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Microbes have inhabited the earth for hundreds of millions of years longer than humans. The microbiota–gut–brain axis (MGBA) represents a bidirectional communication pathway. These communications occur between the central nervous system (CNS), the enteric nervous system (ENS), and the emotional and cognitive centres of the brain. The field of research on the gut–brain axis has grown significantly during the past two decades. Signalling occurs between the gut microbiota and the brain through the neural, endocrine, immune, and humoral pathways. A substantial body of evidence indicates that the MGBA plays a pivotal role in various neurological diseases. These include Alzheimer's disease (AD), autism spectrum disorder (ASD), Rett syndrome, attention deficit hyperactivity disorder (ADHD), non-Alzheimer's neurodegeneration and dementias, fronto-temporal lobe dementia (FTLD), Wilson–Konovalov disease (WD), multisystem atrophy (MSA), Huntington's chorea (HC), Parkinson's disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), temporal lobe epilepsy (TLE), depression, and schizophrenia (SCZ). Furthermore, the bidirectional correlation between therapeutics and the gut–brain axis will be discussed. Conversely, the mood of delivery, exercise, psychotropic agents, stress, and neurologic drugs can influence the MGBA. By understanding the MGBA, it may be possible to facilitate research into microbial-based interventions and therapeutic strategies for neurological diseases. [ABSTRACT FROM AUTHOR]

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Microbes have inhabited the earth for hundreds of millions of years longer than humans. The microbiota–gut–brain axis (MGBA) represents a bidirectional communication pathway. These communications occur between the central nervous system (CNS), the enteric nervous system (ENS), and the emotional and cognitive centres of the brain. The field of research on the gut–brain axis has grown significantly during the past two decades. Signalling occurs between the gut microbiota and the brain through the neural, endocrine, immune, and humoral pathways. A substantial body of evidence indicates that the MGBA plays a pivotal role in various neurological diseases. These include Alzheimer’s disease (AD), autism spectrum disorder (ASD), Rett syndrome, attention deficit hyperactivity disorder (ADHD), non-Alzheimer’s neurodegeneration and dementias, fronto-temporal lobe dementia (FTLD), Wilson–Konovalov disease (WD), multisystem atrophy (MSA), Huntington’s chorea (HC), Parkinson’s disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), temporal lobe epilepsy (TLE), depression, and schizophrenia (SCZ). Furthermore, the bidirectional correlation between therapeutics and the gut–brain axis will be discussed. Conversely, the mood of delivery, exercise, psychotropic agents, stress, and neurologic drugs can influence the MGBA. By understanding the MGBA, it may be possible to facilitate research into microbial-based interventions and therapeutic strategies for neurological diseases.

Introduction Countless substances used for their psychotropic effects may induce adverse cardiac effects, such as QT prolongation. This category of substances holds illicit drugs as well as medications, with their effects influenced by dosage, concomitant use and patient specific factors. The appraisal of cardiac consequences is essential as delayed repolarization may lead to the rare but potentially deadly polymorphic ventricular tachycardia. Objectives The goal of this presentation is to underscore the cardiac risks associated with both medication use and substance abuse in order to ensure the suitable psychopharmacological treatment, especially in particular situations of drug using patients. Methods The subject of the presentation is a 17-year-old female adolescent hospitalized in our clinic, with multiple substance abuse, as seen in qualitative multidrug test (cannabis, amphetamines, ecstasy, barbiturates, benzodiazepines), previously under complex treatment prescribed by an adult psychiatrist (3 atypical antipsychotics, 1 selective serotonin reuptake inhibitor, 1 anticonvulsant, 1 benzodiazepine). Specialty literature has been reviewed concerning the cardiac effects of both the abuse substances and the psychiatric medications. Results Multiple drugs involved may cause a myocardial repolarization delay, the patient having a QTc of 508 msec at the admission. Consequent to parenteral fluids and treatment managing, ECG revealed a decrease to 379 msec 7 days later in the stay. This finding could not be viewed solely as caused by drug use, psychiatric medication or individual factors, but rather as their aggregation. Conclusions Psychotropic substances use may lead to QT prolongation, which calls for close cardiac supervision whenever patient’s behaviour warrants or when pharmacologic intervention is required. Disclosure No significant relationships.

