Unauthorized reproduction of this article is prohibited. Background:Mental health conditions are common among persons with HIV (PWH). An understanding of factors associated with prescription medication use for these conditions and clinical impact of the prescription medications may improve care of mental health disorders in PWH.Methods:Psychotropic medication use was examined among PWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Multivariable logistic models and Cox regression models estimated the association between psychotropic medications (any/none) with baseline and incident slow gait (>1 s/m) and neurocognitive impairment (NCI) for more than 4 years.Results:Of 1035 participants, the median age was 51 years.81% were men, 30% black, non-Hispanic, and 20% Hispanic. Psychotropic medication use was similar between men (34%) and women (38%; P = 0.19). PWH using psychotropic medications had greater odds of baseline slow gait {odds ratio 1.61, [95% confidence interval (CI): 1.23 to 2.10]; P < 0.001}. Men but not women using psychotropic medications had an increased risk of developing slow gait [hazard ratio 1.85; (1.29 to 2.65) vs 0.77; (CI: 0.35 to 1.68), P interaction = 0.045]. The sex-specific odds ratios for medication use and NCI were qualitatively but not statistically different [men: 1.79; (1.14-2.80); women: 1.27; (0.56-2.90); P interaction = 0.47]. Psychotropic medication use was associated with an increased risk of incident NCI [hazard ratio 2.18; (95% CI: 1.23 to 3.84), P = 0.007] in both men and women.Conclusions:Psychotropic medications are associated with impairment in functional outcomes of aging, with a greater risk of baseline NCI and incident slow gait among men. Further investigation is needed to optimize outcomes in PWH and prescription of psychotropic medications among both men and women.

Adherence to combination antiretroviral therapy is important for achieving optimal HIV-related outcomes. Epidemiologic data indicate that persons with mental disorders are disproportionately affected by HIV/AIDS, which is concerning since having a mental disorder has been associated with poor adherence to medications for treatment of chronic disease states. The purpose of this study was to examine the relationship between the presence of mental disorders and adherence to combination antiretroviral therapy. Additionally, this study examined the relationship between adherence to psychotropic medications and adherence to antiretroviral therapy. Study data were collected from the Texas Medicaid Vendor Drug Program database and Texas Medicaid enrollment files. Adherence to and persistence with antiretroviral therapy, as well as adherence to psychotropic medications when applicable, were evaluated over a 12-month period in 1,321 patients starting a new combination antiretroviral regimen. The presence of a mental disorder was defined based on prescription claims for psychotropic medications. Proportion of days covered was used to calculate adherence, while persistence was defined as the number of days persistent with all antiretrovirals in the index regimen. Logistic regression was used to evaluate the relationship between psychotropic medication use and adherence to antiretroviral therapy (90% cut-off), as well as the relationship between adherence to psychotropic medications (80% cut-off) and adherence to antiretroviral therapy. The relationship between antiretroviral persistence and psychotropic medication use was evaluated using multiple linear regression. Factorial ANOVA was used to evaluate the interactions between race/ethnicity, gender, and psychotropic medication use in their effects on adherence to and persistence with antiretroviral therapy. No significant relationship was found between the presence of a mental disorder and adherence to or persistence with combination antiretroviral therapy in this study. However, the limitations of using psychotropic medication use as a proxy for mental disorders may have affected the results. Adherence to psychotropic medications overall (n = 501; OR = 3.37, 95% CI: 1.86 – 6.10; p < 0.001) and specifically to antidepressants (n = 443; OR = 4.23, 95% CI: 2.31 – 7.75; p < 0.001) was significantly associated with adherence to antiretroviral therapy, indicating a possible relationship between effective treatment for mental disorders and combination antiretroviral therapy adherence. While additional research is needed to clarify this relationship, these data support the need for an integrated approach to treatment of mental disorders and HIV/AIDS. / text

