New antipsychotics continuously arrive on the market, which thereby influences the approved and off-label prescribing (OLP) schemes. We aimed to identify the recent trends in the OLP of ...antipsychotics. We conducted a literature review based on three different populations: adult, pediatric, and elderly patients.
A literature search was performed in the PubMed and ScienceDirect databases using the following keyword algorithm: "offlabel" AND ("antipsychotic*" OR "neuroleptic*"). The period investigated ranged from January 2000 to January 2015. Only Englishwritten pharmacoepidemiological studies were included.
Seventy-seven relevant results were identified. Among adults, OLP consisted of 40 to 75% of all antipsychotic prescriptions. The main indications were mood disorders, anxiety disorders, insomnia and agitation. Quetiapine was the most frequently prescribed offlabel antipsychotic, especially for anxiety and insomnia. Among children, OLP was estimated between 36 and 93.2% of all antipsychotic prescriptions. Risperidone and aripiprazole were primarily used and were most often prescribed for attention deficit hyperactivity disorder, anxiety, or mood disorders. Among elderly individuals, OLP consisted of 22 to 86% of all antipsychotic prescriptions. Antipsychotic OLP was particularly frequent for agitation; however, a recent decrease in this OLP was identified.
Antipsychotics have largely been prescribed off-label in recent years. The types of antipsychotic OLP practices differ according to the age category of patients. OLP is often used in cases of therapeutic dead-ends or for specific disorders with few or no currently approved medications. However, other OLP practices only reflect temporary prescription trends for mild symptoms, which may induce safety concerns.
Depressive syndromes are frequent and heterogeneous brain conditions with more than 90% of patients suffering from sleep complaints. Better characterizing this “sleep” domain may allow to both better ...treat acute episodes with existing chronotherapeutics, but also to prevent the manifestation or recurrences of mood disorders. This work aims to i) review theoretical and fundamental data of chronotherapeutics, and ii) provide practical recommendations. Light therapy (LT) can be used as a first-line monotherapy of moderate to severe depression of all subtypes. LT can be also used as a combination with antidepressant to maximize patients’ response rates, which has a clear superiority to antidepressant alone. Sleep deprivation (SD) is a rapid and powerful chronotherapeutic with antidepressant responses within hours in 45-60% of patients with unipolar or bipolar depression. Different strategies should be combined to stabilize the SD antidepressant effect, including concomitant medications, repeated SD, combination with sleep phase advance and/or LT (triple chronotherapy). Melatonin treatment is of interest in remitted patients with mood disorder to prevent relapses or recurrences, if a complaint of insomnia, poor sleep quality or phase delay syndrome is associated. During the acute phase, melatonin could be used as an adjuvant treatment for symptoms of insomnia associated with depression. The cognitive behavioral therapy for insomnia (CBT-I) can be recommend to treat insomnia during euthymic phases. The Interpersonal and social rhythm therapy (IPSRT) is indicated for the acute treatment of bipolar depression and for the prevention of mood episodes. Chronotherapeutics should always be associated with behavioral measures for healthy sleep.
•Light therapy is recommended as a first-line monotherapy for all depression subtypes.•Sleep deprivation has a rapid action stabilized with triple chronotherapy.•Melatonin use in case of insomnia, poor sleep quality or phase delay syndrome.•IPSRT and CBTI-BP as preventive strategies for both depressive and manic episodes.•IPSRT is also recommended in acute depressive bipolar depression.
Increasing evidence suggest a bidirectional link between disrupted circadian rhythms and alcohol use disorders (AUD). A better understanding of these alcohol-induced changes in circadian rhythms will ...likely provide important therapeutic solutions. We conducted a systematic review based on the PubMed database examining biological rhythms in all stages of alcohol use: acute alcohol consumption, AUD, alcohol withdrawal, and abstinence. Different changes in circadian rhythms have been observed after a single acute alcohol intake, but also during AUD and alcohol withdrawal. Following a single acute alcohol intake, changes in biological rhythms are dose-dependent, reflected in the melatonin and cortisol secretions, and the core body temperature (CBT) rhythms. These alterations normalize the next morning and appear mostly for acute alcohol intake higher than 0.5 g/kg. These alterations are more severe during AUD and persist over time. In addition, interestingly, opposite patterns of the melatonin physiological ratio between diurnal and nocturnal secretion (N/D ratio < 1) have been observed during AUD and appear to be a marker of chronic daily use. During alcohol withdrawal, circadian rhythms desynchronization correlates with the severity of alcohol withdrawal symptoms and withdrawal complications such as delirium tremens. During abstinence a resynchronization of circadian rhythms of cortisol and CBT appears in most patients about 1 month after alcohol withdrawal. Disruption of melatonin circadian rhythms can persist after 3–12 weeks of abstinence. The circadian genetic vulnerability associated with biological rhythms alterations in alcohol use disorders increases the risk of relapses. Circadian-based interventions could play a critical role in preventing and treating AUD.
•Following a single acute alcohol intake, circadian rhythm changes appear and are transient and dose-dependent•A reverse Nocturnal/Diurnal melatonin ratio seems to be specifically related to alcohol use disorder.•A continuum of circadian rhythm alterations induced by alcohol goes from healthy individuals, to HAD, and AUD.•During alcohol withdrawal, circadian rhythms desynchronization is a marker of the severity of withdrawal symptoms.•For most individuals, circadian rhythms resynchronize within about 2 to 3 weeks of abstinence except for melatonin levels.
