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1
Åkerblad, Ann-Charlotte. "Adherence to Antidepressant Medication". Doctoral thesis, Uppsala University, Department of Neuroscience, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7769.
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Non-adherence to medication is a major obstacle in the treatment of depression. The objectives of the present study were to explore the effect of two interventions aiming to increase antidepressant treatment adherence, and to examine long-term consequences and costs of depression in adherent and non-adherent primary care patients.
A randomised controlled design was used to assess the respective effects of a written educational adherence enhancing programme and therapeutic drug monitoring in patients with major depression treated with sertraline for 24 weeks. All patients were prospectively followed during two years.
Treatment adherence was found in 41% of the 1031 included patients. None of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the group receiving the written educational material had responded at week 24 as compared to patients in the control group.
The overall remission rate after two years was 68%. In total, 34% of the responders experienced at least one relapse. Response and remission rates at week 24, year 1 and year 2 were significantly higher in adherent as compared to non-adherent patients. No relationship between adherence and relapse rate was seen.
The mean total cost per patient during two years was KSEK 363 whereof indirect costs represented 87%. No significant differences in costs between intervention groups or between adherent and non-adherent patients could be demonstrated. However, the mean cost per patient was 39% lower for treatment responders as compared to non-responders.
Non-adherence was predicted by age below 35 or above 64 years, no concomitant medications, personality disorder, sensation seeking personality traits and substance abuse.
The results indicate a strong positive relationship between treatment adherence and clinical outcome. In addition, the study shows that depression is a costly disease and that certain patient characteristics predict non-adherence.
2
Åkerblad, Ann-Charlotte. "Adherence to antidepressant medication /". Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7769.
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Cotterchio, Michelle. "Antidepressant medication use and breast cancer risk". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0007/NQ41131.pdf.
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Gallagher, Shawn Patrick, i Shawn Patrick Gallagher. "Antidepressant Medication Adherence in Active Duty Army Soldiers". Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626157.
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Depression can be painful, disabling, and result in fatal consequences. The most common treatment, antidepressant medication, can effectively treat depressive symptoms. Though, adhering to antidepressant medication treatment is a complex phenomenon that can elude even the most informed who suffers from depression. While much is known about antidepressant medication adherence in the general population, there is a dearth of knowledge about it in active duty United States Army soldiers with depression.
The purpose of this research was to explore antidepressant adherence among United States Army soldiers with depression in relation to the potential correlates of illness perceptions, beliefs about medication, social support, and selected demographic variables. This descriptive study analyzed findings to determine significant correlations or predictors of antidepressant adherence in soldiers with depression.
Fifty-one participants, ranging from 24 to 36 years of age (M= 29 years of age) were recruited through Facebook™ (i.e., social media). After answering basic demographic and ‘insider’ knowledge, screening questions participants completed measures of medication adherence, illness perceptions, social support, depression, anxiety, post-traumatic stress, and alcohol use.
Age and gender were the only variables significantly associated with medication adherence (r= -0.317, p= 0.024 and r= -0.331, p= 0.018) respectively and the only predictors of antidepressant medication adherence (R2= 0.206, Adjusted R2: 0.173, F: 6.234, p= 0.004). Antidepressant adherence scores indicated low levels of adherence.
The findings of this study suggest those who are younger and are female United States Army soldiers may be more likely to report higher levels of antidepressant adherence.
5
Linton, Pamela. "Correlates of Antidepressant Medication Compliance Use Among Depressed Women". DigitalCommons@USU, 2001. https://digitalcommons.usu.edu/etd/2537.
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Medication compliance/noncompliance was examined in context of: severity of symptoms; medical side effects; medication education; perceived stigma; and effects on family/social support system. A null hypothesis was formulated for each correlate, stating that those patients who reported a high level of an independent variable (IV) would not be any more likely to discontinue their medication than patients who reported a low level of an IV. To obtain data, a medical usage questionnaire and a depression, assessment (OQT"-45.2) were used. Statistical significance was not obtained for any of the hypothesized relationships but trends were consistent with the established literature. The implication points to the efficacy of relational therapy as a conjunct to the medical treatment of depression.
6
Saad, Mysa. "Characteristics of Cardiorespiratory Function During Sleep Related to Depression and Antidepressant Medication Use". Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39417.
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Through a series of original research articles, this thesis explores the characteristics of autonomic cardiac regulation and respiratory function during sleep in association with depression and antidepressant medication use and validates a novel diagnostic biomarker of depression. Cardiorespiratory dysfunction during sleep may contribute to the increased risk of developing cardiovascular disease amongst individuals with depression. Sleep represents a unique physiological state shielded from many external confounding factors and may be a more relevant window to observe the effects of depression on cardiorespiratory function. In a first study, we found that depression was associated with abnormal autonomic modulation of cardiac activity during sleep. Specifically, depression was associated with reduced heart rate variability compared to healthy controls, and this difference was most prominent during sleep as compared to wake, which may indicate impairments in the parasympathetic modulation of the cardiac sinoatrial node. Secondly, we validated a machine-learning algorithm that uses patterns of heart rate during sleep to identify depression. This algorithm was found to have 79.9% classification accuracy, based on the differences in autonomic modulation associated with distinct mental states. The algorithm was highly generalizable across different depression subgroups and thus may be useful as an adjunct diagnostic tool. Finally, we found that the use of antidepressants, particularly serotonergic agents, was associated with worse sleep-related respiratory disturbances compared to non-medicated individuals with depression and those using non-serotonergic antidepressants. We proposed that depression-related alterations in serotonin receptor expression and binding may shape the response of the respiratory system to the use of serotonergic agents. Considering the high comorbidity between depression and sleep-related breathing disturbances and their impact on cardiovascular health, this has great clinical implications for the management of depression. Taken together, these results show that depression is associated with several sleep-related abnormalities in terms of cardiorespiratory function, which may represent a valid biomarker of depression.
7
Dimidjian, Sona. "Behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of major depression /". Thesis, Connect to this title online; UW restricted, 2005. http://hdl.handle.net/1773/9064.
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Weaver, Alice. "'Journeys through depression' : patients' experiences of transformational change through mindfulness based cognitive therapy (MBCT) and antidepressant medication (ADM)". Thesis, University of Exeter, 2015. http://hdl.handle.net/10871/18309.
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Background: Mindfulness-based cognitive therapy (MBCT) is a promising new alternative to anti-depressant medication (Kuyken et al., 2015) and whilst some qualitative studies have explored participants' experiences of MBCT, none yet have explored experiences of participants who are considering coming off their antidepressant medication alongside MBCT or how patients experience change in relationships with self, others and illness. Aim: To examine MBCT participants' experience of change across 24 months, particularly in relation to change in views of their self and their illness over time. Method: Thematic analysis of in-depth retrospective interviews with 42 participants, two years after attending an 8 week MBCT group with an invitation to taper their antidepressant medication (ADM). Each participant took part in one retrospective interview which was semi-structured and focused on experiences of MBCT and ADM over the previous two years since attending an MBCT group and how these have impacted on a change in self and experience of illness. Findings and conclusion: Four over-arching themes were found: taking control, relationships (with self, other and illness), rebuilding the self and shifts in perspective. The findings in the current study are very similar to those found in transformation in the physical chronic illness literature (e.g. Paterson et al., 1999). Perhaps MBCT could be the challenge which lead patients suffering from chronic depression towards change and creates a context in which patients can consider self and identity.
