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1
Antona, Annamaria. "Repurposing of psychotropic drugs for cancer therapy." Doctoral thesis, Università del Piemonte Orientale, 2021. http://hdl.handle.net/11579/127826.
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Despite improvements in cancer therapy, overall survival for most cancer types has changed a little in the past decades. Drug repositioning represents a promising approach for discovering new therapeutic strategies for cancer therapy.
Since several epidemiological studies reported lower cancer incidence in individuals receiving long term psychotropic drugs treatment, in this project we investigated 27 psychotropic drugs for their cytotoxic activity in several cancer cell lines. Consistent with the cationic amphiphilic structure of the most cytotoxic compounds, we investigated their effect on mitochondrial and lysosomal compartments. Penfluridol, ebastine, pimozide, fluoxetine, fluspirilene and nefazodone showed significant cytotoxicity, in the low micromolar range, in all cell lines tested.
In MCF7 cells these drugs triggered mitochondrial membrane depolarization, increased the acidic vesicular compartments and induced phospholipidosis. Neither caspase nor autophagy inhibitors rescued cells from death induced by fluoxetine, fluspirilene and nefazodone. Treatment with 3-methyladenine rescued cell death induced by pimozide and spiperone. Conversely, inhibition of lysosomal cathepsins significantly reduced cell death induced by ebastin, penfluridol, pimozide, spiperone and mildly by fluoxetine. Lastly, spiperone caused apoptosis in colorectal and breast. Our unpublished data on the characterization of spiperone activity on adherent and stem-like colorectal cancer cells demonstrated that its cytotoxicity is linked to perturbations of intracellular calcium (Ca2+) homeostasis, which likely result in mitochondrial Ca2+ overload and membrane depolarization, cell cycle block in G1 phase, and apoptosis. Spiperone induced a PLC dependent Ca2+ release from the endoplasmic reticulum (ER) along with ER stress and unfolded protein response activation, resulting in CHOP upregulation.
Altogether these data support the clinical development of psychotropic drugs for cancer therapy.
2
Chan, Kin-yi Ivy. "A study of determinants of relapse in psychotropic substance abuse /." Hong Kong : University of Hong Kong, 1995. http://sunzi.lib.hku.hk/hkuto/record.jsp?B19470757.
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Mitchell, Alexander Lawson. "Regulation of 5-HT receptors by psychotropic drugs." Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298235.
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Goldwasser, Ruth Pilczyk. "The usage of psychotropic medications by family caregivers /." Connect to thesis, 1996. http://eprints.unimelb.edu.au/archive/00002534.
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Moorman, Jennifer Mary. "Studies on neuroadaptation to psychotropic drugs involving serotonergic receptor function." Thesis, University of Oxford, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.244529.
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Purcell, Gregory Mark. "Intervention to improve the level of documentation of antipsychotic related adverse drug reactions." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/10340.
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Antipsychotic drugs are the mainstay of treatment for psychotic disorders according to the Standard Treatment Guidelines (2012). However, these drugs are associated with multiple severe adverse drug reactions. In order to limit the effect of adverse drug reactions on patient care, documentation is necessary. Documentation of adverse drug reactions entails recording the reaction experienced, as well as supplementary information. Proper documentation can prevent future occurrences of the same or similar adverse drug reactions. The aim of this study was to determine the effects of an educational intervention targeting increasing documentation of the adverse effects of antipsychotic drugs. The objectives of the study were: to determine the pre-intervention extent and frequency of documentation of antipsychotic-related adverse drug reactions in the patient medical record; to implement an intervention aimed at educating the relevant healthcare professionals, focusing on the adverse drug reactions of antipsychotic drugs and how to record or document these reactions; to assess the post-intervention extent and frequency of documentation of antipsychotic-related adverse drug reactions in the patient medical record; and to assess the attitude of healthcare providers towards the documentation of antipsychotic related adverse drug reactions before and after the intervention.
7
Golby, Jim. "Psychopharmacological aspects of skilled behaviour." Thesis, University of Leeds, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.329505.
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8
Chan, Kin-yi Ivy, and 陳健儀. "A study of determinants of relapse in psychotropic substance abuse." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1995. http://hub.hku.hk/bib/B31250038.
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9
Beckett, Nicola Michelle. "Isotopic Profiling of Selected Designer Drugs for Forensic Intelligence Purposes." Thesis, Griffith University, 2015. http://hdl.handle.net/10072/366425.
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Driven by forensic intelligence, illicit drug chemical profiling via Gas Chromatography-Mass Spectrometry (GC-MS) remains the leading approach that forensic scientists and law enforcement agencies pursue in a bid to counteract the ever-increasing drug epidemic. An alternative approach for forensic drug investigations that delivers intelligence at a more specific level than that of chemical profiling is isotopic profiling via Isotope Ratio Mass Spectrometry (IRMS). The analysis of selected stable isotopes (18O:16O,15N:14N, 13C:12C and 2H:1H, for example) that compose drug molecules has been suggested as a credible technique that can aid in forensic drug investigations. This research, consisting of four individual projects, was designed to investigate the potential of using isotopic profiling for source, synthetic procedure and batch linkage or discrimination of selected designer drugs/Novel Psychoactive Drugs (NPDs).Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Institute for Glycomics
Science, Environment, Engineering and Technology
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10
Confer, Jennifer, and Deborah Laird. "Psychotropic Polypharmacy in Outpatients with Schizophrenia: Comparison of Oral Psychotropic Adherence Rates, Duplication of Therapy, Psychiatric Hospitalizations, Cost of Services, and Concomitant Medications." The University of Arizona, 2007. http://hdl.handle.net/10150/624327.
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Class of 2007 AbstractObjectives: A prescription claims database from COPE Behavioral Services in Tucson, Arizona was used to retrospectively assess the differences between patients receiving <4 and those receiving > 4 psychotropic medications over a 12-month period in adult patients with schizophrenia. Methods: Medication groups (i.e., < 4 versus > 4 concomitant psychotropic agents) were compared for differences in gender, age, duplication of antipsychotic therapy, adherence rates, court order treatment status, psychiatric hospitalization rates and length of stay, cost of services provided, and concomitant psychotropic medications. Results: A total of 506 adult patients with schizophrenia (F=214 and M=292) met the inclusion criteria for receiving psychotropic medications during the 12-month study. Of those, 388 patients (76.7%) were found to have an average of < 4 medications, while 118 patients (23.3%) were found to have > 4 medications. Duplication of antipsychotic therapy was more common in the > 4 group (29.7%) compared to the < 4 group (3.1%), p < 0.001. Psychotropic adherence rates were significantly higher in the > 4 group based on month’s supply of prescriptions. Demographic differences between groups included: increased age, more women, fewer court order status, and higher cost of care in the > 4 compared to the < 4 medication group. No differences in hospitalizations, length of stay, and hospital costs were found between groups. Conclusions: Our findings suggest that patients with schizophrenia with increased rates of polypharmacy have higher adherence rates, more duplication of antipsychotics, and a higher cost of care (i.e., case management, laboratory, other services, total prescription costs) compared to patients receiving < 4 psychotropic medications.
11
Dunbar, Philip Gordon. "Approaches to the synthesis of pentacyclic dibenzazepines and phenothiazines." Diss., The University of Arizona, 1987. http://hdl.handle.net/10150/184295.
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Rigid analogues of the tricyclic antidepressant imipramine and the phenothiazine tranquilizer promazine were designed and their syntheses were attempted. Conformational rigidity was expected to reduce the side effects of these drugs by limiting their binding to multiple receptors. Ortho-directed metalation followed by acylation provided synthetic intermediates for the formation of the desired pentacyclic congeners. The known dilithiation of phenothiazine and iminodibenzyl and n-butyllithium, followed by acylation with dimethylformamide, gave carboxaldehydes at the 1 and 4 positions respectively. Ortho-lithiated nicotinamides were acylated by these aldehydes exclusively at the 4 position to provide the key intermediate alcohol amides. Difficulties in amide hydrolysis are discussed. Catalytic hydrogenation over palladium-on-carbon in refluxing acetic acid yielded carboxylic acids, apparently via the gamma-lactones formed in situ. The lactones could not be isolated easily due to instability to oxidation. Pentacyclic lactams were formed by dehydration, and borane was used to reduce the carbonyl function. Only the iminodibenzyl lactam was reduced, and problems encountered in subsequent pyridine ring reduction are discussed. Cis and trans ring fusion isomers were identified by ¹³C nmr. Attempted one-pot synthesis of this pentacycle and a regioisomer by double acylation of 4,5-dilithioiminodibenzyl with 2,3-pyridinedicarboxylic anhydride, and 3,4-pyridinedicarboxylic anhydride failed. Mechanistic considerations are discussed regarding regiochemistry and reactivity of the nitrogen and carbon anions involved. Ortho-lithiation of 3-bromopyridine to form 3-pyridyne in the presence of the preformed N-lithioiminodibenzyl-4-carboxaldehyde was unsuccessful in providing a pentacyclic benzonaphthyridinobenzazepine. The resulting 2- and 4-lithiated 3-bromopyridines were trapped by the aldehyde instead. Both hydroxymethylbromopyridines were identified by their proton coupling patterns in the pyridine ring. These compounds are discussed as potential precursors to pentacyclic benzazepinopyridobenzazepines. Several other attempts at forming benzonaphthyridinobenzazepines and naphthyridinophenothiazines were unsuccessful. Intermediates were obtained by carbon acylation of the dilithiated iminodibenzyl and phenothiazine with arecoline esters, arecaidine, and pyridine-3-carboxaldehyde. Dibenzylic alcohol reduction is discussed, as is its labile oxidation. None of the resulting pyridylmethyl heterocycles could be cyclized.
12
Vanderpot, Lynne Esther. "The interrelationship between spirituality and psychiatric medication use : a hermeneutic phenomenological study." Thesis, University of Aberdeen, 2015. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=229440.
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This thesis explores the perceived relationship between spirituality and psychiatric medication use in individuals living with severe mental health problems. The biological approach to mental health treatment is the dominant paradigm of care across the Western world, which justifies the use of psychopharmacology as a first-line therapy. In the last 30 years, the steady rise in the use of prescription medications has generated much debate and controversy. Historically, much of what we know about psychiatric medication comes from professionals and experts. Comparatively little is known about the perspectives of service users. There is also strong evidence to suggest that religion and spirituality are playing a growing role in addressing mental health problems. Both spirituality and psychiatric medication are known to mediate the processes of wellness and recovery, yet it is not well understood how their interactions may impact upon recovery. The intention of this thesis was to explore this unknown area. The methodology used in this thesis was hermeneutic phenomenology. A purposive sample of twenty people who self-identified as spiritual and/or religious, and were or had in the past taken psychiatric medication participated. Data were collected via in-depth, unstructured interviews, and analysed using a modified approach, based on the works of other researchers. The key finding in this study is that people experienced a multiplicity of interactions between spirituality and psychiatric medication which significantly impacted treatment outcomes, in both positive and negative ways. The overall findings of this research highlights the need for greater awareness of spirituality as a nonpharmacological factor which can impact upon drug treatment outcomes.
13
Mathis, Leigh Ann. "Student Psychotropic Drug Use, Past Therapy Experience and Length of Therapy." TopSCHOLAR®, 2008. http://digitalcommons.wku.edu/theses/49.
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14
Bell, Paul. "The use of saccadic eye movements in the clinical psychopharmacology of psychotropic drugs." Thesis, Queen's University Belfast, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261766.
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Warne, Rhonda J. "Trends in the use of psychotropic medication in residential aged care facilities prior to and after the advent of an accredited pharmacist conducted medication review service." Thesis, The University of Sydney, 2001. https://hdl.handle.net/2123/27725.
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Aim:
To investigate trends in the use of psychotropic medication in
residential aged care facilities prior to and after the advent of an
accredited pharmacist conducted medication review service
(PCMRS).
Objectives:
1. To compare the mean number of psychotropic medications in the
treatment group and comparison group prior to and after the
implementation of a pharmacist conducted medication review
service.
2. To compare the distribution of classes of psychotropic drugs
between the treatment and comparison groups prior to and after a
PCMRS
3. To evaluate the appropriateness of psychotropic medication in
terms of dose, dosing intervals, dose administration and dosing
regimens of benzodiazepines.
Study Design:
A comparative design with repeated measures was used with
residents in the treatment group exposed to a pharmacist conducted
medication review service. For the treatment group data were
collected prior to and after the implementation of this service. For the
comparison group data were collected over corresponding time
periods.
Setting:
A convenience sample of 14 residential aged care facilities in the
Sydney metropolitan area was recruited. The treatment group
consisted of 128 residents randomly selected from 12 residential aged
care facilities serviced by accredited pharmacists. The comparison
sample consisted of all the 121 residents from 2 residential aged care
facilities.
Results:
There was a significant downward trend in psychotropic drug use in
the treatment group. While in the comparison group there was an
increase in psychotropic drug use between the two time periods (p
<0.001). There were no differences in the distribution of psychotropic
drug classes between the treatment and comparison groups overtime.
A trend towards improvement in the overall appropriateness of a
resident's psychotropic medication regimen in the treatment group
was also observed overtime (p= 0.13). Fifty percent of the
pharmacist's recommendations in the treatment group adopted by the
general practitioner related to achieving a more appropriate use of the
medication and 40% to ceasing a drug.
Conclusion:
This research provides preliminary evidence of a reduction of
psychotropic drug use in residential aged care facilities following a
pharmacist conducted medication review service. The concomitant
improvement in the overall appropriateness of use adds credence to a
positive contribution of the pharmacist to the quality use of
psychotropic medication.
16
Gartside, Sarah Elizabeth. "The effect of psychotropic drugs on 5-HT-mediated neuroendocrine responses in the rat." Thesis, University of Oxford, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.302846.
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Backus, Lisa Ione. "Functional interactions between 5-HT receptor subtypes : implications for the actions of psychotropic drugs." Thesis, University of Oxford, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.236178.
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Wong, Deysi Viviana Tenazoa. "AvaliaÃÃo da equivalÃncia farmacÃutica da Carbamazepina e Diazepam comercializados no Programa de FarmÃcia popular do Brasil." Universidade Federal do CearÃ, 2009. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=4186.
