Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders Increased prevalence of type 2 diabetes mellitus among psychiatric inpatients with bipolar I affective and schizoaffective disorders independent of psychotropic drug use. Cardiovascular and Neurological Adverse Events Associated With Antidepressant Treatment in Children and Adolescents The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes. Patterns of concomitant psychotropic medication use during a 2-year study comparing clozapine and olanzapine for the prevention of suicidal behavior. Potentially Inappropriate Use of Psychotropic Medications in Hospitalized Elderly Patients in France A pharmaco-EEG study on antipsychotic drugs in healthy volunteers The effectiveness of a new generation of computerized drug alerts in reducing the risk of injury from drug side effects: a cluster randomized trial Evaluating the cost-effectiveness of fall prevention programs that reduce fall-related hip fractures in older adults. Glucagon-like peptide-1 receptor agonists as add-on therapy to basal insulin in patients with type 2 diabetes: a systematic review Are benzodiazepines still the medication of choice for patients with panic disorder with or without agoraphobia? Changes in body weight and food choice in those attempting smoking cessation: a cluster randomised controlled trial Long-acting phenothiazine (fluphenazine decanoate) treatment of psychosis. Depression, psychotropic medication, and risk of myocardial infarction. Prospective data from the Baltimore ECA follow-up. Descriptors of American Physical Therapy Association physical therapist members' reading of professional publications Patient Choice in Diabetes Education Curriculum: Nutritional versus standard content for type 2 diabetes Prevalence and Correlates of Obesity in a Community Sample of Individuals with Severe and Persistent Mental Illness Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. Dronabinol in severe, enduring anorexia nervosa: a randomized controlled trial. Lithium use and discontinuation in a health maintenance organization. A double-blind comparison of risperidone, quetiapine and placebo in patients with schizophrenia experiencing an acute exacerbation requiring hospitalization Omega-3 Polyunsaturated Fatty Acids in Prevention of Mood and Anxiety Disorders Practice parameter: Thymectomy for autoimmune myasthenia gravis (an evidence-based review)
OBJECTIVE . The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use . METHODS . This cross-sectional study used Medicaid cl aims for calendar year 2001 from all 50 states and Washington , DC , to examine 60641 children with an autism spectrum disorder diagnosis .  Logistic regression with r and om effects was used to examine the child , county , and state factors associated with psychotropic medication use . RESULTS . Of the sample , 56 % used at least 1 psychotropic medication , 20 % of whom were prescribed ≥3 medications concurrently . Use was common even in children aged 0 to 2 years ( 18 % ) and 3 to 5 years ( 32 % ) . Neuroleptic drugs were the most common psychotropic class ( 31 % ) , followed by antidepressants ( 25 % ) and stimulants ( 22 % ) . In adjusted analyses , male , older , and white children ; those who were in foster care or in the Medicaid disability category ; those who received additional psychiatric diagnoses ; and those who used more autism spectrum disorder services were more likely to have  used psychotropic drugs  . Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications . CONCLUSIONS . Psychotropic medication use is common among even very young children with autism spectrum disorders . Factors unrelated to clinical presentation seem highly associated with prescribing practice s. Given the limited evidence base , there is an urgent need to assess the risks , benefits , and costs of medication use and underst and the local and national policies that affect medication use BACKGROUND There are numerous reports of abnormal glucose metabolism , including increased rates of type 2 diabetes mellitus , in psychiatric patients . It remains unclear , however , whether there is an intrinsic relationship between abnormal glucose metabolism and particular psychiatric disorders , because the relationship is complicated by treatment with psychotropic medications that promote weight gain and hyperglycemia . This study aim ed to clarify this relationship . METHODS The medical records of 243 in patients , aged 50 - 74 years , with diagnoses of major depression , bipolar I disorder , schizoaffective disorder , schizophrenia , and dementia were review ed . Psychiatric and type 2 diabetes mellitus diagnoses , medications , body mass index ( BMI ) , age , gender , and race were recorded . Diabetes rates were compared to age , race , and gender-matched rates in the US general population . RESULTS Rates of type 2 diabetes mellitus were : schizoaffective ( 50 % ) > bipolar I ( 26 % ) > major depression ( 18 % ) = dementia ( 18 % ) > schizophrenia ( 13 % ) ( p < 0.006 ) . Diabetic patients had a higher mean BMI ( p = 0.01 ) , but not a significantly higher use of psychotropic medications previously reported to be associated with new-onset type 2 diabetes ( e.g. , phenothiazines , clozapine , olanzapine ) . Logistic regression revealed that psychiatric diagnosis and BMI were the only significant and independent predictors of diabetes diagnosis . Compared to national norms , diabetes rates were significantly elevated only in bipolar I affective and schizoaffective patients . LIMITATIONS This study was a retrospective chart review of older , hospitalized patients . CONCLUSIONS This is the first published study to show an increased prevalence of type 2 diabetes