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Holland, Kate E., i n/a. "Conformity and resistance: Discursive struggles in the Australian mental health field". University of Canberra. Communication, 2007. http://erl.canberra.edu.au./public/adt-AUC20081022.153830.
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This research explores areas of contention in the mental heath field in Australia through a
qualitative analysis of voices and practices that can broadly be seen as talking with and
talking back to psychiatry. The thesis is informed by key shifts in thinking that underpin
postpsychiatry and analyses a set of materials through an interpretive lens of reading
psychiatry against the grain (Bracken & Thomas, 2005; Lewis, 2006). In particular, it
examines a failed ethics application to conduct research with people diagnosed with a mental
illness, an anti-stigma campaign, the practices of some prominent mental health organisations
in Australia, a conversation with two members of an emerging consumer/survivor network in
Australia, and a television documentary and online discussion forum about an antidepressant
medication. The research draws from discourse analytic methods and concepts from social
movement framing research to identify factors shaping conformity and resistance to
psychiatric doxa in the Australian mental health field.
The research identifies the discursive repertoires that characterise the mental health field as a
"game" in which competing perspectives vie for recognition. In relation to research ethics
committees, the thesis argues that deference to clinical expertise is a potential barrier to
cultural studies of psychiatry and a more inclusive agenda in mental heath research and
practice. Some practices for ethics committees to consider when reviewing research that
involves people who may have been diagnosed with a mental illness are proposed. The
research also identifies problematic features of anti-stigma campaigns that direct their efforts
toward protecting and promoting the discourse of biomedical psychiatry. A critique of this
type of campaign is offered in relation to perspectives from postpsychiatry and social
constructionism. On the basis of this research, it is argued that organisations that champion
"mental health literacy" are limited in their ability to give voice to the goals and priorities of
those who are calling for a more open, reflexive and democratic debate in mental health. The
central argument of this thesis is that elevating first-person and postpsychiatry perspectives is
necessary in order to interrogate and address the dominance of the medical model in
psychiatry and its consequences.
10
Chabenat, Apolline. "Alteration of camouflage and behaviour in two marine invertebrates, Sepia officinalis and Carcinus maenas, by antidepressant medication Hidden in the sand: Alteration of burying behaviour in shore crabs and cuttlefish by antidepressant exposure". Thesis, Normandie, 2020. http://www.theses.fr/2020NORMLH15.
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Les juvéniles de la seiche commune, Sepia officinalis, et du crabe vert, Carcinus maenas, se développent au niveau de la zone intertidale et des eaux côtières affectées par la pollution continentale telle que les résidus pharmaceutiques. Cette recherche se concentre sur les effets de deux antidépresseurs, la fluoxétine et la venlafaxine, sur le camouflage et le comportement de la seiche et du crabe vert. Ces deux molécules sont particulièrement inquiétantes car elles sont conçues pour agir sur le système sérotoninergique et sont communément détectées dans les environnements aquatiques. Ainsi, pour se rapprocher de scénarii d’exposition réalistes, la fluoxétine a été associée ou non à la venlafaxine. Les résultats montrent des effets significatifs à des concentrations environnementalement réalistes, d’autant plus avec le mélange des deux antidépresseurs, sur des paramètres sensibles tels que le comportement d’ensablement, le changement de couleur et la coloration cryptique chez nos deux espèces, ainsi que l’activité locomotrice chez le crabe et le comportement prédateur chez la seiche. En outre, l’exposition de stades de développement précoces aux antidépresseurs semble modifier la maturation et les processus d’apprentissage chez la seiche. Enfin, ces résultats ont démontré la nécessité de mener davantage d’études avec de faibles concentrations sur les comportements clefs d’espèces non-ciblesJuveniles of the common cuttlefish, Sepia officinalis, and the green shore crab, Carcinus maenas, develop themselves in the intertidal zone and coastal waters impacted by continental pollution such as pharmaceutical residues. This research focused on the effects two antidepressants, the fluoxetine and the venlafaxine, on the camouflage and behaviour of cuttlefish and shore crabs. Both molecules are worrying because they are designed to act on serotonergic system and are commonly detected in aquatic environments. Thus, to approach realistic scenario of exposure fluoxetine was either combined or not with venlafaxine. The results show significant effects of antidepressants at environmentally realistic concentrations, especially the combination of fluoxetine and venlafaxine, on sensitive endpoints such as burying behaviour, colour change and background matching, locomotor activity in crabs and predatory behaviour in cuttlefish. Furthermore, the exposure to antidepressants at early development stage seems to alter maturation and/or learning processes in cuttlefish. Overall, these studies demonstrated the need to investigate further with low range concentrations on key behaviours of non-target species
11
Ryan, Elizabeth. "The Therapeutic Alliance in Cognitive Therapy for Depression in Combination with Antidepressant Medication: Relations to Subsequent Symptom Change and Treatment Retention". The Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=osu1262278719.
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Boudreau, Denise M. "The association between HMG-CoA inhibitor use and breast cancer risk & a validation study of patient interview data and pharmacy records for antihypertensive, statin, and antidepressant medication use /". Thesis, Connect to this title online; UW restricted, 2002. http://hdl.handle.net/1773/7934.
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Ashbury, Janet E. "Selective serotonin reuptake inhibitors (SSRIs) and breast cancer : a record linkage study". Thesis, Kingston, Ont. : [s.n.], 2008. http://hdl.handle.net/1974/971.
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Fulton-Kehoe, Deborah. "Use of antidepressant medications in relation to the incidence of breast cancer /". Thesis, Connect to this title online; UW restricted, 2005. http://hdl.handle.net/1773/10941.
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Wilson, Susan Jenifer. "The effect of psychotropic medication on sleep and daytime sleepiness in volunteers and depressed patients". Thesis, University of Bristol, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297973.
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Sekar, Sakthivel. "Investigation of Neuronal Effects of Anxiogenic and Antidepressant Medications using Pharmacological Magnetic Resonance Imaging". Thesis, University of Newcastle Upon Tyne, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.519474.
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Gribbin, Jonathan. "Falls in older people and the role of commonly prescribed antidepressant and antihypertensive medications". Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/28451/.