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Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgicoA equivalÃncia farmacÃutica entre dois medicamentos relaciona-se à comprovaÃÃo de que ambos contÃm o mesmo fÃrmaco (mesma base, sal ou Ãster da mesma molÃcula terapeuticamente ativa), na mesma dosagem e forma farmacÃutica, o que pode ser avaliado por meio de testes in vitro. No Brasil, os medicamentos alopÃticos sÃo divididos em trÃs categorias quanto ao registro junto à AgÃncia Nacional de VigilÃncia SanitÃria: medicamentos novos, medicamentos similares e medicamentos genÃricos. O objetivo foi avaliar a EquivalÃncia FarmacÃutica da Carbamazepina 200 mg (CBZ) e Diazepam 10 mg (DZP) comercializados no programa FarmÃcia Popular do Brasil, visando discutir a importÃncia da qualidade dos medicamentos para a saÃde pÃblica. Utilizou-se como SubstÃncia QuÃmica de ReferÃncia (SQR) carbamazepina e diazepam, com teor declarado de 99,6 e 99,9%, respectivamente. Realizaram-se testes fÃsico-quÃmicos tais como: determinaÃÃo de peso mÃdio, desintegraÃÃo, dureza, friabilidade, teor, uniformidade de conteÃdo e perfil de dissoluÃÃo, segundo a FarmacopÃia Brasileira (F.Bras.) 4a ediÃÃo. Os resultados indicaram uma dureza menor nos comprimidos de DZP da FarmÃcia Popular. Em relaÃÃo ao Perfil de dissoluÃÃo da CBZ, a anÃlise por ANOVA indicou haver diferenÃas significativas (p<0,05) entre os perfis de dissoluÃÃo da FarmÃcia popular em relaÃÃo ao genÃrico e referÃncia nos tempos avaliados. Comparou-se o perfil de dissoluÃÃo do comprimido da FarmÃcia Popular em relaÃÃo ao medicamento referÃncia, atravÃs dos cÃlculos dos fatores de diferenÃa (f1) e semelhanÃa (f2). Obteve-se um valor de 46,29 e 35,00, respectivamente, indicando diferenÃas nos perfis avaliados. Nos comprimidos de DZP, verificou-se que os valores de percentagem de fÃrmaco dissolvido para as trÃs amostras avaliadas, foram superiores a 85% em 15 minutos de teste, e a comparaÃÃo pelo cÃlculo dos fatores de f1 e f2, nÃo pÃde ser aplicada neste caso. Evidenciou diferenÃa (p<0,05) nos primeiros 75 minutos avaliados para as trÃs amostras, o que pode nÃo ter uma significÃncia farmacÃutica. Os outros parÃmetros fÃsico-quÃmicos cumpriram com as especificaÃÃes da F. Bras. em todas as amostras de CBZ e DZP. Portanto, os comprimidos de CBZ da FarmÃcia Popular nÃo sÃo equivalentes farmacÃuticos em relaÃÃo ao medicamento referÃncia.
Two drugs are considered pharmaceutically equivalent when both contain the same drug (base, salt or ester of the same active ingredient), at the same dosage and pharmaceutical form determined in vitro. In Brazil, the allopathic drugs are classified into three cathegories when registered in the Brazilian health surveillance agency (AgÃncia Nacional de VigilÃncia SanitÃria): new, similar or generic drugs. This work aimed to determine the pharmaceutical equivalence of Carbamazepine 200 mg (CBZ) and Diazepam 10 mg (DZP) marketed in the Brazil Popular Pharmacy program, discussing the importance of drugs for public health. Carbamazepine SQR and Diazepam SQR were used as reference drugs with 99.6 and 99.9% declared content, respectively. Physicochemical studies, such as mean weight, disintegration, hardness, friability, content, content uniformity and dissolution profile were performed in accordance to Brazilian Pharmacopeia 4th edition. The results indicated a lower hardness of DZP Popular Pharmacy tablets. Despite the dissolution profile of CBZ, the ANOVA test presented significant statistical difference (p<0.05) between Popular Pharmacy tablets and generic or reference drugs in all the time point evaluated. The dissolution profile of Popular Pharmacy and reference tablets were compared through the f1 (difference) and f2 (similarity) factors. Values of 46.29 and 35.00 respectively were found suggesting a difference on the profiles evaluated. The DZP tablets, despite the sample, showed a dissolution fraction higher than 85% in 15 minutes. f1 and f2 were not possible to be calculated in these cases. The variance analysis evidenced, for all the samples, statistical difference (p< 0.05) in the first 75 minutes evaluated, what might not have pharmaceutical importance. The other physicochemical parameters were in accordance with Brazilian Pharmacopeia for all the CBZ and DZP samples. Therefore, the CBZ tables cannot be considered pharmaceutically equivalents to the reference ones.
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Tamm, Leanne. "Single and combined effects of stimulant medication and contingencies on the cognitive performance of children with attention deficit hyperactivity disorder /." Full text (PDF) from UMI/Dissertation Abstracts International, 2000. http://wwwlib.umi.com/cr/utexas/fullcit?p3004383.
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Lefever, Timothy W. "Effects of olanzapine on olfactory delayed matching-to-sample in rats." View electronic thesis (PDF), 2009. http://dl.uncw.edu/etd/2009-3/lefevert/timothylefever.pdf.
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Nanchy, Nicole, and Michelle Sereese Green. "An exploratory study of barriers to psychotropic adherence from the client's perspective." CSUSB ScholarWorks, 2006. https://scholarworks.lib.csusb.edu/etd-project/3057.
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The purpose of this study was to identify barriers to psychotropic adherence regimens in clients with Severe and Persistent Mental Illness (SPMI). Medication non-adherence perpetuates the cycle of psychotic episodes, which leads to rehospitalization, incarceration, and homelessness.
22
Ritter, Erin C. "Portrayals of mental illness in primetime television and psychotropic drug commercials." Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file 0.26 Mb., 106 p, 2006. http://proquest.umi.com/pqdlink?did=1163268081&Fmt=7&clientId=79356&RQT=309&VName=PQD.
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MacPherson, Tom. "Genetic and pharmacological investigation of α4-containing GABAA receptors in conditioned behaviours influenced by cocaine." Thesis, University of Sussex, 2014. http://sro.sussex.ac.uk/id/eprint/47585/.
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α4-subunit containing GABAA receptors (α4-GABAARs) are often found co-assembled with δ-subunits in extrasynaptic locations on nucleus accumbens (NAc) medium spiny neurons (MSNs), were they mediate a tonic form of inhibition thought to control the excitability of the neuron. This thesis combines genetic and pharmacological techniques to explore the role of α4-GABAARs in locomotor and reward-conditioned behaviours. Activation of α4-GABAARs by systemic or intra-accumbal administration of THIP, a GABAAR agonist with a preference for δ-subunits, was able to reduce cocainepotentiated locomotor activity in wildtype but not GABAAR α4-subunit knockout mice. Similarly, the ability of repeated cocaine to induce behavioural sensitisation was unaffected in GABAAR α4-subunit knockout mice, but systemic THIP was able to reduce the sensitised increase in locomotor activity in wildtype but not knockout mice. α4-GABAARs are also able to modulate behavioural responses to reward-conditioned stimuli and their enhancement by cocaine. Deletion of GABAAR α4-subunits from dopamine D1-expressing neurons facilitated cocaine-CPP, and activation of α4- GABAARs on NAc D1-MSNs was able to attenuate cocaine-enhancement of cocaine CPP. Conversely, deletion of GABAAR α4-subunits from dopamine D2-expressing neurons increased CRf responding, and activation of α4-GABAARs on NAc D2-MSNs was able to attenuate cocaine-potentiation of CRf responding. These data also indicate that there is a dissociation in the NAc MSNs mediating cocaine-CPP and CRf responding. This may be explained by the different glutamatergic inputs needed to provide information about conditioned cues important for these behaviours. The data presented within this thesis indicate that α4-GABAAR-mediated inhibition of D1- and D2-expressing neurons plays an important physiological role in controlling behavioural responses to conditioned cues. Furthermore, NAc α4βδ GABAARs may provide a potential therapeutic target by which to limit the enhancement of locomotor and conditioned-behaviours by cocaine.
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Fröhlich, Samanta Maria Etges. "Impacto do consumo de psicotrópicos nas despesas familiares no Brasil." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/142853.
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Introdução: nas quatro últimas décadas, os medicamentos psicotrópicos assumiram uma significativa importância na vida de milhões de pessoas. Os custos diretos e indiretos associados aos psicotrópicos são frequentemente desconhecidos. Aspectos econômicos dos psicotrópicos foram estudados em outros países, mas essas informações ainda são escassas no Brasil. Uma fonte de dados para estudos sobre despesas familiares e gastos em saúde é a Pesquisa de Orçamentos Familiares. Objetivos: desenhar o perfil de brasileiros que adquirem medicamentos psicotrópicos, bem como, avaliar o gasto com esses medicamentos e o seu impacto no orçamento familiar brasileiro nos últimos anos. Métodos: estudo transversal, onde os dados utilizados são provenientes da Pesquisa de Orçamentos Familiares de 2002-2003 e de 2008-2009, envolvendo entrevistas de uma amostra complexa, composta por 48.470 domicílios pesquisados em 2003, 128.300 pessoas e 55.970 domicílios visitados em 2009. Modelos de regressão multivariáveis de Poisson com variância robusta foram construídos através do SAS/SUDAAN 10.0.1. Todos os rendimentos e despesas foram convertidos para valores mensais e corrigidos para a inflação do período. Resultados: a prevalência de aquisição de psicotrópicos pela população brasileira em 2008-2009 foi de 5,2% (IC95%=5,0-5,5), resultando em um gasto anual de R$507 milhões. Essa aquisição foi mais frequente em mulheres, indivíduos brancos, de idades mais avançadas, que não vivem com o cônjuge, com grau mais 9 elevado de instrução e de maior renda. Indivíduos que gastaram com psicotrópicos apresentaram despesas maiores com plano de saúde (RP=1,40, IC95%: 1,30-1,50) e consultas médicas (RP=2,51, IC95%: 2,32-2,72). A média mensal de despesas com psicotrópicos, por domicílio, aumentou de R$ 54,38 em 2003 para R$ 78,73 em 2009, com os valores já corrigidos pela inflação. Entre os domicílios que não gastaram com psicotrópicos, a renda média mensal per capita foi de R$1.026,73 e os gastos mensais per capita foram de, em média, R$73,92 com saúde, R$130,17 com alimentação e R$12,77 com lazer. Entre os domicílios que adquiriram psicotrópicos, a renda média mensal per capita foi de R$1.154,40 e, suas despesas mensais médias, per capita, de R$210,38 com saúde, R$162,08 com alimentação e R$15,45 com lazer. Conclusões: houve um aumento acima da inflação nos gastos com medicamentos psicotrópicos entre os anos avaliados. A aquisição desses medicamentos está relacionada a famílias de níveis socioeconômicos mais elevados. As diferenças encontradas podem representar diferentes níveis tanto de acesso aos serviços médicos de diagnóstico e tratamento quanto aos próprios medicamentos. O orçamento das famílias brasileiras não parece mostrar remanejamento de recursos em função da compra de psicotrópicos. Se a mudança epidemiológica, em sua primeira etapa, representou a transição das doenças infecciosas para as doenças crônicas não transmissíveis, o quadro que pode representar o futuro seriam as doenças neurodegenerativas, mantidas as tendências de aumento da expectativa de vida.Introduction: over the past four decades the use of psychotropic drugs increased its relevancy to the lives of millions of people. The direct and indirect costs associated to psychotropics are usually unknown. Economic aspects of psychotropic medicine have been studied in other countries, although such information is still scarce in Brazil. A data source for studies about household expenditure and health care costs is the Survey on Household Budgets. Objectives: to draw a profile of Brazilian people that acquire psychotropic drugs, as well as evaluate spends with these medicine and its impacts on the Brazilian household budget on the recent years. Methods: a cross-sectional study, with data used are from the Survey on Household Budgets from 2002-2003 and from 2008-2009, which involved interviews of a complex sample made of 48,470 households on 2003, 128,300 people and 55.970 homes in 2009. Poisson multilevel regression models with robust variance were made by SAS/SUDAAN 10.0.1. All income and spends were adjusted to a monthly basis and indexed by inflation. Results: the prevalence of psychotropics acquisition in the Brazilian population in 2008-2009 was of 5.2% (CI95%=5.0-5.5), resulting in an annual expenditure of R$507 millions. The use of psychotropic drugs was more frequent among women, white people, older people, do not co-habit with a spouse or partner, more schooled and wealthier. Individuals that spent with psycotropics had more 11 spends with health insurance (PR=1.40, CI95%: 1.30-1.50) and medical consults (PR=2.51, CI95%: 2.32-2.72). The average monthly spends with psychotropics per household increased from R$54.38 in 2003 to R$78.73 in 2009, with values indexed by inflation. Among the households that did not purchase psychotropics, the average monthly per capita income was of R$1,026.73 and the monthly per capita spends were, in average, of R$73.92 with health care, R$103.17 with food and R$12.77 with leisure. Among the household that presented expenditure with psychotropics, the average monthly per capita income was of R$1,154.40 and its average monthly per capita spends were of R$210.38 with health care, R$162.087 with food and R$15.45 with leisure. Conclusion: there was an above inflation increase in the psychotropic drugs spends between the evaluated years. The psychotropics acquisition relates to higher socio-economic leveled families. The differences that were found may represent different levels of access to medical diagnose and treatment and to medication. The Brazilian household budgets do not seem to re-adequate resources to meet the purchase of psychotropics. If the epidemiologic change, at its first stage, represented the transition from infectious diseases to non-transmissive chronic illnesses. the picture that can represent the future would be the neurodegenerative diseases, if the trend of increasing life expectancy is kept.
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Giron, Maria Stella T. "The rational use of drugs in a population of very old persons /." Stockholm : [Karolinska institutets bibl.], 2002. http://diss.kib.ki.se/2002/91-7349-155-1.