mellitus among psychiatric patients with particular psychiatric illnesses independent of the effects of age , race , gender , medication , and body mass . This finding , which requires replication in a larger scale , prospect i ve study , suggests an intrinsic relationship between abnormal glucose metabolism and bipolar I affective and schizoaffective disorders A retrospective cohort design of Medicaid medical and pharmacy cl aims for 1996 through 2005 was employed for 14 171 children and adolescents prescribed an antidepressant medication and a r and om sample of 4500 children not treated with any class of psychotropic medication to compare the prevalence rates of cardiovascular and neurological adverse events . The treated cohort evinced a higher prevalence of cardiovascular events , orthostatic hypotension , seizures , insomnia , and headaches . In the treated cohort , patients were at a significantly higher risk for incident cardiovascular events when exposed to selective serotonin reuptake inhibitors and weight-inducing antidepressants , mood stabilizers , and antipsychotics .  Incident orthostatic hypotension was associated with weight-inducing antidepressants and mood stabilizers .  Incident seizures and extrapyramidal symptoms were unrelated to antidepressant or co-prescribed psychotropic medications , but both were significantly associated with comorbid central nervous system , organic brain/mental retardation , or preexisting cardiovascular or cerebrovascular conditions . Headaches and dizziness were significantly related to taking mood stabilizers OBJECTIVE To evaluate the impact of regular multidisciplinary team interventions on the quantity and quality of psychotropic drug prescribing in Swedish nursing homes . DESIGN A r and omized controlled trial . SETTING A sample of 33 nursing homes : 15 experimental homes and 18 control homes representing 5 % of all Swedish nursing homes . PARTICIPANTS The sample consisted of 1854 long-term care residents with an average age of 83 years . Seventy percent of the residents were women , and 42 % had a documented diagnosis of dementia . An additional 5 % had a psychotic disorder , and 7 % had a diagnosis of depression . INTERVENTION Experimental homes participated in an outreach program that was design ed to influence drug use through improved teamwork among physicians , pharmacists , nurses , and nurses ' assistants . Multidisciplinary team meetings were held on a regular basis throughout the 12-month study period . MEASUREMENTS Lists of each resident 's prescriptions were collected 1 month before and 1 month after the 12-month intervention . Measures included the proportion of residents with any psychotropic drug , polymedicine , and therapeutic duplication and proportion of residents with nonrecommended and acceptable drugs in each psychotropic drug class , as defined by current Swedish guidelines . RESULTS Baseline results show extensive psychotropic drug prescribing , with the most commonly prescribed drugs being hypnotics ( 40 % ) , anxiolytics ( 40 % ) , and antipsychotics ( 38 % ) . After 12 months of team meetings in the experimental homes , there was a significant decrease in the prescribing of psychotics ( -19 % ) , benzodiazepine hypnotics ( -37 % ) , and antidepressants ( -59 % ) . Orders for more acceptable antidepressants also increased in the experimental homes . In the control homes there was increased use of acceptable antidepressants , but there were no significant reductions in other drug classes . CONCLUSIONS There is excessive prescription of psychotropic drugs in Swedish nursing homes . Improved teamwork among caregivers can improve prescribing as defined by clinical guidelines BACKGROUND Results from the International Suicide Prevention Trial ( InterSePT ) indicate that clozapine is more effective than olanzapine in reducing suicidal behavior in schizophrenic and schizoaffective patients . However , because InterSePT allowed the uncontrolled use of concomitant psychotropic medications ( CPMs ) , it is possible that the antisuicidal effect of clozapine may have been influenced by greater use of such agents . This article describes the use patterns of CPMs during InterSePT and examines whether CPM use may have affected study outcome . METHOD In this study , 479 patients received clozapine and 477 patients received olanzapine .  Concomitant psychotropic medications were grouped into 4 classes : antipsychotics , antidepressants , sedatives/anxiolytics , and mood stabilizers . The doses of each CPM were converted into dosage equivalents of st and ard reference drugs . An analysis of covariance was performed to compare mean daily doses of CPMs between the 2 groups over the 2-year treatment period . The duration of treatment for each patient was 2 years , with the first patient entering the study in March 1998 and the last patient completing treatment in February 2001 . RESULTS Approximately 90 % of patients in both treatment groups received at least 1 CPM . The mean + /- SD number of CPMs per patient was 3.8 + /- 2.90 in the clozapine group and 4.2 + /- 3.16 in the olanzapine group . For each CPM class , the mean daily dose was statistically significantly lower in the clozapine group ( antipsychotics , p < .001 ; antidepressants , p < .01 ; sedatives/anxiolytics , p < .001 ; mood stabilizers , p < .05 ) . Analyses of  CPM use by study intervals , suicide attempters versus nonattempters , study completers versus noncompleters , and geographic region result ed in similar findings . CONCLUSION The results support the conclusion that the effects of clozapine in reducing the risk of suicidal behavior derive from its intrinsic pharmacology and not from the influence of concomitant