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Background Falls in older people result in harm for individuals and are a major public health problem, but there is little published data on the recording and incidence of falls seen in primary care, with which to consider the implications of recent policy initiatives. A range of factors contribute to falls risk. Amongst these, the role of some medications is well established, but the evidence base regarding the effects of some of the most commonly prescribed medications remains meagre and inconsistent. Aims The project aims to quantify the overall incidence and distribution of recorded falls among older people in primary care in the UK, and the associated risk of death. The falls risk profile of more recently introduced serotonin noradrenalin reuptake inhibitors (SNRls) is explored to assess whether it is more favourable than that of selective serotonin reuptake inhibitors (SSRls). Similarly, prescribing of subclasses of antihypertensive medication is explored to establish whether any of them modify risk of falling. Finally, other classes or sub-classes of medication prescribed in primary care are identified whose apparent falls risk warrants further investigation. Methods Analysis of falls and prescribing history in the electronic records of patients aged 60 years and over from The Health Improvement Network (THIN) using cohort, survival, case-control and case series study designs. Results Amongst people aged >60 years the overall crude incidence rate of recorded falls was 3.58/100 person-years (3.56-3.61), higher in older age groups, in women and least advantaged social groups, and was constant in the period 2003-2006. Fallers experienced a substantial increase in mortality (two-fold increase for recurrent fallers, and more than five-fold for those aged 60-74 years). This increase is independent of fractures recorded at the time of the fall or subsequently. People who fall have an increased rate of subsequent fracture (approximately three-fold and, for recurrent fallers aged 60-74 years more than eight-fold). There was an increased risk of current prescribing of SNRls (adjusted OR 1.79, 1.42 - 2.25) in first fall cases compared with controls. This was similar in magnitude to that seen with tricyclic antidepressants and SSRls. The increase in risk was apparent within the first 28 days after first prescription. The effects were also apparent in the self-controlled case series analysis: the incidence risk ratio for the period 1-28 days after initiation of treatment compared with unexposed periods was 1.49 (1.15 - 1.93). There was an increased risk of current prescribing of thiazides (adjusted OR 1.28, 1.16-1.42). At 3 weeks after first prescribing the adjusted risk remained 4.28 (1.19-15.42). In the case series analysis the incidence risk ratio for the period 21 days after first prescription was 2.80 (1.7 - 4.57). We found a reduced risk for current prescribing of beta blockers (adjusted OR 0.90; 0.85- 0.96), but a weakly positive effect in the case series analysis for the corresponding period IRR 1.23 (1.02-1.48). Taken together, the case-control and case series analyses of other subclasses of antihypertensives provided weak or no evidence for an effect on falls. In the hypothesis generating case-control analysis of other medication classes, unadjusted odds ratios of greater than 1.7 were found in a number of classes of medication including: laxatives, antifungals, corticosteroids, insulin, antibiotics for mild to moderate acne, and vaccines for influenza and other infections. Conclusions Older people with a recorded fall represent a group who are at increased risk of death, irrespective of whether they have a subsequent fracture. Nevertheless the incidence of falls recorded in primary care suggests that guidance about asking patients if they have fallen in the last year appears not to have been followed during the study period. The fact that the incidence rate of falls is strongly associated with social disadvantage suggests the need to target the design and delivery of interventions accordingly. The falls risk profile of SNRls, which is similar to that of SSRls and TCAs, suggests that clinicians initiating prescribing of SNRls should be alert to the increased risk of falls. Similarly, clinicians initiating prescribing of thiazides in older people, which has generally been considered a 'safe' option for older patients, should be alert to the possibility of an increased risk of falls in the first three weeks of prescribing. Case series analysis of recurrent periodic exposures can elucidate bias in classis case-control analysis of the same data, and will be useful in assessing the falls risk profile of other medications such as insulin. Given the small size of sources of detailed data about older people who fall and the imprecision in their measurement of exposure to medications and potential confounders, case-control and case series analysis of first falls in THIN represents a valuable source of new evidence about medication risk factors.
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Cui, Ling 1978. "A comparative study of the diffusion of antihypertensive and antidepressant medications in Germany in Japan". Thesis, Massachusetts Institute of Technology, 2005. http://hdl.handle.net/1721.1/32283.
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Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2005.Includes bibliographical references (p. 137-141).
This thesis analyzes and compares the diffusion of antihypertensive and antidepressant medications in Germany and Japan during the time period of 1992 and 2003. The antihypertensive medications are classified as new, middle and old generations and the antidepressants are classified as new and old generations in this study. The demographic, economic, price, promotional, regulatory, and cultural factors that contributed to the sales level, number of compounds available in the market, and launch time of these medications are also examined using quantitative and qualitative methods at therapeutic class, generation, as well as product levels. The qualitative analysis includes discussions on the general health care systems, health care polices, and country-specific hypertension- and depression-related cultural backgrounds. Econometric tools (descriptive statistics and linear regression models) are used as means of quantitative analysis. The diffusion of different generations of medications is examined. The degree of the use of branded vs. generic medications are also compared. Finally, Chow-tests are conducted for cross-country and cross- therapeutic-class comparisons. This study finds that there are significant branded-v-generic, cross-generation, cross- class, cross-country differences in the diffusion of the selected therapeutic classes in the two countries. The factors examined contributed to the diffusion to various extents. Among which, the cultural factor played an important role in the adoption and sales of new medications of both therapeutic classes in both countries, especially the antidepressants in Japan. The promotional factors appear not to be very significant in the sales volumes, partially due to the regulatory settings of the two national-based health care systems.
y Ling Cui.
S.M.
19
Fitton, Catherine Alexandra. "Identifying adverse outcomes in neonates and children following in utero exposure to medication". Thesis, University of Aberdeen, 2019. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=240861.
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Introduction: Many medications have an unproven safety profile for use during pregnancy, leading to issues when chronic diseases, such as hypertension and depression, present during pregnancy. The focus of this research programme is to determine whether in utero exposure to antihypertensive and antidepressant medication is associated with increased risk of adverse events at birth, and up to 27 months of age in the child. Methods: Two systematic reviews were performed to identify current published literature and knowledge gaps. Following this, using Scottish healthcare data, a cohort of 268,711 children born 2010-2014 were identified. Following cleaning of the data, multiple imputation was used to account for missing values. Poisson, linear and multinomial regressions were performed to identify the relationship between in utero medication exposure and child outcomes. Results: In utero antihypertensive exposure was associated with preterm birth, low birth weight, small for gestational age, but not developmental issues. However, untreated hypertension was associated with low birth weight, preterm birth, and small for gestational age. In utero antidepressant exposure was associated with preterm birth, low birth weight, small for gestational age, preeclampsia, having a special needs indicator at 10 days and 6-8 weeks post-birth, developmental issues at 27 months Conclusions: This research programme identified several adverse outcomes following in utero exposure to antihypertensive and antidepressant medication.
20
Ghanem, Simon. "Inflammation in young Swedish men and risk of adult-onset depression defined by prescription of antidepressant medications". Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-86370.