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Lesén, Eva. "Psychotropic drugs among the elderly : Population-based studies on indicators of inappropriate utilisationin relation to socioeconomic determinants and mental disordersEva LesénGothenburg." Doctoral thesis, Nordic School of Public Health NHV, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3721.
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Background: Drug utilisation among the elderly is complex due to multiplemorbidities, extensive drug utilisation and an increased sensitivity to drugs. One of the most common drug groups utilised in this population is psychotropic drugs, which include antipsychotics, anxiolytics, hypnotics, and antidepressants. In appropriat eutilisation of drugs among the elderly is an issue of great public health importance. Aims: The overall aim of this thesis is to assess and analyse potentially in appropriat eutilisation of psychotropic drugs among the elderly in Sweden. The specific aims are to assess to what extent the indicator “concurrent use of three or more psychotropic drugs”captures the utilisation of Potentially Inappropriate Psychotropics (PIP) among theelderly, and to analyse potentially inappropriate utilisation of psychotropic drugs inrelation to time, mental disorders, institutionalisation, and socioeconomic determinants among the elderly in Sweden. Methods: Data from individual-based registers on dispensed drugs and socioeconomic determinants in 2006, the Gothenburg 95+ Study (1996-1998), and aggregated drug sales statistics from 2000-2008 were used. The agreement between the two indicators“concurrent use of three or more psychotropic drugs” and PIP was assessed. Utilisationof psychotropic drugs and PIP was assessed in relation to mental disorders and institutionalisation among the 95-year olds, and in relation to socioeconomic determinants among individuals aged 75 years and older. Further, trends over time inutilisation of PIP and recommended drugs were analysed. Results: During 2006, about half of the elderly aged 75 years and older utilised psychotropic drugs and one fifth of all elderly utilised PIP. One fourth of individualsutilising PIP were captured by the indicator “concurrent use of three or morepsychotropic drugs”. In 1996-1998, less than one tenth of the 95-year olds with depression utilised antidepressants, while hypnotics and anxiolytics were more common. Individuals with low income and the non-married were more likely to utilise PIP compared to those with high income and the married, respectively. During 2000-2008, utilisation of PIP decreased and utilisation of recommended psychotropic drugs increased. Conclusions: There are substantial problems in the utilisation of psychotropic drugsamong the elderly. This thesis found that the agreement between two indicators of inappropriate psychotropic drug utilisation was poor, which emphasises the importance of choosing relevant indicators. The findings also show socioeconomic inequities inpsychotropic drug utilisation among the elderly, a low utilisation of antidepressants among 95-year olds diagnosed with depression, and a trend towards the utilisation of recommended rather than inappropriate psychotropic drugs among the elderlyBakgrund: Användning av läkemedel bland äldre är komplicerat på grund avmultisjuklighet, användning av flera läkemedel och en ökad känslighet för läkemedel.En av de vanligaste läkemedelsgrupperna hos äldre är psykofarmaka, som inkluderarantipsykotika, ångestdämpande, sömnmedel och antidepressiva läkemedel. Olämpliganvändning av läkemedel bland äldre är ett betydande folkhälsoproblem. Syfte: Det övergripande syftet med avhandlingen är att beskriva och analyserapotentiellt olämplig användning av psykofarmaka bland äldre i Sverige. De specifikasyftena är att undersöka i vilken utsträckning indikatorn ”samtidig användning av treeller fler psykofarmaka” fångar användningen av potentiellt olämpliga psykofarmaka(PIP) bland äldre och att analysera potentiellt olämplig användning av psykofarmaka irelation till förändring över tid, psykiatriska diagnoser, boendeform och socioekonomiska determinanter bland äldre i Sverige. Metod: Avhandlingen baseras på data från individbaserade register över läkemedelsköp och socioekonomiska determinanter under 2006, Göteborg 95+ studien (1996-1998)samt aggregerade data över läkemedelsförsäljning under 2000-2008. Överensstämmelsen mellan de två indikatorerna ”samtidig användning av tre eller flerpsykofarmaka” och PIP undersöktes. Användning av psykofarmaka och PIP studerades i relation till psykiatriska diagnoser och boendeform hos 95-åringar och i relation till socioekonomiska determinanter hos de som var 75 år och äldre. Vidare analyseradesförändring över tid i användning av PIP och rekommenderade psykofarmaka. Resultat: Hälften av alla äldre som var 75 år och äldre använde psykofarmaka under2006 och en femtedel av alla äldre använde PIP. En fjärdedel av individerna somanvände PIP fångades av indikatorn ”samtidig användning av tre eller flerpsykofarmaka”. Bland 95-åringarna med depression år 1996-1998 använde färre än enav tio antidepressiva läkemedel, medan sömnmedel och ångestdämpande läkemedel varvanligare. PIP var vanligare hos de äldre med låg inkomst och bland de som inte vargifta, jämfört med individer med hög inkomst och de gifta. Under 2000-2008 minskade användningen av PIP medan användningen av rekommenderade psykofarmaka ökade. Slutsatser: Det finns fortfarande stora problem i äldres användning av psykofarmaka.Avhandlingen visar en låg överensstämmelse mellan två indikatorer för olämpliganvändning av psykofarmaka, vilket pekar på betydelsen av att välja relevantaindikatorer. Avhandlingen visar också på socioekonomiska ojämlikheter i användningenav psykofarmaka hos äldre, en låg användning av antidepressiva läkemedel bland 95-åringar med depression och en ökning i användningen av rekommenderade istället förolämpliga psykofarmaka bland äldre
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Lloyd, Edward John, and mikewood@deakin edu au. "A common structural basis for central nervous system drug design." Deakin University. School of Biological Sciences, 1986. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20050902.115505.
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The main theme of this thesis is that there is a common structural basis for drugs acting on the central nervous system (CNS), and that this concept may be used to design new CNS-active drugs which have greater specificity and hence less side-effects.
To develop these ideas, the biological basis of how drugs modify CMS neurotransmission is described, and illustrated using dopaminergic pathways. An account is then given of the use of physicochemical concepts in contemporary drug design. The complete conformational analysis of several antipsychotic drugs is used to illustrate some of these techniques in the development of a model for antipsychotic drug action.
After reviewing current structure-activity studies in several classes of CNS drugs (antipsychotics, anti-depressants, stimulants, hal1ucinogens, anticonvulsants and analgesics), a hypothesis for a common structural basis of CNS drug action is proposed- This is based on a topographical comparison of the X-ray structures of eight representative CNS-active drugs, and consists of three parts: 1.there is a common structural basis for the activity of many different CNS-active drug classes; 2. an aromatic ring and a nitrogen atom are the primary binding groups whose topographical arrangement is fundamental to the activity of these drug classes;
3. the nature and placement of secondary binding
determines different classes of CNS drug activity. A four-Point model for this common structural basis is then defined using 14- CNS-active drug structures that include the original eight used in proposing the hypothesis. The coordinates of this model are: R1 (0. 3.5, 0), R2 (0, -3.5, O), N (4.8. -0.3, 1.4), and R3 (6.3, 1.3, 0), where R1 and R2 represent the point locations of a hydrophobic interaction of the common aromatic ring with a receptor, and R3 locates the receptor point for a hydrogen bond involving the common nitrogen, N. Extended structures were used to define the receptor points R1, R2 and R3, and the complete conformational space of each of the 14 molecules was considered.
It is then shoun that the model may be used to predict whether a given structure is likely to show CNS activity: a search over 1,000 entries in the current Merck Index shows a high probability (82%) of CNS activity in compounds fitting the structural model.
Analysis of CNS neurotransmitters and neuropeptides shows that these fit the common model well. Based on the available evidence supporting chemical evolution, protein evolution, and the evolution of neurotransmitter functions, it is surmised that the aromatic ring/nitrogen atom pharmacophore proposed in the common model supports the idea of the evolution of CNS receptors and their neurotransmitters, possibly from an aromatic amine or acety1cho1ine acting as a primaeval communicating molecule.
The third point in the hypothesis trilogy is then addressed. The extensive conformation-activity analyses that have resulted in well-defined models for five separate CNS drug classes are used to map out the locations of secondary binding groups relative to the common model for anti-psychotics, antidepressants, analgesics, anticholinergics, and anticonvulsants. With this information, and knowledge derived from receptor-binding data, it is postulated that drugs having specified activity could be designed.
In order to generate novel structures having a high probability of CNS-activity, a process of drug design is described in which known CNS structures are superimposed topographically using the common model as a template. Atoms regarded as superfluous may be selectively deleted and the required secondary binding groups added in predicted locations to give novel structures.
It is concluded that this process provides the basis for the rational design of new lead compounds which could further be optimized for potent and specific CNS activity.
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Wieliczko, Monika J. "Psychological effects of MDMA." Thesis, Canterbury Christ Church University, 2016. http://create.canterbury.ac.uk/14928/.
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Zinberg's Interaction Model implies that the content of a drug-induced experience is a function of the pharmacological properties of the drug, the set (the user’s characteristics e.g. motivation and personality), and the setting (the physical and social context). The current research investigated the function of the set and setting and their role in shaping the psychological effects of 3,4-methylenedioxmethamphetamine (MDMA), as well as their role in reducing the risk of drug abuse. An online survey was distributed among adult MDMA polydrug users (n = 158) and MDMA-naïve controls (alcohol, nicotine and cannabis users, n = 138). Participants answered questions regarding their pattern of drug use, their motivation for MDMA use and the setting (e.g. clubbing, home with friends), as well as the subjective effects of MDMA. Participants also completed a range of self-report measures of self-reflection and insight, emotional intelligence, and personality, as well as a drug dependency measure. MDMA users displayed higher levels of self-reflection and insight, openness to new experience and lower levels of neuroticism and conscientiousness, in comparison to the control group. The significant predictors of self-reflection and insight were openness, emotional intelligence, MDMA use, extraversion and neuroticism. When the analysis was rerun only for the MDMA group, the significant predictors of self-reflection and insight were openness, emotional intelligence and self-insight effects of MDMA. High levels of self-reported negative effects of MDMA were predictors of a problematic drug use. These findings suggest that there might be a relationship between MDMA use and higher levels of self-reflection and insight; however, longitudinal studies are required to further investigate the causality of this relationship. The results add to existing evidence that MDMA has potential for altering emotional experiences. Further research utilising a prospective design is warranted.
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Shearer, James Douglas National Drug & Alcohol Research Centre Faculty of Medicine UNSW. "Modafinil for psychostimulant dependence." Publisher:University of New South Wales. National Drug & Alcohol Research Centre, 2008. http://handle.unsw.edu.au/1959.4/41423.
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Psychostimulant dependence is a major public health issue in many parts of the world associated with a wide range of psychological, medical and social problems. Psychosocial interventions are the mainstay of treatment for psychostimulant problems, although their effectiveness is compromised by poor uptake and compliance. Despite increasing knowledge of the neurobiological consequences of psychostimulant use, no medications to date have been any more successful than placebo in reducing psychostimulant use in dependent patients. Modafinil is a non-amphetamine type psychostimulant that may have potential as an agonist pharmacotherapy for psychostimulant dependence. The aim of this thesis was to examine the safety, efficacy and cost-effectiveness of modafinil 200 mg/day over ten weeks plus a four session brief CBT intervention for methamphetamine and cocaine dependence through two concurrent randomised placebo controlled trials. There were no statistically significant differences between modafinil and placebo in treatment retention, medication adherence, psychostimulant abstinence, psychostimulant craving or severity of psychostimulant dependence. Methamphetamine-dependent subjects tended to provide more illicit psychostimulant negative urine samples while in treatment than those who received placebo. There appeared to be a reduction in self-reported days of psychostimulant use among methamphetamine-dependent subjects who received modafinil compared to placebo, but the effect size was too small to be statistically significant in this sample. The reduction in self-reported psychostimulant use did reach statistical significance in methamphetamine-dependent subjects with no other substance dependence. Uptake of counselling was the most significant predictor of reduced psychostimulant use post treatment, and the addition of counselling improved the cost-effectiveness of modafinil relative to placebo. Modafinil appeared to be safe, well-tolerated, and non-reinforcing in this treatment population. Compared to placebo, there was a significant increase in weight in subjects who completed the 10-week course of treatment, and a significant decrease in systolic blood pressure in methamphetamine-dependent subjects who received modafinil. The results support further trials of modafinil in methamphetamine-dependent patients, although future trials in cocaine-dependent patients from this treatment population were not likely to be viable. Modafinil appeared to be modestly effective in reducing, but not stopping, methamphetamine use in selected patients. Multi-centre trials with larger sample sizes, and measures sensitive enough to detect quantitative changes in psychostimulant use would be needed to confirm the findings. Blood pressure and weight may be important indicators of clinical outcome, and warrant particular attention in future trials, particularly given the cardio-toxicity of both methamphetamine and cocaine. Strategies to enhance medication adherence including a higher dose and counselling adherence are recommended to improve outcomes. Given the predominance of behavioural and psychosocial factors in psychostimulant dependence, it is likely that the role of medications such as modafinil will be as an adjunct to psychosocial therapy.
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Stein, Dan J. "Philosophy of psychopharmacology : a naturalist approach." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/21761.