Background: Miguel de Cervantes (1547–1617) was a Spanish writer, who has often been considered as the greatest writer in the Spanish language and one of the world's outstanding novelists. His novel Don Quixote, is a work often cited as both the first modern novel and one of the best works of world literature. The life of Cervantes has been full of fascinations, imaginations, attracting the attention from all walks of people, including psychiatrists. Methods: With career interest in psychopharmacology, the author in this review intends to focus on Cervantes's notions in his works on the use of psychotropic agents. The author also categorized psychotropic agents into four different scenarios of use – therapeutic remedies, toxic and poisonous agents (love philters, poisonous potions), antidotes as well as drugs of abuse (witches' ointments). Results: Cervantes' works were found that Cervantes made references to those preparations in Don Quixote, The Galatea, Journey to Parnassus, The Spanish English Lady, The Lawyer of Glass, The Jealous Old Man from Extremadura, The Dialogue of the Dogs, Pedro de Urdemalas and The Diversion. The main agents cited by Cervantes in the context analyzed included henbane, tobacco, rhubarb, rosemary, vervain, and in a masked way, opium. Cervantes did not identify the ingredients of other preparations with psychotropic properties, although, in the sense of the symptoms described by the author, they could be plants of the Solanaceae family, such as the henbane, nightshade, jimson weed, belladonna, or mandrake. Conclusion: Cervantes' texts, although by no means scientific treatises, give us with a correct description of the uses (and effects) of psychotropic substances in late Renaissance Spain, and explain how a group of drugs could have four archetypal qualities – remedy, poison, antidote, and drug of abuse.

Background Transportation of medications across borders can present challenges for international travellers. We investigated the provision of official country-specific information available to individuals travelling with medications. Methods Data from official government sources relating to restrictions on the transportation of medications for personal use were analysed to determine compliance with international recommendations and identify variation in practice between countries. Results Schedule 1 drug classifications and import restrictions for narcotic and psychotropic drugs varied widely between countries. Some countries do not conform to recommendations from the International Narcotics Control Board. Conclusions Healthcare professionals should be broadly aware of country-specific restrictions on therapeutic drug transportation and be able to direct travellers to definitive sources of information. [ABSTRACT FROM AUTHOR]

Neurotoxicity is not uncommon in use of the drugs in many therapeutic classes. Manifestations of neurotoxicity vary from ototoxicity, visceral neuropathy and neuromuscular blockade (defeat of the peripheral nervous system) to impaired consciousness, nonspecific encephalopathy, seizures and non-convulsive epileptic status (central nervous system damage). The article presents predisposing factors of neurotoxicity, as well as the mechanisms of its development. On the example of neuroactive drugs (anticonvulsants, anesthetics and psychotropic drugs) their effect in the antenatal period and during lactation is examined. In the post-neonatal period antibiotics play an important role in the neurotoxic effect, in particular, ß-lactams and fluoroquinolones.

