Thesis (M.S.)--University of Michigan, 1999. / Running title: Psychotropics and agitation. Includes bibliographical references.

Thesis (M.S.W.)--University of Hong Kong, 1995. / Includes bibliographical references (leaf 87-95).

Thesis (M.S.)--University of Michigan, 1999. / Running title: Psychotropics and agitation. Includes bibliographical references.

The majority of the population in South Africa use traditional health care to treat various mental conditions. This thesis has two main objectives; to bring together a comprehensive and detailed record of psychotropic plants used in southern Africa by indigenous peoples for medicinal or cultural purposes. Secondly, this research attempts to investigate the validity and rationale of the use of these plants by screening them in various biological assays for psychotropic activity. Plants were selected, based on their traditional use and availability, and were screened in four assays, which detect biological activity of a useful nature. A number of in vitro enzymatic and neuronal signal transduction assays were employed in this thesis, the inhibition of the serotonin reuptake transporter protein (SERT); inhibition of catabolic enzymes (e.g. acetylcholinesterase, monoamine oxidase); GABAA- benzodiazepine receptor binding. The influence of legislation, past and present, on the state of traditional medicine is highlighted. Aspects of the philosophies and practises of the various practitioners of South African traditional medicine will be discussed. An annotated list compiled from available ethnobotanical literature of plants traditionally used for central nervous system-related purposes is provided. It contains more than 330 species, from 94 families, which are currently used or have been used for cultural, medicinal and recreational purposes related to the central nervous system (CNS). Where available, information pertaining to plant part used, preparation method, dosage, route of administration, known and potentially active constituents are included. Seventy five extracts from 34 indigenous plant species used in South African traditional medicine or taxonomically related to these were investigated for their affinity to the serotonin reuptake transport protein, making use of an in vitro [3H]-citalopram serotonin reuptake transport protein binding assay. Aqueous and 70% ethanolic extracts of various plant parts were screened and 45 extracts derived from 15 plant species showed affinity. The affinity of 12 extracts from four plants was characterized as high (more than 50% inhibition at 5, 1, and 0.5 mg/ml). Plant species with high affinity to the serotonin reuptake transport protein included Agapanthus campanulatus, Boophone disticha, Datura ferox and Xysmalobium undulatum. Agapanthus campanulatus yielded high activity in aqueous extracts from leaves and flowers. B. disticha showed high activity both in aqueous and ethanolic extracts of leaves and bulbs. D. ferox showed high activity in aqueous extracts from the seeds and X. undulatum showed high activity in the ethanolic extract of the whole plant. Two compounds, buphanadrine and buphanamine, were isolated by bioassay-guided fractionation on vacuum-liquid-chromatography (VLC) and preparative thin-layer-chromatography (TLC) from B. disticha. The structures of the compounds were determined by 1H and 13C NMR. Fractions were tested for affinity to the serotonin transporter in a binding assay using [3H]-citalopram as a ligand. The IC50 values of buphanidrine and buphanamine were 274 ìM (Ki = 132 ìM) and 1799 ìM (Ki = 868 ìM), respectively. The two alkaloids were also tested for affinity to the 5HT1A receptor, but only showed slight affinity. Aqueous and ethanol extracts of 43 plants that are traditionally used to treat against epilepsy and convulsions were initially tested in the GABAA-benzodiazepine receptor binding assay, where the binding of 3H-Ro 15-1788 (flumazenil) to the benzodiazepine site is measured. The GABAA-benzodiazepine receptor complex is involved in epilepsy and convulsions. Out of the 118 extracts tested, one aqueous and 18 ethanol extracts showed activity. The most active extracts were the ethanolic leaf extracts of Searsia tridentata, Searsia rehmanniana and Hoslundia opposita and the ethanolic corm extract of Hypoxis colchicifolia, which all showed good dose-dependent activity. A further forty-six ethanol extracts from another 35 species, both indigenous and exotic that are traditionally used predominantly as sedatives or to treat various CNS-related ailments were tested in the GABAA-benzodiazepine receptor-binding assay. Out of the 46 extracts tested, seven showed good activity and 10 showed moderate activity. The most active extracts were the ethanolic leaf extracts of Arctopus echinatus, Artemisa afra, four Helichrysum species and Mentha aquatica which all showed good dose-dependent activity. Two biflavonoids with