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Thesis (DPhil)--Stellenbosch University, 2008.ENGLISH ABSTRACT: The use of psychiatric medication is an important part of modern medical and psychiatric practice. Clinical psychopharmacology raises a broad range of philosophical issues, including metaphysical, epistemological, and moral questions. This dissertation attempts to provide a conceptual framework for addressing several of these questions, and for formulating a conceptual basis for psychiatry in general and clinical psychopharmacology in particular. The dissertation begins by heuristically contrasting two broad approaches towards a range of questions in the philosophy of science, language, and medicine. A classical position takes an essentialist and objective view of categories while a critical position emphasizes that categories are often metaphoric and subjective. A synthetic or integrated position might be possible, in which radial categories are often based on metaphoric extensions of basic-level sensorimotor-affective experience, and are embodied in the brain-mind and in social practices. Rather than attempt to defend an integrated position in purely conceptual terms, the dissertation supports this view of categories using data from the cognitive-affective sciences. An important category for philosophy of medicine is disorder, and the dissertation argues that certain universal considerations explain agreement about prototypical disorders. Extensions of disorder metaphors are theory-driven and valueladen, and although disagreement about atypical conditions is likely, reasonable debate is possible. The dissertation then considers several conceptual questions, namely the nature of psychotropics, of emotion, and of the self. In each case, a classical position which attempts an essentialist definition is contrasted with a critical position which emphasizes that these constructs are socially constructed and crucially subjective. Cognitiveaffective data is then employed to support an integrative position which emphasizes the embodiment of complex brain-mind phenomena in the brain-mind and in social practices. Explanatory questions considered are how best to explain pharmacotherapy and psychotherapy, how to account for placebo responses, and the relevance of evolutionary explanations of disorder. It is argued that a functionalist account fails to explain psychopharmacological phenomena, including pharmacotherapy and placebo effects. Instead, an account which emphasizes how psychobiological mechanisms produce complex brain-mind phenomena is needed. Evolutionary explanations add to this account, but cannot by themselves differentiate disorder from non-disorder. Ethical questions include the question of whether psychiatric disorders should be treated, whether such disorders should be treated with psychotropics, and whether psychotropics should be used to enhance. The cognitive-affective sciences support the treatment of typical disorders. In more atypical cases, pharmacotherapy, psychotherapy, and non-medical interventions should be considered on an individual basis. As technologies expand, considerations about the value of accepting fate versus the value of attempting to improve life by a range of methods, will need to be weighed carefully. In summary, this dissertation puts forward a philosophy of psychopharmacology which argues that psychiatry practice can be viewed, naturalistically, as based on the natural and human sciences. At the same time, good psychiatric practice involves an engagement with the complex realities of the human condition, including a consideration of individuals’ suffering. Good psychopharmacological practice requires integrating the objective and the subjective, considering both explanation and understanding, and providing a balanced view of the good and bad of psychotropics that avoids both unrealistic optimism and undue pessimism.
AFRIKAANSE OPSOMMING: Die gebruik van psigiatriese medikasie maak belangrike deel uit van moderne mediese en psigiatriese praktyk. Psigofarmakologie bring wye reeks filosofiese kwessies ter sprake, met inbegrip van metafisiese, epistemologiese, en morele vrae. Hierdie proefskrif poog om konseptuele raamwerk te verskaf ten einde verskeie van hierdie vrae die hoof te bied, en na die formulering van konseptuele basis vir psigiatrie in die algemeen en kliniese psigofarmakologie in die besonder om te sien. Die proefskrif begin deur twee algemene benaderings ten opsigte van reeks vrae in die filosofie van wetenskap, taal en geneeskunde te kontrasteer. Klassieke posisie huldig essensialistiese en objektiewe siening van kategorieë, terwyl kritiese posisie klem daarop lê dat kategorieë dikwels metafories en subjektief is. Sintetiese of geïntegreerde posisie is dalk moontlik, met radiale kategorieë wat dikwels op metaforiese uitbreidings van konsepte op basiese vlak sensorimotor-affektiewe ervaring gebaseer word, en in die bewussyn-brein en in sosiale gebruike vergestalt word. Eerder as om te probeer om geïntegreerde posisie in suiwer konseptuele terme te verdedig, steun die proefskrif hierdie siening van kategorieë met behulp van data uit die kognitiewe-affektiewe wetenskappe. Belangrike kategorie vir die filosofie van geneeskunde is steuring, en die proefskrif voer aan dat sekere universele oorwegings ’n verklaring bied vir ooreenstemming ten opsigte van prototipiese steurings. Uitbreidings van die steuring metafoor is teoriegedrewe en waardebelaai, en alhoewel daar waarskynlik meningsverskil omtrent atipiese toestande kan voorkom, is redelike bespreking haalbaar. Die proefskrif neem dan verskeie konseptuele vrae in aanmerking, naamlik die aard van psigotropika, van emosie, en van die self. In elke geval word klassieke posisie wat essensialistiese definisie aandurf, gekontrasteer met kritiese posisie wat beklemtoon dat hierdie konstrukte sosiaal gekonstrueer en besonder subjektief is. Kognitiewe-affektiewe data word dan aangewend om integratiewe posisie te handhaaf wat die vergestalting van komplekse bewussyn-brein fenomene in die bewyssyn-brein en in sosiale praktyke beklemtoon. Verklarende vrae het aandag geskenk aan die beste wyse om farmakoterapie en psigoterapie te verklaar, aan die wyse waarop placebo-reaksies verklaar kan word, en aan die rol van proksimale en evolusionêre verklarings. Daar word aangevoer dat funksionalistiese verklaring nie daarin slaag om psigofarmakologiese verskynsels, met inbegrip van farmakoterapie en placebo-effekte, te verklaar nie. In plaas daarvan word verklaring wat beklemtoon hoe psigobiologiese meganisme komplekse fenomene kan laat ontstaan, benodig. Evolusionêre verklarings dra tot hierdie verklaring by, maar kan nie op sigself steuring van niesteuring onderskei nie. Etiese vrae sluit die vraag in of psigiatriese steurings behandel moet word, of sodanige steurings met psigotropika behandel moet word, en of psigotropika gebruik moet word om te verhoog. Die kognitief-affektiewe wetenskappe ondersteun die behandeling van tipiese steuringe. In meer atipiese gevalle moet farmakoterapie, psigoterapie, en nie-mediese intervensies op individuele basis oorweeg word. Algaande tegnologieë uitbrei, moet ons oorwegings van die waarde van lotsaanvaarding sowel as die waarde van ’n poging om ’n mens se lewe te verbeter, versigtig in ag neem. Ter opsomming, hierdie proefskrif stel filosofie van psigofarmakologie voor wat aanvoer dat psigiatriese praktyk naturalisties verstaan kan word, soos gebaseer op die natuur- en geesteswetenskappe. Terselfdetyd, behels goeie psigofarmakologiese praktyk ‘n verwantskap met die komplekse werklikhede van die menslike kondisie. Dit vereis ‘n omvattende oorweeging van en omgang met individuele pasiënte se lyding. Goeie psigofarmakologiese praktyk integreer die “objektiewe” en die “subjektiewe” aspekte van die menslike bestaan, streef na sowel verklaring en verstaan, verskaf ‘n gebalanseerde perspektief oor die goed en die sleg van psigiatriese medikasies, en middel tussen onrealistiese optimisme en buitensporige pessimisme.
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Morello, Manuela Roque Siani. "Medicamentos psicoativos na rede pública de saúde de RibeirãoPreto-SP: perfil de utilização e fatores associados." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/60/60137/tde-30102014-163819/.
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O crescente consumo de medicamentos psicoativos (MPA) pela população brasileira e mundial no século XXI, atrelado ao fato de que algumas dessas substâncias podem gerar dependência física e/ou psíquica nos sujeitos que os utilizam, apontam para a necessidade de desenvolver estudos epidemiológicos que forneçam subsídios para o planejamento de intervenções em saúde que garantam o uso racional desses medicamentos. Este estudo transversal visa estimar a prevalência e caracterizar o perfil de utilização de MPA entre usuários de medicamentos atendidos por todas as farmácias das unidades de saúde do município de Ribeirão Preto-SP, relacionando esses achados com fatores associados ao consumo dessas substâncias. Uma amostra de 1355 usuários de medicamentos (psicoativos ou não) foi entrevistada nas filas das referidas farmácias de setembro a dezembro de 2012. Os pesquisadores coletaram dados sociodemográficos e relacionados à saúde dos indivíduos, além de registrarem todos os medicamentos contidos nas prescrições. Em seguida, três instrumentos foram aplicados para avaliar as variáveis clínicas (i) conhecimento dos indivíduos sobre a farmacoterapia, (ii) adesão à farmacoterapia e (iii) qualidade de vida relacionada à saúde (QdV). A prevalência de uso de MPA foi 31,0% (n=420), sendo que os mais prescritos foram antidepressivos (53,5%) e benzodiazepínicos (24,6%). A maioria dos usuários de MPA era do gênero feminino (81,9%), vivia com companheiro (52,6%), não trabalhava (70,7%), possuía plano de saúde privado (69,2%) e renda per capita de até um salário mínimo (54,0%), não realizava acompanhamento com psicólogo (93,3%), não praticava atividade física regular (78,3%), consumia café diariamente (81,0%), não consumia álcool (86,7%), não fumava (81,4%) e não encontrava-se em polifarmácia (62,4%). A idade média foi 54,5 (DP 13,9) e a escolaridade média correspondeu ao Ensino Fundamental incompleto. Pouco mais da metade dos usuários de MPA exibiram conhecimento satisfatório sobre a farmacoterapia e foram considerados aderentes (57,8% e 53,0%, respectivamente) e a maioria não apresentou QdV satisfatória (73,1%). Houve diferença estatisticamente significativa (p<0,05) entre usuários de MPA e não usuários para as variáveis gênero, faixa etária, situação conjugal, moradia, situação profissional, cuidador, acompanhamento com psicólogo, atividade física regular, consumo de álcool, tabagismo, polifarmácia, conhecimento médio sobre a farmacoterapia, adesão média à farmacoterapia, QdV satisfatória, índice médio EQ- 5D e QdV autorreferida média. Os valores de odds ratio (OR) ajustados mostraram que os fatores associados positivamente com o uso de MPA foram gênero feminino (OR = 2,02; IC 95% 1,31; 3,11) e maior idade (ORref./idosos = 0,36; IC 95% 0,13; 0,99). Dentre os usuários de benzodiazepínicos, 51,1% relatou estar em uso desses MPA há dois anos ou mais, dos quais 55,1% eram idosos. Aproximadamente um em cada três indivíduos utilizava pelo menos um MPA no período estudado, sendo que idosos e mulheres apresentaram maiores chances de uso. Os MPA mais prevalentes foram os antidepressivos e os benzodiazepínicos, sendo a maioria dos usuários destes últimos estava em tratamento com esses MPA há mais de dois anos, dos quais mais da metade eram idososThe increasing consumption of psychoactive drugs (PAD) in Brazil and worldwide, linked to the fact that some of these substances can cause physical and/or psychic dependence in their users, indicate the need to develop epidemiological studies providing support for planning of health interventions so as to ensure the rational use of these medicines. This cross-sectional study aims to estimate the prevalence and characterize the usage profile of PAD among drug users served by all health facilities\' pharmacies in Ribeirão Preto-SP, relating these findings with factors associated with the consumption of these substances. From september to december 2012, a sample of 1355 drug users (psychoactive or not) was interviewed while waiting in the pharmacies to get their medication. The researchers collected sociodemographic and health related data of individuals, in addition to registering all drugs contained in prescriptions. Then, three instruments were applied to assess the clinical variables (i) knowledge of pharmacotherapy, (ii) adherence to the pharmacotherapy and (iii) health related quality of life (QoL). The prevalence of PAD usage was 31,0% (n = 420), and the most prescribed were antidepressants (53,5%) and benzodiazepines (24,6%). Most PAD users were female (81,9%), lived with a partner (52,6%), did not have a job (70,7%), had a private health insurance (69,2%) and income per capita up to the minimum wage (54,0%), did not undergo follow-up with a psychologist (93,3%), did not practice regular physical activity (78,3%), consumed coffee daily (81,0%), did not consume alcohol (86,7%), did not smoke (81,4%) and were not found in polypharmacy (62,4%). The mean age was 54,5 (SD 13,9) and the average schooling corresponded to incomplete primary education. Over half of the users of MPA exhibited satisfactory knowledge about pharmacotherapy and were considered adherent (57,8% and 53,0%, respectively), and most showed no satisfactory QoL (73,1%). There was a statistically significant difference (p <0.05) between PAD users and nonusers for the variables gender, age, marital status, housing, employment status, caregiver, follow up with psychologist, regular physical activity, alcohol consumption, smoking, polypharmacy, average knowledge about pharmacotherapy, mean adherence to pharmacotherapy, satisfactory QoL, mean EQ-5D index and average self-reported QoL. The adjusted odds ratios (OR) showed that the factors positively associated with the PAD use were female gender (OR = 2,02; 95% CI 1,31; 3,11) and age (ORref./elderly = 0,36, 95% CI 0,13; 0,99). Considering benzodiazepines users, 51,1% reported being in use these PAD for at least two years, 55,1% of whom were elderly. Approximately one in three individuals used at least one PAD in the period studied, while the elderly and women were more likely to use. The most prevalent PAD were antidepressants and benzodiazepines, with most users of the latter receiving these MPA for over two years, of which more than half were elderly.
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Öhman, Daniel. "Bioanalytical development for application in therapeutic drug monitoring : focus on drugs used in psychiatry /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/med775s.pdf.
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Gustafsson, Maria. "Optimizing drug therapy among people with dementia : the role of clinical pharmacists." Doctoral thesis, Umeå universitet, Geriatrik, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-118309.
