Perfil toxicológico dos suicídios no Rio Grande do Sul, Brasil, 2017 a 2019 / Perfil toxicológico de los casos de suicidio en Rio Grande do Sul (Brasil), 2017-2019 / Toxicology of suicide cases in the state of Rio Grande do Sul, Brazil, 2017 to 2019

RESUMO Objetivo. Descrever o perfil toxicológico de todas as vítimas de suicídio no Rio Grande do Sul, Brasil, de 2017 a 2019. Métodos. Neste estudo descritivo e transversal, foram consultados todos os laudos periciais e as ocorrências policiais relacionados aos óbitos por suicídio no estado. Foram realizadas análises de correspondência múltipla e construídos modelos independentes de regressão logística, tendo como variáveis dependentes o etanol, os ansiolíticos, os antidepressivos, as substâncias ilícitas e os agentes tóxicos não medicamentosos. Resultados. Foram realizados 2 978 exames de alcoolemia, com resultado positivo em 28,5%. A chance de resultados positivos para alcoolemia foi 0,5 (IC95%: 1,1 a 2,2) vez maior para suicídio durante a noite, 1,0 (IC95%: 1,4 a 2,9) vez maior para suicídio aos finais de semana e 0,9 (IC95%: 1,3 a 2,7) vez maior na presença de antecedentes criminais. A pesquisa de psicotrópicos (2 900 amostras) detectou algum medicamento em 30,4%. Os ansiolíticos foram a classe mais frequente, com chance 1,5 (IC95%: 1,6 a 4,1) vez maior em mulheres e 0,8 (IC95%: 1,2 a 2,7) vez maior para suicídios ocorridos no outono-inverno. As substâncias ilícitas (n = 338) tiveram chance 4,1 (IC95%: 1,9 a 14,4) vezes maior de detecção na macrorregião de Pelotas em relação à de Passo Fundo e 1,2 (IC95%: 1,3 a 3,6) vez maior em pessoas com resultados positivos para etanol. Não houve diferença significativa entre adolescentes e adultos. Conclusões. Embora sem evidência de causalidade, os resultados mostram um vínculo entre o suicídio e diversos psicoativos. Os médicos legistas devem ser orientados quanto à necessidade de realização de exames toxicológicos em todos os casos de suicídio.

ABSTRACT Objective. To describe the toxicology of suicide cases recorded in the state of Rio Grande do Sul, Brazil, from 2017 to 2019. Method. The present descriptive, cross-sectional study examined all the medico-legal reports and police records related to suicide deaths in the state. Multiple correspondence analyses were performed along with independent logistic regression models having ethanol, anxiolytic and antidepressant drugs, illicit drugs, and non-medical substances as dependent variables. Results. Ethanol was investigated in 2 978 samples, with positive results in 28.5%. The odds of a positive ethanol finding were 0.5 time higher (95%CI: 1.1; 2.2) for suicides occurring at night, 1.0 (95%CI: 1.4; 2.9) time higher for suicides occurring on weekends, and 0.9 (95%CI: 1.3; 2.7) time higher in individuals with a prior criminal record. Investigation of psychotropic drugs (2 900 samples) was positive in 30.4% samples. Anxiolytics were the most common medication detected, with 1.5 (95%CI: 1.6; 4.1) time higher odds of occurrence in women and 0.8 time higher odds (95%CI: 1.2; 2.7) for suicides occurring in the fall-winter. The odds of detecting illicit drugs (n = 338) were 4.1 times higher (95%CI: 1.9; 14.4) in the regions of Pelotas (south of the state) vs. Passo Fundo (north), and 1.2 (95%CI: 1.3; 3.6) time higher in cases with positive ethanol results, without significant difference between adolescents and adults. Conclusions. Despite the lack of evidence on causality, the present results support a link between suicide and several psychoactive drugs. Medico-legal experts should be guided regarding the need to perform toxicological tests in all suicide cases.