activity in the 3H-Ro 15-1788 (flumazenil) binding assay were isolated by high pressure liquid chromatography (HPLC) fractionation of the ethanol extract of the leaves from Searsia pyroides. The structures of the two biflavonoids were elucidated by nuclear magnetic resonance spectroscopy (NMR) to be agathisflavone and amentoflavone. Agathisflavone and amentoflavone competitively inhibited the binding of 3H-Ro 15-1788 with a Ki of 28 and 37 nM, respectively. Extracts of Searsia dentata and Searsia pentheri were not as active as the extract from Searsia pyroides; both were found to contain apigenin and agathisflavone. The monomer apigenin, agathisflavone and amentoflavone were fitted into a pharmacophore model for ligands binding to the GABAA receptor benzodiazepine site. This reflected the affinities of the compounds in the [3H]-flumazenil binding assay. Mentha aquatica, a mint that is found in Europe and Africa, is used in Zulu traditional medicine for spiritual purposes. The ethanolic leaf extract showed a strong affinity to the GABA-benzodiazepine receptor. Viridiflorol from the essential oil and (S)-naringenin from an ethanolic extract was isolated by bioassay-guided fractionation using binding to the GABA-benzodiazepine site. Viridiflorol had an IC50 of 0.19 M and (S)-naringenin of 0.0026 M. Twenty plants used in Zulu traditional medicine for several CNS-related ailments were screened for MAO inhibition and specific MAO-B inhibition activity. MAO-B inhibitors are currently employed in the treatment of neurodegenerative related illnesses such as Parkinson's and Alzheimer's diseases. A photometric peroxidase linked assay was used to determine the inhibition of the oxidative deamination of tyramine by MAO isolated from rat liver. Ruta graveolens exhibited the best MAO inhibitory activity (ethyl acetate leaf extract = IC50 5 ± 1 ìg/ml, petroleum ether extract = 3 ± 1 ìg/ml) and specific MAO-B inhibition (ethyl acetate leaf extract = IC50 7 ± 6 ìg/ml petroleum ether extract = 3 ± 1 ìg/ml). Schotia brachypetala, Mentha aquatica and Gasteria croucheri also exhibited good MAO-B inhibition activity. Six extracts of varying polarity of Mentha aquatica were tested in a photometric peroxidase linked MAO bioassay. The 70% ethanol extract had highest inhibitory activity. (S)-Naringenin was isolated from the extract by bioassay guided fractionation on VLC and preparative TLC. The structure of the compound was determined by 1H, 13C and 13C-DEPT NMR and optical rotation. The IC50 values for MAO inhibition by naringenin were 342 ± 33 ìM for the rat liver mitochondrial fraction, 955 ± 129 ìM for MAO-A and 288 ± 18 ìM for MAO-B respectively. South African traditional medicine clearly utilizes many botanical species with CNS-related activity. Only a small number of the more than 330 southern African plant species reported to treat or alter the CNS have been scientifically evaluated. To date very few of the active compounds have been isolated and identified. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2009.

In light of the increasing number of mentally ill inmates in the criminal justice system, felony mental health courts aim to de-criminalize these individuals and link them to appropriate types of treatment within the community. Few studies have investigated the successful linkage of community-based treatment among felony mental health court participants. More specifically, there is an absence of research on the efficacy of pharmacotherapy on recidivism status among felony mental health court defendants. This retrospective study used archival data to determine if receiving pharmacotherapy will increase duration of time between arrests and keep felony mental health court participants out of the criminal justice system longer. The study also aimed to investigate if psychotropic medication use helped to reduce the risk of violent arrests among those participating in the felony mental health program. Lastly, it evaluated whether drugs from specific classes had more of an effect on recidivism status than others. Cox regression analyses, with propensity score adjustments, were used to determine if psychotropic medication keeps felony mental health court participants out of the criminal justice system longer. Cox regression analysis was also used to determine if specific drugs from different classes had more of an effect on time to re-arrest than others. Lastly, a binary logistic regression, with propensity score adjustments, was used to determine if psychotropic medication helped to reduce the risk of future violent offenses after entry into the FMHC program. All analyses included covariates to control for any potentially confounding factors to the outcome. The study yielded non-significant results when testing whether or not the use of psychotropic medication had an impact on the time to re-arrest, and on risks of future violent offenses.