psychotropic medications Abstract Background : In France , there is evidence to suggest that 50 % of elderly individuals are prescribed psychotropic medications . However , it is known that use of these agents increases the risk of falls , fractures and delirium in older people . Objective : To study the consumption of ‘ potentially inappropriate medication ’ ( PIM ) among patients aged ≥75 years , paying particular attention to psychotropic drugs and the factors influencing the use of ‘ potentially inappropriate psychotropics ’ ( PIPs ) . Method : This was a cross-sectional analysis of a prospect i ve multicentre cohort of 1306 hospitalized French patients aged ≥75 years ( the SAFEs [ Sujet Âgé Fragile : Évaluation et suivi ( Frail Elderly Subjects : Evaluation and follow-up ) ] cohort ) . The present analysis involved the 1176 patients for whom there was information on the usual treatments being taken in the 2 weeks before hospitalization . The drugs were coded according to the Anatomical Therapeutic Chemical classification ; the Beers list as up date d in 2003 defined which medications were considered PIPs . St and ardized geriatric assessment variables were recorded on inclusion in the study . Logistic regression analysis was performed to identify factors linked to use of psychotropics and PIPs . Results : The mean number of drugs taken was 5.7 ± 2.9 per patient . Twenty-eight percent of patients took at least one PIM . The number of patients who had taken at least one psychotropic drug  in the 2 weeks before hospitalization ( mean 1.6 ± 0.9 psychotropics per patient ) was 589 ( 50.1 % ) . More than half of both the 510 patients with a depressive syndrome and the 543 patients affected by dementia were treated with psychotropics . Multivariate analysis showed that prescription of psychotropics was linked to the presence of a dementia syndrome ( odds ratio [ OR ] = 1.4 ; 95 % CI 1.1 , 1.9 ; p = 0.03 ) , the presence of a depressive syndrome ( OR = 1.7 ; 95 % CI 1.3 , 2.1 ; p < 0.001 ) , living in an institution ( OR = 2.2 ; 95 % CI 1.5 , 3.4 ; p < 0.001 ) , use of more than five drugs ( OR = 3.2 ; 95 % CI 2.5 , 4.2 ; p < 0.001 ) and Charlson ’s co-morbidity score > 1 ( OR = 0.6 ; 95 % CI 0.5 , 0.8 ; p = 0.001 ) . Nineteen percent of all psychotropics prescribed were PIPs . Of these PIPs , 66.5 % were anxiolytics , 28.4 % were antidepressants and 5.1 % were  antipsychotics  . Use of PIPs in the multivariate analysis was associated only with consumption of more than five drugs ( OR = 1.7 ; 95 % CI 1.1 , 2.5 ; p = 0.01 ) . Conclusion : PIM use is common among hospitalized older adults in France . The most important determinant of risk of receiving a psychotropic medication or a PIP was the number of drugs being taken . The elderly , who have multiple comorbidities , complex chronic conditions and are usually receiving polypharmacy , are at increased risk for adverse drug events . These adverse events are often linked to problems that could be preventable such as delirium , depression and falls . Regular review of prescriptions would help optimize prescription of psychotropics in the elderly . The Beers list is a good tool for evaluating PIMs but is too restrictive with respect to psychotropics ; in the latter respect , the list could usefully be widened Rationale Both psychotropic drugs and mental disorders have typical signatures in quantitative electroencephalography ( EEG ) . Previous studies found that some psychotropic drugs had EEG effects opposite to the EEG effects of the mental disorders treated with these drugs ( key – lock principle ) . Objectives We performed a placebo-controlled pharmaco-EEG study on two conventional antipsychotics ( chlorpromazine and haloperidol ) and four atypical antipsychotics ( olanzapine , perospirone , quetiapine , and risperidone ) in healthy volunteers . We investigated differences between conventional and atypical drug effects and whether the drug effects were compatible with the key – lock principle . Methods Fourteen subjects underwent seven EEG recording sessions , one for each drug ( dosage equivalent of 1 mg haloperidol )  . In a time-domain analysis , we quantified the EEG by identifying clusters of transiently stable EEG topographies ( microstates ) . Frequency-domain analysis used absolute power across electrodes and the location of the center of gravity ( centroid ) of the spatial distribution of power in different frequency b and s. Results Perospirone increased duration of a microstate class typically shortened in schizophrenics . Haloperidol  increased mean microstate duration of all classes , increased alpha 1 and beta 1 power , and tended to shift the beta 1 centroid posterior . Quetiapine decreased alpha 1 power and shifted the centroid anterior in both alpha b and s. Olanzapine shifted the centroid anterior in alpha 2 and beta 1 . Conclusions The increased microstate duration under perospirone and haloperidol was opposite to effects previously reported in schizophrenic patients , suggesting a key – lock mechanism . The opposite centroid changes induced by olanzapine and quetiapine compared to haloperidol might characterize the difference between conventional and atypical antipsychotics Context Computerized drug alerts for psychotropic drugs are expected to reduce fall-related injuries in older adults . However , physicians over-ride most alerts because they believe the benefit of the drugs exceeds the risk . Objective To determine whether computerized prescribing decision support with patient-specific risk estimates would increase physician response to psychotropic drug alerts and reduce injury risk in older people . Design Cluster r and omized controlled trial of 81 family physicians and 5628 of their patients aged 65 and older who were prescribed psychotropic medication .  