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Background: Depression is a major disability that has been studied extensively in regard to systemic inflammation. Cross-sectional studies have shown that systemic inflammatory parameters are raised in individuals with depression, but few studies have explored the longitudinal direction of associations. The aim of this study is to investigate whether heightened ESR-levels during adolescence increases the risk of subsequent depression during adulthood measured by antidepressant medication. Methods: This register-based cohort study included 196,667 Swedish men who were born in 1952 to 1956, attended mandatory military conscription assessments in late adolescence, and were followed up to 2009 through linkages of various national registers. The association between erythrocyte sedimentation rate, measured at conscription examination, and antidepressant treatment in middle age was examined using logistic regression with adjustment for confounding by BMI, stress resilience, socioeconomic index and household crowding. Results: Erythrocyte sedimentation rate was not positively associated with an increased subsequent risk of antidepressant treatment. The characteristics of >18,5 BMI, low stress resilience, lower household crowding and the socioeconomic index belonging to ‘office worker’, were of higher risk for antidepressant treatment. Conclusion: This study shows that the systemic inflammatory marker erythrocyte sedimentation rate is not positively associated with subsequent development of depression defined by antidepressant treatment.
21
Löppönen, P. (Pekka). "Preceding medication, inflammation, and hematoma evacuation predict outcome of intracerebral hemorrhage:a population based study". Doctoral thesis, Oulun yliopisto, 2016. http://urn.fi/urn:isbn:9789526211282.
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Abstract Primary intracerebral hemorrhage (pICH) is a severe, suddenly occurring disease involving high mortality and poor functional outcome. In the absence of curative treatment patient management is mainly supportive with the emphasis on preventing hematoma enlargement and complications. Better understanding of the factors predicting outcome are needed to define effective treatments. An unselected population-based registry study of 982 pICH patients admitted to Oulu University Hospital during the years 1993 to 2008 was conducted The study revealed that concomitant use of warfarin and serotonin-modulating antidepressants at the time of pICH increases the case fatality rate compared to patients with warfarin alone. An elevated C-reactive protein value on admission was an independent predictor of unfavorable outcome after pICH. This association was not explained by pre-existing heart disease, diabetes, severity of the bleeding, or infections. Patients undergoing surgical hematoma evacuation were observed to have improved 3-month survival compared to conservatively treated patients. Improved survival was noticed especially in patients with ≤70 years of age with ≥30ml supratentorial ICHs. Hematoma evacuation did not improve functional outcome. Earlier ischemic stroke was found to be an independent predictor of recurrent pICH. Diabetes seemed to increase and treated hypertension decrease the risk for fatal recurrence. Aspirin or serotonin-modulating antidepressants did not seem to increase the risk of recurrenceTiivistelmä Primääri aivoverenvuoto (pICH) on vakava, yhtäkkisesti alkava sairaus, johon liittyy korkea kuolleisuus ja vaikea vammautuminen. Parantavan hoidon puuttuessa on hoito lähinnä elintoimintoja tukevaa vuodon laajenemisen ja komplikaatioiden estämistä. Ennusteeseen vaikuttavien tekijöiden parempi tunteminen on ehto tehokkaiden hoitojen löytämiseksi. Väitöskirjatutkimustani varten kerättiin Oulun yliopistollisen sairaalan alueelta vuosien 1993-2008 aikana 982 aivoverenvuotoon sairastuneen potilaan väestöpohjainen aineisto. Tutkimus osoitti, että varfariinin ja selektiivisen serotoniinin takaisinoton estäjän (SSRI) yhteiskäyttö aivoverenvuodon aikana lisäsi kuolevuutta pelkkään varfariiniin nähden. Alkuvaiheen koholla oleva C-reaktiivinen proteiini oli itsenäinen aivoverenvuodon jälkeistä vammautuneisuutta ennustava tekijä. Yhteys ei selittynyt olemassa olevalla sydänsairaudella, diabeteksella, aivoverenvuodon vaikeudella tai infektioilla. Kirurginen aivoverenvuodon poistoleikkaus paransi kolmen kuukauden ennustetta verrattuna potilaisiin ilman leikkausta. Erityisesti leikkaus auttoi alle 70-vuotiaita potilaita, joilla oli yli 30 millilitran kokoinen pinnallisempi vuoto. Leikkaus ei parantanut fyysistä kuntoutumista. Aiempi sairastettu aivoinfarkti oli itsenäinen aivoverenvuodon uusiutumista ennustava tekijä. Diabetes saattaa lisätä ja hoidossa oleva verenpainetauti laskea riskiä tappavaan uusintavuotoon. Aspiriinin tai SSRI:n käyttö eivät lisänneet uusintavuodon riskiä
22
Dublin, Sascha. "Risk of epithelial ovarian cancer in relation to use of antidepressants, benzodiazepines, and other medications acting on the central nervous system /". Thesis, Connect to this title online; UW restricted, 1999. http://hdl.handle.net/1773/10861.
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Rissanen, I. (Ina). "Nervous system medications and suicidal ideation and behaviour:the Northern Finland Birth Cohort 1966". Doctoral thesis, Oulun yliopisto, 2015. http://urn.fi/urn:isbn:9789526208077.