Thesis (DPhil)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: The use of psychiatric medication is an important part of modern medical and psychiatric practice. Clinical psychopharmacology raises a broad range of philosophical issues, including metaphysical, epistemological, and moral questions. This dissertation attempts to provide a conceptual framework for addressing several of these questions, and for formulating a conceptual basis for psychiatry in general and clinical psychopharmacology in particular. The dissertation begins by heuristically contrasting two broad approaches towards a range of questions in the philosophy of science, language, and medicine. A classical position takes an essentialist and objective view of categories while a critical position emphasizes that categories are often metaphoric and subjective. A synthetic or integrated position might be possible, in which radial categories are often based on metaphoric extensions of basic-level sensorimotor-affective experience, and are embodied in the brain-mind and in social practices. Rather than attempt to defend an integrated position in purely conceptual terms, the dissertation supports this view of categories using data from the cognitive-affective sciences. An important category for philosophy of medicine is disorder, and the dissertation argues that certain universal considerations explain agreement about prototypical disorders. Extensions of disorder metaphors are theory-driven and valueladen, and although disagreement about atypical conditions is likely, reasonable debate is possible. The dissertation then considers several conceptual questions, namely the nature of psychotropics, of emotion, and of the self. In each case, a classical position which attempts an essentialist definition is contrasted with a critical position which emphasizes that these constructs are socially constructed and crucially subjective. Cognitiveaffective data is then employed to support an integrative position which emphasizes the embodiment of complex brain-mind phenomena in the brain-mind and in social practices. Explanatory questions considered are how best to explain pharmacotherapy and psychotherapy, how to account for placebo responses, and the relevance of evolutionary explanations of disorder. It is argued that a functionalist account fails to explain psychopharmacological phenomena, including pharmacotherapy and placebo effects. Instead, an account which emphasizes how psychobiological mechanisms produce complex brain-mind phenomena is needed. Evolutionary explanations add to this account, but cannot by themselves differentiate disorder from non-disorder. Ethical questions include the question of whether psychiatric disorders should be treated, whether such disorders should be treated with psychotropics, and whether psychotropics should be used to enhance. The cognitive-affective sciences support the treatment of typical disorders. In more atypical cases, pharmacotherapy, psychotherapy, and non-medical interventions should be considered on an individual basis. As technologies expand, considerations about the value of accepting fate versus the value of attempting to improve life by a range of methods, will need to be weighed carefully. In summary, this dissertation puts forward a philosophy of psychopharmacology which argues that psychiatry practice can be viewed, naturalistically, as based on the natural and human sciences. At the same time, good psychiatric practice involves an engagement with the complex realities of the human condition, including a consideration of individuals’ suffering. Good psychopharmacological practice requires integrating the objective and the subjective, considering both explanation and understanding, and providing a balanced view of the good and bad of psychotropics that avoids both unrealistic optimism and undue pessimism. / AFRIKAANSE OPSOMMING: Die gebruik van psigiatriese medikasie maak belangrike deel uit van moderne mediese en psigiatriese