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Little is known about the combined use of benzodiazepines and antidepressants in older psychiatric patients. This study examined the prescription pattern of concurrent benzodiazepines in older adults treated with antidepressants in Asia, and explored its demographic and clinical correlates.
The data of 955 older adults with any type of psychiatric disorders were extracted from the database of the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) project. Demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Both univariate and multiple logistic regression analyses were performed.
The proportion of benzodiazepine and antidepressant combination in this cohort was 44.3%. Multiple logistic regression analysis revealed that higher doses of antidepressants, younger age (<65 years), inpatients, public hospital, major comorbid medical conditions, antidepressant types, and country/territory were significantly associated with more frequent co-prescription of benzodiazepines and antidepressants.
Nearly, half of the older adults treated with antidepressants in Asia are prescribed concurrent benzodiazepines. Given the potentially adverse effects of benzodiazepines, the rationale of benzodiazepines and antidepressants co-prescription needs to be revisited.
Background: This study examined the use of low doses of antipsychotic medications (300 mg/day CPZeq or less) in older Asian patients with schizophrenia and its demographic and clinical correlates.
Methods: Information on hospitalized patients with schizophrenia, aged 55 years or older, was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001–2009). Data on 1,452 patients in eight Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, Taiwan, India, and Malaysia were analyzed. Sociodemographic and clinical characteristics and antipsychotic prescriptions were recorded using a standardized protocol and data collection procedure.
Results: The prescription frequency for low doses of antipsychotic medications was 40.9% in the pooled sample. Multiple logistic regression analysis of the whole sample showed that patients on low doses of antipsychotic medications were more likely to be female, have an older age, a shorter length of illness, and less positive symptoms. Of patients in the six countries and territories that participated in all the surveys between 2001 and 2009, those in Japan were less likely to receive low doses of antipsychotics.
Conclusion: Low doses of antipsychotic medications were only applied in less than half of older Asian patients with schizophrenia.
Prescribing of psychotropic drugs, such as antipsychotics, antidepressants, anxio- lytics and mood stabilizers, is common in psychiatric inpatients for acute and maintenance treatment of psychiatric illness.
While no one will disagree that the psychotropic drugs should be kept to an effective minimum dosage, it is reported that Asian patients usually require a lower dosage of antipsychotic drugs than Caucasian patients (Chiu et al., 1992; Ko et al., 1989). The differences in prescribing patterns are not just observed in the dosages of psychotropic drugs, but are also seen in the types of psychotropic drugs, the use of poly-antipsychotic drugs, and the concurrent use of psychotropic drugs. Generally, prescribing patterns may be based on the following factors:
biological factors including genetic susceptibility to adverse effects (Lam et al., 1995). Some researchers have argued that ethnicity may provide a marker for individual genetic variation, and that drug choice and dose should vary according to different races (Jones & Perlis, 2006);
ethnicity factors (Opolka et al., 2004), in that Caucasian patients were more likely to receive an atypical antipsychotic and less likely to receive a depot injection than Latino patients (Covell et al., 2002);
prescribers' professional training, where postgraduate and continuing medical education can affect the prescribing habit (Hull et al., 2005). Findings from clinical trials, particularly results from industrial sponsored clinical trials may influence prescribing patterns (Perlis et al., 2005);
health care system and medical insurance (Sleath & Shih, 2003).
In 1999, the first collaborative attempt to study the prescribing of psychotropic drugs in several East Asian countries was initiated.
Background: We evaluated the combined and differential effects of physical, social and productive activities on cognitive decline and whether they were modified by the presence of the APOE-ε4 allele.
Methods: In a prospective cohort study of 1635 community-dwelling Chinese older adults aged 55 or older participating in the ongoing Singapore Longitudinal Aging Study, physical, social and productive leisure activities were assessed at baseline, and cognitive decline (at least one point drop) in MMSE scores between baseline and follow-up after one year.
Results: Cognitive decline was observed in 30% of the respondents. Controlling for age, gender, education and other risk factors, odds ratios (ORs) were significantly reduced in those with medium (OR: 0.60, 95% CI: 0.45–0.79) and high activity levels (OR: 0.62, 95% CI: 0.46–0.84). A stronger association was shown for productive activity (OR = 0.36), than for physical (OR = 0.78) and social activities (OR = 0.85). These associations showed statistically significant interactions with APOE genotype, being more pronounced in those with the APOE-ε4 allele.
Conclusion: Increased leisure activity, especially productive activities more than physical or social activities, was associated with a lowered risk of cognitive decline. APOE-ε4 genotype individuals appeared to be more vulnerable to the effects of low and high levels of leisure activities.
The objective was to investigate the occurrence and characteristics of oculogyric spasm (OGS) in an Asian country.
All 2035 Asian (88% Chinese, 7% Malays and 5% Indonesians) psychiatric in-patients in the state psychiatric hospital in Singapore were surveyed for occurrence of oculogyric spasm (OGS) over a two-month period.
Thirty-four patients (1.7%) developed OGS (53% male and 47% female). All the 34 patients had been on maintenance antipsychotic drugs for more than five months. Eighteen patients had recurrent attacks. The mean chlorpromazine equivalent daily dose for those patients with recurrent OGS was 511 mg. This was significantly higher (P < 0.05) than the 277 mg daily dose received by those without recurrent OGS. Most (68%) of the attacks occurred between 1400–2000 h suggesting that OGS may have a diurnal variation.
GS presenting as tardive dystonia may be due to a relative increase in cholinergic activity.
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