Los textos literarios del Siglo de Oro constituyen una interesante fuente para el estudio de la sociedad española tardorrenacentista y novobarroca, incluyendo sus figuras más marginales. En el presente trabajo, hemos analizado el mundo mágico de brujas y hechiceras desde la perspectiva del uso extraterapéutico de agentes farmacológicos y psicotrópicos, a través de los principales autores áureos, centrándonos, básicamente, en Miguel de Cervantes y Lope de Vega. Se han estudiado los principales agentes empleados en la elaboración de las pócimas venenosas de bruja, destacando las plantas alucinógenas de la familia de las Solanaceae (beleño, mandrágora, belladona, estramonio, solano, eléboro), además de otras, como el acónito, la cicuta, la adelfa, la verbena o la adormidera. Otras sustancias de procedencia animal o mineral también se emplearon en la confección de estos preparados (sapos, arsénico). Finalmente, se han analizado las posibles fuentes documentales en materia científica que pudieron utilizar estos dos destacados literatos, como el Dioscórides comentado por Andrés Laguna en ambos casos, y la Historia Natural de Plinio, comentada por Francisco Hernández y Gerónimo de Huerta, y el opúsculo Il Sapere Util’e Delettevole de Constantino Castriota, en el caso particular de Lope de Vega. WITCHES’ POTIONS IN THE LITERATURE OF THE SPANISH GOLDEN AGE: THE OTHER SIDE OF THE THERAPEUTIC AND PSYCHOTROPIC AGENTS ABSTRACT The literary texts of the Golden Age are an interesting source for the study of Spanish late Renaissance and early Baroque society, including their most marginal figures. In the present work, we have analyzed the magical world of witches and sorceresses from the perspective of extra-therapeutic use of pharmacological and psychotropic substances, through the main golden authors, focusing basically on Miguel de Cervantes and Lope de Vega. The main agents used in the production of witches poisonous potions have been studied, highlighting the hallucinogenic plants of the Solanaceae family (henbane, mandrake, belladonna, jumsonweed, nightshade, hellebore), in addition to others, such as aconite, hemlock, oleander, vervain or poppy. Other substances of animal or mineral origin were also used in the preparation of these compounds (toads, arsenic). Finally, we have analyzed the possible documentary sources in scientific matter that could be used by these two prominent writers, such as the Dioscorides commented by Andrés Laguna in both cases, and Pliny’s Natural History, commented on by Francisco Hernández and Gerónimo de Huerta, and the booklet Il Sapere Util’e Delettevole by Constantino Castriota, in the particular case of Lope de Vega.

Objective We conducted a prospective naturalistic study of pregnant women with bipolar disorder ( BD) to evaluate symptoms of BD across childbearing and assess whether pharmacotherapy reduced their severity. Methods Assessments were scheduled at 20, 30, and 36 weeks' gestation and 2, 12, 26, and 52 weeks postpartum. Symptoms were assessed using the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Supplement ( SIGH- ADS) and Mania Rating Scale ( MRS). Results Pregnant women (N=152) with BD were evaluated; 88 women (58%) were treated and 64 untreated (42%) with psychotropic drugs during pregnancy. Among the 88 women treated, 23 (26%) discontinued their medication in the first trimester and the remaining 65 (74%) were exposed throughout pregnancy or in the second and third trimesters. More than two-thirds (73%) of the women who remained in the study took psychotropic agents postpartum. The mean scores on the SIGH- ADS were in the mild range of depressive symptoms in both the psychotropic-treated and untreated groups in both pregnancy and postpartum. The majority of women had no or few symptoms of mania. Of the pregnant women treated with psychotropic agents, 66% received a guideline-concordant drug, and 34% received either antidepressant monotherapy (for BD I) or mono- or polypharmacy with a variety of other agents. Conclusions This sample of perinatal women with BD was characterized by mild residual symptoms of depression independent of pharmacotherapy, which poses a risk for recurrence and impaired parenting. The treatment of childbearing women with BD deserves urgent clinical and research attention to improve psychiatric outcomes. [ABSTRACT FROM AUTHOR]

The paper discusses whether the irritable bowel syndrome is an independent nosological entity. It presents data on the association of this functional disease with mental disorders with emphasis on comorbidity with depression, as well as on the efficiency of psychopharmacotherapy options. Particular attention is given to the possibility of using antidepressants. An observation of the efficacy of paroxetine is outlined.

