There is an increasing interest in how therapeutic drugs could alter the human gut microbiota composition and function. While some knowledge is accumulating on the antimicrobial impact of some psychotropics on isolated strains or the gut microbiota of animal models, information about other classes of psychotropics and representative species from the human gut is poorly investigated. The antimicrobial effect of psychotropic drugs is usually neglected as a confounding factor when investigating gut microbiome biomarkers, knowing that patients are generally put in long-term medication. The purpose of the present study was to investigate (in vitro and ex-vivo) the antimicrobial activity of some oral commonly prescribed psychotropics from different therapeutic classes on colonic microbiota diversity and metabolism and the potential capacity of probiotics to alleviate related dysbiosis. The findings of this study revealed an important in vitro inhibitory activity of psychotropic drugs, which were also expressed as drastic alterations in gut microbiota composition ex-vivo. Indeed, the relative abundances of Firmicutes and Actinobacteria were lowered while the Proteobacteria population was increased. Families of Lachnospiraceae, Lactobacillaceae, and Erysipelotrichaceae were also declined by psychotropics (aripiprazole) treatment. These microbial changes were translated into a decrease of the major SCFA (butyrate, acetate, and propionate) at the metabolic level. The addition of a probiotic combination (Lactobacillus rhamnosus and Bifidobacterium longum) concomitantly with a psychotropic (aripiprazole) had a protective effect by attenuating the decline of microbiota composition and increasing the concentrations of SCFA. These findings provide evidence that psychotropics, through their antimicrobial effect, have the potential to alter the human gut microbiota composition and metabolism, while probiotics can mitigate the related dysbiosis.

Dementia, a clinical condition that affects the psychological ability of patients, is distinguished by a significant overall decline in cognitive function that results in distorted perception. Guiding nursing practice in the long-term care (LTC) setting to decrease the unnecessary use of psychotropics is critical because doing so relates to the patients' quality of life and safety. In the LTC facility that served as the practicum site for this study, there was an observed overuse of psychotropic medications in the care of patients with dementia. The practice-focused question guiding this project asked whether a nursing staff development program would decrease the use of psychotropics in dementia patients. The purpose of the project was to inform nursing staff through an educational program on alternative methods to use when dementia patients exhibit increased disturbing behaviors. The conceptual framework for the project was the knowledge-to-action model. The nursing staff development program had a positive effect on the nursing staff as evidenced by a statistically significant improvement in knowledge and attitudes about the use of psychotropics in caring for dementia patients. The use of psychotropic in the dementia patient decreased from 22.32% to 15.77%, the lowest score achieved by the organization in 5 years. The dementia patients benefited from this project and its positive social change implications for nursing practice by decreasing dementia patients use of psychotropics, minimizing their side effects to the patients and providing an overall feeling of well-being.

Les résidus d'antibiotiques et de psychotropes sont déversés dans l'environnement, en conséquence d'une utilisation massive et souvent inadaptée de ces substances dans les domaines médicaux et vétérinaires et d’une métabolisation incomplète dans l’organisme. Les eaux de surface et les eaux souterraines sont les réceptacles majeurs de ces polluants et représentent également les sources d'eau utilisées pour la consommation humaine. Notre recherche s’est focalisée sur la phototransformation et l’oxydation par le chlore et le peroxyde d’hydrogène de quatre composés : deux antibiotiques et deux psychotropes : sulfaméthazine, sulfaméthoxypyridazine, amitriptyline et clomipramine). Ces deux derniers processus sont utilisés fréquemment dans les filières de traitement de l’eau.D’abord, une étude cinétique nous a permis à déterminer des constantes cinétiques. Pour chaque composé, une dégradation plus ou moins rapide a été observée suivant le procédé de photolyse ou d’oxydation employé. L’étude cinétique a été appliquée également sur des eaux naturelles pour prévoir le devenir des composés pharmaceutiques et estimer leur dégradation après photoréaction et chloration. Puis, de nombreux sous produits de chloration et de photolyse ont été identifiés par LC/MS/MS et des mécanismes réactionnels ont été proposés. / Antibiotics and psychiatrics residues are dumped into the environment due to their massive and inappropriate use in human and veterinary medicine either to an incomplete metabolism into organism. Surface waters and ground waters are the major receptacles of these pollutants and also represent sources of water used for human consumption. This study was specifically focused on photolysis of four pharmaceuticals compounds: two antibiotics and two psychiatrics (sulfamethazine, sulfamethoxypyridazine, amitriptyline and clomipramine) also on their oxidation by chlorine and hydroxyl radicals, two processes mainly used in water treatment.First, kinetic studies were conducted and rate constants were determined. For each pharmaceutical, different rates of degradation were observed depending on photolysis or oxidation process. To better assess pharmaceutical removal under water treatment conditions, an estimation of pharmaceutical removal in natural water was undertaken. Secondly, several degradation products formed during chlorination and photolysis were identified by LC/MS/MS and degradation pathways were proposed