RESUMEN Objetivo. Describir el perfil toxicológico de todas las víctimas de suicidio en Rio Grande do Sul desde el 2017 hasta el 2019. Métodos. En este estudio descriptivo y transversal se consultaron todos los informes periciales y policiales sobre las muertes por suicidio en el estado. Se realizaron análisis de correspondencia múltiple y se crearon modelos independientes de regresión logística, con empleo de etanol, productos ansiolíticos y antidepresivos, sustancias ilícitas y agentes tóxicos no medicamentosos como variables dependientes. Resultados. Se realizaron 2 978 exámenes de alcoholemia, con resultado positivo en un 28,5%. La probabilidad de obtener resultados positivos para alcoholemia aumentó 0,5 (IC95%: 1,1-2,2) en casos de suicidio durante la noche, 1,0 (IC95%: 1,4-2,9) en casos de suicidio en los fines de semana y 0,9 (IC95%: 1,3-2,7) cuando había antecedentes penales. En la investigación de productos psicotrópicos (2 900 muestras) se detectó algún medicamento en un 30,4%. Los ansiolíticos fueron la clase detectada con más frecuencia, con un aumento de la probabilidad de 1,5 (IC95%: 1,6-4,1) en las mujeres y de 0,8 (IC95%: 1,2-2,7) en casos de suicidio durante el otoño y el invierno. El aumento de la probabilidad de detección de sustancias ilícitas (n = 338) fue de 4,1 (IC95%: 1,9-14,4) en la macrorregión de Pelotas en comparación con la de Passo Fundo y de 1,2 (IC95%: 1,3-3,6) en personas con resultados positivos en la prueba de detección de etanol, sin que hubiera ninguna diferencia significativa entre adolescentes y adultos. Conclusiones. Aun sin haberse comprobado la causalidad, los resultados muestran que existe un vínculo entre el suicidio y diversos productos psicoactivos. Es preciso orientar a los médicos legistas con respecto a la necesidad de realizar exámenes toxicológicos en todos los casos de suicidio.

The use of benzodiazepines by women cared for at a Family Health Unit / El empleo de benzodiazepinas por mujeres atendidas en una Unidad de Salud de la Familia / O uso de benzodiazepínicos por mulheres atendidas em uma Unidade de Saúde da Família

ABSTRACT Objective: Estimate the prevalence of benzodiazepine use by adult women at a Family Health Unit and identify the risk factors associated with this usage. Method: Quantitative cross-sectional study that employed secondary data developed at a Family Health Unit in the state of São Paulo, Brazil. We collected the data from the following sources: medical charts, registration forms, and the archive of prescriptions from the pharmacy at the referred health unit. We employed the chi-squared, Student's t, and Mann-Whitney tests, as well as logistic regression analysis. Results: We identified 81 benzodiazepine users amongst 1,094 adult women (7.4%). Regarding the risk factors, the comparison between the groups of benzodiazepine users (n = 64) and non-users (n = 70) showed that having a chronic disease and using other psychotropic drugs were significantly associated with the use of benzodiazepines. Conclusion: The prevalence found was lower than the described in previous studies performed in Primary Health Units. The group that must receive greater attention regarding the consumption of benzodiazepines is that of middle-aged women or older, with low education levels, and chronic illnesses.

RESUMEN Objetivo: Estimar la prevalencia del empleo de benzodiazepinas por mujeres adultas en una Unidad de Salud de la Familia e identificar los factores de riesgo asociados con dicho uso. Método: Estudio cuantitativo de cohorte transversal, que se utilizó de datos secundarios, desarrollados en una Unidad de Salud de la Familia del interior de São Paulo. Los datos fueron recogidos de las siguientes fuentes: fichas médicas, fichas de registro y archivo de recetas de la farmacia de la mencionada unidad de salud. Fueron utilizadas las pruebas de Chi cuadrado, t de Student, Mann-Whitney y análisis de regresión logística. Resultados: Fueron identificadas 81 usuarias de benzodiazepinas entre 1.094 mujeres adultas (7,4%). Con respecto a los factores de riesgo, la comparación de los grupos de usuarias (n = 64) y no usuarias de benzodiazepinas (n = 70) señaló que tener enfermedad crónica y usar otro psicótropo estuvieron significativamente asociados con el uso de benzodiazepinas. Conclusión: La prevalencia encontrada fue menor que la descrita en estudios previos realizados en Unidades Básicas de Salud. El grupo que debe recibir mayor atención con relación al consumo de benzodiazepinas es el de mujeres de mediana edad o más, con poca escolaridad y enfermedad crónica.

