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Concept: Psychiatric medication

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This article describes epidemiologic evidence concerning risk of gun violence and suicide linked to psychiatric disorders, in contrast to media-fueled public perceptions of the dangerousness of mentally ill individuals, and evaluates effectiveness of policies and laws designed to prevent firearms injury and mortality associated with serious mental illnesses and substance use disorders.

Concepts: Epidemiology, Mental health, Mental disorder, Schizophrenia, Psychiatry, Mental illness, Psychiatric medication, Cross-cultural psychiatry

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BACKGROUND: Religious participation or belief may predict better mental health but most research is American and measures of spirituality are often conflated with well-being. AIMS: To examine associations between a spiritual or religious understanding of life and psychiatric symptoms and diagnoses. METHOD: We analysed data collected from interviews with 7403 people who participated in the third National Psychiatric Morbidity Study in England. RESULTS: Of the participants 35% had a religious understanding of life, 19% were spiritual but not religious and 46% were neither religious nor spiritual. Religious people were similar to those who were neither religious nor spiritual with regard to the prevalence of mental disorders, except that the former were less likely to have ever used drugs (odds ratio (OR) = 0.73, 95% CI 0.60-0.88) or be a hazardous drinker (OR = 0.81, 95% CI 0.69-0.96). Spiritual people were more likely than those who were neither religious nor spiritual to have ever used (OR = 1.24, 95% CI 1.02-1.49) or be dependent on drugs (OR = 1.77, 95% CI 1.20-2.61), and to have abnormal eating attitudes (OR = 1.46, 95% CI 1.10-1.94), generalised anxiety disorder (OR = 1.50, 95% CI 1.09-2.06), any phobia (OR = 1.72, 95% CI 1.07-2.77) or any neurotic disorder (OR = 1.37, 95% CI 1.12-1.68). They were also more likely to be taking psychotropic medication (OR = 1.40, 95% CI 1.05-1.86). CONCLUSIONS: People who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorder.

Concepts: Mental health, Mental disorder, Abnormal psychology, Psychiatry, Generalized anxiety disorder, Psychiatric medication, Insomnia, Spirituality

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BACKGROUND:: Academic medical institutions have instituted conflict of interest (COI) policies in response to concerns about pharmaceutical industry influence. OBJECTIVE:: To determine whether exposure to COI policies during psychiatry residency training affects psychiatrists' antidepressant prescribing patterns after graduation. RESEARCH DESIGN:: We used 2009 physician-level national administrative prescribing data from IMS Health for 1652 psychiatrists from 162 residency programs. We used difference-in-differences estimation to compare antidepressant prescribing based on graduation before (2001) or after (2008) COI policy adoption across residency program groups with maximally, moderately, and minimally restrictive COI policies. The primary outcomes were shares of psychiatrists' prescribing of heavily promoted, brand reformulated, and brand antidepressants. RESULTS:: Rates of prescribing heavily promoted, brand reformulated, and brand antidepressants in 2009 were lower among post-COI graduates than pre-COI graduates at all levels of COI restrictiveness. However, differences between pre-COI and post-COI graduates' prescribing of heavily promoted medications were larger for maximally restrictive programs than both minimally restrictive programs [-4.3 percentage points; 95% confidence interval (CI), -7.0, -1.6] and moderately restrictive programs (-3.6 percentage points; 95% CI, -6.2, -1.1). The difference in prescribing reformulations was larger for maximally restrictive programs than minimally restrictive programs (-3.0 percentage points; 95% CI, -5.3, -0.7). Results were consistent for prescribing of brand drugs. CONCLUSIONS:: This study provides the first empirical evidence of the effects of COI policies. Our results suggest that COI policies can help inoculate physicians against persuasive aspects of pharmaceutical promotion. Further research should assess whether these policies affect other drug classes and physician specialties similarly.

Concepts: Pharmacology, Medicine, Physician, Pharmaceutical industry, Medical school, Psychiatric medication, Internal medicine, IMS Health

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Antipsychotic drugs are usually the first line of treatment for schizophrenia; however, many patients refuse or discontinue their pharmacological treatment. We aimed to establish whether cognitive therapy was effective in reducing psychiatric symptoms in people with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs.