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Abstract The aim of this thesis was to explore the associations between the use of nervous system medications and suicidal ideation and behaviour in various different diagnostic groups in a large population-based cohort. Information on prescribed antipsychotic, antidepressant, benzodiazepine and antiepileptic medications within the Northern Finland Birth Cohort 1966 was collected from the register of the Social Insurance Institution of Finland and from a postal questionnaire sent to all cohort members in 1997. The presence of suicidal ideation and depression and anxiety symptoms was assessed via the Hopkins Symptom Checklist-25 questionnaire in 1997. Data on suicides were collected from the cause-of-death statistics and on suicide attempts from the Finnish Care Register for Health Care in a 15-year follow up. The use of antipsychotic, antidepressant, or benzodiazepine medication was associated with increased suicidal ideation, suicide attempts, and suicides. Antiepileptic medication was not associated with increased suicidality. The polypharmacy of nervous system medications was associated with increased suicidality. All nervous system medications were associated with increased severity of depression and anxiety symptoms. When depression and anxiety symptoms were taken into account, most of the associations between medication and suicidal ideation were statistically non-significant. Regarding specific groups, among those who did not have psychosis, high doses of antipsychotic medication correlated particularly with increased suicidal ideation even when other symptoms of depression and anxiety were taken into account. Among those with insomnia, the use of antidepressant medication associated with increased suicidal ideation also when other symptoms were taken into account. Although nervous system medication is associated with increased suicidal ideation, the association with other symptoms is also strong, and therefore it could not be stated that medication associates specifically with suicidal ideation. However, certain groups, i.e., non-psychotic subjects with high doses of antipsychotic medication, or subjects with insomnia and using antidepressant medication, should be closely monitored as they could be more vulnerable to suicidal ideationTiivistelmä Tämän väitöstutkimuksen tarkoituksena oli tutkia hermostoon vaikuttavien lääkkeiden, lähinnä psykoosilääkkeiden, masennuslääkkeiden, bentsodiatsepiinien sekä epilepsialääkkeiden, yhteyttä itsetuhoisiin ajatuksiin, itsemurhayrityksiin ja itsemurhiin. Aihetta tutkittiin eri diagnoosiluokissa suuressa väestöaineistossa, Pohjois-Suomen vuoden 1966 syntymäkohortissa. Tieto tutkimushenkilöiden lääkkeenkäytöstä vuodelta 1997 kerättiin Kelan lääkeostorekisteristä sekä postikyselyn avulla. Itsetuhoisten ajatusten ja muiden masennus- ja ahdistusoireiden vakavuutta mitattiin Hopkins Symptom Checklist-25 -kyselyn avulla vuonna 1997. Tieto itsemurhista kerättiin 15 vuoden seurannassa kuolinsyyrekisteristä ja tieto itsemurhayrityksistä hoitoilmoitusrekisteristä. Psykoosilääkkeiden, masennuslääkkeiden ja bentsodiatsepiinien käyttö oli yhteydessä lisääntyneisiin itsetuhoisiin ajatuksiin, itsemurhayrityksiin ja itsemurhiin. Epilepsialääkkeet eivät liittyneet itsetuhoisuuteen. Usean hermostoon vaikuttavan lääkkeen yhtäaikainen käyttö oli yhteydessä lisääntyneeseen itsetuhoisuuteen. Kaikki hermostoon vaikuttavat lääkkeet liittyivät lisääntyneisiin masennus- ja ahdistusoireisiin. Kun lääkityksen yhteys masennus- ja ahdistusoireisiin otettiin huomioon, lääkkeet eivät olleet erityisesti yhteydessä itsetuhoisiin ajatuksiin. Diagnostisten ryhmien välillä ei ollut eroa hermostoon vaikuttavien lääkkeiden ja itsemurhayritysten tai itsemurhien välisessä yhteydessä. Henkilöillä, joilla ei ole psykoosia, suuremmat psykoosilääkeannokset olivat yhteydessä itsetuhoisten ajatusten vakavuuteen kun muiden masennus- ja ahdistusoireiden vakavuus otettiin huomioon. Unettomuudesta kärsivillä henkilöillä masennuslääkkeen käyttö oli liittyi lisääntyneisiin itsetuhoisiin ajatuksiin kun muut oireet huomioitiin. Hermostoon vaikuttavat lääkkeet ovat yhteydessä lisääntyneisiin itsetuhoisiin ajatuksiin, mutta ne ovat myös vahvasti yhteydessä muihin masennus- ja ahdistusoireisiin. Tietyt henkilöt voivat kuitenkin olla erityisen herkkiä nimenomaan itsetuhoisille ajatuksille, ja heitä tulisi seurata erityisen tiiviisti. Tällaisia ovat henkilöt, joilla ei ole psykoosia, mutta jotka käyttävät suuria psykoosilääkeannoksia, sekä vakavasta unettomuudesta kärsivät henkilöt, jotka käyttävät masennuslääkettä
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Hulkko, A. (Anja). "The association of lifetime antipsychotic and other psychiatric medications with cognition in schizophrenia:the Northern Finland Birth Cohort 1966 Study". Doctoral thesis, Oulun yliopisto, 2017. http://urn.fi/urn:isbn:9789526216836.
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Abstract Antipsychotic medication forms the basis of the long-term, even lifelong treatment of schizophrenia. Antipsychotic polypharmacy and adjunctive psychiatric medications are also common treatment strategies. The long-term effects of psychiatric medication, especially on cognition in schizophrenia, are largely unknown. Cognitive impairment is a central, persisting symptomatic feature during the lifespan course of schizophrenia and a key predictor of functional outcome. This naturalistic study aimed to analyse how the lifetime exposure to antipsychotic, benzodiazepine and antidepressant medications, and lifetime trends in antipsychotic use, were associated with cognition in early midlife in schizophrenia. Non-psychotic controls were included as a reference group of normative cognitive performance. The study samples consisted of 40–60 subjects with schizophrenia and 73–191 non-psychotic controls from the Northern Finland Birth Cohort 1966. Data on the lifetime use of medications were collected from medical records, registers and interviews and connected with information from extensive psychiatric and neurocognitive assessments at the ages of 34 and 43 years. Higher cumulative lifetime exposure to antipsychotics was associated with poorer verbal learning and memory at 34 years of age, a decline in verbal learning and memory between the ages of 34 and 43 years and poorer global cognition at the age of 43 years in schizophrenia. A relatively long antipsychotic-free period before the cognitive assessment was associated with better global cognition at 43 years of age. Other lifetime trends in antipsychotic use, antipsychotic polypharmacy or cumulative benzodiazepine or antidepressant exposures were not associated with global cognition. This naturalistic study was the first to report an association between higher cumulative lifetime antipsychotic exposure and poorer cognition in early midlife in schizophrenia, which was not likely confounded by the use of other psychiatric medications or illness-related factors. Though residual confounding is still possible, these results suggest that high-dose long-term antipsychotic treatment may have some influence on the clinical course of schizophrenia, possibly by attenuating cognitive recovery. More research on the long-term effects of psychiatric medications is needed to develop the safe and effective treatment of schizophreniaTiivistelmä Psykoosilääkitys on skitsofrenian pitkäaikaisen, jopa elinikäisen hoidon perusta. Useiden psykoosilääkkeiden yhtäaikaiskäyttö ja muiden psyykenlääkkeiden oheiskäyttö ovat yleisiä hoitostrategioita. Psyykenlääkkeiden pitkäaikaisvaikutuksia etenkin kognitioon skitsofreniassa tunnetaan huonosti. Kognitiiviset puutokset ovat keskeinen, elinaikaisesti pysyvä skitsofrenian oirepiirre ja merkittävimpiä ennustetekijöitä. Tämän naturalistisen tutkimuksen tavoite oli analysoida elinaikaisen psykoosi-, bentsodiatsepiini- ja masennuslääkealtistuksen sekä elinaikaisten psykoosilääkkeiden käytön trendien yhteyttä kognitioon varhaisessa keski-iässä skitsofreniassa. Ei-psykoottiset verrokit toimivat normatiivisen kognitiivisen suorituskyvyn vertailuryhmänä. Tutkimusaineisto koostui Pohjois-Suomen vuoden 1966 syntymäkohorttiin kuuluvista 40 ja 60 henkilöstä, joilla oli skitsofrenia, sekä 73 ja 191 ei-psykoottisesta verrokista. Tiedot psyykenlääkkeiden elinaikaiskäytöstä kerättiin sairauskertomuksista, rekistereistä ja haastatteluista, ja ne yhdistettiin 34 ja 43 vuoden iässä tehtyihin laajoihin psykiatrisiin ja neuropsykologisiin tutkimuksiin. Korkeampi kumulatiivinen elinaikainen psykoosilääkealtistus oli yhteydessä heikompaan kielelliseen muisti- ja oppimissuoriutumiseen 34-vuotiaana ja sen suurempaan laskuun 34 ja 43 ikävuoden välillä sekä heikompaan kognitioon 43-vuotiaana skitsofreniassa. Suhteellisen pitkä psykoosilääketauko ennen neuropsykologista tutkimusta oli yhteydessä parempaan kognitioon 43-vuotiaana. Muut elinaikaisen psykoosilääkityksen käytön trendit, psykoosilääkkeiden yhtäaikaiskäyttö tai elinaikainen kumulatiivinen bentsodiatsepiini- tai masennuslääkealtistus eivät olleet yhteydessä kognitioon. Tämä naturalistinen tutkimus kuvasi ensimmäisenä yhteyden suuremman kumulatiivisen elinaikaisen psykoosilääkealtistuksen ja heikomman kognition välillä varhaisessa keski-iässä skitsofreniassa. Muiden psyykenlääkkeiden käyttö tai sairauteen liittyvät tekijät eivät näyttäneet sekoittavan tätä yhteyttä. Vaikka on mahdollista, että kaikkia sekoittavia tekijöitä ei pystytty huomioimaan, tulosten perusteella korkea-annoksinen, pitkäaikainen psykoosilääkitys saattaa vaikuttaa skitsofrenian taudinkulkuun heikentämällä kognitiivista toipumista. Lisätutkimusta psyykenlääkityksen pitkäaikaisvaikutuksista tarvitaan skitsofrenian turvallisen ja tehokkaan hoidon kehittämiseksi
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Lundin, Cecilia. "Antidepressant medication and previous or current depression and anxiety disorder: implications on healthcare utilization among pregnant women". Thesis, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-210471.
