A descriptive study of drug therapy and cost for elderly residents in a nursing home

Drug therapy for 115 patients in Health Board contracted beds in a long-stay institution for the elderly were studied. The results were analysed for frequency, type and cost of medicines. 96.5% of patients received a total of 473 routine medicines, an average of 4.1 medicines per patient, females received a higher number of medicines than males. The average cost per person per day was 67.6p for all medicines. The most frequently prescribed medicines were for therapeutic groups CNS (32.3%) CVS (17.8%) and GIS (14.2%).     

Longitudinal prescribing patterns of psychotropic drugs in nursing home residents.

Changes in the use of psychotropic drugs in a large nursing home were examined both in terms of usage for the total facility and in longitudinal changes within individuals. Data for the nursing home showed a gradual increase in use of antidepressants; a decrease in use of antianxiety medications and of sedative-hypnotics. Changes in the number of residents prescribed antipsychotics were not marked. Data within residents showed a great variability in number of psychotropic drugs used, in number of changes in dosage, and in specific patterns of medication change. The first drug change after admission (excluding day of admission) was more likely to involve initiation rather than discontinuation of psychotropic drugs. The medications studied were used over 4–7 months on the average, covering 20–30% of the resident's nursing home stay. The findings suggest that there is continued monitoring of psychotropic medications in the nursing home. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental disorders of drug addicts in treatment: a study of prevalence with retrospective evaluation by means of structured diagnostic interviews

The aim of this research is to evaluate current and lifetime psychiatric morbidity according to ICD-10 criteria of subjects in treatment for psychoactive substance dependence. It is a cross-sectional clinical-epidemiological study also collecting retrospective information by means of structured diagnostic interviews. Ninety-nine outpatients fulfilling criteria of eligibility were recruited by systematic sampling at 8 Italian National Health Service's Drug Dependence Units. Criteria of inclusion were the presence of clinical diagnosis of psychoactive substance dependence according to ICD-10 and age 18-45, while criteria of exclusion were pharmacological distress related to acute withdrawal from street drugs and the presence of severe cognitive impairment, delirium or acute psychoses in order to assure reliability of the interviews. Only 75 patients accepted to participate, were enrolled in the study and interviewed by means of a European adaptation of the Addiction Severity Index. Finally, the Composite International Diagnostic Interview was completed in 65 cases. The prevalence of current psychiatric morbidity for any disorder in addition to substance use disorders was 22.2%, and lifetime prevalence was 35.4% (but, if drop-out cases are excluded from calculation, the prevalence rates grow up to 30-35% and 50-55% respectively). Psychiatric morbidity is more frequent among females and is unrelated to age or lifetime duration of substance use. In almost one-half of the cases mental disorders arose before the beginning of substance use. By order of frequence, anxiety, affective, and schizophrenic syndromes are the most common comorbid diagnoses. Affective disorders are more often secondary, since they mostly develop after the beginning of psychotropic substance use and are uncommon among currently abstinent subjects. Finally, outpatients affected by psychotic disorders are not likely to abstain from psychotropic drugs during the treatment. Psychiatric comorbidity is a considerable point in the clinical management of drug dependence, and for primary and secondary prevention of substance use disorders.     

Substance misuse and psychiatric comorbidity: an overview of the OPCS National Psychiatric Morbidity Survey

There have been a number of national surveys of psychiatric morbidity which have included questions on drugs, alcohol and tobacco. These surveys have helped delineate the overlap between substance use and dependence and other psychological morbidity. There is a strong association reported between high substance consumption and other measures of psychological problems. This article provides an overview of a national household survey, a survey of institutional residents with psychiatric disorders and a national survey of a homeless population. All three surveys used comprehensive and complex sampling strategies and lay interviewers to conduct structured diagnostic interviews. The household survey included over 10,000 households, the institutional survey interviewed 755 individuals and the homeless survey of hostels, night-shelters, day centres and private-sector leased accommodation interviewed 1,061 individuals. This overview looks at patterns of nicotine, alcohol and other drug use in the different samples and examines interactions with other psychiatric morbidity. The survey reports that substance-related disorders are some of the commonest disorders in the community, with 5% of the household sample alcohol dependent, 7% alcohol dependent in the institutional sample and over 21% in the homeless sample recorded as alcohol dependent. Tobacco, alcohol and other drug use and dependence were dramatically higher in the homeless sample than in either of the other two samples. Substance use was significantly associated with higher rates of psychological morbidity as measured by the Clinical Interview Schedule Revised. Future service planning needs to take account of the striking disparity of prevalence of psychiatric disorders in different subsections of the population.     

