Psychotropic Medication Use and Polypharmacy Among Children and Adolescents Initiating Intensive Behavioral Therapy for Severe Challenging Behavior.

OBJECTIVE: To evaluate the prevalence, trends, and factors associated with psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior over a 10-year period. STUDY DESIGN: In this retrospective observational study, we examined data from caregiver interviews and patient medical records on the number and types of psychotropic medications prescribed to patients initiating intensive behavioral therapy between January 1, 2013, and December 31, 2022. Trends in medication use and polypharmacy across the 10-year period were analyzed using regression analysis, while differences in demographics and clinical factors for patients with use and polypharmacy were analyzed using nonparametric statistical analysis with odds ratios presented for significant factors. RESULTS: Data from all 302 pediatric patients initiating intensive behavioral therapy across the 10-year period were analyzed. Among all patients and all years, 83.8% were taking at least 1 psychotropic medication and 68.2% experienced polypharmacy. There were no changes in the prevalence of use, mean number of medications taken, or polypharmacy across the 10-year period. Patients diagnosed with attention-deficit/hyperactivity disorder or anxiety disorder, as well as those exhibiting self-injurious behavior had higher use of psychotropic medication and polypharmacy and were taking more medications overall. CONCLUSIONS: Psychotropic medication use and polypharmacy were extremely high for children and adolescents with severe challenging behavior, but use and polypharmacy did not change over the 10-year period of data collection. Further research is needed to establish the generality of these findings to other regions of the US.

Inflammation and damage-associated molecular patterns in major psychiatric disorders.

BACKGROUND: Emerging evidence indicates that inflammation plays an important role as a mechanism underlying mental disorders. However, most of the research on inflammatory mechanisms focuses on serum levels of interleukins and very few studies have investigated molecules that initiate and expand innate immune pathways such as damage-associated molecular patterns (DAMPs). OBJECTIVES: This study investigated the levels of DAMPs among patients diagnosed with major depressive disorder (MDD), bipolar disorder (BD) I and II, schizophrenia (SCZ), and generalized anxiety disorder (GAD). We quantified serum levels of heat shock proteins (HSPs) 70 and 60 and of S100 calcium-binding protein B (S100B). METHODS: Serum levels of HSP70, HSP60, and S100B were assessed in a sample of participants with psychiatric disorders (n = 191) and a control group (CT) (n = 59) using enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum HSP70 concentrations were significantly higher in the MDD group compared to the CT, SCZ, and BD groups. The GAD group had higher concentrations of HSP70 than the SCZ group. Exploring associations with medications, lithium (p = 0.003) and clozapine (p = 0.028) were associated with lower HSP70 levels. Approximately 64% of the sample had DAMPs levels below the limits of detection indicated by the respective ELISA kit. CONCLUSION: This was the first study to assess DAMPs levels in a transdiagnostic sample. Our preliminary findings suggest that HSP70 may be associated with MDD pathophysiology. Medications such as lithium and clozapine were associated with lower HSP70 levels in BD and SCZ groups, respectively. Therefore, it is worth mentioning that all participants were medicated and many psychotropic drugs exert an anti-inflammatory effect, possibly reducing the signs of inflammation.

Inflammation and damage-associated molecular patterns in major psychiatric disorders

Abstract Background Emerging evidence indicates that inflammation plays an important role as a mechanism underlying mental disorders. However, most of the research on inflammatory mechanisms focuses on serum levels of interleukins and very few studies have investigated molecules that initiate and expand innate immune pathways such as damage-associated molecular patterns (DAMPs). Objectives This study investigated the levels of DAMPs among patients diagnosed with major depressive disorder (MDD), bipolar disorder (BD) I and II, schizophrenia (SCZ), and generalized anxiety disorder (GAD). We quantified serum levels of heat shock proteins (HSPs) 70 and 60 and of S100 calcium-binding protein B (S100B). Methods Serum levels of HSP70, HSP60, and S100B were assessed in a sample of participants with psychiatric disorders (n = 191) and a control group (CT) (n = 59) using enzyme-linked immunosorbent assay (ELISA). Results Serum HSP70 concentrations were significantly higher in the MDD group compared to the CT, SCZ, and BD groups. The GAD group had higher concentrations of HSP70 than the SCZ group. Exploring associations with medications, lithium (p = 0.003) and clozapine (p = 0.028) were associated with lower HSP70 levels. Approximately 64% of the sample had DAMPs levels below the limits of detection indicated by the respective ELISA kit. Conclusion This was the first study to assess DAMPs levels in a transdiagnostic sample. Our preliminary findings suggest that HSP70 may be associated with MDD pathophysiology. Medications such as lithium and clozapine were associated with lower HSP70 levels in BD and SCZ groups, respectively. Therefore, it is worth mentioning that all participants were medicated and many psychotropic drugs exert an anti-inflammatory effect, possibly reducing the signs of inflammation.