praktyk. Psigofarmakologie bring wye reeks filosofiese kwessies ter sprake, met inbegrip van metafisiese, epistemologiese, en morele vrae. Hierdie proefskrif poog om konseptuele raamwerk te verskaf ten einde verskeie van hierdie vrae die hoof te bied, en na die formulering van konseptuele basis vir psigiatrie in die algemeen en kliniese psigofarmakologie in die besonder om te sien. Die proefskrif begin deur twee algemene benaderings ten opsigte van reeks vrae in die filosofie van wetenskap, taal en geneeskunde te kontrasteer. Klassieke posisie huldig essensialistiese en objektiewe siening van kategorieë, terwyl kritiese posisie klem daarop lê dat kategorieë dikwels metafories en subjektief is. Sintetiese of geïntegreerde posisie is dalk moontlik, met radiale kategorieë wat dikwels op metaforiese uitbreidings van konsepte op basiese vlak sensorimotor-affektiewe ervaring gebaseer word, en in die bewussyn-brein en in sosiale gebruike vergestalt word. Eerder as om te probeer om geïntegreerde posisie in suiwer konseptuele terme te verdedig, steun die proefskrif hierdie siening van kategorieë met behulp van data uit die kognitiewe-affektiewe wetenskappe. Belangrike kategorie vir die filosofie van geneeskunde is steuring, en die proefskrif voer aan dat sekere universele oorwegings ’n verklaring bied vir ooreenstemming ten opsigte van prototipiese steurings. Uitbreidings van die steuring metafoor is teoriegedrewe en waardebelaai, en alhoewel daar waarskynlik meningsverskil omtrent atipiese toestande kan voorkom, is redelike bespreking haalbaar. Die proefskrif neem dan verskeie konseptuele vrae in aanmerking, naamlik die aard van psigotropika, van emosie, en van die self. In elke geval word klassieke posisie wat essensialistiese definisie aandurf, gekontrasteer met kritiese posisie wat beklemtoon dat hierdie konstrukte sosiaal gekonstrueer en besonder subjektief is. Kognitiewe-affektiewe data word dan aangewend om integratiewe posisie te handhaaf wat die vergestalting van komplekse bewussyn-brein fenomene in die bewyssyn-brein en in sosiale praktyke beklemtoon. Verklarende vrae het aandag geskenk aan die beste wyse om farmakoterapie en psigoterapie te verklaar, aan die wyse waarop placebo-reaksies verklaar kan word, en aan die rol van proksimale en evolusionêre verklarings. Daar word aangevoer dat funksionalistiese verklaring nie daarin slaag om psigofarmakologiese verskynsels, met inbegrip van farmakoterapie en placebo-effekte, te verklaar nie. In plaas daarvan word verklaring wat beklemtoon hoe psigobiologiese meganisme komplekse fenomene kan laat ontstaan, benodig. Evolusionêre verklarings dra tot hierdie verklaring by, maar kan nie op sigself steuring van niesteuring onderskei nie. Etiese vrae sluit die vraag in of psigiatriese steurings behandel moet word, of sodanige steurings met psigotropika behandel moet word, en of psigotropika gebruik moet word om te verhoog. Die kognitief-affektiewe wetenskappe ondersteun die behandeling van tipiese steuringe. In meer atipiese gevalle moet farmakoterapie, psigoterapie, en nie-mediese intervensies op individuele basis oorweeg word. Algaande tegnologieë uitbrei, moet ons oorwegings van die waarde van lotsaanvaarding sowel as die waarde van ’n poging om ’n mens se lewe te verbeter, versigtig in ag neem. Ter opsomming, hierdie proefskrif stel filosofie van psigofarmakologie voor wat aanvoer dat psigiatriese praktyk naturalisties verstaan kan word, soos gebaseer op die natuur- en geesteswetenskappe. Terselfdetyd, behels goeie psigofarmakologiese praktyk ‘n verwantskap met die komplekse werklikhede van die menslike kondisie. Dit vereis ‘n omvattende oorweeging van en omgang met individuele pasiënte se lyding. Goeie psigofarmakologiese praktyk integreer die “objektiewe” en die “subjektiewe” aspekte van die menslike bestaan, streef na sowel verklaring en verstaan, verskaf ‘n gebalanseerde perspektief oor die goed en die sleg van psigiatriese medikasies, en middel tussen onrealistiese optimisme en buitensporige pessimisme.