RESUMO Objetivo: Estimar a prevalência do uso de benzodiazepínicos por mulheres adultas em uma Unidade de Saúde da Família e identificar os fatores de risco associados a esse uso. Método: Estudo quantitativo de corte transversal, que se utilizou de dados secundários, desenvolvidos em uma Unidade de Saúde da Família do interior de São Paulo. Os dados foram coletados entre a partir das seguintes fontes: prontuários, fichas cadastrais e arquivo de receitas da farmácia da referida unidade de saúde. Foram utilizados os testes qui-quadrado, t de Student, Mann-Whitney e análise de regressão logística. Resultados: Foram identificadas 81 usuárias de benzodiazepínicos entre 1.094 mulheres adultas (7,4%). Em relação aos fatores de risco, a comparação dos grupos de usuárias (n = 64) e não usuárias de benzodiazepínicos (n = 70) apontou que ter doença crônica e usar outro psicotrópico foram significativamente associados ao uso de benzodiazepínicos. Conclusão: A prevalência encontrada foi menor do que a descrita em estudos prévios realizados em Unidades Básicas de Saúde. O grupo que deve receber maior atenção em relação ao consumo de benzodiazepínicos é o de mulheres de meia-idade ou mais, com pouca escolaridade e doença crônica.

El uso de psicofármacos en los centros de protección de adolescentes en Montevideo / The use of psychoactive drugs in adolescents' residential shelters in Montevideo / O uso de psicofármacos em instituições de acolhimento institucional de adolescentes em Montevidéu

Resumen: El presente artículo estudia el fenómeno de la prescripción y el consumo de psicofármacos en los centros de protección para adolescentes, en Montevideo. Se parte del supuesto que el centro de protección incluye al dispositivo psiquiátrico como parte de su estrategia naturalizada de intervención. Se utiliza una metodología cartográfica (Passos, Kastrup y da Escóssia, 2009), con un diseño mixto. Por una parte, se analizan aquellas situaciones cotidianas de los centros que demandan la atención psiquiátrica y se problematiza la puesta en práctica de su tratamiento. Por otra parte, se debate acerca de la construcción de subjetividad de los jóvenes que transitan su adolescencia en estos dispositivos institucionales. Las subjetividades adolescentes aquí son comprendidas gubernamentalmente, como producto del cruce del dispositivo del centro de protección con el psiquiátrico (Foucault, 2002, 2011). El psicofármaco es, en este apartado, entendido como una tecnopolítica que en su uso sistemático, se convierte en cuerpo y al hacerse inseparable, deviene en subjetividad (Preciado, 2013). Como resultado, el 46,6% de los adolescentes tenía prescripto psicofármacos al momento de la investigación; superando los antecedentes relevados a nivel mundial y local. Los enunciados que fundamentan esta intervención desde la prevención y protección a los adolescentes, invisibilizan un sistema que ofrece el recurso del psicofármaco desde el inicio del proceso de institucionalización. Asimismo, se desarrollan algunas dimensiones institucionales que cronifican sus tratamientos, poniendo en cuestión la atribución exclusiva de la intervención por la situación de salud mental del joven.

Abstract: This article studies the phenomenon of prescription and consumption of psychotropic drugs in adolescent residential shelters in Montevideo. It is assumed that the residential shelter includes the psychiatric device as part of its naturalized intervention strategy. A cartographic methodology is used (Passos et al., 2009), with a mixed design. On the one hand, the daily situations of the shelters that demand psychiatric care are analyzed and the implementation of their treatment is problematized. On the other hand, there is a debate about the construction of the subjectivity of young people who live their adolescence in these institutional devices. The adolescent subjectivities here are understood governmentality, as a product of the meeting between the residential shelter device and the psychiatric one (Foucault, 2002, 2011). Psychopharmaceutical is, in this section, understood as a techno-politics that in its systematic use, becomes a body and, as it becomes inseparable, becomes subjectivity (Preciado, 2013). As a result, 46.6% of adolescents had psychopharmaceuticals prescribed at the time of the investigation; exceeding the global and local level surveyed. The statements of prevention and protection of adolescents that support this intervention, make invisible a system that offers the use of psychopharmaceutical from the beginning of the institutionalization process. Likewise, some institutional dimensions enunciate that their treatments are being cronify, calling into question the exclusive attribution of the intervention on mental health as a single situation of an adolescent.