Growth and weight status of Brazilian children with autism spectrum disorders: A mixed longitudinal study / Crescimento e massa corporal em crianças brasileiras com transtornos do espectro autista: um estudo longitudinal misto

ABSTRACT Objective: This study examined the growth status and physical development of Brazilian children with autism spectrum disorders from 4 to 15 years of age. Furthermore, it was examined whether variation in growth patterns and weight status was influenced by the use of psychotropic medications. Methods: One-hundred and twenty children aged 3.6-12.1 years at baseline (average = 7.2 years, SD = 2.3 years) diagnosed with autism spectrum disorders were measured on three repeated occasions across a 4-year period. Stature, body mass, and body mass index were considered. Bayesian multilevel modeling was used to describe the individual growth patterns. Results: Growth in stature was comparable to the age-specific 50th percentile for Centers for Disease Control and Prevention reference data until approximately 8 years, but a substantial decrease in growth rate was observed thereafter, reaching the age-specific 5th percentile at 15 years of age. Both body mass and body mass index values were, on average, higher than both the Brazilian and Centers for Disease Control and Prevention age-specific 95th percentile reference until 8 years, but below the 50th specific-age percentile at the age of 15 years. Conclusions: Brazilian boys with autism spectrum disorders between 4 and 15 years appear to have impaired growth in stature after 8-9 years of age, likely impacting pubertal growth. A high prevalence of overweight and obesity was observed in early childhood, although a trend of substantial decrease in body mass and body mass index was apparent when children with autism spectrum disorders entered the years of pubertal development.

RESUMO Objetivo: Este estudo examinou o estado de crescimento e o desenvolvimento físico de crianças brasileiras com transtornos do espectro autista entre 4 e 15 anos. Adicionalmente, examinamos se a variação nos padrões de crescimento e na massa corporal foi influenciada pelo uso de medicamentos psicotrópicos. Métodos: 120 crianças com idades entre 3,6 e 12,1 anos no início do estudo (média = 7,2 anos, DP = 2,3 anos) diagnosticadas com transtornos do espectro autista foram avaliadas em três ocasiões repetidas em um período de 4 anos. Foram considerados estatura, massa corporal e índice de massa corporal. O modelo multinível bayesiano foi utilizado para descrever os padrões de crescimento individual. Resultados: O crescimento em estatura foi comparável ao percentil 50 específico para a idade para os dados de referência do Centro de Controle e Prevenção de Doenças dos Estados Unidos até cerca de 8 anos. Porém, foi observada uma redução substancial na taxa de crescimento depois dos 8 anos, atingindo o percentil 5 específico para a idade aos 15 anos de idade. Tanto os valores de massa corporal quanto de índice de massa corporal foram, em média, maiores comparativamente ao percentil 95 específico para a idade até aos 8 anos da referência brasileira e do Centro de Controle e Prevenção de Doenças dos Estados Unidos, porém abaixo do percentil 50 específico para a idade aos 15 anos de idade. Conclusões: Os meninos brasileiros com transtornos do espectro autista entre 4 e 15 anos parecem ter retardo do crescimento na estatura após os 8-9 anos, provavelmente afeta o crescimento púbere. Foi observada uma alta prevalência de sobrepeso e obesidade na primeira infância, apesar de uma tendência de redução substancial na massa corporal e no índice de massa corporal ter sido aparente quando as crianças com transtornos do espectro autista entraram nos anos de desenvolvimento púbere.

Growth and weight status of Brazilian children with autism spectrum disorders: A mixed longitudinal study.

