Prescription Patterns for Bipolar Disorder in Asian Countries:Findings from Research on Asian Prescription Pattern-Bipolar Disorder

Objective@#Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed. @*Methods@#The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≥ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method. @*Results@#Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries. @*Conclusion@#Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≥ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment.

A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists

Objective@#Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate. @*Methods@#We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide. @*Results@#The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively). @*Conclusion@#Policy on polypharmacy may influence psychiatrists’ decision-making. Thus, policies considering rational polypharmacy should be established.

Antipsychotic medication and QT prolongation

The QT interval represents ventricular depolarisation and repolarisation. Prolongation of this interval can lead to life-threatening complications. These can include arrhythmias such as Torsades de Pointes and Ventricular Fibrillation, which may ultimately lead to death. Many risk factors have been identified in prolonging the QT interval, one of which is medication commonly used in the treatment of Psychiatric ailments. This article describes Antipsychotic drugs causing prolonged QT interval and the possible underlying mechanisms alongside the current best practice on the management of this potentially fatal complication

Community-based rehabilitation and the Clubhouse Model as means to recovery and mental health services reform / Rehabilitación basada en la comunidad y el modelo Clubhouse como medio de recuperación y reforma de los servicios de salud mental

The article focuses on the trends of community-based rehabilitation (CBR) and the psychosocial Clubhouse rehabilitation model (CH) as tools for mental health (MH) policy reforms. It is based on documentation of the transnational project ôEmpowering Adults with Mental Illness for Learning and Social Inclusion in the years 2010-2012õ and other sources. The collection of data and subsequent analysis were prepared in the context of about 30 international MH policy recommendations from the 1990s until 2012. The documents were analyzed and compared with different recovery-oriented approaches like the CH model and with the key concepts of rehabilitation science, linked with the recent trends of the psychosocial rehabilitation. Some of the most important intergovernmental MH policy recommendations are the United Nations (UN) Convention on Rights of People with Disabilities (CRPD, UN 2006), the joint CBR û Guidelines of the WHO (2010), ILO, UNESCO and several international associations as the WAPR (WAPR & WHO Consensus Statement 1996), as well as the WHO Pyramid Framework for the Optimal mix of MH services (WHO 2007), complemented with the WHOÆs Comprehensive MH Action Plan 2013-2020 approved in May 2013. All these sources include the spectrum of MH disorders. The combining factors are the human rights û based on a more holistic understanding of the disabilities instead of a merely medical approach. All the above recommendations are aimed at worldwide utilization.

Se examinan las tendencias de rehabilitación basada en la comunidad (CBR) y el modelo de rehabilitación psicosocial denominado Clubhouse (CH) como instrumentos de políticas de reforma de la Salud Mental (MH). El trabajo se basa en documentación del proyecto transnacional ôEmpoderamiento de adultos con enfermedad mental para aprendizaje e inclusión social en 2010-2012õ además de otras fuentes. La colección de datos y subsecuentes análisis se prepararon en el contexto de cerca de 30 recomendaciones internacionales de políticas de salud mental desde los años 90 hasta el 2012. Los documentos fueron analizados y comparados con diferentes enfoques orientados a la recuperación, tales como el modelo CH, y con conceptos clave de la ciencia de Rehabilitación, vinculados con tendencias recientes de la rehabilitación psicosocial. Algunas de las más importantes recomendaciones intergubernamentales de políticas de salud mental son las Guías conjuntas de Trabajo de la Organización Mundial de la Salud (OMS) y UNESCO y varias asociaciones internacionales tales como la Asociación Mundial de Rehabilitación Psiquiátrica (WAPR) y el Marco Piramidal de la OMS para la óptima combinación de servicios de Salud Mental, complementados con el Plan Integral de Acción en Salud Mental 2013-2020 aprobado por la OMS este año. Todas estas fuentes incluyen el espectro total de trastornos mentales. Factores de combinación son los derechos humanos, basados en una comprensión más holística de las discapacidades en lugar de un enfoque meramente médico. Todas estas recomendaciones están orientadas a su utilización a nivel global.