To search for informative clinical and laboratory parameters predicting a risk of pulmonary inflammatory processes as complications in acute poisoning by psychotropic drugs, the authors examined 120 and 160 patients with pneumonia-uncomplicated and -complicated disease, respectively. The occurrence of pulmonary inflammatory processes in the above pathology was shown to be favored by long-term blood intoxication, severity and duration of consciousness and respiration disorders that required that artificial ventilation be made. The laboratory criteria for a risk of this complication might be considered those observed within the first 3 days: blood leukocytes were more than twice greater than the normal values in combination with a 2-fold or more decrease in lymphocytes, including B-lymphocytes, iNST-test values being twice increased as compared with the normal values on day 3 of the study, as well as low IgM and IgG values at all its stages. Along with this, there was a progressive rise in MDA, high concentrations of histamine, fibrinogen, and AE at all stages of the study, with AT levels being 1.6 elevated as compared with the normal values.

The unexpected and catastrophic cardiovascular effects of psychotropic drugs are well described albeit uncommon. The list of drugs which have been associated with prolonging QT interval and hence potentially causing Torsades de pointes is exhaustive. The insight into the plausible mechanisms are largely unclear. However, the practical implications of anticipating and recognizing QT prolongation cannot be overemphasized. [ABSTRACT FROM AUTHOR]

Objective: Pregnancy and lactation are risk periods when women are susceptible to psychiatric illnesses. As well as side effects and teratogenic effects of drug utilization, negative effects of untreated psychiatric illnesses on the fetus and mother may be issues of concern. Management of pregnancy and lactation periods may become complicated by a relapse of a psychiatric illness or by using a drug with unexpected harm effecting mother or baby. Mental health professionals are commonly confronted with patients who ask for advice during such times. In determining the course of treatment, the attitudes of mental health professionals are as important as the attitudes of patients. This study was conducted to evaluate attitudes and personal opinions of psychiatrists. Methods: An Internet survey was designed to ask questions about the tendency to use pharmacotherapy, electroconvulsive therapy (ECT), or psychotherapy, or to stop or lower the dosage of medicines, and the personal principles of psychiatrists during pregnancy and lactation. The relationship between academic degrees and professed knowledge levels of psychiatrists about management of treatments of pregnant and lactating women and personal comments were also evaluated. Of those asked, 246 psychiatrists replied and 213 online-surveys were completed. Results: Of the respondents, 22.2% were psychiatry residents, 50.9% were attending psychiatrists, 6.6% were assistant professors, 9% were associate professors, and 11.3% were full professors. The results showed that avoidance of starting drug therapy, terminating an ongoing drug treatment, seeking alternatives to drug treatment, transitioning to ECT treatment and consulting a higher center were significantly more common in pregnancy than during the lactation period (p<0.05). Low, dosage-safe medicine use was preferred in both periods. In cases where drug utilization was deemed necessary, higher scores were obtained regarding the opinion that it was necessary to 'avoid pregnancy' than to 'avoid lactation'. The attitudes of psychiatrists did not change according to the level of their knowledge that they professed. Of psychiatrists, 85% stated that they know and successfully apply drug utilization principles in pregnancy and lactation (always and generally), and 81% stated that during examination, they were able to provide their patients needed information and training. Psychiatrists did not prefer to terminate a pregnancy if medicine was needed for treatment with a response rate of 61.1% for 'never'. Conclusions: The present study showed that the psychiatrists were reluctant in prescribing psychotropic drugs during pregnancy, but they were more comfortable doing so in the lactation period. The attitudes of the psychiatrists seemed independent from their generally stated knowledge levels. The present study is valuable because it shows the differences in attitudes of the psychiatrists regarding their treatment approaches in the periods of pregnancy and lactation. More understandable messages from the leading researchers in this area and guidelines are needed for outlining clearer principles. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To test the hypothesis that the load of psychotropic agents was associated with subsequent dementia occurrence by a nationwide database. Design: Propensity score matched case-control study. Setting: National Health Insurance Research database. Participants: A total of 32,649 older people with dementia and 32,649 matched dementia-free older people. Measurements: Use of psychotropic drugs (anxiolytics, antipsychotics, hypnotics, and antidepressants), defined daily dose (DDD) of psychotropic drugs, diagnosis of dementia, and propensity score. Intervention: None. Results: Compared with nonusers, ever use of psychotropic agents was associated with higher odds of subsequent dementia [adjusted odds ratio (OR): 3.73; 95% confidence interval (CI) (3.59–3.88)]. Significantly, the association was stronger with longer term exposure to psychotropic agents. The ORs at exposures of <90 days, 90–180 days, and >180 days, were 3.14 (95% CI 3.01–3.28); 5.48 (5.07–5.93); and 7.54 (6.73–8.44), respectively. A similar and stronger association was identified when cumulative dose was used to measure the exposure of psychotropic agents [<90 DDDs, 3.40 (95% CI 3.26–3.54); 90–180 DDDs 6.38 (5.76–7.07), and >180 DDDs, 7.35 (6.29–8.58)]. Conclusions: We found that a higher burden of psychotropic agents was strongly associated with a higher odds of subsequent dementia. Careful monitoring of any elderly who is prescribed or uptitrated psychotropic agents is highly recommended, especially those who combine use of more than one agent. Furthermore, providing timely assessment for cognitive function for older patients consuming psychotropic drugs is of great importance. [Copyright &y& Elsevier]