Resumo: Este artigo estuda o fenômeno da prescrição e consumo de drogas psicotrópicas em instituições de acolhimento institucional para adolescentes, em Montevidéu. Presume-se que o estabelecimento de acolhimento institucional inclui ao dispositivo psiquiátrico como parte de sua estratégia de intervenção naturalizada. Uma metodologia cartográfica é utilizada (Passos et al., 2009), com um desenho misto. Por um lado, as situações cotidianas dos centros que demandam atendimento psiquiátrico são analisadas, e a implementação de seu tratamento é problematizada. Por outro lado, há um debate sobre a construção da subjetividade dos jovens que passam sua infância e adolescência nesses dispositivos institucionais. As subjetividades adolescentes aqui são entendidas de forma governamental, como produto do cruzamento do dispositivo do acolhimento institucional com o psiquiátrico (Foucault, 2002, 2011). O psicofármaco é, nesta seção, entendido como uma tecnopolítica que, em seu uso sistemático, torna-se um corpo e, tornando-se inseparável, torna-se subjetividade (Preciado, 2013). Como resultado, 46,6% dos adolescentes tinham psicofármacos prescritos no momento da investigação; superando os precedentes pesquisados nos níveis global e local. As narrações que sustentam essa intervenção a partir da prevenção e proteção dos adolescentes, tornam invisível um sistema que oferece o uso de psicofármacos desde o início do processo de institucionalização. Da mesma forma, algumas dimensões institucionais encontradas cronificam seus tratamentos, colocando em questão a atribuição exclusiva da intervenção psiquiátrica como estratégia de proteção da saúde mental do jovem singular.

A saúde e o psicotrópico no sistema prisional / Health and psychotropics in the prision system / La salud y el psicotrópico en el sistema prisional

A saúde e o uso do psicotrópico no sistema prisional habitam um paradoxo. As práticas de saúde podem fortalecer estratégias de controle e produzir mortificação, como podem escapar dos investimentos biopolíticos e produzir resistência. Afirma-se que as condições de confinamento são paupérrimas e contribuem para a prevalência de doenças infectocontagiosas. Diante desta realidade, foi aprovada a Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional (PNAISP), em 2014, em consonância com os princípios do Sistema Único de Saúde, visando garantir a integralidade e a universalidade de acesso aos serviços de saúde para a população penitenciária. Neste contexto, esse artigo buscou apresentar as práticas de saúde e o uso do psicotrópico no sistema prisional da Penitenciária de Segurança Máxima II, localizada no Complexo Penitenciário de Viana, no Espírito Santo. (AU)

Health and the use of psychotropics within the prison system constitute a paradox. Health practices can bolster strategies of control and produce mortification, as well as elude biopolitical investments and cause resistance. Conditions of confinement are very poor and contribute to the pervasiveness and spread of infectious diseases. In face of these conditions, the National Policy for Comprehensive Health for Persons Deprived of Liberty in the Prison System (PNAISP) was approved in 2014 in concordance with the principles of the Brazilian national public health system (SUS). The passing of this legislation sought to guarantee universal healthcare coverage and access to inmate populations. In this context, the article discusses prison health practices and the use of psychotropic drugs by inmates at the Maximum Security Penitentiary II, located within the Penitentiary Complex of Viana in Espírito Santo, Brazil. (AU)

La salud y el uso del psicotrópico en el sistema penitenciario habitan una paradoja. Las prácticas de salud pueden fortalecer estrategias de control y producir mortificación, como pueden escapar de las inversiones biopolíticas y producir resistencia. Se afirma que las condiciones de detención son muy pobres y contribuyen a la prevalencia de las enfermedades infecciosas. Ante esta realidad, se aprobó la Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional (PNAISP), en 2014, en consonancia con los principios del Sistema Único de Saúde, con el objetivo de garantizar la integralidad y la universalidad de acceso a los servicios de salud para la población penitenciaria. En este contexto, ese artículo buscó presentar las prácticas de salud y el uso del psicotrópico en el sistema penitenciario de la Penitenciária de Segurança Máxima II, ubicada en el Complexo Penitenciário de Viana, en Espírito Santo. (AU)

Development of LC-MS/MS assay for simultaneous determination of 25 psychotropic drugs in human blood / 中国法医学杂志