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

Submitted in partial compliance with the requirements of the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, Durban, South Africa, 2016. / There are now several thousand remedies available to a homoeopath and this number is continually increasing with the increase in homoeopathic research and provings. This growing wealth of data does, however, make choosing a homoeopathic remedy difficult and some homoeopaths argue that the essence of homoeopathic remedies are being lost in this excess of data. In an attempt to more accurately see a remedy’s ‘picture’ and gain deeper insight into remedies, Scholten (1993), Sankaran (2005a) and Mangialavori (2010) developed different methods which can now be collectively referred to as “group analysis”. The aim of group analysis is to find symptoms, sensations and pathological tendencies that are common to all remedies within a group. This study involved applying Sankaran’s group analysis approach to the psychoactive plant drug remedies with the rationale of filtering and organizing the mass of data we now have available on this group. This will enable both students and professionals of homoeopathy to develop a deeper understanding, and hence greater utilization, of the psychoactive plant drug remedies. The following five homoeopathic remedies were chosen for this study on the grounds that they have all been extensively proved through both homoeopathic provings and cured clinical cases and there is a vast amount of literature available on these remedies in materia medica and repertories: • Anhalonium lewinii (Cactaceae family) • Cannabis indica (Hamamalidae family) • Coffea cruda (Rubiaceae family) • Nux moschata (Magnolianae family) • Opium (Papaveraceae family) A computer repertory search was conducted using RadarOpus (Archibel, 2014) to extract all rubrics containing the selected remedies. Parameters were set to retain only rubrics that have less than 50 remedies and at least two of the selected psychoactive plant remedies in them. This was to ensure that only well-defined, characteristic remedies were looked at. The rubrics were visually analyzed, compared and contrasted to determine the common sensations within them and mental, general and particular symptoms were analyzed in terms of Sankaran’s model of Vital Sensation (2005a). The vital sensation of the psychoactive plant drug remedies was found to be that of horror, fear or fright. All the remedies belonging to this group experience the sensation of horror either through their perception of pain or through dreams, visions, hallucinations or anxiety. This sensation pervades all these remedies which are constantly trying to escape this sensation by either increasing or decreasing their activity and sensitivity. The active reaction to the sensation of horror is to increase activity. This is expressed through increased sensitivity; mental clarity; sensations of contraction, fullness, heaviness, heat or moisture; delirium, hallucinations and instability. The passive reaction to the sensation of horror is to decrease activity. This is expressed through insensitivity; lack of mental clarity; sensations of expansion, emptiness, lightness, cold or dryness; sleep, stupor and unconsciousness. The compensation, or coping mechanism that psychoactive plant drug remedies develop, is a transcendence of their condition: they transcend, or escape, their condition by no longer feeling or doing anything, by becoming numb and insensitive. The researcher suggests that although the remedies of the psychoactive plant drug group can be classified according to different miasms, the over-riding miasm of this group is the sycotic miasm with its fundamental sense of having a ‘fixed weakness’ within themselves. The researcher also proposes that the psychoactive plant remedies have an affinity for the central nervous system and for ailments caused by strong emotions such as joy, anger, excitement, fear or fright. These remedies tend to produce pathologies of the central nervous system and sleep including increased reflexes, involuntary motions, trembling, jerking; weakness, atrophy, slowness, paralysis; unconsciousness; catalepsy; Autism Spectrum Disorders; hypersensitivity; insensitivity or absence of sensitivity; pain; formication; mental confusion, poor comprehension, nonsensical speech; memory disorders; delirium, hallucinations, schizophrenia; mood disorders; behavioural disorders; anxiety; insomnia, narcolepsy and nightmares. The researcher found group analysis to be a powerful methodology that, if employed correctly, can aid homoeopaths to learn and understand remedies in their ‘totality’. / M