Psychotropic medications produce their effects, in part, through increasing neurotrophin levels in the brain. Since studies concerning nerve growth factor (NGF) analysis have been limited in scope, in the current experiments we investigated the effects of diverse psychotropic agents on NGF protein levels in various brain regions of rat.Materials and MethodsMale Wistar rats receivedacute and chronic administration of drugs and electroconvulsive shock (ECS). Twenty four hr after the last treatment, NGF quantification was performed using sandwich ELISA kit. ResultsAcute administration of desipramine, phenelzine, fluoxetin, chlordiazepoxide (10 mg/kg, each), haloperidol (1 mg/kg), or clozapine (20 mg/kg) failed to alter NGF protein in any brain structure investigated. However, a single ECS treatment significantly elevated NGF protein in the hippocampus. Chronic administration (21 days) of desipramine, fluoxetine, phenelzine, haloperidol and clozapine led to a reliable enhancement of NGF protein in the frontal cortex. In addition desipramine, fluoxetine, phenelzine, and clozapine significantly increased NGF protein in the hippocampus. In the olfactory bulb, chronic injections of desipramine and fluoxetine elevated NGF level, however, phenelzine and haloperidol decreased NGF. Repeated applications of ECS (10 days) led to a remarkable augmentation of NGF protein in the frontal cortex, hippocampus, amygdala, and olfactory bulb. Neither acute nor chronic treatment with the benzodiazepine chlordiazepoxide altered NGF level in the examined brain regions.ConclusionThese findings suggest that diverse psychotropic treatments may regulate NGF protein level in a brain region-specific fashion which may be indicative of their therapeutic properties.

The article discusses patterns of psychotropic agents use among a sample of patients with Obsessive-Compulsive Disorder (OCD) symptoms with differences associated with different OCD symptoms. The study results found that more than half of the sample of subjects were taking psychopharmacological agents and majority of them were taking Selective Serotonin Reuptake Inhibitors (SSRIs).

Drugs represent the most common cause of platelet dysfunction in our overmedicated society.While acetylsalicylic acid (aspirin), adenosine diphosphate receptor antagonists (clopidogrel and prasugrel), and integrin αIIbβ3 (GPIIb-IIIa) receptor blockers (abciximab, eptifibatide, and tirofiban) are well-known prototypes of antiplatelet drugs, other widely used agents such as nonsteroidal anti-inflammatory drugs, antibiotics, cardiovascular and lipid-lowering drugs, selective serotonin reuptake inhibitors, and volume expanders can also impair platelet function and thus cause or aggravate hemorrhages in certain clinical settings. Therefore, induction of a bleeding diathesis remains a significant concern. This is especially relevant in patients with preexisting hemostatic defects of any kind, which may remain compensated as long as platelet function (and/or coagulation) is not inhibited pharmacologically. Identification of individual patients with preexisting hemostatic defects remains crucial (1) to prevent otherwise unexpected bleeding complications, (2) to manage hemorrhagic symptoms adequately, (3) to minimize the risk from invasive procedures, and (4) to avoid unnecessary patient exposure to blood products. This article provides a review of the large variety of agents that have not been designed for antiplatelet therapy but nevertheless interfere with platelet reactivity or induce platelet inhibition. In particular, drug interactions and mechanisms by which these agents can trigger or cause platelet dysfunction are detailed. [ABSTRACT FROM AUTHOR]

