Prescription antipsychotics

This experiment describes a quantitative analysis for the active ingredients in a prescription antipsychotic medication. The separation makes use of a cyanopropyl derivatized column and a mobile phase of 70% v/v acetonitrile, 5% v/v methanol, and 25% v/v 0.1 M aqueous KH2PO4. A UV detector set to 215 nm is used to measure the eluent s absorbance. 

Principally because of its efficacy/tolerability ratio, prescriptions for quetiapine are growing faster than for any other atypical antipsychotic drug at present (personal communication, Astra Zeneca). 

Kuno, E. 8c Rothbard, A. B. (2002). Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. Am. J. Psychiatry, 159, 567-72. 

The cross-national prescribing database using the same methodology provided a useful and valid comparison of patterns of prescribing psychotropic medications in mental health services in Australia, Thailand, and Malaysia (Ng et al, submitted). The study was carried out in three outpatient mental health centres in North Western Mental Health (NWMH) in Melbourne (September to November 2002), Prince of Songkla University Hospital in Hat Yai (January to March 2003), and Hospital Kuala Lumpur (January to March 2003). The proportions of outpatients treated with a primary diagnosis of a psychotic illness were 91%, 41%, and 75% in the Australian, Thai, and Malaysian samples respectively. Considering psychotropic prescriptions in schizophrenia alone, the majority of patients were prescribed antipsychotics Australia (93.7%), Thailand (92.9%), and Malaysia (97.7%). 

Chong, M. Y., Tan, C. H., Fujii, S. et al. (2004). Antipsychotic drug prescription for schizophrenia in East Asia rationale for change. Psychiatry Clin. Neuroscl, 58(1), 61-7. 

Table 12.1 Percentages of prescription of atypical antipsychotic drugs in each country/territory...

Sim, K., Su, A., Leong, J. Y. et al. (2004a). High dose antipsychotic use in schizophrenia findings of the REAP (research on East Asia psychotropic prescriptions) study. Pharmacopsychiatry, 37(4), 175-9. 

Information about prescription drag use alcohol or other substance use family medical history and history of trauma, depression, or head injury should be obtained. It is important to rule out medication use as a contributor or cause of symptoms (e.g., anticholinergics, sedatives, hypnotics, opioids, antipsychotics, and anticonvulsants) as contributors to dementia symptoms. Other medications may contribute to delirium, e.g.,... 

A large and growing number of older people across the world suffer from schizophrenia. Recommendations for their treatment are largely based on data extrapolated from studies of the use of antipsychotic medications in younger populations. In addition most manufacturers of such medications recommend prescription of reduced doses to the elderly. The evidence base for these assumptions is unclear and raises obvious questions regarding the appropriateness of such prescribing practice. 

Duggan, Mark. 2005. Do New Prescription Drugs Pay for Themselves The Case of Second-Generation Antipsychotics. Journal of Health Economics 2A l-31. 

In addition to the somatic side-effects of neuroleptics, there are a number of important psychiatric side-effects, such as demotivation or indifference (a direct effect of most drugs, actually part of the definition of the neuroleptic effect). This may mimic the negative features of the illness and may lead to prescriptions of an antidepressant when a reduction in dose or change of antipsychotic may be more appropriate. A second key problem is anxious activation or akathisia. This dose-dependent dysphoric state may lead to an apparent worsening in the clinical picture and accordingly an increase in antipsychotic dose rather than decrease and may be so intolerable as to lead on to suicide. 

These authors also found that 65% (New York) and 67% (Ohio) of the sampled medicated patients who received an antipsychotic prescription were not diagnosed with a psychotic disorder. Similarly, 0% and 20% of the sampled medicated patients who received a stimulant medication were not diagnosed with ADHD, and 27% and 42% of the sampled medicated patients who received antidepressants were not diagnosed with major depression, dysthymia, bipolar disorder, or related conditions. In discussing the appropriateness of the medication treatments in the survey, the authors concluded that approximately 10% of the treatments in each sample were deemed inappropriate. 

In view of the large number of potential adverse effects, the benefits and risks of antipsychotic treatment have to be weighed carefully against each other in each individual patient the unrestricted prescription of these medications is just as unwarranted as total abstinence from medications. 

As part of a comprehensive rehabilitation program, prescription medications may help recovering substance abusers with persistent mental health needs. For example, anti-anxiety medications such as diazepam (Valium) and antipsychotic drugs such as haloperidol (Haldol) may address acute needs. 

Barbui C, Ciuna A, Nose M, Patten SB, Stegagno M, Burti L, Amaddeo F, Tansella M (2004) Off-label and non-classical prescriptions of antipsychotic agents in ordinary in-patient practice. Acta Psychiatr Scand 109(4) 275-278. doi 283 [pii]... 

Although this fact seems to have been lost on most medication prescription writers, the dopamine-blocking capacity of all the newer antipsychotic... 

Recent studies of overall pediatric use have shown a 6- to 20-fold increase in prescription of atypical antipsychotics in four state Medicaid-programs and, nationally, a sixfold increase in pediatric visits that included prescriptions of antipsychotic medication, more than 90% of which were prescriptions for atypical antipsychotics. 

Drug companies heavily promote that unproven speculation that the problems they treat are biological in origin and result from biochemical imbalances. Advertising slogans are used to justify the prescription of medications. For example, Janssen (2005), the manufacturer of the antipsychotic drug Risperdal, offers a section About Bipolar Disorder, downloaded from its Web site in February 2006. It declares,... 

The symptoms associated with mental health disorders frequently arc treated with prescription medications, most commonly prescriptions for an antianxicty or antidepressant agent. (Antipsychotic medications account for a small fraction of the total number of prc.scriptions provided.) And considerable relief is reported National surveys suggest that approximately three fourths of patients who receive these medications report some degree of symptomatic relief... 

From the data reviewed here, it appears that Asian patients receiving antipsychotic medications are at increased risk of developing extrapyramidal syndrome. This would imply that Asians should receive lower doses of antipsychotics, because the antipsychotic effect of these medications occurs at a lower level of dopamine receptor blockade than does extrapyramidal syndrome. Reasons for the decreased risk of TD found in some studies are unclear but could include prescription of lower doses of antipsychotic medication or differences in either patient populations or methods of assessment. 

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