Objective To establish a LC-MS/MS assay for simultaneous determination of 25 psychotropic drugs in human blood and apply the method to analyze the relationship between(driving under the inference of drugs, DUID)and traffic violations. Methods Acetonitrile was added to the sample for precipitating the protein, the mixture was centrifuged for 10min at 4℃ , 14000r/min, the supernatant was filtered, and then the filtrate was analyzed with LC-MS/MS. The separation was performed on C18 chromatography column (50mm×3.0mm, 2.6μm), the mobile phase was consisted of 0.1% formic acid (phase A), acetonitrile:methanol=1:1 (phase B) with gradient elution. Results The calibration curves for 25 psychotropic drugs were linear over the ranges of 0.05~20ng/mL, R=0.9944~0.9996, the assay recoveries were 83.0%~99.7%, the method recoveries were 80.2%~97.4%, the intraday and interday precious were 1.6%~14% and 3.1%~14% respectively. The method was applied to analyze 3140 human samples stored by Center of Forensic Sciences of Hangzhou. Conclusion The method is sensitive and accurate for fast detection of 25 psychotropic drugs in human blood.

Analysis of the Utilization of Narcotic Drugs and CategoryⅠPsychotropic Drugs in Our Hospital / 中国药房

OBJECTIVE:To provide reference for rational use of narcotic drugs and category Ⅰ psychotropic drugs. METH-ODS:The utilization of narcotic drugs and category Ⅰ psychotropic drugs in clinical wards of Zhengzhou People's Hospital during Jan.-Dec. in 2014 was analyzed statistically in respects of drug types,department distribution medication purpose,DDDs,DDC, DUI,etc. RESULTS:A total of 16 kinds of narcotic drugs and one kind of categoryⅠpsychotropic drugs were used in 28 981 pre-scriptions of narcotic drugs and category Ⅰ psychotropic drugs in our hospital in 2014;A total of 16 kinds of narcotic drugs and one categery Ⅰ psychotropic drugs were used,narcotic drugs mainly included Sufentanil citrate injection(7 816 prescriptions)and Fentanyl citrate injection (5 104 prescriptions),and category Ⅰ psychotropic drugs mainly was Ketamine hydrochloride injection (190 prescriptions). Narcotic drugs and category Ⅰ psychotropic drugs were mainly used in anesthesia department,pain depart-ment and medical oncology department. Main purpose of narcotic drugs and category Ⅰ psychotropic drugs were intraoperative an-esthesia,cancer pain and postoperative analgesia. Top 3 drugs in the list of DDDs were Sufentanil citrate injection,Fentanyl citrate injection(0.1 mg)and Remifentanil for injection. CONCLUSIONS:The utilization of narcotics and category Ⅰ psychotropic drugs are generally rational in the hospital;the doctors can grasp the indication and medication principle,and use drugs rationally accord-ing to disease condition.

<b>Two Cases where Kampo Medicines Successfully Replaced Psychotropic D</b><b>rugs</b> / 日本東洋医学雑誌

Psychotropic drug dependence, especially with benzodiazepines, is recognized as a growing problem. Several alternative agents such as selective serotonin reuptake inhibitors (SSRIs) have been suggested as benzodiazepine replacements. The author here reports two cases with neurosis in which psychotropic drugs were successfully replaced with Kampo medicines such as saikokeishito, saikokeishikankyoto, kihito, kamishoyosan, and saikokaryukotsuboreito. As two patients discontinued benzodiazepines, rebound symptoms arose in one, and the other exhibited withdrawal symptoms and relapsed. These symptoms gradually improved, however, and Kampo medicines were able to contribute toward their complete alleviation. This suggests that Kampo therapy can be an alternative to psychotropic drugs, especially benzodiazepines.