Full textAbstract:
Background: Drugs are one of the cornerstones in the management of many diseases. In general, drugs are used for diagnosis, prevention, mitigation of symptoms, and, sometimes, to cure disease. However, drug treatment in elderly people, especially those with dementia and cognitive impairments, may involve significant risk of adverse drug events. The aim of this thesis was to identify the extent of potentially inappropriate drug treatment among people with dementia and cognitive impairment and to assess the occurrence and character of drug-related problems that lead to acute hospital admissions. Another aim was to assess the potential impact of a comprehensive medication review conducted by clinical pharmacists as part of a health care team on quality of patients’ drug therapy and drug-related hospital readmission rates. Method: Long-term use of antipsychotic/psychotropic drugs and associated factors were investigated among 344 and 278 people respectively with dementia living in specialized care units. Trends in the prescribing of potentially inappropriate drugs between 2007 and 2013, comprising 2772 and 1902 people, living in nursing homes in the county of Västerbotten, were assessed using six national quality indicators. Data on drug use, function in the activities of daily living, cognitive function and behavioral and psychological symptoms were collected using the Multi-Dimensional Dementia Assessment Scale. Further, an investigation of a separate corresponding population from 2012 was done, where potentially inappropriate drug use was measured before and after a total of 895 medication reviews. Finally, a randomized, controlled trial was carried out among people 65 years or older with dementia or cognitive impairment in internal medicine and orthopedic wards at two hospitals in northern Sweden. The proportion of hospital admissions that were drug-related were estimated, and also whether comprehensive medication reviews conducted by clinical pharmacists as part of a health care team could affect the risk of drug-related hospital readmissions. Results: Antipsychotic and other psychotropic drugs were frequently prescribed to people with dementia living in specialized care units for prolonged periods. Associations were found between behavioral and psychological symptoms and different psychotropic drugs. The extent of potentially inappropriate drug use declined between 2007 and 2013. In the separate corresponding population from 2012, the frequency of potentially inappropriate drug use was significantly reduced among people who underwent medication reviews. Hospitalizations due to drug-related problems among old people with dementia or cognitive impairment were prevalent. We found that inclusion of a clinical pharmacist in the health care team significantly reduced the risk of drug-related 30-day and 180-day readmissions. However, in a subset of patients with concomitant heart failure no effect was seen. Conclusion: Among patients with dementia or cognitive impairment long-term treatment with antipsychotic and other psychotropic drugs is common. The results indicate that these drugs are prescribed to treat behavioral and psychological symptoms among cognitively impaired individuals, despite limited evidence of their efficacy and the high risk of adverse effects. Drug-related problems, such as adverse drug reactions, constituted a major cause of hospital admissions. By reducing potentially inappropriate drug use and optimizing overall drug therapy, inclusion of clinical pharmacists in a health care team might improve the quality of patient care and reduce the risk of hospital readmissions among people with dementia.
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Pooviboonsuk, Prakob. "An investigation of the relationship between event-related potentials (ERPs) and the amnesiac and sedative effects of psychotropic drugs." Thesis, King's College London (University of London), 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339129.
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Conte, Cécile. "Evaluation des consommations médicamenteuses associées au décours d'un lymphome : approche pharmacoépidémiologique." Thesis, Toulouse 3, 2018. http://www.theses.fr/2018TOU30185/document.
Full textAbstract:
Ces travaux de thèse présentent une approche de pharmaco-épidémiologie explorant l'exposition médicamenteuse chez des patients atteints de lymphome tout au long de leur parcours de soin. L'utilisation des données du Système National d'Information Inter-régimes de l'Assurance Maladie (SNIIRAM) nous a permis de quantifier cette exposition médicamenteuse et de déterminer les facteurs associés dans le contexte de la vie réelle. Les travaux de recherche réalisés au cours de cette thèse répondaient à 3 objectifs. Dans un premier objectif, nous avons souhaité valider l'utilisation du SNIIRAM à des fins de recherche pour améliorer la robustesse des futures études menées sur le lymphome. Après avoir défini plusieurs algorithmes d'identification des cas incidents de lymphome, nous avons testé leur validité par confrontation aux données cliniques exhaustives du Registre des cancers du Tarn. Les paramètres de performance obtenus permettent de considérer les données disponibles dans le SNIIRAM comme un outil puissant pour mener des études pharmaco-épidémiologiques ou médico-économiques sur le Lymphome. Le second objectif était d'explorer l'existence d'une surconsommation de médicaments psychotropes au cours de la phase active de traitement par rapport à une population témoin, sous l'hypothèse d'une initiation accrue de ces médicaments pour pallier les complications psychologiques associées à la prise en charge du Lymphome. Par ailleurs, la chronicisation fréquemment observée de ce type de consommation peut conduire à terme à des complications potentiellement évitables. Pour répondre à cet objectif, nous avons réalisé une étude selon une approche " new-user design ", à partir d'une cohorte de patients incidents de lymphome identifiés dans les données du SNIIRAM à l'échelon régional. Nous avons observé un taux d'initiation supérieur au taux observé en population générale ou chez des patients atteints d'autres pathologies mettant en jeu le pronostic vital (infarctus du myocarde). En fonction de la classe thérapeutique étudiée, 20 à plus de 50% des patients restaient exposés de façon inappropriée (au-delà des recommandations) à ces médicaments. Le troisième objectif a donc été d'explorer les déterminants associés à une utilisation prolongée de médicaments psychotropes dans la phase de l'après-cancer à partir des données de l'Echantillon généraliste des bénéficiaires (EGB). [...]This thesis presents a pharmacoepidemiology approach to describe drug utilization in lymphomas during their whole care pathway. The use of the French claims database (Système National d'Informations Inter-Régimes de l'Assurance Maladie (SNIIRAM)) allows to exhaustively quantify this drug utilization in real life conditions. This thesis consists of three mains objectives. First, we aimed to develop validated algorithms for the identification of incident cases of lymphoma. For the validation, we used data from a regional Cancer Registry as the gold standard. The purpose of this validation study was to enhance validity of future studies conducted on lymphomas in the SNIIRAM database. The results of this study associated to strengths of this database demonstrate that this approach is of great interest to conduct pharmacoepidemiological or medico-economic studies in lymphomas. Second, we aimed to estimate the incidence of use of psychotropic drugs during the active treatment phase of lymphoma in comparison with control groups. Indeed, the increased probability of developing anxio-depressive disorders after diagnosis could lead to an increased initiation of psychotropic drugs and a potential inappropriate chronic use of these drugs after initiation. Such inappropriate chronic use can unnecessarily expose patients to adverse event. For this aim, we conducted a new-user cohort study using data from the SNIIRAM database. The results of this study revealed that the initiation rate of these drugs is higher than in the general population or for life-threatening diseases such as myocardial infarction. Moreover, we observed an inappropriate prolonged use for a significant fraction of patients (20% to more than 50% according to therapeutic class). On the basis of these findings, the third objective was to identify factors associated with prolonged use of these drugs during survivorship. This study was conducted using data from the General Sample of Beneficiaries (EGB). [...]
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Hughes, Shannon. "Navigating Health Sources on the Internet: A Mixed-Methods Examination of Online Consumer Reviews and Expert Text on Psychotropic Drugs." FIU Digital Commons, 2010. http://digitalcommons.fiu.edu/etd/231.
Full textAbstract:
Purpose: The Internet has provided an unprecedented opportunity for psychotropic medication consumers, a traditionally silenced group in clinical trial research, to have voice by contributing to the construction of drug knowledge in an immediate, direct manner. Currently, there are no systematic appraisals of the potential of online consumer drug reviews to contribute to drug knowledge. The purpose of this research was to explore the content of drug information on various websites representing themselves as consumer- and expert-constructed, and as a practical consideration, to examine how each source may help and hinder treatment decision-making. Methodology: A mixed-methods research strategy utilizing a grounded theory approach was used to analyze drug information on 5 exemplar websites (3 consumer- and 2 expert-constructed) for 2 popularly prescribed psychotropic drugs (escitalopram and quetiapine). A stratified simple random sample was used to select 1,080 consumer reviews from the websites (N=7,114) through February 2009. Text was coded using QDA Miner 3.2 software by Provalis Research. A combination of frequency tables, descriptive excerpts from text, and chi-square tests for association were used throughout analyses. Findings: The most frequently mentioned effects by consumers taking either drug were related to psychological/behavioral symptoms and sleep. Consumers reported many of the same effects as found on expert health sites, but provided more descriptive language and situational examples. Expert labels of less serious on certain effects were not congruent with the sometimes tremendous burden described by consumers. Consumers mentioned more than double the themes mentioned in expert text, and demonstrated a diversity and range of discourses around those themes. Conclusions: Drug effects from each source were complete relative to the information provided in the other, but each also offered distinct advantages. Expert health sites provided concise summaries of medications’ effects, while consumer reviews had the added advantage of concrete descriptions and greater context. In short, consumer reviews better prepared potential consumers for what it’s like to take psychotropic drugs. Both sources of information benefit clinicians and consumers in making informed treatment-related decisions. Social work practitioners are encouraged to thoughtfully utilize online consumer drug reviews as a legitimate additional source for assisting clients in learning about treatment options.
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Mawanda, Francis. "Emerging risk factors for dementia: associations between clinical infections, PTSD, psychotropic PTSD medication use, and the risk for dementia." Diss., University of Iowa, 2015. https://ir.uiowa.edu/etd/2117.
Full textAbstract:
Dementia is a major public health problem worldwide. Emerging research indicates that clinical infections and PTSD could be important risk factors for dementia. However, evidence for infections and the risk of dementia primarily examines central nervous system (CNS) infections. Extant epidemiological evidence for systemic bacterial infections and the risk for dementia is limited while that for PTSD and the risk for dementia did not account for psychotropic medications commonly used in management of PTSD and could affect cognitive function. The purpose of this study was to 1) review the evidence for CNS infections as possible causes of Alzheimer’s disease (AD) dementia, and 2) using nationwide Veterans Health Administration databases, conduct original retrospective cohort analyses in nationally representative samples of U.S. veterans aged 56 years and older to determine the associations between systemic bacterial infections, PTSD, and psychotropic PTSD medication use with the risk for developing dementia.
Review of the research pertaining to an infectious AD etiology hypothesis including the various mechanisms through which different clinical and subclinical infections could cause or promote the progression of AD, and the concordance between putative infectious agents and the epidemiology of AD showed evidence linking AD to an infectious cause to be largely inconclusive; however, the amount of evidence suggestive of an association is too substantial to ignore.
Analysis of the associations between systemic bacterial infections and the risk for dementia showed a significant association between exposure to any systemic bacterial infection and an increased risk for dementia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.16-1.24) after adjustment for demographic characteristics, and medical and psychiatric comorbidity. In addition, septicemia (HR=1.39; 95%CI=1.16-1.66), bacteremia (HR=1.22; 95%CI=1.0-1.49), osteomyelitis (HR=1.20; 95%CI=1.06-1.37), pneumonia (HR=1.10; 95%CI=1.02-1.19), UTI (HR=1.13; 95%CI=1.08-1.18), and cellulitis (HR=1.14; 95%CI=1.09-1.20) were independently associated with significantly increased risk of developing dementia after adjustment for potential confounders.
Analysis of the associations between PTSD and psychotropic PTSD medication use with the risk for dementia showed a significant association between PTSD and the risk for dementia (HR=1.35; 95%CI=1.27-1.43) after adjustment for demographic characteristics, medical and psychiatric comorbidity, and health care utilization. Analysis of the impact of psychotropic PTSD medications including selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), benzodiazepines (BZA), novel antidepressants (NA) and atypical antipsychotics (AA) on the association between PTSD and the risk for dementia showed significant interactions between PTSD and use of SSRIs (p<.0001), NAs (p=.0016), and AAs (p<.0001). Multivariate analysis showed a significant association between PTSD and an increased risk for dementia among individuals not using any psychotropic PTSD medications at baseline (HR=1.70; 95%CI=1.58-1.82). PTSD patients using SSRIs (HR=2.10; 95%CI=1.82-2.41), NAs (2.19; 95%CI=1.94-2.48) or AAs (4.56; 95%CI=4.04-5.15) were significantly more likely to develop dementia compared to those without PTSD and not using any psychotropic PTSD medications. PTSD patients using SSRIs (HR=1.24; 95%CI=1.08-1.42), NAs (HR=1.29; 95% CI=1.14-1.46) or AAs (HR=2.69; 95%CI=2.38-3.04) were also significantly more likely to develop dementia compared to those with PTSD and not using any psychotropic PTSD medications. SNRI (HR=1.35; 95%CI=1.26-1.46) and BZA drug use (HR=1.40; 95%CI=1.35-1.45) at baseline was associated with an increased risk for dementia regardless of PTSD diagnosis.
These findings indicate; 1) evidence for an infectious AD etiology hypothesis in inconclusive, 2) both severe (e.g. sepsis), and less severe (e.g. cellulitis) systemic bacterial infections are collectively and independently associated with an increased risk of dementia among older U.S. veterans hence prevention of systemic bacterial infections could positively influence the risk for dementia among older adults, and 3) PTSD and psychotropic medication use are associated with an increased risk for dementia among U.S. veterans.
Further epidemiologic, clinical, and basic science research is required to elucidate the mechanisms and the associations between infections and the risk for dementia and to determine if the independent and effect modifying impacts of psychotropic PTSD medication use on the risk for dementia are related to differences in PTSD severity, other psychiatric comorbidity, or whether psychotropic PTSD medication use is an independent risk factor for dementia.
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Fontanella, Andréia Turmina. "Uso de psicofármacos : uma abordagem de gênero : dados da pesquisa nacional sobre o acesso, utilização e promoção do uso racional de medicamentos – PNAUM 2014." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2017. http://hdl.handle.net/10183/179737.