Psychopharmacological and behavioural interventions are used to treat challenging behaviours (e.g., self-injury, aggression, stereotypy, bizarre vocalizations) in individuals with intellectual disability (ID), often in combination. However, little is known about the behavioural mechanisms underlying psychopharmacological treatment. Establishing a better understanding of these mechanisms could contribute to improving treatment efficacy. For this study, I conducted repeated functional analyses using single-subject experimental designs to assess the impact of naturally varying dosages of psychotropic medications on behaviour function. Four individuals with ID who engaged in challenging behaviour and were undergoing psychotropic medication changes participated. Medication impact across two topographies for one participant, and three topographies for another participant were assessed, for a total of seven cases. For Analysis 1, I calculated standardized mean differences between baseline and final drug administration phases to estimate the overall effect of medication. I used this information to examine whether response rate following drug administration was related to response rate during baseline, referred to as rate-dependency. Rate-dependency was not observed. Analysis 2 explored the relation between psychotropic medications and behaviour function identified through functional analyses. Challenging behaviour was the dependent variable, while functional analysis conditions and psychotropic medication level served as independent variables. The latter was a quasi-experimental variable given participants’ psychiatric team prescribed changes independent of the researchers. Behaviour function correspondence, defined as no function change after a medication manipulation, was observed across 14 of the 21 medication manipulations (67%). / October 2015

In Manitoba, as elsewhere, there is a growing trend towards the use of pharmaceuticals and medical technology (pharmaceuticalization) on children and youth in care (C/YIC). As legally mandated guardians and trained experts on children and youth, social workers in Manitoba may play pivotal roles in the decision to medicate C/YIC with psychotropics. Yet there are no studies on Manitoba social workers’ experiences with medicated children/youth or on their perceptions and attitudes towards medicating C/YIC with psychotropics. Using a multilevel Social Structure and Personality analytic, I explored what Manitoba social workers from various fields of practice have to say about this trend. Data consisted of five in-depth interviews and 29 self-completed questionnaires. Findings highlighted that social workers in Manitoba are dealing with increasingly complex cases within a system of residual social welfare. Funding and resource constraints, lack of skilled medical professionals and educators quick to refer all contribute towards medicating C/YIC.

Abstract available in the Journal of the American Psychiatric Nurses Association.

<p>Several classes of psychotropic medications are known to produce neurological side effects. It has long been recognized that antipsychotic drugs classically block the D₂ subtype of DA receptors inducing a range of acute and subacute extrapyramidal syndromes (EPS), including parkinsonism and akathisia, as well as chronic syndromes such as tardive dyskinesia. More recently, SSRI-type drugs, which, as the name suggests, inhibit the serotonin transporter (SERT), and have been found to induce a similar profile of EPS. It is unclear how medications with such different pharmacological actions can produce similar neurological side effects. The goal of this thesis was to study the neurochemical alterations induced by antipsychotic and SSRI medications, with a specific focus on the nigrostriatal pathway, the causative location of parkinsonism.</p> <p>Environmental enrichment and exercise (EE) has been shown to have protective effects in various neurological settings. In the first experiment, we studied the changes induced by SERT inhibition compared to those induced by a non-pharmacological form of therapy, namely, environmental enrichment with exercise. The SSRI, fluoxetine (FLX) significantly reduced the levels of tyrosine hydroxylase (TH) and phosphorylated glycogen synthase kinase-3β (pGSK-3β-inactive), while increasing phosphorylated TH (pTH) in the striatum (STR). EE also reduced TH and increased pTH, but contrary to FLX, it significantly increased striatal pGSK-3β protein expression.</p> <p>Microglia, the brain’s primary immune cells, have been implicated in several neuroinflammatory conditions, including Parkinson’s disease. The purpose of the second experiment was to explore the modulatory effects of microglia on neuroleptic-induced changes in the nigrostriatal system. The typical antipsychotic, haloperidol (HAL), did not affect the overall levels of TH, though it did induce a robust increase in pTH. The microglial NADPH oxidase inhibitor, apocynin (APO), significantly attenuated this increase in pTH. HAL also induced a significant increase in striatal pGSK-3β, while apocynin, rather surprisingly, induced a stark decrease in pGSK-3β protein expression.</p> <p>The results of this thesis indicate that both pTH and pGSK-3β are intriguing markers to study in the context of dopamine neurotransmission. In addition, EE proved to be a valuable modality in which to compare the downstream effects of pharmacological treatment. It is also clear that microglia fulfill an undefined, but fascinating role as modulators of neural transmission.</p> / Master of Science in Medical Sciences (MSMS)