Intervention Intervention physicians received information about patient-specific risk of injury  computed at the time of each visit using statistical models of non-modifiable risk factors and psychotropic drug doses . Risk thermometers presented changes in absolute and relative risk with each change in drug treatment . Control physicians received commercial drug alerts . Main outcome measures Injury risk at the end of follow-up based on psychotropic drug doses and non-modifiable risk factors . Electronic health records and provincial insurance administrative data were used to measure outcomes . Results Mean patient age was 75.2 years .  Baseline risk of injury was 3.94 per 100 patients per year . Intermediate-acting benzodiazepines ( 56.2 % ) were the most common psychotropic drug . Intervention physicians review ed therapy in 83.3 % of visits and modified therapy in 24.6 % . The intervention reduced the risk of injury by 1.7 injuries per 1000 patients ( 95 % CI 0.2/1000 to 3.2/1000 ; p=0.02 ) . The effect of the intervention was greater for patients with higher baseline risks of injury ( p<0.03 ) . Conclusion Patient-specific risk estimates provide an effective method of reducing the risk of injury for high-risk older people . Trial registration number clinical trials.gov Identifier : NCT00818285 OBJECTIVES To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults . DESIGN Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature . SETTING Model represents population level interventions . PARTICIPANTS No human subjects were involved in the study . MEASUREMENS : The last Cochrane data base review and meta-analyses of r and omized controlled trials categorized effective fall-prevention interventions into seven groups : medical management ( withdrawal ) of psychotropics , group tai chi , vitamin D supplementation , muscle and balance exercises , home modifications , multifactorial individualized programs for all elderly people , and multifactorial individualized treatments for high-risk frail elderly people . Fall-related hip fracture incidence was obtained from the literature . Salary figures for health professionals were based on Bureau of Labor Statistics data . Using an integrated healthcare system perspective , healthcare costs were estimated based on practice and studies on falls in older adults . Base case incremental cost utility ratios were calculated , and probabilistic sensitivity analyses were conducted . RESULTS Medical management of psychotropics and group tai chi were the least-costly , most-effective options , but they were also the least studied . Excluding these interventions , the least-expensive , most-effective options are  vitamin D supplementation and home modifications . Vitamin D supplementation costs less than home modifications , but home modifications cost only $ 14,794/ quality -adjusted life year ( QALY ) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi , home modification is most likely to have the highest economic benefit when QALYs are valued at $ 50,000 or $ 100,000 . CONCLUSION Of single interventions studied , management of psychotropics and tai chi reduces costs the most . Of more-studied interventions , home modifications provide the best value . These results must be interpreted in the context of the multifactorial nature of falls The prevalence of obesity and diabetes continues to rise in the US . Glucagon-like peptide-1 receptor agonist ( GLP-1RA ) is an effective treatment option for type 2 diabetes mellitus ( T2DM ) that promotes weight loss . Common and effective treatment options added to metformin therapy ( basal insulin , sulfonylureas , and pioglitazone ) contribute to weight gain , which makes the addition of GLP-1RAs advantageous . Exenatide was the first agent in this class and has recently been approved for use in combination with insulin glargine by the US Food and Drug Administration and the European Medicines Agency . Until recently , there was a lack of data examining basal insulin combined with these agents . The main purpose of this article is to review the prospect i ve interventional data on the safety and efficacy of GLP-1RAs ( exenatide , liraglutide , albiglutide , lixisenatide ) combined with basal insulin therapy in nonpregnant adults with T2DM . Data bases search ed were PubMed , Cochrane Central Register of Controlled Trials and the Data base of Systematic Review s ( inception to January 2012 ) . Abstract s presented at relevant diabetes and endocrine meetings from 2009 to 2011 were also review ed , as were reference lists of identified publications . A total of five studies met the criteria and were included in the review . Data from these studies demonstrated that this combination therapy offers advantages for the treatment of diabetes , such as additional lowering of A1c without major risk for hypoglycemia , lower basal insulin requirements , decreased postpr and ial glucose levels ( with or without fasting plasma glucose decreases ) , and weight loss , or at the very least , less weight gain . However , the gastrointestinal side effects and high cost of these agents may limit their use . This review demonstrates that adding a GLP-1RA to an existing basal insulin regimen is a reasonable treatment strategy in nonpregnant adult patients with T2DM OBJECTIVE Recently , pharmacological treatment guidelines for panic disorder have changed as newer treatment options have become available . The authors examined how the use of psychotropic drugs has shifted over the course of 10 years to determine if prescribing patterns have changed to reflect these revised treatment guidelines . METHOD