Stevens johnson syndrome associated with lamotrigine

Stevens-Johnsons Syndrome [SJS] is an immune-complex-mediated hypersensitivity reaction and has been linked as an adverse side effects to many drugs. Lamotrigine, an anticonvulsive medication and also a commonly used mood stabiliser, can be associated with this adverse reaction. Although this has not been reported very commonly, SJS has high mortality and morbidity and requires careful attention as the use of Lamotrigine is increasing in clinical practice. We present a case where the patient developed Stevens -Johnson Syndrome three weeks after being started on Lamotrigine. The case is discussed for its relevance to the use of Lamotrigine which is currently prescribed very commonly in psychiatric practices

Assessing mental capacity

The issue of assessment of capacity has gained a paramount importance in day to day clinical settings. With the introduction of Human Rights and other related legislations, capacity of the patients for accepting treatment or medical interventions and making decisions for health and other related issues have assumed even more importance in current clinical practices. This paper describes the principles about assessment of capacity for the clinicians for assessing mental capacity in their patients with reference to the guidelines as recommended by current legislations in UK

Metabolic syndrome: Relevance to psychiatry

The treatment of mental illnesses is receiving considerable attention in the current medical literature and has been a focus of reviews for adapting a holistic approach for recognition and management of the physical health needs of these patients. Metabolic syndrome, a major public health problem linked to cardiovascular and other morbidities, has gained a significant importance in clinical settings and patients with severe mental illnesses who are at higher risk for different components of this syndrome due to their illness and its treatment require careful and regular monitoring in this regard. This article summarises the current thinking about the concept, nature and extent of this syndrome with special reference to mental health and discusses its relevance in the current management of these disorders

New perspectives in the treatment of schizophrenia

Following the introduction of chlorpromazine in 1950s, for many years little progress was made in the discovery of new drugs for schizophrenia. Dopamine D2 receptors blockade was recognized as the only therapeutic target for antipsychotic drugs and formed the basis for further developments in this area. Later on enhanced efficacy of clozapine in both positive and negative symptoms in schizophrenia opened a new channel for discovery of new pharmacological treatments for this illness. Further developments looked at designing compounds, which were chemically similar to clozapine and have efficacy in both negative and positive symptomatology with diminished risk of extrapyramidal side effects. This new family of drugs, the so-called atypical antipsychotics, mainly act as serotonin- dopamine antagonists [SDA] and have shown wider spectrum of antipsychotic activity than conventional antipsychotic drugs. Their use in clinical practice is now well established and despite some limitations, clinicians prefer their use as first line treatment in schizophrenia and other related illnesses. This paper summarises current findings in the pharmacological treatment of schizophrenia and attempts to provide a review of these new drugs with future directions in this area

Psychiatric morbidity among male students

An epidemiological study was conducted to assess the mental health problems of first year male students studying in two educational institutions. Based on the findings of general health questionnaire and hospital anxiety and depression scale, the estimated prevalence of psychological disturbance was found to be 33% for the whole sample. Present findings are discussed in terms of early identification and provision of better health facilities for the students population

Life events and schizophrenia

Present paper describes the findings of a study which was carried out to determine the frequency of adverse life events in a group of seventy five Schizophrenic patients. Life event histories of these patients for the six months period before onset or relapse of their illness were compared with control subjects using Bedford's Life Events and Difficulties Schedule, The Schizophrenic patients reported significantly more life events with suggestive trends for the influence of gender and marital status on the frequency of life events

Psychiatric morbidity among overseas students

As immigration for higher education is becoming more common now a days, the adjustment of overseas students to the host country is receiving more attention. This paper describes the results of a study which examined the prevalence and pattern of psychological disturbances among overseas and British students studying at Edinburgh University. The practical implications of these findings and suggestions for future research are discussed