Breast cancer and benign breast disease patients evaluated in relation to oxidative stress

The 'WHO Analgesic Ladder' is a well validated approach for the selection of appropriate analgesic therapy for cancer pain as well as pain in AIDS. The mainstay of analgesic intervention for cancer and AIDS pain of moderate to severe intensity continues to be the appropriate use of opioid analgesics. There is, however, a growing appreciation for the role of adjuvant analgesics, such as antidepressants and other psychotropic medications, at each step of the WHO Analgesic Ladder, particularly in the treatment of neuropathic pain. Knowledge of the indications and usefulness of psychotropic analgesic drugs in cancer and AIDS pain populations will be most important to clinicians practicing in psycho-oncology/AIDS settings, particularly since these drugs are useful not only in the treatment of psychiatric complications of cancer and AIDS, but also as adjuvant analgesic agents in the management of pain. This paper reviews the literature on the use of antidepressants, psychostimulants, neuroleptics, anticonvulsants and other psychotropic analgesics in the management of cancer and AIDS pain. Mechanisms of analgesia, drug selection, and recommendations for clinical usage are discussed. The appropriate and timely use of psychotropic adjuvant analgesic drugs represents an opportunity for active psychiatric contribution to the multidisciplinary management of cancer and AIDS pain.     

Incidence of IDDM in children living in Puerto Rico. Puerto Rican IDDM Coalition

OBJECTIVE: To determine incidence, geographic distribution, and seasonal variation of IDDM in children 0-14 years of age living in Puerto Rico. Because these data have been collected through the infrastructure of the World Health Organization's DiaMond project, these results are directly comparable with incidence data from other population worldwide involved in this study. RESEARCH DESIGN AND METHODS: Beginning in 1990, new cases of IDDM were registered retrospectively from 1985 and prospectively to 1994 by review of medical records from island hospitals. Included in the hospital registry are 1,527 cases of IDDM. Validation of the primary source was by three secondary lists of cases obtained through diabetic camps, surveys of schools, and a government registry. Long linear modeling (capture-recapture) was used to correct incidence. RESULTS: Mean incidence of IDDM from 1985-1994 was 18.0 cases/100,000 children per year (95% CI 17.6-18.3). There was a slight female rather than male predominance: 51% of the cases were girls, and 49% were boys. Although Puerto Rico has marked variation in rainfall, altitude, and genetic markers, no significant differences are found in the incidence rates of different areas or seasons of the island. CONCLUSIONS: This registry of Puerto Rican children is the largest IDDM registry of minority children in the U.S. The results of this study indicate that the annual incidence of IDDM of children living in Puerto Rico is higher than the incidence of other multiracial ethnic groups living in the U.S.     

Psychiatric disturbances of aged patients in skilled nursing homes

The authors found that 85% of 74 patients supported by Medicaid in two skilled nursing facilities had significant psychiatric disorders in addition to serious multiple medical illnesses. Almost two-thirds of the psychiatric disturbances had not been diagnosed. Although staff were more concerned with the psychosocial than the physical aspects of patients' problems in more than half of the cases, they often had difficulty recognizing the legitimacy of psychological complaints and relating to patients with psychological disturbances. Staff were not clear about the orders for psychotropic medications that were prescribed for more than half of the patients. The authors point out that more psychiatric consultation is needed to ensure appropriate and effective care for psychiatric patients in such facilities.     

Patients admitted to psychiatric hospital: Presenting problems and resolution at discharge.

Examined a cohort of admissions (N?=?280) to a 150-bed public psychiatric hospital to investigate homogeneity in patient problems and patient subtypes. The interrelationships of presenting problems, treatment provided, length of stay, resolution of presenting problems, and several other variables were also studied. Results indicated that many problems experienced by patients were not psychiatric symptoms. Most presenting problems were addressed but few resolved. The primary form of treatment was psychotropic medication. Many patients were discharged before treatment effectiveness was determined. Little association was found between diagnosis, patients' problems or patient subgroup, and psychotropic drugs prescribed. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Migrant mental health: A model for indicators of mental health and health care consumption.

