitoring of Patients Prescribed Antipsychotics and other Psychotropic Medicines, NICE CG178, General Medical Council Ethical Standards and Royal College of Psychiatrists – College Report CR210.The main objectives of the audit were to determine if:Patients have been appropriately informed of off-label status and consent recorded.Alternative licensed treatment first used/ruled out.Appropriate communication on transfer of care.Appropriate physical health monitoring completed.BackgroundQuetiapine is associated with various physical side effects. Patients should be fully informed of the expected risks and benefits of treatment, and the limited evidence base for off-label prescribing.There are additional issues around the transfer of prescribing to primary care.MethodThe sample consisted of 50 consecutive patients selected from the crisis team caseload in the month of December 2018.Data reviewed in this audit were taken from six months period.Records audited were obtained from RiO (electronic records) and prescription charts.Data collection was started in January 2019 and completed in March 2019The audit tool was a dichotomous scale questionnaire based on NICE guidelines.Result4 patients from the sample (8%) were prescribed off-label quetiapine.100% had physical health monitoring completed as per Trust policy.100% off-label indication been clearly documented in notes.100% Consent to treatment was documented.100% had medication reviewed in the previous 6 months.75% had licensed medication used or ruled out before considering off-label quetiapine use25% risks/benefits of treatment were documented as part of a patient discussion.25% had documented evidence that alternative treatment options were discussed.25% had documented evidence of Community consultant/GP consent/agreement was obtained before transfer of prescribing75% had a documented plan for review of quetiapine for treatment efficacy and side effects50% had a documented plan in place for ongoing physical health monitoringConclusionSuggested a wider audit may be required with greater patient numbers and which specifically filters for patients prescribed quetiapine.Audit result has been shared with Crisis team members, Medicines Optimisation Committee and South Locality Quality Standards Committee in the trust.

An audit into the use of psychotropic medications in patients with autism spectrum disorder in a high security psychiatric hospital

AimsAutism Spectrum Disorder (ASD) is a common neurodevelopmental disorder associated with difficulties in social communication and language development, preoccupations, a need for routine, sensory sensitivities and emotional dysregulation. People with autism who have violently offended may be prescribed psychotropic medications to treat comorbidities, or off-license to manage aggressive or challenging behaviours. However, the evidence base for their use remains scarce.MethodThis was a retrospective audit at Broadmoor Hospital, a high security psychiatric hospital in the United Kingdom, into the safe and appropriate prescribing of psychotropic medicines in those with an ASD compared to guidance from the National Institute for Health and Care Excellence (CG142): “Autism spectrum disorder in adults: diagnosis and management”. This first cycle was undertaken during May and June 2020 and included all patients with a confirmed or equivocal diagnosis of ASD in the preceding five years.ResultA total of 22 participants were included in this study. Of these, 17 participants had a confirmed diagnosis of ASD and five participants had a suspected diagnosis of ASD, but without formal confirmation with neurocognitive testing. A total of 13 (76.5%) participants with confirmed ASD were prescribed antipsychotic medication, nine of whom had an established comorbid mental disorder with psychotic symptoms. Of the remaining four, three had a diagnosis of a personality disorder. Three participants in this study had a confirmed diagnosis of ASD without any additional comorbid mental health diagnoses. No patients were prescribed psychotropic medicines for the core symptoms of ASD. The specific documentation of off-license use of antipsychotic medicines in those without a diagnosis of a psychotic disorder was poor. This was not recorded in any such participant in the preceding 12 months.ConclusionThis audit highlighted that dual diagnoses of ASD alongside non-affective psychosis and personality disorder are over-represented in this high security setting. The NICE clinical guidelines CG142 guidelines state that “antipsychotic medications should only be used for behaviour that challenges if …. the risk to the person or others is very severe”. By definition, all patients admitted to high security are deemed to be a grave and imminent risk to the public. Psychotropic medicines may therefore be clinically indicated at a much earlier stage than in community patients, instigated alongside appropriate psychosocial interventions and treatment of comorbid conditions. It may be that catered guidelines need to be formulated to support the safe and appropriate prescribing of psychotropic medicine in forensic settings.

Drug Policy in India: An Analysis

The Narcotic Drugs and Psychotropic Substances Act, or NDPS Act, was enacted to control addictive drugs and prohibit their possession, dispersion, sale, import, and trade in India. Psychotropic agents have the potential to change an individual’s consciousness, while narcotic drugs relieve anxiety. The Indian Parliament passed the NDPS Act on November 14, 1985. Nonetheless, these types of drugs are important in the practice of medicine. Consequently, the Act contains provisions for the cultivation of cannabis, poppy, and coca seeds and the production of certain psychotropic medicines used for medical purposes. The Act’s primary objective is to regulate the manufacturing, ownership, selling, and transportation of narcotics and psychotropic drugs. The Act forbids the selling of nearly 200 psychotropic medications, resulting in these drugs being inaccessible over the counter to the general public. These medications are only available for use with a prescription. Violations of this law can result in a sentence of incarceration or a fine, or both, depending on the offense’s severity, which is determined by the severity of the situation at hand. If the drugs are being used for personal benefit, the penalty can be minimized. Furthermore, the legislation has been revised several times since its inception.

Dementia Management Act and Death Toll by Dementia Drug

The Dementia Management Act (DMA) came into effect on August 4, 2011, in South Korea. Medical data on the correlation between Alzheimer's disease (AD) and anti-AD drug (AAD) groups were observed from 2010 to 2019. This study investigated the increase and decrease in deaths and AAD used to treat AD. It is known that psychotropic medicines should not be administered for dementia patients because they increase all-cause mortality. This study demonstrated that acetylcholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists increase the death toll when used to treat dementia.