O autor faz uma análise crítica do consumo de medicamentos psicotrópicos e apresenta os resultados de um inquérito epidemiológico realizado no Distrito de São Paulo com vistas a determinar os níveis de prevalência e incidência do consumo destes medicamentos, os padrões de consumo, os tipos de medicamentos mais frequentemente utilizados e a associação do uso de psicotrópicos a algumas variáveis sócio-demográficas. Inicialmente discute os aspectos psico-sociais da ansiedade chamando a atenção para o risco da utilização de ansiolíticos, hipnóticos e sedativos para o alívio da ansiedade objetiva, a qual representa uma resposta de defesa do indivíduo frente ao seu meio ambiente; defende a idéia de que esta forma de ansiedade é útil e necessária ao Homem e que a utilização indiscriminada de medicamentos psicotrópicos para o seu alívio representa um prejuízo para o desenvolvimento emocional individual e para a progressão teleológica da sociedade. Discute aspectos do mercado destes medicamentos apontando os papéis desempenhados pelos principais envolvidos em uma complexa relação de interesses: a indústria farmacêutica, a classe médica, os pacientes e os proprietários de farmácias. Em relação ao mercado brasileiro, discute o importante segmento ocupado pelos produtos classificados como \"antidistônicos\" que, a seu ver, representam uma forma disfarçada de colocação no mercado de produtos psicotrópicos cuja venda escapa aos rigores da legislação que regula a prescrição e aquisição de medicamentos contendo substâncias psicotrópicas. O inquérito epidemiológico realizado em 1976-1978 indica que entre 3690 indivíduos de 16 ou mais anos de idade pertencentes a 1345 famílias a prevalência de consumo no último ano foi de 122,2/1000 habitantes (75,7/1000 para o sexo masculino e 163,2/1000 para o sexo feminino). A incidência de novos consumidores nos últimos 30 dias foi 7,6/1000 habitantes (5,8/1000 para o sexo masculino e 9,2/1000 para o sexo feminino). Observou-se uma tendência ao crescimento dos níveis de consumo com a idade e valores de prevalência de consumo sempre maiores entre as mulheres do que entre os homens (produto cruzado igual a 2,38). A idade média dos consumidores de psicotrópicos é 5,13 anos superior a dos não consumidores. A prevalência de consumo nas áreas geográficas de melhor qualidade de vida é 62 por cento superior àquela das áreas de menor qualidade de vida. Foram observados três padrões característicos de consumo: o uso regular (56,1 por cento dos consumidores), o uso esporádico (38,1 por cento dos consumidores) e o uso episódico (4,4 por cento dos consumidores). Os consumidores esporádicos tendem a ser mais constantes no seu comportamento do que os consumidores regulares e episódicos. Os medicamentos ansiolíticos, hipnóticos e sedativos são os mais frequentemente usados (86,5 por cento cos casos) e, pelo menos, 62,6 por cento deles podem ser adquiridos sem a apresentação de receita médica. Somente os derivados da benzodiazepina (ansiolíticos e hipnóticos) representam\' 72,8 por cento de todos os produtos consumidos. Em 81,6 por cento dos casos o uso se deu por indicação médica, em 2,7 por cento dos casos a indicação foi do \"farmacêutico\", em 4,4 por cento dos casos a indicação foi de um parente ou conhecido e em 10,2 por cento dos casos foi o próprio usuário que decidiu a indicação. Dentre os médicos, são os clínicos gerais os que mais prescrevem psicotrópicos (57,4 por cento do total) e eles têm clara preferência pelos produtos livres de controle de receituário. Há indícios de que possa haver maiores níveis de consumo entre mulheres com vínculo matrimonial rompido (viúvas, separadas e desquitadas) na faixa etária de 30 a 50 anos. Outrossim, foram observados maiores níveis de consumo em pessoas com menor grau de instrução. Não foi encontrada qualquer relação entre consumo de medicamentos e as condições de habitação (medidas pelo índice de aglomeração). / The author critically analyzes the consumption of psychotropic drugs and also presents the results of an epidemiological survey taken within the District of São Paulo, which was performed in order to determine the prevalence and incidence of the consumption of such drugs, the consumption patterns, the types of medications most frequently taken, and to determine a relation between the use of psychotropics and social demographic variables. First, some psycho-social aspects of anxiety are presented, emphasizing the risks involved when minor tranquilizers, hypnotics, and sedatives