Full textAbstract:
Apesar de amplamente prescritos, os psicofármacos são ainda controversos quanto a sua utilização. O uso em larga escala remete a outras dimensões do problema, que extrapolam à psiquiatria e permeiam as áreas da psicologia e das ciências sociais. Entender o uso destes medicamentos é entender as características da população que os utiliza. Assim, esta dissertação objetivou descrever a prevalência autorreferida de uso de psicofármacos pela população urbana brasileira, focando nas diferenças entre homens e mulheres. Para isso, foi avaliada a prevalência global, e estratificada por sexo, do uso de medicamentos psicotrópicos valendo-se dos dados da Pesquisa Nacional Sobre o Acesso, Utilização e Promoção do Uso Racional de Medicamentos (Pnaum). Os psicofármacos foram agrupados em 4 classes terapêuticas: antidepressivos; ansiolíticos; antipsicóticos e estabilizadores do humor. Foram calculadas as prevalências e razões de prevalência e seus intervalos de confiança de 95% [IC95%] e foram aplicados testes do qui-quadrado de Pearson para avaliação da significância estatística das diferenças entre os grupos, considerando o nível de significância de 5%. Entre os entrevistados, 8,0% declararam utilizar ao menos um psicofármaco. Esta prevalência sobe para 10,9% quando considerado apenas o sexo feminino, que chega a apresentar prevalência de uso 2 vezes maior do que os homens na faixa etária dos 35 aos 46 anos de idade. As prevalências de uso de psicofármacos para homens, mulheres e amostra sem distinção de sexo aumentam com o aumento da idade, número de doenças crônicas e número de medicamentos utilizados para o tratamento destas doenças. Os antidepressivos e ansiolíticos figuram como as classes terapêuticas mais utilizadas, sendo estas mesmas classes mais prevalentes entre as mulheres, em todas as faixas etárias, enquanto os antipsicóticos e 8 estabilizadores do humor foram mais prevalentes entre os indivíduos do sexo masculino. Os resultados indicam um maior uso destes medicamentos por parte das mulheres, e um padrão diferenciado entre elas e os homens no que se refere às classes terapêuticas. Buscando compreender estas diferenças, esta dissertação percorre aspectos relacionados às especificidades biológicas dos sexos e aos papéis sociais exercidos por homens e mulheres, incluindo suas implicações no modelo de saúde.Although widely prescribed, psychotropic drugs are still controversial as to their use. Large-scale use refers to other dimensions of the problem, which go beyond psychiatry and permeate areas of psychology and social sciences. Understanding the use of these drugs is, therefore, understanding the characteristics of the population that uses them. Thus, this dissertation aimed to describe the selfrefered prevalence of psychotropic medication use by the Brazilian urban population, focusing on the differences between men and women. For this, the overall prevalence and stratified by sex prevalence of the psychotropic drugs use were evaluated using data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (Pnaum). The psychotropic drugs were grouped into four therapeutic classes: antidepressants; anxiolytics; antipsychotics and mood stabilizers. Prevalence, prevalence estimates and their 95% confidence intervals [95% CI] were calculated and Pearson's qui-square tests were used to assess the statistical significance of the differences between the groups, considering a significance level of 5%. Among those interviewed, 8.0% reported using at least one psychotropic drug. This prevalence rises to 10.9% when considered only female, which has a prevalence of use 2 times higher than men in the age group of 35 to 46 years of age. The prevalences of psychoactive drugs use for men, women and non-gender sample increases with increasing age, number of chronic diseases and number of drugs used to treat diseases. Antidepressants and anxiolytics appear as the most commonly used therapeutic classes, the same classes being more prevalent among women in all age groups, while antipsychotics and mood stabilizers were more prevalent among males. The results indicate a greater use of these drugs by women, and a differentiated 10 pattern between them and the men regarding the therapeutic classes. Seeking to understand these differences, this dissertation covers aspects related to the biological specificities of the sexes and to the social roles played by men and women, including its implications in the health model.
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Machado, Pedro Nuno Fontão. "Perto de ti, matas. Longe de ti, eu morro: Uma etnografia sobre usos de drogas de rua." Master's thesis, Universidade de Évora, 2008. http://hdl.handle.net/10174/18503.
Full textAbstract:
O presente documento apresenta uma etnografia, realizada numa freguesia de Vila Nova de Gaia, sobre o uso, em contexto de rua, de substâncias denominadas "pesadas". Partindo de uma linha teórico metodológica que se demarca dos paradigmas tradicionais que perspectivam o fenómeno droga através das dimensões da delinquência ou da patologia, procedemos a uma análise, em contexto natural, dos espaços e actores relacionados com o psicotropismo. Concluímos que uma relação de dependência com as drogas emerge de uma dimensão processual, para a qual contribui o contexto sociocultural e o quadro relacional onde o indivíduo se insere. Daí, recorrermos ao conceito de itinerário de consumo na abordagem das relações estabelecidas com as substâncias. ABSTRACT; This document presents an ethnography, developed in Vila Nova de Gaia, about consumption, in street environment, of as common sense defines "hard" drugs. Through a theoretical and methodological approach that makes a difference among the traditional paradigms, which conceive the drug phenomenon under the delinquency and pathological dimensions, we analyse, in natural environment, the places and the actors which are involved in the drug scene. We concluded that the drug addiction relationship comes from a sequential dimension, in which sociocultural environment and relationship background make a contribution. Is that the reason why we use consumption itinerary concept to approach the relations between individual and drugs.
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Lindqvist, Emma, and Maria Pixell. "Återhämtning efter psykos : En litteraturstudie." Thesis, Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-29027.
Full textAbstract:
Bakgrund: Varje år insjuknar 1500–2000 personer i psykos i Sverige, och cirka 30000–40 000 personer i Sverige har diagnosen schizofreni. Läkemedel är grunden i behandlingen av schizofreni, detta i kombination med olika psykosociala behandlingar samt åtgärder. Återhämtning beskrivs som en djupt personlig, unik förändringsprocess. Sjuksköterskor i Sverige arbetar enligt HSL, Hälso- och sjukvårdslagen och hälsa är ett av omvårdnadens centrala begrepp som sjuksköterskan skall jobba utifrån. Syfte: Syftet är att beskriva erfarenheter av återhämtning från psykos hos personer med schizofreni samt beskriva urvalsgrupperna i artiklarna.Metod: En deskriptiv litteraturstudie innefattande 11 vetenskapliga artiklar sökta i PubMed och PsychINFO. Huvudresultat: I föreliggande studie var syftet att beskriva erfarenheter från psykos hos personer med schizofreni. Det som framkom i resultatet visade att ett stort stöd från omgivning samt medicinering var nödvändigt för en god återhämtning. Att umgås med familj och vänner gav en känsla av acceptans samt minskade symtomen. Psykofarmaka visar sig dock påverka sömn samt livskvalitet på ett negativt sätt vilket hämmade följsamheten. Många beskrev att de förlorat sin självbild efter psykosen vilket gav en sämre självkänsla, det hämmade återhämtning samt återgång till arbete. När de hittat acceptans i sin sjukdom samt inte såg sig själva som en diagnos och lärde sig nå sina mål främjade det återhämtningsprocessen och personerna kunde se en ljus framtid.Slutsatser: Personer med schizofreni upplever idag svårigheter att komma tillbaka till det vanliga livet efter en psykos. Personerna berättar att de förlorat sin identitet, vänner, familj och arbete och till följd av detta förlorat hopp och framtids utsikter. Denna stigmatisering beror mycket på okunskap i samhälle och därför är det viktigt att soms juksköterska ha kunskap inom detta ämne för att kunna ge en god omvårdnad.Background: Every year 1500-2000 people gets a psychosis in Sweden, and about 30000-40000 people in Sweden is diagnosed with schizophrenia. Medicines are the basis for the treatment of schizophrenia, this in combination with various psychosocial treatments as well as measures. Recovery is described as a deep personal, uniquechange process. Nurses in Sweden work according to the law “HSL”, the Swedish Health and Medical Service Act. Health is one of the nursing concepts that the nurse should work from outside.Aim: The aim of this study is to describe people diagnosed with schizophrenia experiences of recovery after psychosis, as well as describing the selection groups in thearticles. Methods: A descriptive literature study of 11 studies with a qualitative approach. Main results: In the present study, the purpose was to describe psychosocial experiencei n schizophrenia patients. What was found in the results showed that a strong support from the environment and medication was necessary for a good recovery. To spend time with family and friends gave a sense of acceptance and reduced the symptoms. Psychiatric drugs prove to affect sleep and quality of life in a negative way, which impeded compliance. Many described that they lost their self-esteem after psychosis, resulting in a worse self-esteem, inhibited recovery and return to work. When theyfound acceptance in their illness and did not see themselves as a diagnosis and learned to reach their goals, it promoted the recovery process and they could see a brighter future.Conclusion: People with schizophrenia experience difficulties in returning to normal life after a psychosis. The people tell that they lost their identity, friends, family and work and as a consequence they lost hope and prospects. This stigmatization depends largely on ignorance in society and therefore it is important as a nurse to have knowledge of this subject in order to provide good care.
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Ayivor, Divine. "Policy Implications and Perceptions of African American Men who Used Ritalin as Children." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5446.
Full textAbstract:
Even though there are high diagnosis rates of ADHD among young African American
men, policy makers and parents have largely viewed the use of Ritalin as a psychotrop
ic
drug that raises public health concerns. African American parents may be reluctant to
treat their children pharmacologically. Very few studies have fully explored the
perceptions of African American men
about the consequences of their
Ritalin
use
as
chi
ldren. The purpose of this qualitative study was to explore the experiences of African
American men who used Ritalin as children
so that
policy makers
and
parents of children
with ADHD
might
better understand the social and public health implications of
tr
eatment options. The theoretical framework for this study
included
Anderson's cultural
identity theory of drug abuse
and
Brady and O'Conno
r's community organizing theory
.
Data were collected through semistructured interviews with
9
African American men
who
were prescribed Ritalin as children. These data were then inductively coded and
analyzed using Braun and Clarke's thematic analysis approach. Participants believed that
Ritalin helped them with focus in their academic endeavors and did not lead them to dr
ug
abuse
or addiction
.
By giving voice to the experiences of
this population
, educators
and
policy makers
can better assist
parents
who might be reluctant to give their child Ritalin
as their fears about Ritalin prescriptions leading to drug abuse and addiction later in life
may be less founded than some believe. This
presents
a social change
advantage for all
communities, especially those in low income areas.
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Čipkienė, Erika. "Narkotikų prevencijos, organizuojant ugdymo procesą, teorinis ir empirinis pagrindindimas." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2009. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2009~D_20090629_134854-01551.
Full textAbstract:
Erikos Čipkienės magistro darbo Narkotikų prevencijos, organizuojant ugdymo procesą, teorinis ir empirinis pagrindimas objektas yra prevencinės veiklos vaidmuo organizuojant ugdymo procesą bendrojo lavinimo mokykloje.
Darbe analizuojama mokslinė literatūra apie narkomanijos problemą bei galimus jos prevencijos būdus, organizuojant ugdymo procesą, aptariama narkotikų vartojimo problema Lietuvoje ir Europos šalyse bei narkotikų plitimas mokyklose. Darbe taip pat nagrinėjami būdai, kaip įtraukti į prevencinę veiklą mokinius, mokytojus, mokinių tėvus.
Empirinėje darbo dalyje siekta atskleisti pedagogų ir pačių mokinių požiūrį į prevencinės veiklos organizavimą mokykloje, išryškinant šios veiklos būdus bei efektyvumą lemiančius veiksnius. Tyrimas buvo vykdomas Q tipo duomenų rinkimo metodu – anketine apklausa bendrojo lavinimo mokyklų bei gimnazijų mokiniams ir mokytojams. Anketinėje apklausoje dalyvavo 124 pedagogai ir 246 mokiniai iš Vilniaus miesto mokyklų.
Tyrimas parodė, kad pedagogų ir mokinių požiūris į prevencinės veiklos poreikį ir jos prioritetus mokyklose skiriasi: prevencinės veiklą svarbesne laiko pedagogai. Tyrimas parodė, kad prevencinės veiklos mokyklose galimybių bei šios veiklos formų yra daug, bet ne visos jos efektyvios: ir mokiniai, ir mokytojai efektyvesniais laiko aktyvius prevencijos metodus, akcijas bei renginius. Daugiausia dėmesio prevencijai skiriama lietuvių kalbos, biologijos ir dorinio ugdymo pamokose. Apklausti mokytojai ir mokiniai sutinka, kad... [toliau žr. visą tekstą]The object of the master Degree paper, ”Drug Abuse Prevention in Education process, Theoretical and Empirical Foundation”, written by Erika Cipkiene, is the role of preventive activity when organizing the teaching process in secondary co-educational schools. The work analyses the resources that deal with the information on drug addiction issue and the possible prevention means when organizing educational process; the issues of drug abuse and the spread of drugs at schools in Lithuanian and other European countries are also analyzed the work also aims to find the ways how students, teachers and students’ parents could be involved in the prevention program. The empirical part of the work is dedicated to reveal teachers’ and students’ attitude towards prevention activity organization at school, highlighting the possible preventative actions and factors that determine success. The research was carried out collecting the a type data-a questionnaire was given to secondary school and gymnasium students and teachers. The respondents included 124 teachers and 246 students from various schools in Vilnius .the research revealed the difference between students’ and teachers’ attitude towards the need and priorities of prevention activity in secondary schools. Prevention activity is considered to be more significant by teachers. The research showed a wide variety of preventive means and opportunities, however, not all of them prove to be highly effective-both, students and teachers... [to full text]
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Kuno, Ai. "Growing up with one parent: its association with psychotropic drug use in young adulthood : A register-based study in Sweden." Thesis, Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-132258.
Full textAbstract:
The overall aim of this study was to investigate the association between family structure in childhood and mental health problems in young adulthood. A prospective cohort study was conducted with 481,777 individuals with complete follow-up information, which was obtained from national registers in Sweden. Individuals who were living with only one biological parent at age 17 were compared with those who grew up with two parents with regard to retrieval of prescribed psychotropic drugs at age 35. The association was examined by Cox regression analyses with equal survival time for all individuals included in the analyses. The results demonstrated a higher risk for retrieval of psychotropic medicines among the individuals who grew up with only one parent, with hazard ratio of 1,21 (95%CI: 1,19-1,23). The multivariate analyses showed that a part of the association was explained by familial and individual factors, namely parents’ country of origin, area of residence, parents’ and the individual’s educational attainment, receipt of social benefits and parents’ history of psychiatric disorder. The results indicated that the increased risk of mental health problems among individuals who grew up with only one parent might be accounted for by various psychological, social and economic factors associated to parental separation.
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Sloss, Ian. "The effects of ethanol on memory and neuroplasticity in a vertebrate and an invertebrate model of learning." Thesis, University of Sussex, 2016. http://sro.sussex.ac.uk/id/eprint/65381/.
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Binge drinking is characterised by cycles of ethanol intoxication and withdrawal and is thought to be highly deleterious for the normal functioning of the nervous system. The behavioural and neurophysiological consequences of rapid escalation of blood alcohol concentration and subsequent withdrawal, and their effects on learning and memory and underlying neural circuitry can be studied in suitable animal models. Here, spatial and instrumental learning as well as hippocampal LTP were assessed in C57BL/6J mice for the effects of adolescent intermittent ethanol (AIE) and other ethanol treatments. AIE treatment did not impair spatial or non-spatial memory when tested in adulthood. However, if mice were trained whilst intoxicated during AIE treatment, spatial memory was impaired. Post-training injections of ethanol impaired performance in operant conditioning. A rapid rise and fall in ethanol concentration, prior to stimulation, blocked LTP induction in drug naïve hippocampal slices; an effect that was not seen if the ethanol concentration was gradually increased and decreased. Moreover, AIE treatment caused an NMDA receptor-dependent transient increase in hippocampal LTP. The second part of this study used a novel molluscan model Lymnaea stagnalis and demonstrated that high concentrations of ethanol blocked acquisition and retrieval of an associative memory. However, if acquisition occurred in the presence of ethanol then memory could also be retrieved under ethanol, demonstrating ethanol state dependency. By utilising the cerebral giant cells, a modulatory neuron type with known involvement in memory formation, it was found that ethanol reduced the tonic firing frequency as well as the peak-to-trough and half-width parameters of individual action potentials. The development of in vivo and in vitro ethanol treatment and test protocols, and the findings based on their use, open up new avenues for future systematic investigations on ethanol's effects on behaviour and underlying neural circuitry in both vertebrate and invertebrate model systems.
