The aim was to study utilisation patterns and determinants of antidepressant use in the general population >30 years, especially short-term use or use not related to known psychiatric morbidity.
Participants from a cross-sectional population-based Finnish Health 2000 Study (2000--2001) were linked with the National Prescription Register and National Care Register for Health Care. Within a representative sample (N=7112) of the adult population (>30 years), 12-month DSM-IV depressive, anxiety, and alcohol use disorders were assessed with the M-CIDI. Utilisation patterns of antidepressants were categorised to short-term, intermittent and continuous use. Factors predicting short-term use or use not related to known psychiatric morbidity were investigated.
Of Finnish adults 7.1% had used antidepressants in 2000, of which two-thirds reported a physician-diagnosed mental disorder; a third (35%) had major depressive or anxiety disorder during the previous 12 months. In terms of utilisation pattern, 43% were long-term users, 32% intermittent users and 26% short-term users. Short-term use was related to care by a general practitioner and having no known mental disorder. A quarter of all users had no known psychiatric morbidity. This type of user was most common among the older age groups, and inversely related to being single, on disability pension and using mental health services.
Not all psychiatric indications for antidepressant use could be explored.
Depression remains the main indication for antidepressant use. About a quarter of users had no known psychiatric indication and the indication remained unclear. Short-term and non-psychiatric use are more commonly prescribed for the elderly.
The purpose of this study was to assess trends in utilization and costs of antipsychotic drugs among a population of older adults over time, with respect to the prevalence of users, shifts in prescribing patterns, and related financial implications.
Cross-sectional time series of quarterly and annual antipsychotic utilization and cost were obtained from administrative databases for calendar years 1993 through 2002.
A population-based study of more than 1.4 million residents of the province of Ontario aged 65 years or older.
Data sources used included the Ontario Drug Benefits (ODB) database and Statistics Canada census data.
The prevalence of antipsychotic users increased by 34.8% over the study period from 2.2% at the beginning of 1993 to 3.0% of the elderly at the end of 2002 (p
To investigate associations between exposure to air pollution and child and adolescent mental health.
Swedish National Register data on dispensed medications for a broad range of psychiatric disorders, including sedative medications, sleeping pills and antipsychotic medications, together with socioeconomic and demographic data and a national land use regression model for air pollution concentrations for NO2, PM10 and PM2.5.
The entire population under 18 years of age in 4 major counties. We excluded cohort members whose parents had dispensed a medication in the same medication group since the start date of the register. The cohort size was 552 221.
Cox proportional hazards models to estimate HRs and their 95% CIs for the outcomes, adjusted for individual-level and group-level characteristics.
The average length of follow-up was 3.5 years, with an average number of events per 1000 cohort members of ~21. The mean annual level of NO2 was 9.8 µg/m(3). Children and adolescents living in areas with higher air pollution concentrations were more likely to have a dispensed medication for a psychiatric disorder during follow-up (HR=1.09, 95% CI 1.06 to 1.12, associated with a 10 µg/m(3) increase in NO2). The association with NO2 was clearly present in 3 out of 4 counties in the study area; however, no statistically significant heterogeneity was detected.
There may be a link between exposure to air pollution and dispensed medications for certain psychiatric disorders in children and adolescents even at the relatively low levels of air pollution in the study regions. The findings should be corroborated by others.
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To describe the prevalence of various psychiatric and behavioral symptoms among patients with dementia in nursing homes and acute geriatric wards and to investigate the administration of psychotropic medications to these patients.
425 consecutive patients (>70 years) in six acute geriatric wards in two city hospitals and seven nursing homes in Helsinki, Finland, were assessed with an extensive interview, cognitive tests, and attention tests. Of these, 255 were judged to have dementia according to the following information: previous dementia diagnoses and their adequacy, results of CT scans, Mini-mental State Examination (MMSE) tests, Clinical Dementia Scale (CDR) tests, and DSM-IV criteria. Psychiatric and behavioral symptoms were recorded over two weeks for each patient.
