The therapeutic transnosological use of psychotropic drugs

The current clinical use of psychotropic drugs is transnosologically oriented. This is facilitated by the current classification of mental disorders (International Classification of Diseases, 10th Revision [ICD-10]) and is perhaps justified if depression and psychosis (taken here as examples) are considered as being complex syndromes with heterogeneous etiologies, but common pathogenesis, more than specific entities. However, this approach does not identify possible differences between specific psychiatric entities, which could in turn mask differences in therapeutic responses and, therefore, therapeutic outcome. This is compounded by the current disharmony between the nosological classification of diseases, drug development, clinical research, and therapeutic uses of psychotropic drugs. Functional pharmacology targeting abnormal behavioral traits could represent an avenue for future research and treatment.     

妊娠期患者的精神药物使用问题

概述:妊娠对于重性精神疾病患者来说至少面临两方面挑战:即精神疾病的遗传风险以及精神药物的可能致畸风险.本文复习了相关文献及研究证据,包括抗精神病药物、抗抑郁药物及心境稳定剂等在妊娠期患者的使用问题,最后介绍了最新治疗指南及FDA建议.     

The rational use of psychotropic drugs in pregnancy and postpartum

When a pregnant woman or nursing mother requires psychotropic medication, one must consider the effect of such medications on the fetus or baby. The authors review the evidence for teratogenic effects of such drugs given during pregnancy, toxic or withdrawal effects in the newborn and dangers to the breast-fed baby. Suggestions are made for judicious use of psychotropic drugs in pregnant or nursing women.     

Placebo use in clinical trials on psychotropic drugs in France

The use of placebos is often justified in therapeutic drug testing. They may be employed in order to compare their effects with those of a so-called active treatment, to compare two active medications, in double-blind comparisons of two drugs of different appearance (double-dummy technique) or to carry through initial washout periods. Although the scientific justification for this procedure is hardly contestable, the methodological difficulties and demands must be considered. The clinical use of placebo comparison poses a true ethical dilemma which increases with the effectiveness of psychotropic drugs. Placebos were used relatively rarely in France before 1978 as a general review of 120 controlled psychotropic drug trials published in French shows. Various precautions undertaken in drug testing designs respond, nevertheless, to both ethical and methodological demands in the majority of the cases. Examples are given regarding the testing of major or minor tranquilizers and antidepressive drugs.     

青岛市残疾精神分裂症患者精神药物使用调查研究

目的：了解青岛市残疾精神分裂症患者药物使用情况。方法：调查残疾精神分裂症患者及同期门诊患者各500例的精神药物使用情况。结果：残疾组合并使用抗精神病药、抗震颤麻痹药,苯二氮董类药和镇静安眠药较多。残疾组以典型抗精神病药为主,门诊组以非典型抗精神病药为主。结论：残疾精神分裂症患者的治疗有待改善。     

Psychological considerations in the use of psychotropic drugs with women patients

The use of psychotropic drugs with women patients raises special considerations. In some settings women are medicated too readily, and in others they have inadequate access to comprehensive care that includes medication. However, judicious use of medications to relieve disabling symptoms frequently promotes productive psychotherapy. Either prescribing drugs or withholding medication may involve special transference and countertransference issues for the woman patient. Women also have special concerns and conflicts about the effects of psychotropic drugs on pregnancy and lactation and about side effects involving sexual functioning and change of appearance.     

综合医院患者出院后服用精神科药物的依从性及其影响因素

目的 探讨某综合医院经精神科会诊后首次诊断为焦虑或抑郁的住院患者出院后遵医嘱服用精神科药物的情况及其影响因素.方法 本研究为前瞻性研究.选择2011年10月～2014年4月某综合医院精神科会诊后符合ICD-10抑郁发作、广泛性焦虑障碍、惊恐障碍、躯体形式障碍或分离转换障碍诊断标准的住院患者共512例,出院3个月后完成电话随访者452例,统计3个月来患者遵医嘱服用精神科药物的天数.采用多因素回归分析法分析性别,年龄,受教育程度,家庭人均年收入,婚姻状况,自知力,精神检查的时间,精神疾病诊断,出院的书面建议:是否包含复诊、是否认为精神科药物对自己有帮助、出院时入院主要疾病的恢复情况等因素是否影响服药依从性.结果 家庭人均年收入、精神检查时间、出院书面指导是服药依从性的保护性因素.结论 在出院书面建议中应该加上精神科用药指导,以提高患者服用精神科药物的依从性,改善患者的生活质量.     

Considerations in the use of psychotropic drugs in elderly mentally retarded persons

ABSTRACT. Elderly people tend to be large consumers of medication in general and psychotropic drugs in particular. Sedative/hypnotics, anxiolytics, antidepressants, and neuroleptic drugs tend to be the most commonly used psychotropic medications among elderly people who are not developmentally disabled. These drugs are probably commonly employed among elderly mentally retarded people as well; although the rank order of use probably differs. A number of physiological changes which accompany greater age are described and the impact on pharmacokinetic variables outlined. Other factors associated with aging, which influence drug actions, are also outlined. The net effect appears to be that most drugs are more potent, more toxic, or longer lasting among the elderly. Data are also presented on tardive dyskinesia insofar as aging is concerned. This is followed by overall conclusions and some suggested guidelines for the use of these drugs in older mentally retarded persons.