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Foley, Christine Marie. "Comparison And Application Of Methods To Address Confounding By Indication In Non-Randomized Clinical Studies". 2013. https://scholarworks.umass.edu/theses/1121.
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Objective: The project aimed to compare marginal structural models, and propensity score adjusted models with Cox Proportional Hazards models to address confounding by indication due to time-dependent confounders. These methods were applied to data from approximately 120,000 women in the Women’s Health Initiative to evaluate the causal effect of antidepressant medication with respect to diabetes risk.
Methods: Four approaches were compared. Three Cox Models were used. The first used baseline covariates. The second used time-varying antidepressant medication use, BMI and presence of elevated depressive symptoms and adjusted for other baseline covariates. The third used time-varying antidepressant medication use, BMI and presence of elevated depressive symptoms and adjusted for other baseline covariates and propensity to taking antidepressants at baseline. Our fourth method used a Marginal Structural Cox Model with Inverse Probability of Treatment Weighting that included time-varying antidepressant medication, BMI and presence of elevated depressive symptoms and adjusted for other baseline covariates.
Results: All approaches showed an increase in diabetes risk for those taking antidepressants. Diabetes risk increased with adjustment for time-dependent confounding and results for these three approaches were similar. All models were statistically significant. Ninety-five percent confidence intervals overlapped for all approaches showing they were not different from one another.
Conclusions: Our analyses did not find a difference between Cox Proportional Hazards Models and Marginal Structural Cox Models in the WHI cohorts. Estimates of the Inverse Probability of Treatment Weights were very close to 1 which explains why we observed similar results.
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Assayag, Jonathan. "Impact of type of drug insurance on adherence, persistence and costs of antidepressant drugs : a Quebec population-based study". Thèse, 2012. http://hdl.handle.net/1866/8557.
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Contexte: À date, il existe peu de données sur l’adhésion, la persistance et les coûts associés aux antidépresseurs selon le type d’assurance médicament (privé ou public).
Objectif: Comparer selon le régime d’assurance médicament (privé ou public), l'adhésion, la persistance et les coûts des antidépresseurs.
Méthodes de recherche: Une étude de cohorte appariée a été réalisée en utilisant des bases de données du Québec.
Sujets: Nous avons sélectionné 194 patients assurés par un régime privé et 1923 patients assurés par le régime public de la Régie de l’assurance maladie du Québec (RAMQ) (18-64 ans) qui ont rempli au moins une ordonnance pour un antidépresseur entre décembre 2007 et septembre 2009.
Mesures: L’adhésion, mesurée sur une période d’un an, a été estimée en utilisant le proportion of prescribed days covered (PPDC). Un modèle de régression linéaire a été utilisé afin d’estimer la différence moyenne en PPDC entre les patients assurés par un régime privé et ceux assurés par le régime public de la RAMQ. La persistance a été comparé entre ces deux groupes avec un modèle de régression de survie Cox, et le coût mensuel d'antidépresseurs ($ CAN) a été comparé entre ces deux groupes en utilisant un modèle de régression linéaire.
Résultats: Le PPDC parmi les patients assurés par un régime privé était de 86,4% (intervalle de confiance (IC) 95%: 83,3%-89,5%) versus 81,3% (IC 95%: 80,1%-82,5%) pour les patients assurés par le régime public de la RAMQ, pour une différence moyenne ajustée de 6,7% (IC 95%: 3,0%-10,4%). La persistance après un an parmi les patients assurés par un régime privé était de 49,5% versus 18,9% pour les patients assurés par le régime public de la RAMQ (p <0,001), et le rapport de risque ajusté était de 0,48 (IC 95%: 0,30-0,76). Comparativement aux patients assurés par le régime public de la RAMQ, les patients ayant une assurance privée ont payé 14,94 $ CAD (95% CI: $12,30-$17,58) de plus par mois en moyenne pour leurs antidépresseurs.
Conclusion: Les patients assurés par un régime privé avaient une meilleure adhésion, persistance, mais avaient aussi un plus haut coût pour leurs antidépresseurs que ceux assurés par le régime public de la RAMQ. Cette différence de coûts peut être due aux différentes exigences de paiement en pharmacie entre les deux régimes ainsi qu’aux limites des honoraires des pharmaciens imposés par le régime public.Background: The influence of the type of drug insurance on adherence, persistence and cost of antidepressants is not well known. Objective: To compare adherence, persistence and cost of antidepressants in patients with private and public drug insurance. Research Design: A matched cohort study was conducted using prescription claims databases from Quebec, Canada. Subjects: 194 privately and 1923 publicly insured patients (18-64 years) who filled at least one prescription for an antidepressant between December 2007 and September 2009. Measures: Adherence over one year was estimated using the proportion of prescribed days covered (PPDC). The difference in mean PPDC between patients with private and public drug insurance was estimated with a linear regression model. Persistence was compared between the groups with a Cox regression model, and the monthly cost of antidepressants (CAD$) was compared between the two groups using linear regression. Results: The PPDC was 86.4% (95% CI: 83.3-89.5) in patients with private and 81.3% (95%CI: 80.1-82.5) in patients with public drug insurance and the adjusted mean difference was 6.7% (95% CI: 3.0-10.4). Persistence was 49.5% in patients with private and 18.9% in patients with public drug insurance at one year (p<0.001), and the adjusted hazard ratio was 0.48 (95%CI: 0.30-0.76). Patients privately insured paid 14.94$ CAD (95% CI: 12.30; 17.58) more per month on average for their antidepressants. Conclusion: Better adherence and persistence and higher costs were observed in privately insured patients. Cost difference might be due to different pharmacy payment requirements and pharmacists’ honorary restrictions under the public plan.