Analysis of the Application of TypeⅡPsychotropic Drugs in Our Hospital during 2012-2014 / 中国药房

OBJECTIVE:To provide reference for rational application of typeⅡpsychotropic drugs. METHODS:The applica-tion of type Ⅱ psychotropic drugs in our hospital during 2012-2014 was analyzed statistically in respects of consumption sum,con-sumption amount,DDDs,DDC,etc. The trend of the application of type Ⅱ psychotropic drugs and the reasonability of medication structure were evaluated in our hospital. RESULTS:9 type Ⅱ psychotropic drugs were used in our hospital during 2012-2014,in-cluding 5 oral preparations and 4 injections. The consumption sum of drugs during 2012-2014 were 22 551.33 yuan,31 489.95 yu-an and 57 742.87 yuan,increasing by 39.64% in 2013 and 83.37% in 2014. The number of type Ⅱ psychotropic drugs increased year by year,and the amount of estazolam was the largest and took up the first place in 3 years. DDDs of estazolam also occupied the first place in the list of DDDs. DDC of Phenobarbital tablet was the smallest. CONCLUSIONS:Type Ⅱ psychotropic drugs mainly are oral drugs and reasonable in structure in our hospital during 2012-2014. The consumption sum and amount of type Ⅱpsychotropic drugs increase reasonably year by year.

Questionnaire survey on seminar for the Board Certified Psychiatric Pharmacy Specialis held bySapporo Society of Hospital Pharmacy / 医薬品情報学

<b>Objective</b>: To nurture pharmacists capable of contributing to the prevention of adverse reactions to psychotropic agents, the Sapporo Hospital Pharmacist Association has been holding a seminar for psychiatric pharmacy specialist.  A questionnaire survey was conducted to clarify the usefulness of this seminar and its future direction, and evaluate the necessity of providing information on psychotropic drugs.<br><b>Methods</b>: An anonymous 21-item questionnaire was distributed to participants in the 2008 Sapporo Hospital Pharmacist Association seminar for psychiatric pharmacy specialist.<br><b>Results</b>: The mean recovery rate was 76.3%, and the respondents had a broad background in terms of age, gender, etc.  The seminar was identified as being beneficial, and the participants’ awareness of the accreditation of Board Certified Pharmacist in Psychiatric Pharmacy showed regional characteristics.<br><b>Conclusion</b>: Based on the survey results, guidelines on conducting the seminar in the future were successfully developed.  From now on, it is important to create an environment to nurture psychiatric pharmacy specialist in the Sapporo area.  Additional efforts should be made so that the provision of information on psychotropic drugs in the seminar can contribute to the prevention of adverse reactions to them.

Psychiatric out-patient's perspectives on medication information given by doctors

Objective: To investigate patient’s perceived satisfaction and adequacy of information given by doctors on prescribed drugs in an outpatient psychiatric setting. Methods: The sampling was done consecutively with a target sample size of 200 patients. A simple questionnaire that was developed with 10 close-ended questions and yes or no answers was administered by the interviewing team. This questionnaire assessed patients' knowledge on prescribed medications and their perception on the adequacy of information given. Results: More than 80% of the patients were informed regarding the reasons, timing to take medication(s), duration of drug treatment and type of prescribed drugs. Half of them were informed regarding the side effect profiles of their prescribed medications. Majority of them (80%) were satisfied with the information given despite only 49% of the patients being given adequate information on their medications. Conclusion: Patients who are adequately informed about their medications are more significantly satisfied than those inadequately informed. (χ2=4.085, p<0.05).

Utilization of Psychotropic Drugs in Hospitalized Patients with Depression of Our Hospital in 2008 / 中国药房

OBJECTIVE:To investigate the drug treatment of hospitalized patients with depression in our hospital during 2008. METHODS: In cross section study, the medical records which in accordance with ICD-10 diagnostic criteria for depression disorders in our hospital during 2008 were retrieved, then the utilization of psychotropic drugs was analyzed and summarized. RESULTS: The utilization rate of new antidepressants including selective serotonin reuptake inhibiter (SSRI), selective serotonin and noradrenaline reuptake inhibiter (SNRI), noradrenaline and specific serotonin antagon (NaSSA) reached 89.9%, among which sertraline accounted for the largest proportion (22.5%). New antidepressants combined with atypical antipsychotics took up a big proportion, particularly quetiapine (39.2%). CONCLUSION: New antidepressants become the mainstream drug in the treatment of depression. Drug combination occupies a big proportion, especially combining with atypical antipsychotics. The safety of drug combination need to be further explored.