OBJECTIVE: This study examined the growth status and physical development of Brazilian children with autism spectrum disorders from 4 to 15 years of age. Furthermore, it was examined whether variation in growth patterns and weight status was influenced by the use of psychotropic medications. METHODS: One-hundred and twenty children aged 3.6-12.1 years at baseline (average=7.2 years, SD=2.3 years) diagnosed with autism spectrum disorders were measured on three repeated occasions across a 4-year period. Stature, body mass, and body mass index were considered. Bayesian multilevel modeling was used to describe the individual growth patterns. RESULTS: Growth in stature was comparable to the age-specific 50th percentile for Centers for Disease Control and Prevention reference data until approximately 8 years, but a substantial decrease in growth rate was observed thereafter, reaching the age-specific 5th percentile at 15 years of age. Both body mass and body mass index values were, on average, higher than both the Brazilian and Centers for Disease Control and Prevention age-specific 95th percentile reference until 8 years, but below the 50th specific-age percentile at the age of 15 years. CONCLUSIONS: Brazilian boys with autism spectrum disorders between 4 and 15 years appear to have impaired growth in stature after 8-9 years of age, likely impacting pubertal growth. A high prevalence of overweight and obesity was observed in early childhood, although a trend of substantial decrease in body mass and body mass index was apparent when children with autism spectrum disorders entered the years of pubertal development.

A vivência do portador de transtorno mental no uso de psicofármacos na perspectiva do pensamento complexo / La vivencia del portador de trastorno mental en el uso de psicofármacos en la perspectiva del pensamiento complejo / The experience of mental disorder patients using psychotropic medication under the perspective of complex thinking

RESUMO Objetivo: conhecer como o portador de transtorno mental vivencia o uso de psicofármacos. Método: pesquisa qualitativa, exploratória e descritiva que utilizou como referencial teórico o pensamento complexo de Edgar Morin. Os dados foram coletados por entrevista semiestruturada, aplicada a 26 portadores de transtorno mental com prescrição médica de psicofármacos, e submetidos à análise categorial temática. Resultados: foi identificada uma categoria central: "A vivência complexa do portador de transtorno mental no uso de psicofármacos", que mostra as inter-relações entre as categorias temáticas: vivenciando os efeitos dos psicofármacos; utilizando os psicofármacos de modo irregular; identificando facilidades e dificuldades no uso de psicofármacos; e desenvolvendo estratégias para manutenção do uso regular de psicofármacos. Conclusão: a vivência do portador de transtorno mental no uso de psicofármacos é um processo dinâmico e complexo que engloba a multidimensionalidade, envolvendo o ser humano e seu tratamento.

RESUMEN Objetivo: conocer como el portador de trastorno mental vivencia el uso de psicofármacos. Método: investigación cualitativa, exploratoria y descriptiva que utilizó como referencial teórico el pensamiento complejo de Edgar Morin. Datos fueron recolectados por entrevista semiestructurada aplicada a 26 portadores de trastorno mental con la prescripción de psicofármacos y fueron sometidos al análisis categorial temático. Resultados: emergió una categoría central: "La vivencia compleja del portador de trastorno mental en el uso de psicofármacos", que muestra las interrelaciones entre las categorías temáticas: vivenciando los efectos de los psicofármacos; utilizando los psicofármacos de modo irregular; identificando facilidades y dificultades en el uso de psicofármacos; y desarrollando estrategias para mantenimiento del uso regular de psicofármacos. Conclusion: que la vivencia del portador de trastorno mental en el uso de psicofármacos es un proceso dinámico y complejo que engloba la multidimensionalidad que envuelve el ser humano y su tratamiento.

ABSTRACT Objective: to understand how mental disorder patients experience the use of psychotropic medications. Method: a qualitative, exploratory and descriptive research, which used Edgar Morin's complex thinking as theoretical reference. The data were collected through a semi-structured interview applied to 26 mental disorder patients with psychotropic medical prescription and who were subjected to theme category-based analysis. Results: a central category emerged "The complex experience of mental disorder patients in the use of psychotropic medication". This category shows the interrelations between thematic categories, such as: experiencing the effects of psychotropic medications; using psychotropic medication irregularly; identifying the advantages and difficulties of using psychotropic medication; and developing strategies to maintain the regular use of psychotropic medication. Conclusions: the experiences of mental disorder patients use of psychotropic medications is a dynamic and complex process that encompasses the multidimensionality involving human beings and their treatment.

