Jisha M Lucca

Psychotropic medication-induced sexual dysfunction and its interference with patient's daily performance: a cross-sectional study

Objectives There are very few studies, especially in the Indian population, addressing the frequency of sexual dysfunction due to psychotropic medications. Therefore, this study aimed to quantify the frequency of sexual dysfunction and its interference in the patients′ daily performance in a hospital-based population taking psychotropic medications. Materials and methods This cross-sectional study was conducted in the psychiatric unit of a Tertiary Care Teaching Hospital in South India over a period of 2 years. The Udvalg for Kliniske Undersogelser side effect rating scale was used to determine sexual dysfunction. A global assessment of interference in daily performance due to side effects was also evaluated. Results The overall incidence of sexual dysfunction was 20.95%. A higher incidence of sexual dysfunction was observed in women [n = 56 (70.88%)] and in the age group 18-29 years [n = 30 (37.9%)]. Amenorrhea [n = 32 (38.5%)] was the most prominently observed sexual dysfunction, followed by galactorrhea [n = 15 (18.07%)] and decreased sexual desire [n = 14 (16.86%)]. Antipsychotics [n = 54 (65.06%)] constituted the most common class of drug implicated in sexual dysfunction, followed by antidepressants [n = 25 (30.12%)]. Withdrawal of the drug [n = 58 (42%)] was the most common intervention for the management of sexual dysfunction. The majority of reports rated interference in daily performance due to side effects as severe [n = 48 (60.75%)], followed by moderate [n = 26 (32.91%)]. Conclusion The incidence rate of sexual dysfunction was 20.95%. Amenorrhea and galactorrhea were the two most prominent sexual dysfunctions affecting the patients with psychotropic medications. Thus it is important for all healthcare professionals to acknowledge and encourage discussion as well as the impact of drugs on sexual function.

Incidence and factors associated with medication nonadherence in patients with mental illness: A cross-sectional study

Background: In spite of the progress made in the treatment of psychiatric disorders during the last few decades, nonadherence continues to be a frequent phenomenon, often associated with potentially severe clinical consequences and increased health-care costs. There are numerous factors associated with medication nonadherence in patients with mental illness. The aim of the study was to determine the incidence and factors associated with medication nonadherence among psychiatric outpatients. Materials and Methods: A cross-sectional study was carried out in the outpatient psychiatric department of an Indian tertiary care private hospital over a period of 1 year. Patients aged 18 years and above who presented with mental illness as diagnosed by the International Classification of Diseases (ICD)-10 and who were receiving at least one psychotropic medication for at least 1 month were included in the study. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). Results: Of the 400 patients, 172 (43%) were nonadherent to their prescribed medications. There is a statistically significant association between the education (P = 0.001), number of drugs (P = 0.002), family income (P = 0.013), and nonadherence. Among the 172 patients, 33.5 % were nonadherent to their therapy due to patient-related factors followed by drug-related factors (32%) and disease-related factors (31%). Conclusion: The overall incidence of medication nonadherence in patients with mental illness was 43%. Numerous factors contributed to medication nonadherence. Strategies need to be developed and implemented to enhance medication adherence, and thereby achieve a better therapeutic outcome in patients with mental illness.

An adverse drug interaction of haloperidol with levodopa

Drug interactions are known to play a significant role in the incidence of adverse drug reactions (ADRs) both in the community and in hospitals. Both the newer atypical antipsychotics and their more traditional counterparts are subject to drug — drug interactions amongst themselves, with other psychotropics, and with the agents used in the treatment of various physical ailments. The most common interactions encountered in clinical practice are pharmacodynamic in nature. It is well established that antipsychotic drugs reduce the efficacy of levodopa in parkinsons disease by blockade of dopamine receptors in the corpus striatum. The case reported here illustrates a common pharmacodynamic drug interaction of haloperidol with levodopa in a 60-year-old female patient.

Identification and management of adverse effects of antipsychotics in a tertiary care teaching hospital

Objective: Antipsychotics have revolutionized psychiatry by allowing significant numbers of patients in long-term hospital settings to be discharged and successfully maintained in the community. However, these medications are also associated with a range of adverse events ranging from mostly annoying to rarely dangerous. This study is carried out to identify the adverse drug reactions (ADRs) to antipsychotics and its management in psychiatric patients. Methods: Prospective interventional study was conducted in the psychiatric unit of a tertiary care hospital. Patients of any age and either sex prescribed with at least one antipsychotic were included and monitored for ADRs. Findings: Among the 517 patients receiving antipsychotics, a total of 289 ADRs were identified from 217 patients at an overall incidence rate of 41.97%. Sixty-seven different kinds of ADRs were observed in the study patients. Central and peripheral nervous system was the most commonly affected system organ class (n = 59) and weight gain (n = 30) was the most commonly observed ADR. Olanzapine was most commonly implicated in reported ADRs (n = 92) followed by risperidone (n = 59). Of the 289 ADRs, 80% required interventions including cessation of drug and/or specific/symptomatic/nonpharmacological treatment. Conclusion: This post marketing surveillance study provides a representative data of the ADR profile of the antipsychotics likely to be encountered in psychiatric patients in an Indian tertiary care hospital.