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Shirama, Flavio Hiroshi. "Estudo de prevalência e caracterização do consumo de psicofármacos por pacientes internados em clínicas médica e cirúrgica de um hospital geral." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/22/22131/tde-05112012-163834/.
Full textAbstract:
Atualmente os psicofármacos têm apresentado altas prevalências de consumo pela população. Visando fornecer subsídios para formulação de estratégias de gerenciamento de segurança no uso destes fármacos, o presente estudo teve como objetivos: identificar, entre pacientes internados em clínicas médica e cirúrgica de um hospital geral, a prevalência do uso de psicofármacos e, analisar a relação do uso destes fármacos com as variáveis demográficas, socioeconômicas e farmacoterapêuticas, com o histórico de saúde e com o resultado da aplicação do instrumento SRQ-20. Foi realizado estudo de corte transversal, com desenho correlacional descritivo e abordagem quantitativa, com 93 pacientes das clínicas em estudo. Para coleta dos dados utilizou-se a entrevista norteada por um questionário envolvendo as variáveis em estudo e pelo instrumento SRQ-20 (Self-Reporting Questionnaire), para a detecção de transtornos mentais comuns. Em seguida, foi verificado o prontuário destes pacientes, buscando a presença de prescrição de psicofármacos. Para avaliar a influência das variáveis independentes sobre o consumo de psicofármacos, foram investigadas associações estatísticas usando o teste Qui-quadrado. Para estimar a Razão de prevalência foi utilizado o modelo de regressão log-binomial simples e múltiplo. O ajuste do modelo foi feito através do procedimento PROC GENMOD do software SAS versão 9.0. Observou-se a prevalência de 38,71% de usuários de psicofármacos, evidenciando a associação do uso de psicofármacos com as variáveis sexo, custeio da internação, religião e resultado positivo no SRQ-20. Os benzodiazepínicos foram os psicofármacos mais consumidos pela amostra (64%), seguidos pelos antidepressivos (32%). As indicações dos benzodiazepínicos relatadas pelos pacientes foram: \"para dormir\" (54%), para \"depressão\" (14%), e para \"ansiedade\" (7%). A principal indicação dos antidepressivos foi a \"depressão\" (50%). Identificou-se que 25% e 22% dos pacientes estavam consumindo, respectivamente, benzodiazepínicos e antidepressivos, sem ter o conhecimento deste fato. Verificou-se que 70% das prescrições de psicofármacos foram realizadas por médicos não-psiquiatras, sendo os benzodiazepínicos a classe mais prescrita pelos não-psiquiatras e os antidepressivos os mais prescritos pelos psiquiatras. Dentre os pacientes em uso de psicofármacos, 59% realizavam apenas tratamento farmacológico, 27,8% possuíam diagnóstico de transtorno mental, 36,1% obtiveram resultado positivo e 36,1% obtiveram resultado negativo no SRQ-20. Foi identificada a automedicação em 5% dos pacientes. Espera-se que a presente pesquisa contribua para despertar a preocupação necessária relacionada ao tema, para a melhoria das informações que devem ser consideradas pelos profissionais de saúde quanto ao tratamento com psicofármacos bem como para implementação de estratégias direcionadas ao uso racional destes medicamentos.Currently, psychotropic drugs have shown high prevalence rates of consumption by the population. Aiming to provide subsidies for formulation of strategies of security management in the use of these drugs, this study aimed to identify, among patients hospitalized in medical and surgical clinics of a general hospital, the prevalence of psychotropic use and analyze the relationship between the use of these drugs and the demographic, socioeconomic and pharmacotherapeutics variables, with the health history and the result of applying the SRQ-20. A cross sectional study with descriptive correlational design and quantitative approach was performed with 93 patients in the clinics. For data collection, an interview guided by a questionnaire involving the study variables and by the SRQ-20 (Self-Reporting Questionnaire) was used for the detection of common mental disorders. Then, the records of these patients were checked, looking for the presence of psychotropic prescription. To evaluate the influence of independent variables on the consumption of psychotropic drugs, statistical associations were investigated using Chi-square test. To estimate the prevalence ratio was used the simple and multiple log-binomial regression models. The model fit was achieved using the PROC GENMOD procedure of SAS software version 9.0. It was observed the prevalence of 38.71% of psychotropic drug users, showing the association between the use of psychiatric drugs and sex, cost of hospitalization, religion and positive result on the SRQ-20. Benzodiazepines were the most consumed psychotropic drugs by the individuals of the sample (64%), followed by antidepressants (32%). The indications of benzodiazepines reported by patients were: \"to sleep\" (54%), for \"depression\" (14%), and \"anxiety\" (7%). The main indication of antidepressants was \"depression\" (50%). It was found that 25% and 22% of the patients were taking, respectively, benzodiazepines and antidepressants, without having knowledge of this fact. It was found that 70% of prescriptions of psychotropic drugs were performed by physicians non-psychiatrists, and the most prescribed by non-psychiatrists were benzodiazepines and the most prescribed by psychiatrists were antidepressants. Among the patients using psychotropic drugs, 59% performed only pharmacological treatment, 27.8% had a diagnosis of mental disorder, 36.1% had positive outcome, and 36.1% had negative outcome in the SRQ- 20. Self-medication was identified in 5% of patients. It is expected that this research contributes to arouse the concern related to this theme required for the improvement of information that should be considered by health professionals regarding treatment with psychotropic drugs and to implement strategies aimed at the rational use of medicines.
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Lövheim, Hugo. "Psychotropic and analgesic drug use among old people : with special focus on people living in institutional geriatric care." Doctoral thesis, Umeå universitet, Institutionen för samhällsmedicin och rehabilitering, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1608.
Full textAbstract:
Old people in general, and those affected by dementia disorders in particular, are more sensitive to drug side effects than younger people. Despite this, the use of nervous system drugs and analgesics among old people is common, and has increased in recent years. Institutional geriatric care accommodates people who need round-the-clock supervision and care, due to somatic, psychiatric, cognitive or behavioral symptomatology. A majority of those living in institutional geriatric care suffers from dementia disorders. This thesis is based on three different data collections. Two large cross-sectional studies, the AC1982 and AC2000 data collections, including all those living in institutional geriatric care in the county of Västerbotten in May 1982 and 2000 respectively (n=3195 and n=3669) and one study, the GERDA/Umeå 85+ data collection, including a sample of very old people, living at home and in institutions (n=546), in the municipalities of Umeå, Sweden and Vaasa and Mustasaari, Finland, in 2005-2006. The use of psychotropic drugs and analgesics was common among old people living in geriatric care and among very old people in general. A higher proportion of people with dementia received certain nervous system drugs, such as antipsychotic drugs. The use of antipsychotic drugs among people with cognitive impairment living in geriatric care was found to be correlated to several behaviors and symptoms that are not proper indications for antipsychotic drug use, and also factors related more to the staff and the caring situation. Over the course of eighteen years, from 1982 to 2000, there has been a manifold increase in the use of antidepressants, anxiolytics and hypnotics in geriatric care, but the use of antipsychotics had decreased slightly. During the same time, the prevalence of several depressive symptoms decreased significantly, correcting for demographical changes. One analysis of calculated numbers needed to treat, however, indicated poor remission rates, suggesting that even better results might be achievable. The prevalence of depressive symptoms among people with moderate cognitive impairment remained unchanged between 1982 and 2000, despite the fact that about 50% were receiving treatment with antidepressants in 2000. One possible explanation might be that depressive symptoms have different etiologies in different stages of a dementia disorder. Approximately a quarter of the people experiencing pain in geriatric care were not receiving any regular analgesic treatment. One possible reason might be misconceptions among the caring staff regarding whether or not the residents were receiving analgesic treatment. Such misconceptions were found to be common. In conclusion, psychotropic and analgesic drug use among old people in geriatric care, and very old people in general, was found to be common and in many cases possibly inappropriate. The use of antipsychotics among people with dementia deserves particular concern, because of the high risk of severe adverse events and the limited evidence for positive effects. The use of antidepressants, on the other hand, might have contributed to a lower prevalence of depressive symptoms among old people.
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Blankert, Bertrand. "Développement de méthodes électroanalytiques hybrides pour l'étude de la biotransformation des médicaments." Doctoral thesis, Universite Libre de Bruxelles, 2006. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210863.
Full textAbstract:
Le thème principal de notre travail consistait en la mise en exergue de l'efficience de la mise en œuvre de techniques hybrides associant l’électrochimie à l’élément biologique (biocapteur) ou l’électrochimie aux performances de la spectrométrie de masse (couplage EC-MS). Les informations fournies, jointes aux résultats des mesures en voltampérométrie sur électrodes solides, permettent une bonne compréhension mécanistique quant au devenir oxydatif de substances médicamenteuses. Notre champ d'investigation s'est plus spécifiquement focalisé sur deux familles de molécules psychotropes (les phénothiazines, et une dibenzoazépine). Celles-ci connaissent un usage thérapeutique intensif et un regain d’intérêt pour des applications nouvelles, mais leur utilisation optimale souffre de l’existence d'effets secondaires physiopathologiques importants et dont l’étiologie est encore mal connue.
En premier lieu, les résultats de la voltampérométrie cyclique et les différentes modulations en ligne d'une cellule électrochimique couplée à la détection par spectrométrie de masse, nous ont permis de mettre en évidence des différences essentielles dans le devenir des phénothiazines quant aux produits d'oxydations générés. Plus précisément, un comportement clairement distinct entre les phénothiazines garnies de deux (2C) ou trois carbones (3C) entre les deux azotes au niveau de leur chaîne latérale a pu être mis en évidence. Les phénothiazines 3C s'oxydent de manière classique en leur sulfoxyde correspondant. Par contre, les phenothiazines 2C, conjointement à la formation de leur sulfoxyde, souffrent dans des conditions énergiques d’oxydation (persulfate, potentiel élevé) d'une rupture de la chaîne latérale et libèrent la phénothiazine base aisément oxydable et donc subissant elle-même une oxydation. Au vu des structures moléculaires en trois dimensions, nous émettons l’hypothèse que volume trop important de la chaîne latérale des phénothiazines 2C empêcherait le déploiement aisé des structures aromatiques en un radical cation coplanaire lors du phénomène d'oxydation. Les tensions intrastructurelles apparues conduiraient au bris de la chaîne latérale. Différents modes d'oxydation (chimique, électrochimique, enzymatique) ont été utilisés et laissent chacun apparaître la dépendance directe entre la puissance de l'agent oxydant appliqué et les produits d'oxydation obtenus. Chaque technique de détection, de manière individuelle, a bien confirmé la dualité entre les deux groupes de molécules. La mise en commun des divers résultats nous a permis l'identification irrévocable des espèces intermédiaires instables et des composés finaux. Par corollaire, nous avons pu postuler un schéma général d'oxydation pour les dérivés phénothiaziniques. Il nous paraît intéressant de transposer nos résultats aux biotransformations des phénothiazines car les produits identifiés ne possèdent pas l'activité pharmacologique du composé parent mais présentent un profil toxicologique bien répertorié dans la littérature. Nos résultats suggèrent d’approfondir les études de biotransformation afin de déterminer si ‘l’éclatement’ oxydatif des phénothiazines 2C est également observé in vivo. Une relation cause/effet de ces métabolites pourrait ainsi être établie.
En deuxième point, au travers de l'association CE/SM ou CE/CL/SM, nous avons étudié l’électroxydation de la clozapine. La génération et l'identification des principaux métabolites de phases I et II, illustre un mimétisme certain avec le CYP450, et nous a permis de confirmer de nombreuses données de la littérature quant à l'oxydation in vivo et in vitro de la clozapine. L'oxydation électrochimique ne génère cependant pas l'ensemble des réactions de métabolisation prises en charge par le système CYP450. Lors de la combinaison CE/SM, par l'absence de séparation chromatographique dans cette configuration, le spectre de masse présente un pic correspondant à un intermédiaire à demi-vie courte, difficilement et rarement mis en évidence: l'ion nitrénium. Cette espèce hautement réactive envers les fonctions thiols des petites molécules et des protéines, se trouve très régulièrement tenue pour responsable majeur de la toxicité avérée de la clozapine.
L'apparition plus abondante de dérivés déméthylés démontre l'influence du potentiel appliqué à l'électrode de travail lors de l'oxydation électrochimique. En effet, les processus de déméthylation nécessitent des potentiels élevés pour être observés. En présence de glutathion, aux différents pics antérieurement identifiés, des pics supplémentaires relatifs à la formation d'adduits de GSH sur la CLZ apparaissent. Les courbes voltampérométriques réalisées sur la clozapine suggèrent la distinctement la formation de l'ion nitrénium et d'une nouvelle espèce aisément électroréduite, probablement une structure quinone imine. L'addition de GSH provoque la disparition des pics de réduction de la CLZ. Ces comportements en VC corroborent les interprétations issues des mesures par couplage EC/CL/SM.