Psychogenic polydipsia and hyponatremia – A side effect of psychosis: a review with a case report / Polidipsia psicogênica e hiponatremia – Efeito colateral da psicose: revisão com relato de caso

ABSTRACT Primary polydipsia, or psychogenic polydipsia, is a condition that results in considerable morbidity and mortality. In psychiatric patients, psychogenic polydipsia and the syndrome of inappropriate antidiuretic hormone secretion may cause hyponatremia. In the 1970s, it was recognized that antipsychotics such as tiotixene and haloperidol could impair the excretion of a free water load. There are also several case reports of drug-induced hyponatremia in patients using atypical drugs suggesting that these probably can also impair water balance and induce hyponatremia. Case report and review of relevant literature are reported in this article. Psychogenic polydipsia is a common cause of hyponatremia among individuals with chronic mental illness. A case of severe hyponatremia caused by psychogenic polydipsia is described involving a female patient with an adult lifelong history of chronic mental illness diagnosed as schizoaffective disorder. After switching her antipsychotic medication to clozapine water ingestion was normalized as well as sodium levels and her psychotic symptoms improved. Primary polydipsia occurs commonly with schizophrenia and other mental diseases and can cause hyponatremia. PPD may present as an acute psychotic state or as inexplicable emergence of seizures. Appropriate, timely clinical assessment with special attention to thirst, fluid intake, and urine output is essential. Proper treatment may include drug withdrawal and fluid and saline restriction. Once corrected, some pharmacological agents can be tried. The article illustrates the importance of the diagnosis of psychogenic polydipsia given its electrolyte disturbances and life threatening situations.

RESUMO A polidipsia primária ou polidipsia psicogênica (PDP) é uma condição que se traduz em altas taxas de morbilidade e mortalidade. Nos doentes psiquiátricos, a PDP e a síndrome da secreção inapropriada do hormônio antidiurético (SIADH) podem resultar em hiponatremia. Nos anos 1970, foi reconhecido que alguns antipsicóticos como o tiotixeno e o haloperidol podiam comprometer a excreção de água livre. Existem ainda diversos casos reportados de hiponatremia iatrogênica em pacientes medicados com antipsicóticos atípicos sugerindo que essa classe farmacológica pode igualmente resultar em hiponatremia. Um caso clínico e uma revisão sobre o tema são reportados neste artigo. A polidipsia psicogênica é uma causa comum de hiponatremia entre os indivíduos com doença mental crônica. Um caso de hiponatremia grave causada por polidipsia psicogênica é descrito envolvendo uma paciente do sexo feminino com antecedentes de perturbação esquizoafetiva. Após alteração da sua medicação antipsicótica para clozapina, observou-se normalização na ingestão hídrica bem como nos níveis de sódio e melhoria da sintomatologia psicótica. A PDP ocorre comumente em doentes esquizofrênicos ou com outras perturbações psiquiátricas e pode resultar em hiponatremia. Um correto diagnóstico com especial atenção a sede, ingestão hídrica e débito urinário é essencial. O tratamento pode incluir a retirada de fármacos e restrição hídrica e salina. Uma vez corrigida, alguns agentes farmacológicos podem ser utilizados.

Consumo de medicação psicotrópica em uma prisão feminina / Consumption of psychotropic medication on a female prison / El consumo de medicamentos psicotrópicos en una prisión femenina / Consommation de médicaments psychotropes dans une prison pour femmes

Esse estudo teve por objetivo mapear o uso de medicação psicotrópica em uma prisão feminina identificando os fatores associados ao uso dessas substâncias no contexto prisional. Foi aplicado um questionário em 92 das 110 mulheres atualmente reclusas. Detectou-se que 18,47% (17 detentas) delas fazem uso de medicação psicotrópica. Após essa etapa foram realizadas seis rodas de conversa com as detentas que fazem uso de medicação psicotrópica, visando aprofundar as análises sobre o uso dessas substâncias. Os resultados apontam que 58,8% (10) das mulheres passaram a fazer uso após a entrada na prisão. Identificou-se que o cotidiano da prisão, a dificuldade de assistência médico-psiquiátrica e a ausência de visitas/contato com a família são elementos centrais para compreender o uso de medicação psicotrópica pelas detentas. Por fim, ressalta-se a importância da atuação e construção de uma psicologia política de caráter interdisciplinar e a serviço de uma sociedade mais justa.

This study aimed to map the use of psychotropic medication in a women's prison identifying the factors associated with the use of these substances in the prison context. Questionnaires were used in 92 of the 110 inmates. Afterwards, six wheel talks were made with prisoners that were using psychotropic medication in order to deepen discussions on the use of these substances. The results show that 18.47% (17) of the prisoners interviewed make use of psychotropic medication, and 58,8% (10) out of those started taking that kind of drug after being captive. Among the factors that contribute to this phenomenon, the quotidian of the prison, the difficult access to medical and psychiatric care and lack of visits /contact with the family are central to understand the use of psychotropic medication by inmates. Finally, we emphasize the importance of the performance and construction of an interdisciplinary character of political psychology and the service of a more just society.