Psychiatric and behavioral symptoms were very common among patients with dementia in both settings. In all, 48% presented with psychotic symptoms (delusions, visual or auditory hallucinations, misidentifications or paranoid symptoms), 43% with depression, 26% agitation, and 26% apathy. Use of psychotropic drugs was also common: 87% were on at least one psychotropic drug, 66% took at least two, 36% at least three, and 11% four or more psychotropic drugs. Of the patients with dementia, 42% were on conventional antipsychotics, and 34% on anxiolytics despite their known side-effects. Only 13% were on atypical antipsychotics and 3% on cholinesterase inhibitors. The use of selective serotonin reuptake inhibitors (SSRIs) was common (31%) among the patients. A surprising finding was that drugs with anticholinergic effects were also frequently (20%) used.
Both behavioural symptoms and use of psychotropic drugs are very common among dementia patients in institutional settings. The frequent use of potentially harmful drugs implies a need for education among physicians taking care of these patients.
AIM: To estimate psychiatric and somatic morbidity in a nation-wide prison population, as inferred from detailed medication sheets. METHOD: Medication sheets from 37 prisons, covering 90% of the Norwegian prison population, were collected and examined by experienced clinicians. All inmates on medication were assigned best-estimate psychiatric and/or somatic diagnoses according to the International Classification of Primary Care diagnostic system. RESULTS: Among the 2617 inmates 919 (35%) had psychiatric disorders, as estimated by our methodology. Depressive disorders (11%) and sleep disorders (11%) were most prevalent. Twenty-six inmates (1%) were prescribed medication indicative of affective psychosis and an additional 77 (3%) received anti-psychotic drugs in doses indicating other psychotic disorders, bringing the sum total of psychosis up to 103 (4%). A total of 848 inmates (32%) were estimated to suffer from somatic disorders. Various pain conditions were prevalent (11%) in addition to obstructive airway diseases and asthma (4%). Both psychiatric and somatic disorders were more prevalent in female prisoners. CONCLUSION: This study has demonstrated high psychiatric and somatic morbidity in a nation-wide population of prison inmates receiving adequate health services. As the morbidity estimates are inferred from prescription drug use they must be interpreted with caution. However, we do believe that our study, utilizing this unconventional but readily available source of information, has yielded valuable knowledge regarding the physical and mental health of a nation-wide prison population.
BACKGROUND: People with a dementia disorder often live in institutional care facilities, particularly when the dementia disorder becomes severe or complicated by various behavioral disturbances. The aim of the present study was to analyze and compare the one-week prevalence of various behavioral symptoms and psychotropic drug treatment among people with cognitive impairment living in institutional care, in two large, comparable samples from 1982 and 2000. METHODS: A comparison was made between two cross-sectional samples, collected in 1982 and 2000 respectively, comprising 3404 participants with cognitive impairment living in geriatric care units in the county of Västerbotten, Sweden. Behavioral symptoms were measured using the Multi-Dimensional Dementia Assessment Scale (MDDAS) and cognition was measured using Gottfries' cognitive scale. RESULTS: Eight out of 25 behavioral symptoms had become less common, and six more common, after controlling for demographic changes. Regressive behavior, resistance to care and passiveness became less common, while certain aberrant motor behaviors showed an increased prevalence. Antidepressant drug use increased from 6.8% to 43.2%, antipsychotic drug use decreased from 38.0% to 26.2% and anxiolytics, hypnotic and sedative drug use increased from 12.7% to 38.5%. CONCLUSION: One-week prevalence of regressive symptoms and resistance to care had decreased and there were signs of a generally increased activity level among old people with cognitive impairment living in institutional geriatric care in 2000 compared to 1982. These changes may be an effect of the extensive changes in pharmacological treatments and in the organization of institutional geriatric care.
The aim was to investigate differences in the prescription of antidepressants during the transition to disability pension (DP) comparing DP due to back pain with DP due to other musculoskeletal and DP due to other somatic diagnoses.
A population-based cohort study with follow-up 3?years before and after the event. Estimated prevalence and adjusted ORs with 95% CIs for antidepressant prescription were computed for the 7-year window (ie, t-3 to t+3) around the DP by generalised estimating equations for repeated measures.
This Swedish population-based nationwide study with registry data included individuals aged 18-64 years, with DP due to back pain (n=2011), DP due to other musculoskeletal (n=3548) or DP due to other somatic diagnoses (n=11 809).
Prescription of antidepressants.
