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Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials
- Authors:
- LIEB Klaus, et al
- Journal article citation:
- British Journal of Psychiatry, 196(1), January 2010, pp.4-9.
- Publisher:
- Cambridge University Press
This review aimed to evaluate the evidence of effectiveness of pharmacotherapy in treating different facets of the psychopathology of borderline personality disorder. A Cochrane Collaboration systematic review and meta-analysis of randomised comparisons of drug v. placebo, drug v. drug, or single drug v. combined drug treatment in adult patients with borderline personality disorder was conducted. Primary outcomes were overall disorder severity as well as specific core symptoms. Secondary outcomes comprised associated psychiatric pathology and drug tolerability. Twenty-seven trials were included in which first- and second-generation antipsychotics, mood stabilisers, antidepressants and omega-3 fatty acids were tested. Most beneficial effects were found for the mood stabilisers topiramate, lamotrigine and valproate semisodium, and the second-generation antipsychotics aripiprazole and olanzapine. However, the robustness of findings is low, since they are based mostly on single, small studies. Selective serotonin reuptake inhibitors so far lack high-level evidence of effectiveness. The current evidence from randomised controlled trials suggests that drug treatment, especially with mood stabilisers and second-generation antipsychotics, may be effective for treating a number of core symptoms and associated psychopathology, but the evidence does not currently support effectiveness for overall severity of borderline personality disorder. Pharmacotherapy should therefore be targeted at specific symptoms.
Regulatory policies on medicines for psychiatric disorders: is Europe on target?
- Authors:
- BARBUI Corrado, GARATTINI Silvio
- Journal article citation:
- British Journal of Psychiatry, 190(2), February 2007, pp.91-93.
- Publisher:
- Cambridge University Press
The European Medicines Agency (EMEA) is the regulatory body that provides the institutions of the European Community with the best possible scientific advice on the quality, safety and efficacy of medicinal products. Drugs approved by the EMEA are automatically marketable in all the European member states. Since the beginning of the EMEA’s activities a number of drugs acting on the central nervous system obtained marketing authorisation. This paper highlights some aspects of the EMEA rules that may negatively affect the evaluation of medicines for psychiatric disorders.
Altering perceptions
- Author:
- SHRUBBS Richard
- Journal article citation:
- Mental Health Today, March 2012, pp.8-9.
- Publisher:
- Pavilion
- Place of publication:
- Hove
In the 1950s and 60s, a raft of research was carried out into psychedelic drugs, such as lysergic acid diethylamide (LSD), psilocybin (a compound found in magic mushrooms), MDMA (ecstasy) and mescaline, which alter cognition and perception, and their potential benefit to people with mental health problems. But at the same time as this research was being carried out, recreational use of psychedelic drugs led to the political view of these drugs being dangerous. As a result, the US banned all uses of psychedelics in 1968, even for research. However, after decades of being seen purely as illegal, the potential for psychedelic drugs to be used as a treatment for mental health problems is being considered once again. A number of studies are taking place that are once again investigating whether psychedelic drugs could have a therapeutic benefit if administered properly. Initial research has shown that MDMA has positive effects on post-traumatic stress disorder and that psilocybins may be able to treat personality disorders. In addition, the fear that psychedelics cause schizophrenia appears to be largely unfounded.
Symptoms of mental health and psychotropic drug use among old people in geriatric care, changes between 1982 and 2000
- Authors:
- LOVHEIM Hugo, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(3), March 2008, pp.289-294.
- Publisher:
- Wiley
Some major changes have occurred in the care of older people in institutions providing geriatric care from a few decades ago to today. How these changes regarding organization, diagnosis and pharmacological treatment, have affected the mental health of the population in general remains unclear. The prevalence of symptoms of mental health in two comparable cross-sectional surveys from 1982 and 2000 were studied. The study population consisted of all the people aged 65 years or older living in geriatric care units in the county of Västerbotten, in northern Sweden. Multivariate regression was used to correct for the effect of change in demographic structure. Six out of 14 symptoms showed a significant decrease, correcting for demographical changes. These were, expressed as descriptions of behaviours, Sad, Crying, Fearful, Disturbed and restless, Lacking initiative and Does not cooperate. Two symptoms showed a significant increase, Overactive/manic and Hallucinates visually. The use of antidepressants had increased from 6.3% 1982 to 39.9% 2000. The use of minor tranquillizers had increased from 13.2% to 39.2% and the prevalence of antipsychotic use had decreased from 25.1% to 20.5%. This article clearly shows that the prevalence of several important symptoms and behaviours in a geriatric care population have decreased over the course of eighteen years, correcting for demographical changes. This might at least partly be accounted for by today's more widespread use of antidepressants and benzodiazepines.
In search of certainty: risk management in a biological age
- Author:
- ROSE Nikolas
- Journal article citation:
- Journal of Public Mental Health, 4(3), September 2005, pp.14-22.