Este estudio tuvo como objetivo mapear el uso de medicación psicotrópica en una prisión de mujeres identificando los factores asociados con el uso de estas sustancias en el contexto penitenciario. Se utilizaron cuestionarios en 92 de las 110 reclusas. Después de eso, se hicieron seis ruedas de conversaciones con las mujeres que utilizaban medicación psicotrópica con el fin de profundizar las discusiones sobre el uso de estas sustancias. Los resultados muestran que el 18,47% (17) de las presas entrevistadas hacen uso de medicación psicotrópica, y el 58,8% (10) comenzaron a tomar después de su ingreso en prisión. Entre los factores que contribuyen a este fenómeno, el cotidiano de la prisión, la dificultad de médicos, psiquiátricos y la falta de visitas /contacto con la familia son fundamentales para la comprensión del uso de la medicación psicotrópica por las internas. Por último, destacamos la importancia de la actuación y la construcción de la psicología política, interdisciplinar y al servicio de una sociedad más justa.

Cette étude visait à cartographier l'utilisation des médicaments psychotropes dans la prison pour femmes à fin d'identifier les facteurs associés à l'utilisation de ces substances dans le contexte carcéral. Un questionnaire a été appliqué dans 92 des 110 femmes actuellement détenues. Il a été constaté que 18,47% (17 détenus) d'entre eux font usage de médicaments psychotropes. Après cette étape ont eu lieu six rondes de conversation avec les détenuesqui font usage de médicaments psychotropes, visant à approfondir l'analyse de l'utilisation de ces substances. Les résultats montrent que 58,8% (10) des femmes ont commencél'utilisation après l'entrée dansla prison. Il a été constaté que le quotidien de la prision, sont au cœur de la compréhension de l'utilisation de médicaments psychotropes par les détenues. Enfin, nous soulignons l'importance de la performance et la construction d'un caractère interdisciplinaire de la psychologie politique et au service d'une société plus juste.

Uso de psicofármacos na infância e na adolescência para o pediatra geral / Psychotropic uses in childhood and adolescence for the general pediatricians

Em situações de urgência e emergência, profissionais de saúde, nem sempre com especialização em saúde mental, acolhem crianças e adolescentes com diversas manifestações de sofrimento psíquico. Estas abrangem síndromes psicóticas, de ansiedade, de depressão com repercussões comportamentais e podem ser relacionadas acasos de abuso físico, sexual ou de uso de drogas lícitas ou ilícitas. Depois da avaliação para construir uma hipótese de diagnóstico, o médico pode, além de utilizar medidas psicossociais, indicar o uso de medicamentos psicotrópicos, tais como antipsicóticos, ansiolíticos e antidepressivos.

It is not unusual that emergency rooms accept children and adolescents in mental suffering states. These entail psychotic, anxiety and depressive syndromes leading to a corresponding behavior, and they could be related to physical or sexual abuse and the use of licit and illicit substances. After diagnosis evaluation, the doctor can perform some psychosocial procedures and can prescribe psychotropic drugs as well.

La obesidad: aspectos psicológicos y conductuales / Obesity: Psychological and Behavioral Aspects

Introducción: La obesidad es un problema médico de creciente gravedad por su morbilidad y su alta y creciente prevalencia. Objetivo: Realizar una revisión actualizada acerca de la obesidad y su tratamiento, con énfasis en los aspectos de mayor interés para la práctica psiquiátrica. Resultados: La obesidad es una enfermedad crónica de difícil manejo y alta tasa de recurrencia, que se asocia con complicaciones médicas graves. Los factores psicológicos y conductuales son muy relevantes en el curso de esta enfermedad. Adicionalmente, algunos pacientes mentales tienen un mayor riesgo de presentar el problema por mayor inactividad, difi cultad para hacer cambios en el estilo de vida y el uso de psicotrópicos, muchos de los cuáles se asocian con aumento de peso.

Introduction: Obesity is a serious medical condition due to its morbidity and high and ever growing prevalence. Objectives: To review the subject of obesity and its treatment, with an emphasis on issues of greater interest to psychiatric practice. Results: This chronic medical condition is very diffi cult to treat and has a high rate of recurrence, and is associated with serious medical consequences. Psychological and behavioral factors strongly infl uence the course of this disease. Additionally, some mental patients are especially vulnerable to obesity due to greater inactivity, diffi culty in performing behavioral changes, and use of psychotropic medications, many of which may cause weight gain.