normal involuntary dyskinetic movements in schizophrenia patients have been documented for more than 140 years. Clinicians should distinguish between two kinds of disturbances-spontaneous dyskinetic movements and movements induced by psychotropic medications-which may look familiar clinically. As a modern term, tardive dyskinesia (TD) is a potentially permanent neurological hyperkinetic movement disorder that occurs after months or years of taking psychotropic drugs. Several distinct forms of TD exist, specifically tardive akathisia, tardive blepharospasm, tardive dystonia, tardive gait, tardive myoclonus, tardive tremor, and tardive tics, and they have different pathophysiologies and treatment. The pathogenesis of TD remains unclear, and the pathophysiology is complex and multifactorial. Moreover, there is solid evidence of a genetic predisposition to TD. This article summarizes recent relevant publications concerning TD and the most recent studies regarding treatment of this disorder with antioxidative agents. [ABSTRACT FROM AUTHOR]

Functional abdominal pain syndrome (FAPS) is a relatively less common functional gastrointestinal (GI) disorder defined by the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits, or menstrual periods (Drossman Gastroenterology 130:1377–1390, ), which points to a more centrally targeted (spinal and supraspinal) basis for the symptoms. However, FAPS is frequently confused with irritable bowel syndrome and other functional GI disorders in which abdominal pain is associated with eating and bowel movements. FAPS also differs from chronic abdominal pain associated with entities such as chronic pancreatitis or chronic inflammatory bowel disease, in which the pain is associated with peripherally acting factors (eg, gut inflammation or injury). Given the central contribution to the pain experience, concomitant psychosocial disturbances are common and strongly influence the clinical expression of FAPS, which also by definition is associated with loss of daily functioning. These factors make it critical to use a biopsychosocial construct to understand and manage FAPS, because gut-directed treatments are usually not successful in managing this condition. [ABSTRACT FROM AUTHOR]

A restraint is a device or medication that is used to restrict a patient's voluntary movement. Reported prevalence of physical restraint varies from 7.4% to 17% use in acute care hospitals up to 37% in long term care in the United States. Prevalence of 34% psychotropic drug use in long term care facilities in the United States has been reported; but use is decreasing, probably due to regulation. Use of restraints often has an effect opposite of the intended purpose, which is to protect the patient. The risk of using a restraint must be weighed against the risk of not using one, and informed consent with proxy decision makers should occur. Comprehensive nursing assessment of problem behaviours, a physician order when instituting restraints, and documentation of failure of alternatives to restraint is required. Ignorance about the dangers of restraint use results in a sincere, but misguided, belief that one is acting in the patient's best interest.Steps can be taken to reduce restraints before the need for restraints arises, when the need for restraints finally does arise, and while the use of restraints is ongoing. [ABSTRACT FROM AUTHOR]