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Psychotropic medication use is widely implicated as a risk factor for injuries, and it is believed that the adverse effect profiles of these medications are exacerbated by the consumption of alcohol. The objectives of this study are (a) to examine the associations between the use of specific classes of psychotropic medications and injuries among elderly participants of the National Population Health Survey (NPHS), and (b) to determine whether and how associations between psychotropic medications and injuries are modified by the consumption of alcohol. Data from Cycles 1 (1994/95), 2 (1996/97), and 3 (1998/99) of the NPHS household longitudinal file were used in this study, selecting community-dwelling participants aged 65 years of age and older in 1994/95. Among antidepressant medications, the magnitude of the risk of injuries was higher for users of tricyclic derivatives (OR=1.4; 95%CI: 0.7 – 2.9) than SSRIs (OR=0.3; 95%CI: 0.1 – 1.0). Benzodiazepine use for any indication increased the risk of injuries, but that effect was not consistent across indications. The use of benzodiazepine antianxiety medications resulted in an increased risk of injuries (OR=2.0; 95%CI: 1.3 – 3.1), but there were no significant effects on the injury risk among benzodiazepine hypnotic and sedative users (OR=0.8; 95%CI: 0.4 – 1.7). Results pertaining to the second objective of this study raised as many questions as they resolved. Alcohol consumption decreased the odds of injury among hypnotic and sedative users, but otherwise, no consistent results were observed. Findings from this study underscore the importance of identifying appropriate alcohol measures for research among elderly populations. They also stress the need to separately consider the impact of different classes of psychotropic medications on injuries (tricyclic antidepressants separate from SSRI antidepressants and antianxiety benzodiazepines separate from hypnotic and sedative benzodiazepines).

Psychotropic medication use is widely implicated as a risk factor for injuries, and it is believed that the adverse effect profiles of these medications are exacerbated by the consumption of alcohol. The objectives of this study are (a) to examine the associations between the use of specific classes of psychotropic medications and injuries among elderly participants of the National Population Health Survey (NPHS), and (b) to determine whether and how associations between psychotropic medications and injuries are modified by the consumption of alcohol. Data from Cycles 1 (1994/95), 2 (1996/97), and 3 (1998/99) of the NPHS household longitudinal file were used in this study, selecting community-dwelling participants aged 65 years of age and older in 1994/95. Among antidepressant medications, the magnitude of the risk of injuries was higher for users of tricyclic derivatives (OR=1.4; 95%CI: 0.7 – 2.9) than SSRIs (OR=0.3; 95%CI: 0.1 – 1.0). Benzodiazepine use for any indication increased the risk of injuries, but that effect was not consistent across indications. The use of benzodiazepine antianxiety medications resulted in an increased risk of injuries (OR=2.0; 95%CI: 1.3 – 3.1), but there were no significant effects on the injury risk among benzodiazepine hypnotic and sedative users (OR=0.8; 95%CI: 0.4 – 1.7). Results pertaining to the second objective of this study raised as many questions as they resolved. Alcohol consumption decreased the odds of injury among hypnotic and sedative users, but otherwise, no consistent results were observed. Findings from this study underscore the importance of identifying appropriate alcohol measures for research among elderly populations. They also stress the need to separately consider the impact of different classes of psychotropic medications on injuries (tricyclic antidepressants separate from SSRI antidepressants and antianxiety benzodiazepines separate from hypnotic and sedative benzodiazepines).