Incidence and predictors of adverse drug reactions caused by drug-drug interactions in psychiatric patients: An empirical study

Introduction: Potential drug-drug interactions (pDDIs) are very frequent in psychiatric practice and result in poor tolerability or reduced efficacy, or both, which can negatively impact patient outcomes. Clinically significant drug-drug interactions (DDIs) are the ones that can result in changes in the therapeutic effect of one of the two drugs, that is, adverse drug reactions (ADRs). The aim of this study was to identify the incidence and pattern of ADRs occurring as results of DDIs in patients with mental illness. Materials and Methods: This empirical study reviewed all the patients with a psychiatric diagnosis as per the Tenth Revision of the International Classification of Diseases (ICD-10) and received at least two medications. DDIs were identified using drug interaction software/databases, standard textbooks, and references. Result: A total of 122 ADRs were identified from 97 patients. The majority [n = 98 (68.5%)] of the DDIs involved pharmacodynamic interactions. Risperidone (41 occurrences) exhibited the greatest propensity to interact with other medications, and the most commonly observed ADR was extrapyramidal symptoms (EPS) (n = 33). More than half of the ADRs were “possible” in their causal relationship. Conclusion: The incidence of ADRs caused by DDIs in this study was 12%. Pharmacodynamic interactions accounted for the majority (68.5%) of ADRs. ADRs are an important cause of the increased burden of disease and unnecessary health-care expenditure. Intense monitoring of psychiatric patients for any DDI, and early detection and prevention of the same may result in improved therapeutic outcomes and decreased unnecessary health-care expenditure.

A Case Report of Isotretinoin-induced Manic Psychosis.

Isotretinoin, an oral vitamin A derivative, used to treat severe treatment-resistant acne. Psychiatric side effects of isotretinoin particularly depression and suicidal thoughts have been well documented. We report a case of isotretinoin-induced manic psychosis in a young female without a family history and history of mental illness.

A prospective observational study to evaluate safety reporting of antidepressants at a tertiary care hospital in India

Objective: This prospective observational study was carried out to identify the prevalence and Severity of ADRs of antidepressant in a tertiary care teaching hospital. Materials and Methods: Patients prescribed with at least one antidepressant were randomly selected and monitored for adverse drug reactions (ADRs), irrespective of their age and gender. Results: Of the 401 patients who received antidepressants, 170 patients (42.39%) experienced 204 ADRs. Selective serotonin receptor inhibitors (SSRIs) [110 (53.92)] was the most common therapeutic class of drugs associated with ADRs. Gastrointestinal system [54 (26.47)] was most commonly affected system organ class. Dry mouth (n = 30) and diaphoresis (n = 21) were the most frequently reported ADRs. As assessed by the World Health organization (WHO) probability scale, 61% of the ADRs were ‘probable’ causality. Among all the ADRs, 22.54% (46) were preventable. Majority of the ADRs [(n = 184) 90.17%] were ‘mild’ in their severity. Conclusion: In this study, incidence of adverse reaction to antidepressants was 42.3% were the most comman SSRI inplicated drug group for the ADRs.

Lorazepam-induced diplopia

Diplopia – seeing double – is a symptom with many potential causes, both neurological and ophthalmological. Benzodiazepine induced ocular side-effects are rarely reported. Lorazepam is one of the commonly used benzodiazepine in psychiatric practice. Visual problems associated with administration of lorazepam are rarely reported and the frequency of occurrence is not established. We report a rare case of lorazepam-induced diplopia in a newly diagnosed case of obsessive compulsive disorder.

Economic impact and severity of adverse drug reactions in patients with mental illness: A prospective observational study

INTRODUCTION: Psychotropic medications are the mainstay in the management of psychiatric disorders but they are not devoid of side effects. The occurrence of adverse drug reactions (ADRs) in Indian psychiatry populace varies from 5.9% to 45%. The cost associated with the management of ADRs in general settings ranges from Rs. 412.76 to 1080/- per ADR. MATERIALS AND METHODS: A prospective observational study was conducted for a period of 1 year. The ADRs were assessed for causality by the World Health Organization probability scale and severity by modified Hartwig and Siegel scale. The direct costs in the management of ADRs were calculated. RESULTS: A total of 494 ADRs were reported and evaluated from 300 patients. Of the total reported ADRs, 3.44% (n = 17) lead to hospital admissions and 2.83% (n = 14) prolonged the hospital stay. The gastrointestinal system 25.10% (n = 125) and central and peripheral nervous system 20.64% (n = 102) were the most common system organ class affected by ADRs. The drug classes mainly implicated with ADRs were antipsychotics 53.03% (n = 262) and antidepressants 23.88% (n = 118). Majority (24.29%) of the reactions that lead to cost impact was moderate in severity. Total cost incurred for the management of 131 reported ADRs was Rs. 57,891.33/- with an average cost of Rs. 117.18/- per ADR. CONCLUSION: In 131 cost impact ADRs, 114 patients had a cost impact of Rs. 57,891.33/- A directly proportionate relationship was observed between the severity and cost incurred for the management of ADRs. Hence, it is necessary to identify and prevent these reactions as they cause burden to the patients.