Before DP, the prevalence of prescription of antidepressants was stable in DP due to back pain, but increased for the other DP groups. Similarly, the likelihood of prescription increased only marginally before DP due to back pain (ORs from 0.86 at t-3 to 1.10 at t-1), but clearly in DP due to musculoskeletal (from 0.42 to 1.15) and somatic diagnoses (from 0.29 to 0.98). Both prevalence measures and risks remained at the elevated levels after DP.
Pathways to DP due to musculoskeletal and somatic diagnoses seem to be partly driven by adverse mental health, which remains at a higher level after DP. The increasing prescription of antidepressants prior to DP suggests that special attention should be paid to mental health for prevention of DP. The period after DP needs attention to avoid deterioration of mental health.
Exposure to adverse childhood experiences has been shown to be associated with negative health outcomes including mental health problems, but only a few studies with register-based data have used psychotropic drugs as an outcome variable. The purpose of this study is to examine whether adverse emotional childhood experiences, such as serious conflicts in the family and frequent fear of a family member, predict the use of psychotropic drugs in adulthood. In addition, the association of a child-parent relationship during childhood with the use of psychotropic drugs is studied.
The participants of the population-based Health and Social Support Study (24,284 working aged Finns) were followed up for 9 years. The information on childhood experiences and child-parent relationships was obtained from the questionnaires in 1998 and 2003. The number of psychotropic purchases (antipsychotics, drugs for bipolar disorder, antidepressants, anxiolytics, hypnotics and sedatives) was obtained from the National-Drug-Prescription-Register. Logistic and multinomial regression models were used.
A graded association between childhood adversities and the use of psychotropic drugs was found, even after adjustments for occupational training, work status, recent life events and health behaviour. Frequent fear of a family member showed the strongest association: the OR for multiple use of antidepressants was 3.08 (95% CI 2.72 to 3.49) and 2.69 (2.27 to 3.20) for multiple use of anxiolytics. Use of psychotropic drugs was clearly increased among those with poor child-parent relationship and multiple childhood adversities.
The results highlight the effect of environmental factors during childhood on mental health and the need for early recognition of families at risk.
Information on who uses antipsychotic medication is limited to cross-sectional data. The objective of this study was to study the patterns of psychopathology at age 8?years and antipsychotic use between the ages of 12 and 25?years.
A total of 5525 subjects from the Finnish Nationwide 1981 birth cohort were linked to the National Prescription Register and the Hospital Discharge Register between 1994 and 2005. Information about parent-reported and teacher-reported conduct, hyperkinetic and emotional symptoms, and self-reported depressive symptoms was gathered at age 8?years. Information about antipsychotic use and about psychiatric disorders treated in hospitals between the ages of 12 and 25?years was register based. Diagnostic classes of hospital treatment included non-affective psychoses, affective disorders, and other psychiatric disorders.
The cumulative incidence of antipsychotic use by age 25?years was 2.8% among men (n?=?69) and 2.1% among women (n?=?55). In both sexes, living with other than two biological parents at age 8?years was associated with antipsychotic use, and three fourths of antipsychotic users had been treated for psychiatric disorders in a hospital. Among men, the most common hospital diagnosis was non-affective psychoses (44% of all antipsychotic users), and antipsychotic use was associated with childhood conduct problems. Among women, the most common hospital diagnosis was affective disorders (38% of all antipsychotic users), and antipsychotic use was associated with emotional problems and self-reported depressive symptoms in childhood.
Antipsychotic use in adolescence and young adulthood is different among men versus women both with regard to hospital diagnoses and childhood psychiatric problems.
Author Affiliations: 1Faculty of Medicine, University of Toronto 2Women's College Research Institute, Women's College Hospital, 3Dalla Lana School of Public Health at the University of Toronto, 4 Sexual Assault/Domestic Violence Care Centre at Women's College Hospital, 5Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto, and 6Sexual Assault/Domestic Violence Treatment Centres in Ontario.
Sexual assault is a common and serious health issue that is underreported and has low follow-up rates. The myriad of psychological sequelae of sexual assault are well documented; however, there is a dearth of literature on the prevalence of preexisting mental health issues in survivors of sexual assault. This exploratory study compares victims seen at a sexual assault treatment center with and without preexisting self-reported mental health histories. The rates of preexisting mental illness in sexual assault victims are significant. Implications for clinical practice and research are discussed.