Concepts: Pharmacology, Randomized controlled trial, Mental disorder, Antipsychotic, Schizophrenia, Psychosis, Psychiatry, Psychiatric medication

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Many women diagnosed with varying psychiatric disorders take antipsychotic medications during pregnancy. The safety of antipsychotic medications in pregnancy is largely unknown.

Concepts: Pregnancy, Childbirth, Infant, Fetus, Breastfeeding, Mental disorder, Psychiatry, Psychiatric medication

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Antipsychotics and mood stabilisers are prescribed widely to patients with psychiatric disorders worldwide. Despite clear evidence for their efficacy in relapse prevention and symptom relief, their effect on some adverse outcomes, including the perpetration of violent crime, is unclear. We aimed to establish the effect of antipsychotics and mood stabilisers on the rate of violent crime committed by patients with psychiatric disorders in Sweden.

Concepts: Medical terms, Crime, Mental disorder, Violent crime, Psychosis, Bipolar disorder, Psychiatry, Psychiatric medication

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Objective: The present study was designed to investigate the frequency of media stigmatization of mentally ill persons after the crash of the “Germanwings”-aircraft on March 2015. Method: Evaluation of 251 texts, which were published in 12 national German newspapers. Categorical distinction between risky coverage and explicit characteristics of stigmatization. Results: In 64.1 % of the evaluated texts, a psychiatric disease of the co-pilot was discussed as the possible cause of the crash, making this the most widely-used explanation in the media that we view “risky coverage”. Characteristics of explicit stigmatization were found in 31.5 % of the texts. Most prominent category of explicit stigmatization was the rubric “Metaphorical language/dramatizations”. It was found in 23.5 % of the articles. Conclusion: Predominantly risky coverage of mentally ill persons has occured in the wake of a spectacular crime. By obtaining professional expertise of psychiatrists and consistent interpretation of journalistic guidelines, unintended effects of stigmatization could be avoided in the future.

Concepts: Present, Future, Mental health, Mental disorder, Psychiatry, Psychiatric medication, Newspaper, Mass media

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The objective of this study was to determine the extent that confusional arousals (CAs) are associated with mental disorders and psychotropic medications.

Concepts: Mental disorder, Psychoactive drug, Psychiatric medication

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Objective To investigate the association between in utero exposure to antidepressants and risk of psychiatric disorders.Design Population based cohort study.Setting Danish national registers.Participants 905 383 liveborn singletons born during 1998-2012 in Denmark and followed from birth until July 2014, death, emigration, or date of first psychiatric diagnosis, whichever came first. The children were followed for a maximum of 16.5 years and contributed 8.1×10(6) person years at risk.Exposures for observational studies Children were categorised into four groups according to maternal antidepressant use within two years before and during pregnancy: unexposed, antidepressant discontinuation (use before but not during pregnancy), antidepressant continuation (use both before and during pregnancy), and new user (use only during pregnancy).Main outcome measure First psychiatric diagnosis in children, defined as first day of inpatient or outpatient treatment for psychiatric disorders. Hazard ratios of psychiatric disorders were estimated using Cox regression models.Results Overall, psychiatric disorders were diagnosed in 32 400 children. The adjusted 15 year cumulative incidence of psychiatric disorders was 8.0% (95% confidence interval 7.9% to 8.2%) in the unexposed group, 11.5% (10.3% to 12.9%) in the antidepressant discontinuation group, 13.6% (11.3% to 16.3%) in the continuation group, and 14.5% (10.5% to 19.8%) in the new user group. The antidepressant continuation group had an increased risk of psychiatric disorders (hazard ratio 1.27, 1.17 to 1.38), compared with the discontinuation group.Conclusions In utero exposure to antidepressants was associated with increased risk of psychiatric disorders. The association may be attributable to the severity of underlying maternal disorders in combination with antidepressant exposure in utero. The findings suggest that focusing solely on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive.

Concepts: Psychology, Mental health, Mental disorder, Psychiatry, Psychiatric hospital, Psychiatric medication, Cross-cultural psychiatry, Moral treatment