Objective(s) Psychotropic medications produce their effects, in part, through increasing neurotrophin levels in the brain. Since studies concerning nerve growth factor (NGF) analysis have been limited in scope, in the current experiments we investigated the effects of diverse psychotropic agents on NGF protein levels in various brain regions of rat. Materials and Methods Male Wistar rats received acute and chronic administration of drugs and electroconvulsive shock (ECS). Twenty four hr after the last treatment, NGF quantification was performed using sandwich ELISA kit. Results Acute administration of desipramine, phenelzine, fluoxetin, chlordiazepoxide (10 mg/kg, each), haloperidol (1 mg/kg), or clozapine (20 mg/kg) failed to alter NGF protein in any brain structure investigated. However, a single ECS treatment significantly elevated NGF protein in the hippocampus. Chronic administration (21 days) of desipramine, fluoxetine, phenelzine, haloperidol and clozapine led to a reliable enhancement of NGF protein in the frontal cortex. In addition desipramine, fluoxetine, phenelzine, and clozapine significantly increased NGF protein in the hippocampus. In the olfactory bulb, chronic injections of desipramine and fluoxetine elevated NGF level, however, phenelzine and haloperidol decreased NGF. Repeated applications of ECS (10 days) led to a remarkable augmentation of NGF protein in the frontal cortex, hippocampus, amygdala, and olfactory bulb. Neither acute nor chronic treatment with the benzodiazepine chlordiazepoxide altered NGF level in the examined brain regions. Conclusion These findings suggest that diverse psychotropic treatments may regulate NGF protein level in a brain region-specific fashion which may be indicative of their therapeutic properties. [ABSTRACT FROM AUTHOR]

Little has been reported about the relationship of a dementia wander garden with scheduled psychiatric medications in addition to changes in fall number and severity. The 28 participating residents of a dementia unit were divided into high (HUG) and low (LUG) wander garden user groups and assessed for the number and severity of falls. The type and dose of scheduled psychiatric medications were monitored for 12 months before and 12 months after the wander garden was opened. Results indicated that the residents experienced about a 30% decrease for the raw number of falls and fall severity scores. The HUG had a significant reduction in high-dose antipsychotics, whereas there was relatively no change in antidepressant, hypnotic, and anxiolytic use. High wander garden user group required fewer scheduled medications and experienced reduced falls and lower fall morbidity than the LUG. The most significant changes in scheduled psychiatric medications were reductions in scheduled antipsychotics and an increase in residents requiring no antipsychotics. [ABSTRACT FROM AUTHOR]

The kidney is a primary route of drug elimination; abnormal kidney function is predicted to alter the pharmacokinetics of agents metabolized and/or excreted predominantly through this route. The high prevalence of mental disorders associated with psychotropic drug use in individuals with deteriorating renal function suggests there is a need to investigate the effects of renal failure on psychotropic pharmacokinetics. The aim of this review is to provide a clinically accessible overview of the effect of chronic renal failure on the pharmacokinetics for each of the major classes of prescribed psychotropic agents. All English language articles published between 1977 and 2008 were searched through PubMed, using the following keywords: “renal,” “kidney,” “pharmacokinetics,” “renal impairment,” “renal insufficiency,” and “renal failure.” Each of these search words was cross-referenced with the non-proprietary name of each psychotropic agent. The manufacturer’s product insert was also reviewed for some agents for updated dosing. Owing to the lack of adequately powered studies, an inclusive manner was used. Chronic renal failure variably affects the pharmacokinetic parameters of psychotropic drugs. A review of each psychotropic drug is provided, with an emphasis on the individual pharmacokinetic parameters and recommended dosing. Conclusions: The adjudication of safe and effective doses for any psychotropic agent needs to be individualized. Tactics including dosage adjustment, slow titration, and careful monitoring for serious adverse events should be incorporated into practice. [ABSTRACT FROM AUTHOR]

This section presents abstracts of medical research related to pediatrics. These include "Influence of Socioeconomic Status on Childhood Acute Lymphoblastic Leukemia Treatment in Indonesia," Increasing Prevalence of Cerebral Palsy Among Very Preterm Infants: A Population-Based Study" and "Vitamin K Prophylaxis for Preterm Infants: A Randomized, Controlled Trial of 3 Regimens."