- Publisher:
- Emerald
The combinations of heightened emphasis on risk and its management in mental health, the precautionary principle, the idea of genetic susceptibility, advances in screening technology, and the promise of preventative pharmaceutical intervention is highly potent, especially in a world in which preventative prescription of psychiatric medication has become routine. Psychiatric professionals are given the obligation of governing, and being governed, in the name of risk, and in a political and public sphere suffused by the dread of insecurity. But there are risks in seeking to govern risk in a biological age. The author argues that the public, politicians and professionals alike might do better to refuse the demands of risk, and learn to live with uncertainty.
Psychiatry and the ‘new genetics’: hunting for genes for behaviour and drug response
- Authors:
- AITCHISON Katherine J., et al
- Journal article citation:
- British Journal of Psychiatry, 186(2), February 2005, pp.91-92.
- Publisher:
- Cambridge University Press
Complex behaviour is determined by a wide range of factors, some of them environmental and some genetic. Each of the latter is presumed to contribute individually only a small amount, but by acting in concert with environmental triggers they can have an enormous impact on the final phenotype. Because each factor adds to the overall combination of predisposing factors, they are referred to as quantitative trait loci (QTLs). Such QTLs provide a challenging quarry for psychiatry in the post-genomic era. The benefits of the human and other genome projects can be harnessed to enable extensive scans of the chromosomes to detect tell-tale patterns of altered genes in affected individuals and to follow these through further at the level of gene expression and protein product.
Antidepressants and public health in Iceland: time series analysis of national data
- Authors:
- HELGASON Tomas, TOMASSON Helgi, ZOEGA Tomas
- Journal article citation:
- British Journal of Psychiatry, 184(2), February 2004, pp.157-162.
- Publisher:
- Cambridge University Press
Major depressive disorder is the second leading cause of disability-adjusted life-years in developed regions of the world and antidepressants are the third-ranking therapy class worldwide. Nationwide data from Iceland are used as an example to study the effect of sales of antidepressants on suicide, disability, hospital admissions and out-patient visits. Sales of antidepressants increased from 8.4 daily defined doses per 1000 inhabitants per day in 1975 to 72.7 in 2000, which is a user prevalence of 8.7% for the adult population. Suicide rates fluctuated during 1950–2000 but did not show any definite trend. Rates for out-patient visits increased slightly over the period 1989–2000 and admission rates increased even more. The prevalence of disability due to depressive and anxiety disorders has not decreased over the past 25 years. The dramatic increase in the sales of antidepressants has not had any marked impact on the selected public health measures. Obviously, better treatment for depressive disorders is still needed in order to reduce the burden caused by them
Prescribing practices of community child and adolescent psychiatrists
- Authors:
- DOERRY Ursula, KENT Lindsey
- Journal article citation:
- Psychiatric Bulletin, 27(10), November 2003, pp.407-410.
- Publisher:
- Royal College of Psychiatrists
A questionnaire was sent to all 55 community child and adolescent psychiatrists working in the West Midlands to examine the prescribing practices of community child psychiatrists, because most previous studies have included prescribing data from specialist (tier 4) services. The survey had a good response rate (87%). The vast majority of child psychiatrists were prescribing stimulants and antidepressants, and over half were prescribing antipsychotics and melatonin. At least half of the consultants would consider prescribing an antipsychotic for the treatment of aggressive behaviour. One-third of consultants cited pressure on services as a reason for prescribing medication. Community child psychiatrists were prescribing more medication than expected, which may have a considerable impact on referral rates to adult services in the future. It is concerning that the increased use of medication may be a reflection of pressure on services.
Problems encountered when testing for LSD in a regional medium secure unit
- Author:
- ACOSTA-ARMAS A. J.
- Journal article citation:
- Psychiatric Bulletin, 27(1), January 2003, pp.17-19.
- Publisher:
- Royal College of Psychiatrists
Between 1998 and 2000, a surprisingly high number of positive results was noticed in our regional medium secure unit when testing for D-lysergic acid diethylamide (LSD). This led to an investigation of possible factors involved. It was felt that the testing protocol, particularly the use of a single, non-isotopic homogeneous immunoassay without routine further confirmatory testing, was largely to blame for what seemed to be a high incidence of false positives. On two different occasions, samples from each patient were sent, on the same day, to two different laboratories. At the first laboratory, only one test method was used and at the second one test plus two confirmatory tests were carried out. Out of a total of 23 patients tested on two separate occasions, the first laboratory gave three positive results the first time and three positive results the second, while the second laboratory gave only one positive result on the second occasion that samples were sent and none on the first. This reinforces the belief that, without adequate confirmatory analysis, many psychiatric and non-psychiatric prescribed drugs can give false positives.
The approved social worker's guide to psychiatry and psychiatric medication
- Authors:
- ADSHEAD Gwen, LACEY Ron
- Publisher:
- Bournemouth University
- Publication year:
- 2003
- Pagination:
- 124p.
- Place of publication:
- Poole
This book was written for those on the Mental Health Social Work Award (ASW) courses and those helping to provide placement opportunities for ASW trainees. It will also be of use to practising ASWs, other mental health professionals, service users and carers. Contents include: an overview of psychiatry; psychotic disorders; neuroses, substance abuse and personality disorders; treatment issues in psychiatry; forensic psychiatry and the law; psychiatry of old age; psychiatry and risk assessment; and patients as parents. The main forms of psychiatric medication are then outlined.