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Ancorado nas discussões teóricas acerca do tema da medicalização e nas pesquisas brasileiras que apontam para o aumento, no país, do consumo do psicofármaco comercialmente chamado Ritalina®, este trabalho tem como objetivo refletir sobre o papel atribuído a esse fármaco na forma como seus consumidores compreendem e constroem a si mesmos, especialmente no que tange à crença cultural no auto-aperfeiçoamento. Os dados empíricos que embasam a discussão aqui proposta foram produzidos através de entrevistas com pessoas que utilizavam a medicação e também por meio da análise do material de divulgação da Ritalina®, que é voltado ao público especializado. Busca ressaltar, assim, a importância de pesquisas sobre a imaginação farmacêutica relacionada a esse medicamento, no que se refere à existência de discursos que destacam valores a respeito de desempenho, concentração e controle. Por fim, são apresentadas justificativas e práticas de utilização que perpassam questões acerca da normalização, tratamento e melhorias de si, bem como se problematiza a existência da categoria de aprimoramento intitulada aprimoramento circunstancial. / Based on theoretical discussions about medicalization and on Brazilian researches that point out to an increase in the consumption of the psychotropic medication commercially known as Ritalin®, the present work aims to reflect on the role accredited to this drug in the way its consumers comprehend and construct themselves, especially regarding a cultural believe in self-enhancement. The empirical data that support the presented discussion was gathered through interviews conducted with people that have used the medication, and also through an analysis of Ritalin’s® advertising material directed to an audience of specialists. Thus, it aspires to call attention to the importance of researches on pharmaceutical imagination, as regards the existence of speeches that highlight values regarding performance, concentration and control. Finally, it presents usages justifications and practices that engage issues regarding normalization, treatment and self - improvement, and at the same time it problematizes the existence of an enhancement category termed as circumstantial enhancement.

Ancorado nas discussões teóricas acerca do tema da medicalização e nas pesquisas brasileiras que apontam para o aumento, no país, do consumo do psicofármaco comercialmente chamado Ritalina®, este trabalho tem como objetivo refletir sobre o papel atribuído a esse fármaco na forma como seus consumidores compreendem e constroem a si mesmos, especialmente no que tange à crença cultural no auto-aperfeiçoamento. Os dados empíricos que embasam a discussão aqui proposta foram produzidos através de entrevistas com pessoas que utilizavam a medicação e também por meio da análise do material de divulgação da Ritalina®, que é voltado ao público especializado. Busca ressaltar, assim, a importância de pesquisas sobre a imaginação farmacêutica relacionada a esse medicamento, no que se refere à existência de discursos que destacam valores a respeito de desempenho, concentração e controle. Por fim, são apresentadas justificativas e práticas de utilização que perpassam questões acerca da normalização, tratamento e melhorias de si, bem como se problematiza a existência da categoria de aprimoramento intitulada aprimoramento circunstancial. / Based on theoretical discussions about medicalization and on Brazilian researches that point out to an increase in the consumption of the psychotropic medication commercially known as Ritalin®, the present work aims to reflect on the role accredited to this drug in the way its consumers comprehend and construct themselves, especially regarding a cultural believe in self-enhancement. The empirical data that support the presented discussion was gathered through interviews conducted with people that have used the medication, and also through an analysis of Ritalin’s® advertising material directed to an audience of specialists. Thus, it aspires to call attention to the importance of researches on pharmaceutical imagination, as regards the existence of speeches that highlight values regarding performance, concentration and control. Finally, it presents usages justifications and practices that engage issues regarding normalization, treatment and self - improvement, and at the same time it problematizes the existence of an enhancement category termed as circumstantial enhancement.