Utilization of Psychotropic Drugs in Our Hospital During 2006～2008 / 中国药房

OBJECTIVE:To probe into the status quo and the tendency of the utilization of psychotropic drugs in our hospital. METHODS:The consumption sum,DDDs and the daily drug cost of psychotropic drugs from 2006 to 2008 were analyzed statistically in this retrospective study. RESULTS & CONCLUSION:The consumption sum of psychotropic drugs in our hospital assumed year-on-year increase tendency. The DDDs of the first generation of psychotropic drugs remained stable. The consumption amount of the non-first generation of antipsychotic drugs increased year on year,with risperidone showing the most rapid increase. Fluoxetine,venlafaxine and paroxetine took the lead among all the antidepressant drugs used. However,the consumption amount of tricyclic antidepressants decreased markedly. Benzodiazepine took the lead among all the antianxiety drugs.

The Effects of Psychotropic Drugs on the beta-Amyloid-Induced Cytotoxicity in PC12 Cells / 신경정신의학

OBJECTIVE: Amyloid beta protein(Abeta) has been regarded to be toxic to neurons in vitro. However, the mechanism of action leading to neuronal death remains unknown. In this study, we report the effects of psychotropic drugs, that are often prescribed for the improvement of psychotic and depressive symptoms in dementia of the Alzheimer's type, on the beta-amyloid-induced cytotoxicity in rat pheochromocytoma(PC12) cells. METHODS: We treated antipsychotics(chlorpromazine, haloperidol, and risperidone) and antidepressants(amitriptyline, fluoxetine, and moclobemide) at 0.1-10 microM concentrations before application of Abeta(10 microM), and compared with control in the absence of psychotropic drugs in cultured PC12 cells. RESULTS: 1) Chlorpromazine, haloperidol and risperidone significantly reduced Abeta-induced cytotoxicity in PC12 cells. 2) Amitriptyline, fluoxetine, and moclobemide significantly reduced Abeta-induced cytotoxicity in PC12 cells. CONCLUSION: Our results suggest that psychotropic drugs in the treatment of dementia of Alzheimer's type may protect the neural cells as well as control neurotransmitter activities.

Therapeutic Drug Monitoring(TDM) of Psychotropic Drugs

Clinicians can use therapeutic drug monitoring(TDM) to optimise dosage decisions with psychotropic drugs, in order to maximize efficacy and prevent toxicity, especially when individuals are nonresponsive to treatment or vulnerable to adverse reactions with standard doses because age, disease states or drug interactions. Currently therapeutic drug concentrations have been established for the TCA and lithium. There is also evidence for the usefulness of TDM with carbamazepine, valproic acid and some antipsychotic drugs. However for most psychotropic drugs this approach remains experimental. TDM-assisted psychiatric treatment is potentially useful and cost effective, particularly when applied by psychiatrists who are knowledgeable of pharmacokinetics and pharmacodynamics.

The Effect of Psychotrophic Drug on Serum Lipid, Lipoprotein and Apolipoprotein / 신경정신의학

OBJECTIVES: Several studies suggest that psychotropic drugs may affect on lipid metabolism and body weight. And the differences of levels of seam lipids were observed in patients with several psychiatric disorders. Hence, in order to elucidate the effects of psychotropic drugs on serum lipid, lipoprotein and apolipoprotein, the authors estimated the serum lipid profile in the psych op harmacological treatment. METHODS: Thirty six patients with schizophrenia and 42 patients with depressive disorder or anxiety disorder were recruited from the inpatient psychiatric units and withdrawn from all psychotropic drugs at least far 3 months. The levels of seam total cholesterol, high-density lipoprotein cholesterol(HDL-C), trighlyceride, apolipoprotein A, apolipoprotein B, and lipoprotein(a) were measured before the treatment and after 2, 4, 8 and 12 weeks of the treatment. RESULTS: No statistically significant change was found on all serum lipid profiles in the antipsychotics group. However, the changes on serum total cholesterol, low-density lipoprotein (LDL-C), apolipoprotein A, and apolipoprotein B from the baseline to the following weeks have been observed in tricyclic antidepressants group. And the serum total cholesterol and apolipoprotein B have been observed to be changed from the baseline to the following weeks in the selective serotonin reuptake inhibitors poop. The changes on seam lipoprotein(a) were proved not to be statistically significant during all the psychotropic drugs treatment. CONCLUSION: These results implicate that all psychotropic drugs might affect on the lipid metabolism, especially for tricyclic antidepressants. Therefore, this implication could be important in clinical situation because the changes on serum lipid profiles may be related to the cardiovascular disease especially in psychiatric patients with the cardiovascular risk factor.