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Taljaard, Lian. "Adherence to antidepressants in psychiatry: a descriptive survey of outpatients in Johannesburg, Gauteng". Diss., 2016. http://hdl.handle.net/10500/21169.
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Text in EnglishPharmacological treatment is often required in the management of psychiatric disorders. Non-adherence to medication represents a significant health concern that prevents patients from fully benefitting from their treatment, and can lead to negative consequences for individuals, their families and the healthcare system. The adherence rates to antidepressant medications in a sample of psychiatric outpatients in the Johannesburg Metropolitan district of Gauteng Province were examined. A descriptive survey method was employed to systematically collect data from n=377 patients using a structured, non-clinical questionnaire and the 8-item Morisky Medication Adherence Questionnaire. Variables were analysed using descriptive and correlational statistical methods. Antidepressant adherence rates were reported as 47.7% (low), 31.3% (medium) and 21% (high). These high rates represent a concern in antidepressant treatment, and health care practitioners and health systems must take this into consideration when planning and developing interventions to improve adherence in this area. The current study found significant correlations between antidepressant adherence rates and some medication-, health system- and moderating variables. Based on these findings, interventions that provide appropriate health-related education about treatment and improved social support systems may be effective in addressing antidepressant non-adherence in psychiatric outpatients in this region.
Psychology
M. Soc.Sc. (Psychology)
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Lorenz, Tierney Kyle Ahrold. "Efficacy of an exercise intervention for sexual side effects of antidepressant medications in women". Thesis, 2013. http://hdl.handle.net/2152/26084.
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Antidepressants are associated with sexual side effects (Clayton, Keller, & McGarvey, 2006). Sexual side effects are associated with non-compliance or discontinuance of antidepressants (Werneke, Northey, & Bhugra, 2006). Despite this, there are few empirically supported treatments for antidepressant side effects. However, in laboratory studies, exercise immediately before sexual stimuli improved sexual arousal of women taking antidepressants (Lorenz & Meston, 2012). I evaluated if exercise improves sexual functioning in women experiencing antidepressant-induced sexual side effects. Fifty-two women reporting antidepressant sexual side effects were followed for 3 weeks of sexual activity only. They were randomized to complete either three weeks of exercise immediately before sexual activity (3x/week) or 3 weeks of exercise separate from sexual activity (3x/week). At the end of the first exercise arm, participants crossed to the other. I measured sexual functioning, sexual satisfaction, depression and physical health. Completers showed modest improvements in sexual functioning and satisfaction. For women taking selective serotonin and norepinephrine reuptake inhibitors, exercising immediately before sexual activity was superior to exercise in general. As well as known effects in improved physical and psychological health, exercise may help improve sexual health and pleasure in women taking antidepressants. These findings have important implications for public health, as exercise is accessible, cheap, and does not add to burden of care.text
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Stewart, JEREMY. "The Impact of Efficacious Treatments for Major Depressive Disorder on Remission Rates of Specific Symptoms: A Re-Analysis of the Treatment of Depression Collaborative Research Program". Thesis, 2009. http://hdl.handle.net/1974/5121.
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Major Depressive Disorder (MDD) is a highly prevalent mental disorder that will affect 12.2% of Canadians over the course of their lifetimes, and 4.8% annually (Patten, et al., 2006). One of the most robust findings in the MDD literature is that the gold-standard treatments – Cognitive-Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), and anti-depressant medications - are equal in their efficacy, and superior to placebo. However, it is unclear whether rates of remission for certain types of symptoms differ among treatments with theoretically different mechanisms. This study re-analyzed data from the Treatment of Depression Collaborative Research Program, which included 158 adults with MDD randomized to CBT, IPT, imipramine or placebo. We statistically derived 4 factors from the baseline Hamilton Depression Rating Scale. We hypothesized that the rate of remission of somatic factors (sleep and appetite) would be most rapid in the group receiving imipramine plus clinical management (IMI-CM), and that the rate of remission for cognitive-affective factors would be fastest in IPT and CBT. Hierarchical regression analyses predicted the sum of symptom scores corresponding to each factor using linear and quadratic time (measured in weeks). Treatment-by-time interactions were entered in a stepwise fashion. There were no significant interactions found in the appetite factor, suggesting that all therapies acted on these symptoms at similar rates. Consistent with hypotheses, IMI-CM produced more rapid remission in sleep symptoms compared to psychotherapy. Surprisingly, IMI-CM was also more rapid at relieving cognitive-affective symptoms. The results lend partial support to the idea that different treatments for MDD may target specific symptoms at different rates according to their underlying mechanisms of action. The findings present some exciting possibilities for elevating response rates through empirically-based “tailored treatments”.Thesis (Master, Psychology) -- Queen's University, 2009-09-03 14:41:46.163
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TSENG, MEI-CHU, i 曾美菊. "Duplicate Medication of Antidepressants and Hypnotics in Outpatient Department of a Northern Taiwan Medical Center : An Epidemiologic Study". Thesis, 2016. http://ndltd.ncl.edu.tw/handle/fs43qg.
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碩士國防醫學院
公共衛生學研究所
104
Objective : The prevalence of major depression and chronic insomnia in Taiwan is increasing with social changes and lifestyle modernization. Our study evaluated the frequency of duplicate hypnotic and antidepressant medication and the factors affecting it, by analyzing data extracted from outpatient department (OPD) of a medical center in northern Taiwan. Methods : Data is extracted from the 2015 OPD records of a medical center in northern Taiwan. The National Health Insurance (NHI) Pharmaceutical Subsidy Anatomical Therapeutic Chemical (ATC) classification system was used to extract the pharmaceutical classification records. The cases included were then divided into 3 subgroups: patients taking antidepressants, patients taking hypnotics, and patients taking both antidepressants and hypnotics. In each subgroup we compare the demography, medical seeking behavior and clinical data between patients receive or do not receive duplicate medication. These data was analyzed by SPSS version 20.0 calculating percentage, average, standard deviation, chi-square test and independent-samples t test, to describe the epidemiologic characteristics. Logistic regression was applied to evaluate the factors affecting duplicate medication, and p value <0.05 was considered significant. Result : Total case number was 28,389 and 28.91% of them have received duplicate medication. 59.20% are female, and most of them aged between 60 to 69 years old (23.19%), with second most aged between 50 to 59 years old (19.67%). The average number of OPD visit is 9.6. 92.83% of the patients received prescription for 28-day medication, and 16.62% have elevated serum creatinine concentration. Conclusion : The common factor of duplicate medication in the three subgroups of our study is the increased number of OPD visit. Therefore we suggest establishing correct medical seeking behavior and medication safety recognition, decreasing the frequency of OPD visit to reduce the incidence of duplicate medication. Key words : antidepressant, hypnotic, duplicate medication, inappropriate prescription
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Samba, Dawda. "Availability of psychotropic medications in primary health care facilities in the Gambia". Master's thesis, 2017. http://hdl.handle.net/10362/24319.