Être professionnel peut nécessiter de trouver de l’énergie sans limite et de remédier aux manquements de la gestion. Les produits stimulants, calmants, antidépresseurs, etc., peuvent y contribuer. Cette thèse s’intéresse à ces dynamiques complexes. A partir d’une revue de littérature et d’un dispositif de recherche-action clinique, elle contribue à la connaissance des interrelations entre l’activité, la santé et les drogues. Elle montre l’existence d’usages fonctionnels multiples irréductibles à l’idée de maladie ou de dangerosité. Elle observe que la prévention officielle masque le réel et organise l’ignorance sur le rôle de l’organisation du travail dans le recours aux psychotropes. Les chiffres sur les troubles de santé des actifs et sur leurs consommations de psychotropes imposent de renouveler le management du travail et de la prévention. Nous proposons de déplacer la prévention des addictions vers l’analyse du travail et l’étude de l’usage des drogues comme un système d’activités de préservation et de reconnaissance de soi. / Being a professional may require unlimited energy and to remedy management shortcomings. Stimulants, anxiolytics, antidepressants, etc., can contribute to this. This Phd thesis deals with these complex dynamics. Based on a review of the scientist literature and a clinical research-action, it contributes to the knowledge of the interrelations between activity, health and psychotropic products. The thesis shows the existence of different functional uses irreducible to the idea of disease or dangerousness. It observes that official prevention masks reality and organizes ignorance about the role of work organization in the use of psychotropics. The figures on the health problems of the active population and on their consumption of psychotropic products require the renewal of management and prevention. We propose to shift the prevention of addictions towards labor analysis and psychotropics' use study as a system of preservation and self-recognition activities.

Ancorado nas discussões teóricas acerca do tema da medicalização e nas pesquisas brasileiras que apontam para o aumento, no país, do consumo do psicofármaco comercialmente chamado Ritalina®, este trabalho tem como objetivo refletir sobre o papel atribuído a esse fármaco na forma como seus consumidores compreendem e constroem a si mesmos, especialmente no que tange à crença cultural no auto-aperfeiçoamento. Os dados empíricos que embasam a discussão aqui proposta foram produzidos através de entrevistas com pessoas que utilizavam a medicação e também por meio da análise do material de divulgação da Ritalina®, que é voltado ao público especializado. Busca ressaltar, assim, a importância de pesquisas sobre a imaginação farmacêutica relacionada a esse medicamento, no que se refere à existência de discursos que destacam valores a respeito de desempenho, concentração e controle. Por fim, são apresentadas justificativas e práticas de utilização que perpassam questões acerca da normalização, tratamento e melhorias de si, bem como se problematiza a existência da categoria de aprimoramento intitulada aprimoramento circunstancial. / Based on theoretical discussions about medicalization and on Brazilian researches that point out to an increase in the consumption of the psychotropic medication commercially known as Ritalin®, the present work aims to reflect on the role accredited to this drug in the way its consumers comprehend and construct themselves, especially regarding a cultural believe in self-enhancement. The empirical data that support the presented discussion was gathered through interviews conducted with people that have used the medication, and also through an analysis of Ritalin’s® advertising material directed to an audience of specialists. Thus, it aspires to call attention to the importance of researches on pharmaceutical imagination, as regards the existence of speeches that highlight values regarding performance, concentration and control. Finally, it presents usages justifications and practices that engage issues regarding normalization, treatment and self - improvement, and at the same time it problematizes the existence of an enhancement category termed as circumstantial enhancement.