Objective: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. Design: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. Main outcome measures: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" Results: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. Conclusions: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health needs of Cambodian and Vietnamese refugees in Porirua

AIMS: To determine the health needs of refugees in the Porirua region. To develop options for health promotion for refugees in the Porirua region. METHODS: Twelve families were interviewed (eight Cambodian and four Vietnamese) representing 68 individuals. Questions were asked of health and other needs, health service utilisation and barriers to health care, particularly language. Additionally, eight key informant interviews were conducted. RESULTS: Families reported 26 out of 68 individuals (38%) as suffering from poor health; asthma, hepatitis B and treated tuberculosis being the three most common conditions. Open questions elicited many vague somatic complaints that may overlay psychiatric morbidity or stress. Health service utilisation was as high, or higher, than a comparable needs assessment in the Porirua region of a population based random household sample in 1993/4. Only six of the 27 refugees (22%) aged 16 or over, by their judgement, considered themselves competent enough in English to communicate independently with a general practitioner or other service provider. This is despite a mean length of residence in New Zealand of four years. Key informant interviews suggested undiagnosed psychiatric morbidity and problems accessing interpreting services, particularly in primary care. CONCLUSIONS: The major unmet health need for this group of refugees is interpreting services. Mental health needs are strongly suspected. The health promotion priority is provision of adequate interpreting services. The new Code of Health and Disability Services Consumers' Rights legally enforces the right to a competent interpreter.     

Distinguishing inter- and intrastrand NOEs involving exchangeable protons in RNA duplexes

Quality of life measures have become increasingly popular as outcome measures despite the lack of consensus on a definition of quality of life. This review describes the most frequently used measures, and discusses the conceptual and measurement issues surrounding quality of life measurement. Finally, it tries to place quality of life in the World Health Organization's model of disease impact.     

Treating chronic pain

Quantifiable and measurable methods accurately assess pain severity and successfully guide physicians in determining which medications and modalities are appropriate and necessary for the treatment of chronic pain. A variety of pain assessment scales and the World Health Organization's three-step analgesic ladder can be the starting point for successful pain management.     

Metabolism of psychotropic drugs: pharmacological and clinical relevance

Cytochrome P-450 (CYP) catalyzes phase I metabolic reactions of psychotropic drugs. The main isoenzymes responsible for their biotransformation are CYP1A2, CYP2D6, CYP3A4 and these of the subfamily CYP2C. The majority of metabolites of psychotropic drugs are biologically active. Some of them retain pharmacological properties of parent compounds (eg. selective serotonin reuptake inhibitors, risperidone, carbamazepine, benzodiazepines), but others display quite different (eg. amitriptyline, buspirone) or even opposite (trazodone) profiles. They are present in vivo in concentrations high enough to contribute to pharmacological and clinical effects of the administrated drugs. Active metabolites of psychotropics are also characterized by pharmacokinetic properties different from their parent compounds, e.g. half-life time, plasma protein binding, blood-brain-barrier penetration, the cerebrospinal fluid (CSF) protein binding and tissue binding. These properties lead, in turn, to differences in the brain/plasma and the CSF/plasma concentration ratios between a drug and its metabolites. Therefore studies relating a pharmacological or therapeutic response of psychotropic drug to its plasma concentrations should not disregard the presence of its active metabolites, considering their distinct pharmacological and pharmacokinetic properties. With regard to a low therapeutic index of psychotropics, interindividual differences in the rate of their metabolism, genetic polymorphism of their main metabolic pathways and metabolic interactions in clinical drug combinations, the phenotyping of patients at the beginning of therapy and a control of drug concentrations (and its active metabolites) at a steady state and during coadministration of another drug, may increase the efficiency and safety of the pharmacotherapy of psychiatric disorders.     

Sleeping problems and health behaviors as mediators between organizational justice and health.

The aim of this longitudinal cohort study was to investigate whether sleeping problems and health behaviors (smoking, alcohol consumption, and sedentary lifestyle) mediate the association between organizational justice and employee health. Health indicators were minor psychiatric morbidity, as assessed by the General Health Questionnaire (U. Werneke, D. P. Goldberg, 1. Yalcin, & B. T. Ustun, 2000), and poor self-rated health status. The results of logistic regression analysis of data for 416 male and 3,357 female hospital employees working during the 1998-2000 period in 10 Finnish hospitals suggest that sleeping problems are one of the underlying factors causing the adverse health effects of low organizational justice at work. No support for a mediating role of health behaviors between low organizational justice and health problems was obtained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)