Although light therapy (LT) has been shown to be efficient in the treatment of seasonal and non-seasonal depression, it is underused in clinical settings and antidepressant drugs (AD) remain so far ...the usual first line treatment. The aim of this systematic review and weighted random effect meta-analysis is to examine the randomized controlled trials that compared directly light therapy and antidepressant drugs, as well as their combination (LT + AD). A total of 397 participants were included, with a moderate to severe major depressive episode, from seven independent populations. The median duration of intervention was 5 wks (range 2–8 wks). The superiority (lower depression score) of LT + Placebo compared to AD + Placebo was non-significant (SMD = 0.19 −0.08–0.45; p = 0.17). The combination LT + AD was superior to AD + Placebo (SMD = 0.56 0.24–0.88; p < 0.001). This superiority was confirmed in the subgroup of patients with non-seasonal depression (SMD = 0.55 0.16–0.93; p = 0.005). Meta-analyses showed no or small heterogeneity between studies (I2 = 0%, 18.41%, and 39.23% respectively). No potential publication biases were observed by statistical tests and visual inspection of the funnel plots. No differences were observed between LT and AD, with a clear superiority of the combination, thus both LT monotherapy and combination may be proposed as a first line treatment in seasonal and non-seasonal depression.
In the context of global warming, new terms emerged in the global media and in the psychology field to embody the negative feelings which come along with climate change such as 'eco-anxiety' or ...'solastalgia'. The pathological character of these emotions is denied although medical opinion is often required for helping people to handle them. Also, no proper medical framework in the field exists to study and care for these patients.
In this narrative review, we aim to (1) analyse the concept of eco-anxiety by focusing on its history and developed concepts, (2) summarize the different scales built to assess eco-anxiety and (3) propose a new medical framework.
We came out with a framework based on the transformation of a physiological adaptative behaviour the 'eco-distress'. It is composed of three dimensions: eco-anger, eco-grief and eco-worry, it is not debilitating in daily life and promotes coping strategies such as management of negative emotions and pro-environmental behaviours (PEB). It can transform itself into a pathological state, the 'ecolalgia', composed of two core dimensions: eco-anxiety and eco-depression, leading to functional impairment and decrease in PEB. If ecolalgia maintains over 15 days, we propose to consider it as a full psychiatric disorder needing medical advice.
This new framework enables a novel approach that is necessary for the improved management of mental health issues related to climate change.
Background
Interest in biological clock pathways in bipolar disorders (BD) continues to grow, but there has yet to be an audit of circadian measurement tools for use in BD research and practice.
...Procedure
The International Society for Bipolar Disorders Chronobiology Task Force conducted a critical integrative review of circadian methods that have real‐world applicability. Consensus discussion led to the selection of three domains to review—melatonin assessment, actigraphy, and self‐report.
Results
Measurement approaches used to quantify circadian function in BD are described in sufficient detail for researchers and clinicians to make pragmatic decisions about their use. A novel integration of the measurement literature is offered in the form of a provisional taxonomy distinguishing between circadian measures (the instruments and methods used to quantify circadian function, such as dim light melatonin onset) and circadian constructs (the biobehavioral processes to be measured, such as circadian phase).
Conclusions
Circadian variables are an important target of measurement in clinical practice and biomarker research. To improve reproducibility and clinical application of circadian constructs, an informed systematic approach to measurement is required. We trust that this review will decrease ambiguity in the literature and support theory‐based consideration of measurement options.
The lack of comprehensive data on the association between psychiatric and substance use disorders and habitual sleep duration represents a major health information gap. This study examines the ...12-month prevalence of mental disorders stratified by duration of sleep. Data were drawn from face-to-face interviews conducted in the National Epidemiologic Survey on Alcohol and Related Conditions III, a nationally representative survey of US adults (N = 36,309). There were 1893 (5.26%) participants who reported <5h of sleep/night; 2434(6.76%) 5 h/night; 7621(21.17%) 6 h/night; 9620(26.72%) 7 h/night; 11,186(31.07%) 8 h/night, and 3245(9.01%) ≥9 h/night. A U-shaped association was observed between sleep duration and all mental disorders. The prevalence of mental disorders was 55% for individuals with <5 h/night and 47.81% for ≥9 h/night, versus 28.24% for the 7 h/night (aOR = 1.90 and 1.39 respectively). The greatest odds ratios were for the <5 h/night group, with an increased risk above 3-fold for panic disorder (PD), post-traumatic stress disorder (PTSD), psychotic disorder, and suicide attempt; between 2 and 3 fold for major depressive disorder (MDD), bipolar disorder (BD), and generalized anxiety disorder (GAD); and between 1 and 2 fold for tobacco and drug use disorders, specific and social phobias. The ≥9 h/night group had an increased risk above 1 to 2-fold regarding tobacco and drug use disorders, MDD, BD, PD, social phobia, GAD, PTSD, psychotic disorder, and suicide attempt. U-shaped associations exist between sleep duration and mental disorders, calling for respect to recommendations for adequate sleep duration in routine clinical care as well as to actions for primary prevention in public health settings.
•This study present nationally representative data on the prevalence of mental disorders stratified by duration of sleep.•A U-shaped association was observed between sleep duration and all psychiatric and substance use disorders.•Highest risks, exceeding a 3-fold increase for some mental disorders, were observed for short sleepers, especially for the <5h/night group.•Adequate sleep duration may have general clinical benefits, calling for actions for primary prevention in public health settings.
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