No contexto atual do tratamento da psicose, há uma ênfase em prol da utilização, quase exclusiva, de psicofármacos. Desse modo, apontamos para a importância de se considerar as repercussões desse uso de forma abusiva no processo de amadurecimento desse sujeito. Para tanto, a presente pesquisa bibliográfica utilizou as bases de dados do Scielo, NCBI, Fiocruz, Anvisa e OMS; além de bibliotecas online de universidades e de instituições psicanalíticas. Para as buscas, utilizamos descritores como: tratamento da psicose, processo de amadurecimento de Winnicott e uso excessivo de psicofármacos. Partimos da constituição e evolução do saber psiquiátrico e psicanalítico acerca da loucura. Em seguida, baseada na teoria do processo de amadurecimento do sujeito de Winnicott, é apresentado o panorama dessa teoria, de modo a fundamentar de que forma a medicação pode interferir nesse processo. Por fim, são discutidas as propostas de tratamento psicanalítico e psiquiátrico da psicose, dando destaque às consequências do uso abusivo dos medicamentos. Nesse sentido, o presente estudo aponta para a importância para uma prática ética dos profissionais que atuam com essa especificidade clínica. Além disso, ressaltamos o aspecto fundamental do uso comedido do psicofármaco para que ele possa auxiliar o sujeito na retomada desse processo. / In the current context of the treatment of psychosis, there is an emphasis in favor of use, almost exclusively, of psychotropic drugs. In this way, we have pointed out the importance of considering the impact of this abusive use in the ripening process of this subject. For both, the present research used the bibliographic data bases of the Scielo, NCBI, Fiocruz, Anvisa and WHO; in addition to online libraries of universities and psychoanalytics institutions. For the searches, we used descriptors such as: treatment of psychosis, ripening process of Winnicott and excessive use of psychotropic drugs. We depart from the constitution and evolution of psychiatric knowledge and psychoanalytic about insanity. Then, based on the theory of the maturation process of the subject of Winnicott, is presented the panorama of this theory, in order to substantiate that form the medications can interfere in this process. Finally, are discussed the proposals of psychoanalytic and psychiatric treatment of psychosis, highlighting the consequences of improper use of medicines. In this regard, the present study points to the importance for an ethical practice of professionals who works with this clinical specificity. In addition, we emphasize the fundamental aspect of cautious use of psychotropic drugs for which he may assist the subject in the resumption of the process.

Abstract The elderly use drugs more commonly than younger persons. Many studies about drug use have concentrated on institutionalized elders. Knowledge of drug use by the oldest old, aged 85 years or over, is scant. Psychotropics are among the drugs most commonly used by the elderly. Psychotropics have many adverse effects, such as balance impairment, sedation, reduced cognition, depression, and extrapyramidal symptoms. We do not know the extent of sedative drug use, including psychotropics and drugs prescribed for somatic disorders that have sedative properties. Withdrawal of unnecessary drugs appears to be beneficial and to improve the functional capacities of the elderly. The aim of this study was to describe the changes in prescription drug use, polypharmacy, and psychotropic use among home-dwelling elderly Finns in the 1990s by using two cross-sectional community surveys. The specific aim was to classify all drugs used in Finland into four groups based on their sedative properties. Drug use, polypharmacy, and, to some extent, psychotropic use increased within a decade. The oldest old used prescription drugs most commonly. Polypharmacy was independently associated with higher age, and in 1998-99, with at least 3 chronic diseases, poor self-perceived health, and the use of home nursing services. Most psychotropic users were on regular medication. The use of hypnotics and antidepressants increased most. Persons with polypharmacy used significantly more commonly psychotropics compared to other people. Over 84-year-olds used psychotropics more commonly than younger persons. Sedative use was common, as 40 % of drug users used them. Sedative use was significantly more common among persons with polypharmacy than others. According to logistic regression models, the use of many sedatives was independently associated with age 80 years or over, female gender, chronic morbidity, smoking, poor self-perceived health/life satisfaction, and the use of home nursing. Both polypharmacy and abundant sedative use were associated with impaired physical functional abilities. Prescribers need to be aware of the increasing polypharmacy and abundant sedative use. Regular assessment of indications is needed to avoid overuse of drugs. Geriatric knowledge is needed to support health centers and specialized units in this demanding task.