La dernière partie de notre travail a consisté en la construction d'un biocapteur à pâte de carbone solide avec inclusion au sein de cette matrice de peroxydase de raifort. Basé sur la capacité reconnue de l'HRP à reproduire in vitro des produits d'oxydation similaires à la métabolisation in vivo, nous avons exploité un tel biocapteur pour l'analyse de la clozapine et de composés thiols. Une compréhension fine du mécanisme opérationnel intrinsèque du biocapteur a pu être suggérée. La génération à la surface de l'électrode de l'ion nitrénium par oxydation enzymatique de la clozapine par l'HRP, suivie de sa réduction immédiate fournit un courant ampérométrique substantiel. Sous des conditions de pH optimales, ce courant de réduction autorise la détermination quantitative de la clozapine dans un domaine de linéarité compris entre 1 x 10-5 M et 1 x 10-6 M. L'addition de composés thiols dans le milieu occasionne une chute de courant par action de ceux-ci sur la structure radical cation ou nitrénium par addition nucléophile. La disparition de l'ion nitrénium et la formation d'un adduit GSH-CLZ inhibent tout processus de réduction à l'électrode du biocapteur. Cette diminution de courant proportionnelle aux concentrations en thiols introduits, permet la détermination quantitative de dérivés thiols. Les courbes de calibration exprimées en pourcentage d'inhibition conduisent facilement à l'évaluation de la constante d'inhibition (Ki) et de CI50. L'étude de la réponse ampérométrique de la clozapine à l'EPC/HRP en l'absence ou présence d'un dérivé thiol envisagé permet la détermination de Km et de caractériser le type d'inhibition qui entre en jeu. De tels paramètres cinétiques nous ont habilités à classer les thiols considérés en fonction de leur puissance réactionnelle envers les substances oxydées de la clozapine.
Au terme de ce travail, nous espérons avoir illustré, par l’étude de quelques molécules modèles, l’intérêt de la mise en œuvre des techniques électrochimiques couplées à l’élément biologique ou à la spectrométrie de masse. Des améliorations au niveau de la cellule électrochimique sont envisageables par l’emploi d’électrodes modifiées, elles laissent entrevoir la possibilité de mimer totalement le système CYP450.
Les résultats fournis par ces techniques hybrides et par voltampérométrie cyclique sont complémentaires, ils procurent un éventail d'informations d'une utilité estimable pour une application dans des études prédictives précoces de candidats médicament.
Doctorat en Sciences biomédicales et pharmaceutiques
info:eu-repo/semantics/nonPublished
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Schmidt, Karl F. "Development of Pharmacological Magnetic Resonance Imaging Methods and their Application to the Investigation of Antipsychotic Drugs: a Dissertation." eScholarship@UMMS, 2006. https://escholarship.umassmed.edu/gsbs_diss/114.
Full textAbstract:
Pharmacological magnetic resonance imaging (phMRI) is the use of functional MRI techniques to elucidate the effects that psychotropic drugs have on neural activity within the brain; it is an emerging field of research that holds great potential for the investigation of drugs that act on the central nervous system by revealing the changes in neural activity that mediate observable changes in behavior, cognition, and perception. However, the realization of this potential is hampered by several unanswered questions: Are the MRI measurements reliable surrogates of changing neural activity in the presence of pharmacological agents? Is it relevant to investigate psychiatric phenomena such as reward or anxiolysis in anesthetized, rather than conscious animals? What are the methods that yield reproducible and meaningful results from phMRI experiments, and are they consistent in the investigations of different drugs?
The research presented herein addresses many of these questions with the specific aims of
1) Developing pharmacological MRI methodologies that can be used in the conscious animal,
2) Validating these methodologies with the investigation of a non-stimulant, psychoactive compound, and
3) Applying these methodologies to the investigation of typical and atypical antipsychotic drugs, classes of compounds with unknown mechanisms of therapeutic action
Building on recent developments in the field of functional MRI research, we developed new techniques that enable the investigator to measure localized changes in metabolism commensurate with changing neural activity. We tested the hypothesis that metabolic changes are a more reliable surrogate of changes in neural activity in response to a cocaine challenge, than changes observed in the blood-oxygen-level-dependent (BOLD) signal alone. We developed a system capable of multi-modal imaging in the conscious rat, and we tested the hypothesis that the conscious brain exhibits a markedly different response to systemic morphine challenge than the anesthetized brain. We identified and elucidated several fundamental limitations of the imaging and analysis protocols used in phMRI investigations, and developed new tools that enable the investigator to avoid common pitfalls. Finally, we applied these phMRI techniques to the investigation of neuroleptic compounds by asking the question: does treatment with typical or atypical antipsychotic drugs modulate the systems in the brain which are direct or indirect (i.e. downstream) substrates for a dopaminergic agonist?
The execution of this research has generated several new tools for the neuroscience and drug discovery communities that can be used in neuropsychiatric investigations into the action of psychotropic drugs, while the results of this research provide evidence that supports several answers to the questions that currently limit the utility of phMRI investigations. Specifically, we observed that metabolic change can be measured to resolve discrepancies between anomalous BOLD signal changes and underlying changes in neural activity in the case of systemically administered cocaine. We found clear differences in the response to systemically administered morphine between conscious and anesthetized rats, and observed that only conscious animals exhibit a phMRI response that can be explained by the pharmacodynamics of morphine and corroborated by behavioral observations. We identified fundamental and drug-dependent limitations in the protocols used to perform phMRI investigations, and designed tools and alternate methods to facilitate protocol development.
By applying these techniques to the investigation of neuroleptic compounds, we have gained a new perspective of the alterations in dopaminergic signaling induced by treatment with antipsychotic medications, and have found effects in many nuclei outside of the pathways that act as direct substrates for dopamine. A clearer picture of how neuroleptics alter the intercommunication of brain nuclei would be an invaluable resource for the classification of investigational antipsychotic drugs, and would provide the basis for future studies that examine the neuroplastic changes that confer therapeutic efficacy following chronic treatment with antipsychotic medications.
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Etchepare, Fanny. "Etude du respect des recommandations de prescription et d'utilisation des médicaments psychotropes chez les sujets âgés en France." Thesis, Bordeaux, 2015. http://www.theses.fr/2015BORD0200/document.
Full textAbstract:
Malgré la fréquence d’utilisation des psychotropes chez les personnes plus âgées et leur propension aux événements indésirables liés aux médicaments, peu d’études se sont intéressées au respect des règles de bon usage des psychotropes dans cette population. L’objectif de ce travail était d’évaluer les modalités d’utilisation des psychotropes et le respect des recommandations de bon usage publiées en France. Deux types de population ont été inclus : un échantillon clinique constitué de patients âgés d’au moins 65 ans hospitalisés dans deux Pôles de psychiatrie à Bordeaux, et un échantillon de la population générale âgée d’au moins 65 ans, à partir d’une base de données de l’assurance maladie française. En population clinique, les règles de bon usage étaient plutôt bien respectées, avec, pour les benzodiazépines, la prescription d’une produit à demi-vie courte dans près de trois quarts des prescriptions et une posologie adéquate dans près de deux tiers des cas. Toutefois, un arrêt de traitement n’était jamais prévu dès l’initiation du traitement et le rythme de prescription était discontinu dans seulement un tiers des cas. Dans la population générale âgée, la durée et la surveillance biologique des traitements antidépresseurs étaient conformes chez moins de 20% des sujets, alors que près des trois quarts des sujets initiant un traitement par benzodiazépine recevaient une durée adéquate. En revanche moins de la moitié des délivrances concernaient une benzodiazépine anxiolytique à demi-vie courte. L’étude de l’impact de la publication des recommandations n’a pas montré qu’elle permettait une amélioration de l’utilisation des psychotropes. Il est nécessaire d’accompagner la publication des recommandations d’autres mesures, afin d’insister sur le bon usage des psychotropes, notamment la durée nécessaire de traitement antidépresseur et le choix d’un anxiolytique à demi-vie courteDespite a high frequency of use and a tendency to present with adverse events of drugs, few studies assessed compliance with guidelines related to proper use of psychotropic drugs in the older population. The aim was to assess the patterns of psychotropic drugs use in this population, as well as the compliance with French guidelines. Two population samples were included, a clinical sample of older psychiatric inpatients and a sample of the older general population using claims database of the national health insurance. In clinical population, compliance with guidelines was rather good, with prescription of a short half-life benzodiazepine in nearly three quarters of prescriptions and adequate dosage in nearly two third of cases. However, treatment discontinuation was never specified at the time of treatment initiation and rhythm of prescription was discontinuous in only one third of cases. In the older general population, duration of antidepressant treatment and biological monitoring was appropriate in only 20 % of patients, whereas nearly three quarters of subjects initiating a benzodiazepine treatment were treated over an appropriate duration. However, less than half of them had received a benzodiazepine anxiolytic of short half-life. The assessment of the impact of practice guidelines publication found no improvement of psychotropic drugs use. Other interventions should accompany guidelines publication in order to underline the importance of proper use of drugs, particularly antidepressant treatment duration and use of short half-life benzodiazepine drugs
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Couto, Fernanda Rocha. "Uso de psicotrópicos em policiais militares." Universidade Federal de Goiás, 2015. http://repositorio.bc.ufg.br/tede/handle/tede/5701.
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INTRODUCTION: Being a military police is stressful. The responsibility for providing security to society brings a health hazard, threats to his / her health and safety. The fear of not coming back home alive or even hurt can lead to anxiety and stress. The search for immediate relief increases the use of psychotropic drugs by the military police. Studies published until now that approached this theme showed methodological limitations. AIMS: To evaluate the use of psychotropic drugs of list B1 (Clonazepam, Bromazepam and Alprazolam) by military police of Goiás State, to identify the group age and gender that used it most, to quantify the time of military police service that they used the psychotropic and to evaluate the proportion of this use according to the military personnel (soldiers and officers). METHODS: A review article was written based on data published between 1990 and 2013 in PubMed and SciElo. Thereafter, and observational, descriptive and retrospective study was done. One hundred military police from Hospital of Military Police in Goiânia city were evaluated by collecting the data presented in medical prescriptions and corporate pharmacy database using a form specially designed for this. INCLUSION CRITERIA: All the controlled B1 prescriptions in 2011. EXCLUSION CRITERIA: Illegible prescriptions, other controlled prescriptions like C1 and patients that are dependent of military police. RESULTS: The frequency of use was divided according to: 1) Genre: men (68%), women (32%); 2) Age: 18 to 35 years old (4%); 36 to 50 years old (52%); 51 to 70 years old (12%); >71 years old (3%); uninformed (29%); 3) Psychotropics: Alprazolam (14%), Bromazepam (13%), Clobazam (1%), Clonazepam (53%), Cloxazolam (7%), Diazepam (1%), Flurazepam (1%), Midazolam (2%), Nitrazepam (7%);4) Trimester: Jan/Mar (22%), Apr/June (39%), July/Sept (31%), Oct/Dec (7%); 5) Service time:<5 years old (2%), 6 to 10 years old (5%), 11 to 20 years old (12%), 21 to 30 years old (48%); 6) Military rank: soldier (63%), officers (11%), pensionary (2%), uninformed (24%). CONCLUSION: The profile of the military police user of psychotropic drugs was female sex with an average age of 47. The most common psychotropic drug was Clonazepam. The service time when they most use the drugs was the one comprehended between 21 and 30 years of activity in the military force. From the Military Police personnel, there was no difference in relation to military officers.
INTRODUÇÃO: A profissão de policial por si só é uma profissão muito estressante. A responsabilidade de proporcionar à sociedade segurança traz uma perigosidade. O homem/mulher dentro da farda colocam a vida em risco. O medo de não voltar para casa com vida ou mesmo ferido acaba proporcionando alto nível de estresse e ansiedade. A busca por alívio imediato aumenta o uso de medicamentos psicotrópicos por policiais e outras profissões com alto nível de estresse. Os estudos que investigaram o tema apresentam limitação metodológica. OBJETIVOS: Avaliar o uso de medicamentos psicotrópicos controlados da Lista B1(Clonazepam, Bromazepam e Alprazolam) em policiais militares do estado de Goiás, identificar a faixa etária e o gênero que mais utilizou os psicotrópicos, identificar o psicotrópico B1 mais utilizado pelo policial militar do estado de Goiás, quantificar o tempo de serviço do policial militar que fez uso com maior assiduidade dos medicamentos psicotrópicos e avaliar a proporção do uso de psicotrópicos segundo o quadro de composição militar (praças e oficiais). CRITÉRIOS DE INCLUSÃO: Todos os receituários controlados B1 de 2011. CRITÉRIOS DE EXCLUSÃO: receituários ilegíveis, receituários de controle especial C1 e pacientes dependentes do policial militar. MÉTODOS: Foi redigido um artigo de revisão da literatura, construído a partir de pesquisas nas bases de dados PubMed/Medline e SciElO entre 1990 e 2013. Em seguida foi elaborado este estudo observacional, descritivo e retrospectivo. Foi desenvolvido com a coleta de dados de 100 receituários escolhidos aletoriamente de policiais atendidos na Farmácia Fundação Tiradentes no Hospital do Policial Militar no município de Goiânia. Foi utilizado formulário elaborado pelo pesquisador e orientador. Os dados foram coletados de receituários controlados B1 arquivados na Farmácia e sistema da corporação, após autorização do estabelecimento. RESULTADOS: A frequência de uso foi dividida em: 1) Gênero: homens - (68%), mulheres (32%); 2) Idade: de 18 a 35 anos (4%); 36 a 50 anos (52%), 51 a 70 anos (12%), > 71 anos (3%), não informado (29%); 3) Psicotrópicos: Alprazolam (14%), Bromazepam (13%), Clobazam (1%), Clonazepam (53%), Cloxazolam (7%), Diazepam (1%), Flurazepam (1%), Midazolam (2%), Nitrazepam (7%). 4) Trimestre: jan/mar (22%), abr/jun (39%), jul/set (31%), out/dez (7%), 5) Tempo de serviço: < 5 anos (2%), 6 a 10 anos (5%), 11 a 20 anos (12%), 21 a 30 anos (48%); 6) Patente: praça (63%), oficial (11%), pensionista (2%), não informado (24%). CONCLUSÃO: A idade média foi de 47,03 e o gênero proporcionalmente que mais usou o psicotrópico foi o sexo feminino, sendo o Clonazepam o mais utilizado. Observou-se ainda que o tempo de serviço militar, entre 21 e 30 anos, contribuiu para o uso. Não houve diferença em relação a patente de Praça e Official.