A total of 443 patients with panic disorder were enrolled in the Harvard/Brown Anxiety Research Project , a prospect i ve longitudinal study of anxiety disorders . These patients were interviewed over the course of 10 years to examine their use of psychotropic medications . RESULTS Despite efforts aim ed at increasing the use of selective serotonin reuptake inhibitors ( SSRIs ) in patients with panic disorder ( e.g. , APA 's practice guideline for panic disorder , Food and Drug Administration approval of particular SSRIs for the treatment of panic disorder ) , only a modest increase in their use was found . Treatment patterns for psychotropic drugs  appear to have remained stable over the past decade , with benzodiazepines being the most commonly used medication for panic disorder . In comparison , SSRI use throughout the follow-up period has remained low . Patients using an SSRI did not have a more favorable clinical course than those using a benzodiazepine , nor were there significantly better rates of remission in patients using SSRIs and benzodiazepines concomitantly . CONCLUSIONS These results highlight a gap between pharmacological treatment guidelines and actual delivery of care in that recommendations to use SSRIs to treat panic disorder are not being followed . Factors potentially associated with promoting and ignoring treatment recommendations are discussed Background Fear of weight gain is a barrier to smoking cessation and significant cause of relapse for many people . The provision of nutritional advice as part of a smoking cessation programme may assist some in smoking cessation and perhaps limit weight gain . The aim of this study was to determine the effect of a structured programme of dietary advice on weight change and food choice , in adults attempting smoking cessation . Methods Cluster r and omised controlled design . Classes r and omised to intervention commenced a 24-week intervention , focussed on improving food choice and minimising weight gain .  Classes r and omised to control received “ usual care ” . Results Twenty-seven classes in Greater Glasgow were r and omised between January and August 2008 . Analysis , including those who continued to smoke , showed that actual weight gain and percentage weight gain was similar in both groups . Examination of data for those successful at giving up smoking showed greater mean weight gain in intervention subjects ( 3.9 ( SD 3.1 ) vs. 2.7 ( SD 3.7 ) kg ) . Between group differences were not significant ( p = 0.23 , 95 % CI −0.9 to 3.5 ) . In comparison to baseline improved consumption of fruit and vegetables and breakfast cereal were reported in the intervention group . A higher percentage of control participants continued smoking ( 74 % vs. 66 % ) . Conclusions The intervention was not successful at minimising weight gain in comparison to control but was successful in facilitating some sustained improvements in the dietary habits of intervention participants . Improved quit rates in the intervention group suggest that continued contact with advisors may have reduced anxieties regarding weight gain and encouraged cessation despite weight gain . Research should continue in this area as evidence suggests that the negative effects of obesity could outweigh the health benefits achieved through reductions in smoking prevalence . Trial registration Current Controlled Trials IS RCT THE EFFICACY of psychoactive drugs in treating psychotic patients is often dependent on maintenance treatment for extended periods . Many psychotropic compounds exhibit short duration s of action , making repeated daily administration necessary . Patients discontinue their medication , with frequent relapses and rehospitalizations for many reasons , including the sense of wellbeing , fear , neglect , lack of insight , poor judgment , delusions , disturbed communication , miscalculation of visits , or expense.1In contrast to the physically ill who maintain treatment because they suffer from their symptoms , psychiatric patients , particularly schizophrenics , may have no such reminder . In the follow-up of one of our recent studies , 2one-fourth of the discharged patients were rehospitalized with active psychotic symptoms within four to eight weeks of a self-induced drug free period . To avoid discontinuation of medication , recurrence of psychosis , and rehospitalization , a longer acting psychotropic compound was needed , similar to depot insulin used in diabetes , and the development of such a compound among the phenothiazines was encouraged BACKGROUND There is suggestive evidence that depression increases risk of myocardial infa rct ion ( MI ) , but there are no prospect i ve studies in which the measure of depression corresponds to clinical criteria . This study examines prospect ively whether a major depressive episode increases the risk of incident MI and evaluates the role of psychotropic medication use in this relationship . METHODS AND RESULTS The study is based on a follow-up of the Baltimore cohort of the Epidemiologic Catchment Area Study , a survey of psychiatric disorders in the general population . A history of major depressive episode , dysphoria ( 2 weeks of sadness ) , and psychotropic medication use were assessed in 1981 , and self-reported MI was assessed in 1994 . Sixty-four MIs were reported among 1551 respondents free of heart trouble in 1981 . Compared with respondents with no history of dysphoria , the odds ratio for MI associated with a history of dysphoria was 2.07 ( 95 % CI , 1.16 to 3.71 ) , and the odds ratio associated with a history of major depressive episode was 4.54 ( 95 % CI , 1.65 to 12.44 ) , independent of coronary risk factors . In multivariate models , use of