are used to relieve objective anxiety, which is the normal individual\'s defense reaction against the agressions of his environment. It sunports the idea that such anxiety is constructive and necessary for man and that the carefree utilization of psychotropic medications will thus harm, both the individual\'s emotional development and the teleological progress of society. The psychopharmaceutical rnarket is then discussed, pointing out the complex relationships among those involved and their various interests: the pharmaceutical industry, the medical class, the patients, and the pharmacy proprietors. In respect to the Brazilian market, those products classified as \"antidistônicos\", (hidden psychotropics), are discussed as a disguised way to legally sell psychotropic drugs over the counter and escape laws applying to their purchase and prescription. The epidemiological survey taken during the years 1976-1978 indicates that 3690 participants, 16 years or older ano distributed among 1345 families, showed a consumption prevalence in the last year of 122.2/1000 inhabitants, (75.7/ 1000 for males ano 163.2/1000 for females). In the last 30 days the incidence of new consumers was 7.6/1000 inhabitants. There is an increasing tendency observed in correspondence to the consumption level and age. Furthermore, the prevalence values are always higher for females than for males, (cross product is equivalent to 2.38); the mean age of psychotropic consumers is 5.13 years higher than nonconsumers. In the geoqraphic areas with a higher standard of living, the consumption prevalence is 62 per cent greater than in those areas with a lower standard of living. Three consumption patterns are characterized: the regular use (56.1 per cent of the consumers), the sporadic use (38.l per cent of the consumers), and the episodic use (4.4 per cent of the consumers). The sporadic consumers tend to have a more consistent behavior compared to those considered regular or episodic consumers. Minor tranquilizers, hypnotics, and secatives are found as being the medications most frequently used, (86.5 per cent of the cases), with at least 62.6 per cent of them purchasable over the counter. Those drugs derived from benzodiazepine, (i.e., minor tranquilizers and hypnotics), alone represent 72.8 per cent of all the medications consumed. In 81.6 per cent of the cases, the medications were taken under a doctor\'s prescription, 2.7 per cent of the cases occurred due to a pharmacist\'s indication, in 4.4 per cent of the cases a relative or friend had suggested the use of the medication, and in 10.2 per cent of the cases the user himself had prescribed the medication. Among physicians, psychotropics are more ofter prescribed by general practitioners, (57.4 per cent of the total cases), whose preference is clearly given to those products freely sold over the counter. There is indication given that women with broken marriages, (widowed, seperated, or divorced), within the age group of 30 to 50 years, have a higher consumption level. High levels of consumption are also observed among less educated persons. No association was found between the consumption of psychotropics and habitation conditions, (measured by the conglomeration index).

Introdução: nas quatro últimas décadas, os medicamentos psicotrópicos assumiram uma significativa importância na vida de milhões de pessoas. Os custos diretos e indiretos associados aos psicotrópicos são frequentemente desconhecidos. Aspectos econômicos dos psicotrópicos foram estudados em outros países, mas essas informações ainda são escassas no Brasil. Uma fonte de dados para estudos sobre despesas familiares e gastos em saúde é a Pesquisa de Orçamentos Familiares. Objetivos: desenhar o perfil de brasileiros que adquirem medicamentos psicotrópicos, bem como, avaliar o gasto com esses medicamentos e o seu impacto no orçamento familiar brasileiro nos últimos anos. Métodos: estudo transversal, onde os dados utilizados são provenientes da Pesquisa de Orçamentos Familiares de 2002-2003 e de 2008-2009, envolvendo entrevistas de uma amostra complexa, composta por 48.470 domicílios pesquisados em 2003, 128.300 pessoas e 55.970 domicílios visitados em 2009. Modelos de regressão multivariáveis de Poisson com variância robusta foram construídos através do SAS/SUDAAN 10.0.1. Todos os rendimentos e despesas foram convertidos para valores mensais e corrigidos para a inflação do período. Resultados: a prevalência de aquisição de psicotrópicos pela população brasileira em 2008-2009 foi de 5,2% (IC95%=5,0-5,5), resultando em um gasto anual de R$507 milhões. Essa