Abstract: Iresine herbstii Hook. (Amaranthaceae) and Brugmansia arborea (L.) Lagerheim (Solanaceae) are used in the northern Peruvian Andes for magic-therapeutical purposes. The traditional healers use Iresine herbstii with the ritual aim to expel bad spirits from the body. Furthermore, Iresine herbstii was used in association with other plants, such as Trichocereus pachanoi Britt. et Rose, for divination, to diagnose diseases, and to take possession of another identity. Also, species of Brugmansia have been reported to be used during ritual practices for magical and curative purposes. Given the above evidence, the aim of the present study is to evaluate if the central effects of Iresine herbstii and Brugmansia arborea could be associated with interaction with SNC receptors. Two Iresine herbstii extracts (methanolic and aqueous) and one Brugmansia arborea aqueous extract were tested for in vitro affinity on 5-HT1A, 5-HT2A, 5-HT2C, D1, D2, α1, and α2 receptors by radioligand binding assays. The biological materials for binding assay (cerebral cortex) were taken from male Sprague–Dawley rats. The extracts affinity for receptors is definite as inhibition percentage of radioligand/receptor binding and measured as the radioactivity of remaining complex radioligand/receptor. The data obtained for Iresine extracts have shown a low affinity for the 5-HT1A receptor and no affinity for 5-HT2A receptor. Otherwise the methanolic extract showed affinity for 5-HT2C receptor (IC50: 34.78μg/ml) and for D1 receptor (IC50: 19.63μg/ml), instead the Iresine aqueous extract displayed a lower affinity for D1 (48.3% at the maximum concentration tested) and a higher value of affinity for D2 receptors (IC50: 32.08μg/ml). The Brugmansia aqueous extract displayed affinity for D1 receptors (IC50: 17.68μg/ml), D2 receptors (IC50: 15.95μg/ml) and weak affinity for the serotoninergic receptors. None of the three extracts showed relevant affinity to the α1, and α2 receptors. The results of our experiments indicate that Iresine herbstii methanolic extract was able to interact with the central 5-HT2C and D1 receptors and Iresine herbstii aqueous extract showed affinity for D2 receptors, thus confirming their ritual use. Instead Brugmansia arborea was able to interact only with the central dopamine receptors tested. Parallel studies are currently in progress for evaluating the extracts affinity and active components towards these and other receptor types (GABAergic). [Copyright &y& Elsevier]

Existing evidence on long-term psychotropic polypharmacy in older people is scarce despite serious safety concerns regarding this issue. This study aims to identify distinct trajectories of longitudinal psychotropic agent use and to examine the association with the risk of mortality and unplanned hospitalization according to distinct trajectories. A retrospective longitudinal cohort study based on data from Taiwan's National Health Insurance Research Database (NHIRD). A population-based study including 39,803 eligible participants aged 65 years or older who were newly prescribed oral psychotropic agents in 2004. We assessed 5 years of monthly consumption of psychotropic agents among eligible participants and used group-based trajectory modeling to identify distinct groups of longitudinal psychotropic use. Cox proportional hazards models were used to examine the association between distinct trajectories of longitudinal psychotropic agent use and subsequent 1- and 3-year unplanned hospitalization and all-cause mortality. Among 39,803 eligible participants, we identified 5 trajectories of longitudinal psychotropic agent use over a 5-year follow-up period: sustained intense (7.1%), moderate increasing (12.1%), decreasing (13.4%), slowly increasing (15.7%), and infrequent users (51.6%). Moderate increasing and sustained intense use were associated with significantly higher risks of unplanned hospitalization [moderate increasing use: hazard ratio [HR] 1.30, 95% confidence interval (CI) 1.18-1.44; sustained intense use: HR 1.40, 95% CI 1.24-1.58] and all-cause mortality (moderate increasing use: HR 1.25, 95% CI 1.09-1.44; sustained intense use: HR 1.32, 95% CI 1.12-1.56) than infrequent use. Similar results were observed at 3 years of follow-up. Older people with moderately increasing and sustained intense use of psychotropic agents over time had higher risks of unplanned hospitalization and mortality. Tracking older people's use of psychotropic agents over time may help to identify individuals at greatest risk of unplanned hospitalization and mortality. [ABSTRACT FROM AUTHOR]