barbiturates , meprobamates , phenothiazines , and lithium was associated with an increased risk of MI , whereas use of tricyclic antidepressants and benzodiazepines was not . Among individuals with no history of dysphoria , only lithium use was significantly associated with MI . CONCLUSIONS These data suggest that a history of dysphoria and a major depressive episode increase the risk of MI . The association between psychotropic medication use and MI is probably a reflection of the primary relationship between depression and MI One of the components of evidence -based practice ( EBP ) is reading the literature . The purpose of this investigation was 1 ) to determine which publications are read most frequently by physical therapists ( PTs ) , 2 ) to identify employment and education characteristics related to reading patterns , and 3 ) to determine how PTs use information gained from reading professional publications . A survey was constructed , pretested , revised , and then mailed to a r and om sample of 1,000 physical therapists , 500 from the general American Physical Therapy Association ( APTA ) membership and 500 from the combined Geriatric and Orthopedic section memberships . The data were analyzed with descriptive statistics . After all mailings , 43.3 % of the sample responded . Of those responding , 66.3 % were employed as clinicians , 14.7 % as clinician-administrators , 6 % as educators , and 4.9 % as administrators . Overall , and for clinicians , the two most frequently read professional publications were non peer- review ed . For clinician groups “ patient management ” was among the top two most selected uses of information from reading professional publications . Educators and those with an advanced doctorate indicated “ class lectures ” as either their second most frequently selected use or tied for first with “ keeping current . ” Only educators and those with or pursuing an advanced doctorate reported using information from reading professional publications for “ research ideas ” or “ research methods ” among their top five uses . Slightly more than 10 % of the respondents cited a peer- review ed published article as having been most influential on their practice . Non peer- review ed professional publications appear to serve as a more frequent source of information for “ patient management ” than do peer- review ed publications . Efforts to increase the use of EBP need to be explored and evaluated for impact on physical therapists ’ practice OBJECTIVE To examine the effects of patient choice between two education curriculums that emphasized either the st and ard or nutritional management of type 2 diabetes on class attendance and other outcomes among a mostly Hispanic patient population . RESEARCH DESIGN AND METHODS A total of 596 patients with type 2 diabetes were r and omly assigned to either a choice or no choice condition . Patients in the choice condition were allowed to choose their curriculum , while patients in the no choice condition were r and omly assigned to one of the two curriculums . Outcomes were assessed at baseline and at a 6-month follow-up . RESULTS When given a choice , patients chose the nutrition curriculum almost four times more frequently than the st and ard curriculum . Contrary to our hypothesis , however , patients who had a choice did not significantly increase their attendance rates or demonstrate improvements in other diabetes outcomes compared with patients who were r and omly assigned to the two curriculums . Patients in the nutrition curriculum had significantly lower serum cholesterol at a 6-month follow-up , whereas patients in the st and ard curriculum had significant improvements in glycemic control . Of the r and omized patients , 30 % never attended any classes ; the most frequently cited reasons for nonattendance were socioeconomic . Hispanic patients , however , were just as likely as non-Hispanic patients to attend classes and participate at the follow-up . Patients who attended all five classes of either curriculum significantly increased their diabetes knowledge , gained less weight , and reported improved physical functioning compared with patients who did not attend any classes . CONCLUSIONS Although providing patients with a choice in curriculums at the introductory level did not improve outcomes , differential improvements were noted between patients who attended curriculums with different content emphasis . We suggest that diabetes education programs should provide the opportunity for long-term , repetitive contacts to exp and on the modest gains achieved at the introductory level , as well as provide more options to match individual needs and interests and to address socioeconomic barriers to participation Individuals with severe and persistent mental illness ( SPMI ) have a preponderance of weight problems , possibly even greater than the obesity epidemic in the general population . Although atypical antipsychotics cause weight gain , their contribution to obesity has not been characterized in a community setting where individuals may take multiple psychotropics associated with weight gain . Using survey information including measured height and weight from a r and om sample of Maryl and Medicaid recipients with SPMI , we compared obesity prevalence to the National Health and Nutrition Examination Survey ( NHANES III ) sample and a Maryl and sample ( Behavioral Risk Factor Surveillance System ) of the general population adjusted to SPMI demographic characteristics . We investigated correlates of obesity in the SPMI sample . The results indicate that both men and especially women with SPMI had a higher prevalence of obesity than the general population ; this portends substantial health implication s. A fourfold association between atypical antipsychotics and prevalent obesity was found in men but not in women ; further work should clarify mechanisms of obesity in the SPMI OBJECTIVE To assess the effectiveness of psychotropic medication withdrawal and a home-based exercise program in reducing  falls in older people .  