aquisição foi mais frequente em mulheres, indivíduos brancos, de idades mais avançadas, que não vivem com o cônjuge, com grau mais 9 elevado de instrução e de maior renda. Indivíduos que gastaram com psicotrópicos apresentaram despesas maiores com plano de saúde (RP=1,40, IC95%: 1,30-1,50) e consultas médicas (RP=2,51, IC95%: 2,32-2,72). A média mensal de despesas com psicotrópicos, por domicílio, aumentou de R$ 54,38 em 2003 para R$ 78,73 em 2009, com os valores já corrigidos pela inflação. Entre os domicílios que não gastaram com psicotrópicos, a renda média mensal per capita foi de R$1.026,73 e os gastos mensais per capita foram de, em média, R$73,92 com saúde, R$130,17 com alimentação e R$12,77 com lazer. Entre os domicílios que adquiriram psicotrópicos, a renda média mensal per capita foi de R$1.154,40 e, suas despesas mensais médias, per capita, de R$210,38 com saúde, R$162,08 com alimentação e R$15,45 com lazer. Conclusões: houve um aumento acima da inflação nos gastos com medicamentos psicotrópicos entre os anos avaliados. A aquisição desses medicamentos está relacionada a famílias de níveis socioeconômicos mais elevados. As diferenças encontradas podem representar diferentes níveis tanto de acesso aos serviços médicos de diagnóstico e tratamento quanto aos próprios medicamentos. O orçamento das famílias brasileiras não parece mostrar remanejamento de recursos em função da compra de psicotrópicos. Se a mudança epidemiológica, em sua primeira etapa, representou a transição das doenças infecciosas para as doenças crônicas não transmissíveis, o quadro que pode representar o futuro seriam as doenças neurodegenerativas, mantidas as tendências de aumento da expectativa de vida. / Introduction: over the past four decades the use of psychotropic drugs increased its relevancy to the lives of millions of people. The direct and indirect costs associated to psychotropics are usually unknown. Economic aspects of psychotropic medicine have been studied in other countries, although such information is still scarce in Brazil. A data source for studies about household expenditure and health care costs is the Survey on Household Budgets. Objectives: to draw a profile of Brazilian people that acquire psychotropic drugs, as well as evaluate spends with these medicine and its impacts on the Brazilian household budget on the recent years. Methods: a cross-sectional study, with data used are from the Survey on Household Budgets from 2002-2003 and from 2008-2009, which involved interviews of a complex sample made of 48,470 households on 2003, 128,300 people and 55.970 homes in 2009. Poisson multilevel regression models with robust variance were made by SAS/SUDAAN 10.0.1. All income and spends were adjusted to a monthly basis and indexed by inflation. Results: the prevalence of psychotropics acquisition in the Brazilian population in 2008-2009 was of 5.2% (CI95%=5.0-5.5), resulting in an annual expenditure of R$507 millions. The use of psychotropic drugs was more frequent among women, white people, older people, do not co-habit with a spouse or partner, more schooled and wealthier. Individuals that spent with psycotropics had more 11 spends with health insurance (PR=1.40, CI95%: 1.30-1.50) and medical consults (PR=2.51, CI95%: 2.32-2.72). The average monthly spends with psychotropics per household increased from R$54.38 in 2003 to R$78.73 in 2009, with values indexed by inflation. Among the households that did not purchase psychotropics, the average monthly per capita income was of R$1,026.73 and the monthly per capita spends were, in average, of R$73.92 with health care, R$103.17 with food and R$12.77 with leisure. Among the household that presented expenditure with psychotropics, the average monthly per capita income was of R$1,154.40 and its average monthly per capita spends were of R$210.38 with health care, R$162.087 with food and R$15.45 with leisure. Conclusion: there was an above inflation increase in the psychotropic drugs spends between the evaluated years. The psychotropics acquisition relates to higher socio-economic leveled families. The differences that were found may represent different levels of access to medical diagnose and treatment and to medication. The Brazilian household budgets do not seem to re-adequate resources to meet the purchase of psychotropics. If the epidemiologic change, at its first stage, represented the transition from infectious diseases to non-transmissive chronic illnesses. the picture that can represent the future would be the neurodegenerative diseases, if the trend of increasing life expectancy is kept.