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ABSTRACT: Background: Medication is a significant component in the implementation of mhGAP in the Gambia. There is growing emphasis on health systems strengthening in the Gambia and the preparedness of facilities to deliver accessible, affordable, acceptable and quality mental health services. Objective: Assess the availability of essential Psychotropic medications at PHC facilities and identify facilitators/barriers to their availability. Design: A questionnaire adapted from the 2015 WHO Essential Drugs List was used to assess the availability of the core psychotropic medications. Setting: 106 facilities have been assessed in the three levels through which PHC is delivered in the Gambia; the primary, secondary and tertiary levels which comprise of Hospitals, Major and Minor Health Facilities, Village Health Post, NGOs and Private Clinics and Major pharmacy Chains. Results: The National availability of psychotropic medicines is 30%, with 27.7% availability in public facilities compared to 32.8% in Private facilities. Monthly treatment costs ranged from US$10.7 for Midazolam (15mg daily) to US$5 for carbamazepine (200mg daily). 1% of facilities have a psychiatric specialist (2 Technical Aid Cuban Psychiatrists and 8 Gambian Psychiatric Nurses). In 14% of the facilities, Auxiliary (untrained) nurses prescribe psychotropic medications. In some cases up to 28% of a monthly earning can go into the purchase of a single antidepressant drug. Conclusion: Availability of psychotropic medicines is low across all the regions in the Gambia and the gap/disparity between public and private sector availability is very apparent. The low availability and high cost of psychiatric treatment, poses significant barriers to patient care and does not correspond with the burden of mental and substance abuse problems at 6.5% of the adult population having mental or substance abuse problems. The private sector medication prices are exorbitant considering the average earning power of a Gambian civil servant.RESUMO: Antecedentes: A medicação é um componente significativo na implementação do mhGAP na Gâmbia. Há uma crescente ênfase no fortalecimento dos sistemas de saúde na Gâmbia e na preparação das instalações para oferecer serviços de saúde mental acessíveis, custo-acessíveis, aceitáveis e de qualidade. Objetivo: Avaliar a disponibilidade de medicamentos psicotrópicos essenciais em instalações de Cuidados de Saúde Primários (CSP) e identificar facilitadores / barreiras à sua disponibilidade. Desenho: Foi utilizado um questionário adaptado da Lista de Medicamentos Essenciais da OMS de 2015 para avaliar a disponibilidade dos medicamentos psicotrópicos do núcleo. Definição: 106 instalações foram avaliadas nos três níveis através dos quais os CSP são fornecidos na Gâmbia; os níveis primário, secundário e terciário, que fazem parte dos Hospitais, maiores ou menores organizações de saúde, Postos de saúde da aldeia, ONGs e Clínicas Privadas e Principais Cadeias the Farmácia. Resultados: A disponibilidade nacional de medicamentos psicotrópicos é de 30%, com disponibilidade de 27,7% em instalações públicas, em comparação com 32,8% em instalações privadas. Os custos mensais do tratamento variaram de US $ 10,7 para Midazolam (15 mg por dia) para US $ 5 para Carbamazepina (200 mg por dia). 1% das instalações possuem um especialista psiquiátrico (2 psiquiatras cubanos de assistência técnica e 8 enfermeiras psiquiátricas gambianas). Em 14% das instalações, os enfermeiros auxiliares (não treinados) prescrevem medicamentos psicotrópicos. Em alguns casos, a compra de um único medicamento antidepressivo pode alcançar até 28% de um salário mensal. Conclusão: A disponibilidade de medicamentos psicotrópicos é baixa em todas as regiões da Gâmbia e a diferença / disparidade entre a disponibilidade do setor público e privado é muito evidente. A baixa disponibilidade e o alto custo dos tratamentos psiquiátricos, representam obstáculos significativos para o atendimento do paciente e não correspondem ao peso real dos problemas mentais e de abuso substância em 6,5% da população adulta. Os preços dos medicamentos do setor privado são exorbitantes considerando o poder médio de ganho de um funcionário gambiano.
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Ponte, Pedro do Rego. "Relationship between preoperative antidepressant and antianxiety medications and postoperative hospital length of stay: A retrospective study on abdominal hysterectomy patients". Dissertação, 2020. https://hdl.handle.net/10216/128322.
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Ponte, Pedro do Rego. "Relationship between preoperative antidepressant and antianxiety medications and postoperative hospital length of stay: A retrospective study on abdominal hysterectomy patients". Master's thesis, 2020. https://hdl.handle.net/10216/128322.
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Chen, Hua. "The economic and clinical impacts of prescribing antidepressant, antconvulsant and antipsychotic medications off-label for patients with schizophrenia, bipolar disorders, depression and anxiety". 2005. http://purl.galileo.usg.edu/uga%5Fetd/chen%5Fhua%5F200508%5Fphd.
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Riley, Nicole Marie. "Injuries Among Elderly Canadians: Psychotropic Medications and the Impact of Alcohol". Thesis, 2011. http://hdl.handle.net/1807/31918.
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Psychotropic medication use is widely implicated as a risk factor for injuries, and it is believed that the adverse effect profiles of these medications are exacerbated by the consumption of alcohol. The objectives of this study are (a) to examine the associations between the use of specific classes of psychotropic medications and injuries among elderly participants of the National Population Health Survey (NPHS), and (b) to determine whether and how associations between psychotropic medications and injuries are modified by the consumption of alcohol. Data from Cycles 1 (1994/95), 2 (1996/97), and 3 (1998/99) of the NPHS household longitudinal file were used in this study, selecting community-dwelling participants aged 65 years of age and older in 1994/95. Among antidepressant medications, the magnitude of the risk of injuries was higher for users of tricyclic derivatives (OR=1.4; 95%CI: 0.7 – 2.9) than SSRIs (OR=0.3; 95%CI: 0.1 – 1.0). Benzodiazepine use for any indication increased the risk of injuries, but that effect was not consistent across indications. The use of benzodiazepine antianxiety medications resulted in an increased risk of injuries (OR=2.0; 95%CI: 1.3 – 3.1), but there were no significant effects on the injury risk among benzodiazepine hypnotic and sedative users (OR=0.8; 95%CI: 0.4 – 1.7). Results pertaining to the second objective of this study raised as many questions as they resolved. Alcohol consumption decreased the odds of injury among hypnotic and sedative users, but otherwise, no consistent results were observed. Findings from this study underscore the importance of identifying appropriate alcohol measures for research among elderly populations. They also stress the need to separately consider the impact of different classes of psychotropic medications on injuries (tricyclic antidepressants separate from SSRI antidepressants and antianxiety benzodiazepines separate from hypnotic and sedative benzodiazepines).