DESIGN A r and omized controlled trial with a two by two factorial design . SETTING Seventeen general practice s in Dunedin , New Zeal and . PARTICIPANTS Women and men aged 65 years registered with a general practitioner and currently taking psychotropic medication ( n = 93 ) . INTERVENTIONS Two interventions : ( 1 ) gradual withdrawal of psychotropic medication versus continuing to take psychotropic medication ( double blind ) and ( 2 ) a home-based exercise program versus no exercise program ( single blind ) . MEASUREMENTS Number of falls and falls risk during 44 weeks of follow-up . Analysis was on an intent to treat basis . RESULTS After 44 weeks , the relative hazard for falls in the medication withdrawal group compared with the group taking their original medication was .34 ( 95 % CI , .16-.74 ) . The risk of falling for the exercise program group compared with those not receiving the exercise program was not significantly reduced . CONCLUSIONS Withdrawal of psychotropic medication significantly reduced the risk of falling , but permanent withdrawal is very difficult to achieve OBJECTIVE The evidence for pharmacological treatment of severe , longst and ing anorexia nervosa ( AN ) is sparse and the few controlled pharmacologic studies have focused on a narrow range of drugs . The aim of the present study was to investigate the effects of treatment with a synthetic cannabinoid agonist on body weight and eating disorder-related psychopathological personality traits in women with severe , enduring AN . METHOD This add-on , prospect i ve , r and omized , double blind , controlled crossover study was conducted between 2008 and 2011 at a specialized care center for eating disorders . Twenty-five women over 18 years with AN of at least 5 years duration were r and omized to treatment with either dronabinol-placebo or placebo-dronabinol .  In addition to the st and ardized baseline therapeutic regime , the participants received dronabinol , 2.5 mg twice daily for 4 weeks and matching placebo for 4 weeks , separated by a 4-week wash-out period . Primary outcome was the mean change in body weight . Secondary outcome was score changes on the Eating Disorder Inventory-2 ( EDI-2 ) . Data were analyzed for the 24 patients who completed the trial . RESULTS During dronabinol treatment , participants gained 0.73 kg ( t = 2.86 , df = 22 , p < 0.01 ) above placebo without significant psychotropic adverse events . Dronabinol significantly predicted weight gain in a multiple linear regression including EDI-2 body dissatisfaction score and leptin . EDI-2 subscale scores showed no significant changes over time . DISCUSSION Dronabinol therapy was well tolerated . During four weeks of exposure it induced a small but significant weight gain in the absence of severe adverse events OBJECTIVE For decades , lithium has been prescribed to treat bipolar disorder . Its efficacy has been documented by clinical trials and by data from specialized clinics . An issue of considerable interest is the use of lithium in managed care systems . This project examined the use of lithium and its continuity of use by enrollees of a health maintenance organization ( HMO ) . METHOD In a 6-year longitudinal cohort study , 1,594 lithium users aged 15 years and older who were enrolled in an HMO were followed from 1986 - 1991 . Data were obtained from automated data bases and from medical record review of a r and om 5 % sub sample of the group ( N = 74 ) . RESULTS Bipolar disorder was the most frequent morbidity treated . Eighty-four percent ( N = 62 or 74 ) received services from a psychiatrist . Annual prevalence of lithium use increased over the 6-year period from 1.4 to 2.3 persons per thous and HMO members . Duration of use varied widely with some long-term but many short-term users . Discontinuation of treatment was associated with evaluated rates of psychiatric hospitalization and use of psychiatric emergency services .  Lithium users were much more likely to receive a variety of other psychotropic drugs than nonusers of the same sex and age . CONCLUSIONS Lithium use in this population was more often sporadic than continuous . Discontinuation of lithium was associated with psychiatric hospitalization . If lithium is to be a cost-effective treatment for bipolar disorder , managed care systems will need to improve adherence to drug treatment regimens OBJECTIVE This study compared the effects of atypical antipsychotics ( risperidone or quetiapine ) with placebo and with each other in recently exacerbated patients with schizophrenia requiring hospitalization . METHODS This international , r and omized , double-blind study included a 2-week monotherapy phase followed by a 4-week additive therapy phase . Recently exacerbated patients with schizophrenia or schizoaffective disorder ( DSM-IV ) were r and omized ( 2:2:1 ) to risperidone ( n = 153 ) ,  quetiapine ( n = 156 ) , or  placebo ( n = 73 ) . Target doses were 4 or 6 mg/day of risperidone and 400 or 600 mg/day of quetiapine by day 5 , with the ability to increase to 600 or 800 mg/day of quetiapine on day 8 . The main outcome measures were the total Positive and Negative Syndrome Scale ( PANSS ) and need for additional psychotropic medications . RESULTS Monotherapy Phase : The combined atypical antipsychotic group ( n = 308 ) reached borderline superiority to placebo ( n = 71 ) at the 2-week endpoint on mean change in total PANSS score ( -24.1 + /- 1.2 and -20.2 + /- 2.0 , respectively ; p = 0.067 ) . The change in the atypical group was driven by the improvement with risperidone ( -27.7 + /- 1.5 vs. -20.2 + /- 2.0 with placebo , p < 0.01 ; and vs. -20.5 + /- 1.5 with quetiapine , p < 0.01 ) ; the improvement with quetiapine was similar to placebo , p = 0.879 . Results were similar on other efficacy endpoints . Additive Therapy Phase : Additional psychotropics were prescribed to fewer ( p < 0.01 ) risperidone ( 36 % ) than quetiapine ( 53 % ) or placebo patients ( 59 % ) . The overall discontinuation rate was 18 % , 26 % , and 38 % , respectively . Risperidone , compared with placebo , was associated with more parkinsonism , akathisia , plasma prolactin changes , and weight gain ; while quetiapine was associated with more somnolence , sedation , dizziness , constipation , tachycardia , thyroid dysregulation , and weight gain . CONCLUSION While the combined atypical antipsychotic group did not experience greater improvements than the placebo group , risperidone , but not quetiapine , was significantly superior in all measured domains to placebo in the management of recently exacerbated hospitalized patients with schizophrenia or schizoaffective disorder , with no unexpected tolerability findings Psychiatric disorders in general , and major depression and anxiety disorders in particular , account for a large burden of disability , morbidity and premature mortality worldwide . Omega-3 polyunsaturated fatty acids ( PUFAs ) have a range of neurobiological activities in modulation of neurotransmitters , anti-inflammation , anti-oxidation and neuroplasticity , which could contribute to psychotropic effects . Here we review ed recent research on the benefits of omega-3 PUFA supplements in prevention against  major depression , bipolar disorders , interferon-α-induced depression patients with chronic hepatitis C viral infection , and posttraumatic stress disorder . The biological mechanisms underlying omega-3 PUFAs ’ psychotropic effects are proposed and review ed . Nutrition is a modifiable environmental factor that might be important in prevention medicine , which have been applied for many years in the secondary prevention of heart disease with omega-3 PUFAs . This review extends the notion that nutrition in psychiatry is a modifiable environmental factor and calls for more research es on prospect i ve clinical studies to justify the preventive application of omega-3 PUFAs in daily practice The Quality St and ards Subcommittee of the American Academy of Neurology is charged with developing practice parameters for neurologists for diagnostic procedures , treatment modalities , and clinical disorders . The selection of topics for which practice parameters are used is based on prevalence , frequency of use , economic impact , membership involvement , controversy , urgency , external constraints , and re sources required . This paper addresses the role of thymectomy in the treatment of nonthymomatous autoimmune MG . In 1939 , Blalock et al.1 reported the remission of generalized MG in a 21-year-old woman after removal of a cystic thymic tumor . Subsequently , Blalock et al.2,3 performed thymectomy  on MG patients without thymoma , found hyperplasia in the thymus gl and s , and reported improvement in at least half of their patients . Since these reports , thymectomy , with or without the presence of thymoma , has gained widespread acceptance as a form of treatment for MG . Because a definitive study of the effectiveness of thymectomy has never been done,4,5 the role of thymectomy in the management of MG remains uncertain . Nevertheless , physicians have to advise their patients regarding the benefits of thymectomy based on the existing literature . Our goal is to develop evidence -based recommendations for clinicians considering  thymectomy for patients with nonthymomatous autoimmune MG by performing a systematic review and analysis of the literature . # # # Identification and selection of studies . We search ed the National Library of Medicine ’s Medline data base from 1966 to February 1998 using the medical subject headings “ myasthenia gravis ” ( restricted to the surgery subheading ) and “ thymectomy . ” To identify articles published before 1966 , or missed by our original search strategy , we review ed the references of the identified articles . We classified the result ing articles into the following categories : Class II , controlled but nonr and omized studies describing outcomes in MG patients with and without thymectomy ; and Class III , uncontrolled case series describing outcomes in patients with or without
We were able to rank most of the psychotropics based on the available evidence and recommendations from subject matter experts .
There were few discrepancies between published evidence and the expert panel in ranking these drugs .
Conclusion Potential for weight gain is an important consideration in choice of any psychotropic .
This tool will help clinicians select psychotropics on a case-by-case basis in order to minimize the impact of weight gain when making both intra-class and interclass choices
Introduction Psychotropic medication use is associated with  weight gain .
While there are studies and review s comparing weight gain for psychotropics within some classes , clinicians frequently use drugs from different classes to treat psychiatric disorders .
Objective To undertake a systematic review of all classes of psychotropics to provide an all encompassing evidence -based tool that would allow clinicians to determine the risks of weight gain in making both intra-class and interclass choices of psychotropics .