BACKGROUND: Antipsychotic and other psychotropic medication use is prevalent among community-dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care (\"the Partnership\") and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.
METHODS: Among community-dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010-2017 Medicare fee-for-service claims using interrupted time series analyses across three periods (\"Pre-Partnership\": July 1, 2010 to March 31, 2012; \"Post-Partnership\": April 1, 2012 to January 31, 2015; \"Five Star Quality Rating\": February 1, 2015 to December 31, 2017).
RESULTS: We included 1,289,401 community dwellers with dementia contributing 26,609,697 person-months. The mean age was 80 years, most were female (70%), approximately 80% were non-Hispanic Whites, 10% were non-Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre-Partnership (β = -0.06, 95% CI: -0.08, -0.05) and post-Partnership (β = -0.02, 95% CI: -0.02, -0.01). Post-Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (β = -0.01, 95% CI: -0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community-dwelling older adults with dementia.
CONCLUSIONS: These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community-dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community-dwellers with dementia.

UNASSIGNED: Rational prescription writing is an important skill to master during internship. This Quality Improvement (QI) project aimed to understand the state of prescription writing among interns posted in the Department of Psychiatry, analyze the causes responsible for errors in prescription writing and bring about a change in the current practice.
UNASSIGNED: The MBBS interns are posted in the Department of Psychiatry for 15 days. During day 1 to day 5 of their posting, a pre intervention phase was conducted wherein prescriptions written by interns in the Department of Psychiatry were collected. The prescriptions were scored based on 14 criteria which were selected based on World Health Organization (WHO) guidelines and Medical Council of India (MCI) ideal prescription format. During PDSA (Plan Do Study Act) Cycle 1, an educational handout was distributed to the interns containing the MCI ideal prescription format and WHO guidelines regarding prescription writing. The brochure was also verbally explained to the interns. From day 7 to day 15 of their posting, prescriptions written by the interns were collected. The prescriptions were scored using the same criteria.
UNASSIGNED: During the pre intervention phase the mean total score of prescriptions was 9.54 ± 1.003. There was a significant improvement in the mean total score to 10.26 ± 0.746. There was a 7.54% improvement. There was also a significant improvement in several individual criteria.
UNASSIGNED: The first PDSA cycle was successful in improving the quality of prescription writing among interns posted in the Department of Psychiatry. There is a need to implement more PDSA cycles to improve the quality still further.

UNASSIGNED: Mental health disorders are prevalent yet undertreated health conditions in the US. Given perceptions about the potential effect of cannabis on individuals with mental health disorders, there is a need to understand the association of cannabis laws with psychotropic use.
UNASSIGNED: To investigate the association of medical and recreational cannabis laws and dispensary openings with the dispensing of psychotropic medications used to treat mental health disorders in the US.
UNASSIGNED: This cross-sectional study of 10 013 948 commercially insured patients used a synthetic control method to examine the association of cannabis policies with prescribing. Data on all patients dispensed prescriptions for each of the 5 classes of psychotropic medications from January 1, 2007, to December 31, 2020, were extracted from Optum\'s deidentified Clinformatics Data Mart Database. Statistical analysis was performed from September 2022 to November 2023.
UNASSIGNED: The 4 exposure variables measured were whether medical or recreational cannabis laws were in effect and whether medical or recreational cannabis dispensaries were open in each state and calendar quarter.
UNASSIGNED: One measure of the extensive margins of dispensing and 2 measures of the intensive margins of dispensing were constructed for 5 medication classes (benzodiazepines, antidepressants, antipsychotics, barbiturates, and sleep medications).
UNASSIGNED: The primary sample (the benzodiazepine sample) included 3 848 721 patients (mean [SD] age, 46.1 [11.4] years; 65.4% women; 53.7% aged 35-54 years). Medical cannabis laws were associated with a 12.4% reduction in the benzodiazepine fill rate (average treatment effect on the treated [ATT], -27.4; 95% CI, -14.7 to 12.0; P = .001), recreational cannabis laws were associated with a 15.2% reduction in the fill rate (ATT, -32.5; 95% CI, -24.4 to 20.1; P = .02), and medical cannabis laws were associated with a 1.3% reduction in the mean number of benzodiazepine fills per patient (ATT, -0.02; 95% CI, -0.02 to 0.02; P = .04). Medical dispensaries were associated with a 3.9% reduction in mean days\' supply per benzodiazepine fill (ATT, -1.7; 95% CI, -0.8 to 0.6; P = .001), while recreational dispensaries were associated with a 6.2% reduction (ATT, -2.4; 95% CI, -1.0 to 0.9; P < .001). Medical cannabis laws were associated with a 3.8% increase in antidepressant fills (ATT, 27.2; 95% CI, -33.5 to 26.9; P = .048), and medical dispensaries were associated with an 8.8% increase (ATT, 50.7; 95% CI, -32.3 to 28.4; P = .004). The mean number of antipsychotic medication fills per patient increased by 2.5% (ATT, 0.06; 95% CI, -0.04 to 0.05; P = .02) after medical cannabis laws and by 2.5% (ATT, 0.06; 95% CI, -0.04 to 0.04; P = .02) after medical dispensary openings. Findings for the other drug classes showed substantial heterogeneity by state and direction of association.
UNASSIGNED: This cross-sectional study of commercially insured patients suggests that there may have been meaningful heterogeneous associations between cannabis policy and state and between cannabis policy and drug class (eg, decreases in dispensing of benzodiazepines but increases in dispensing of antidepressants and antipsychotics). This finding suggests additional clinical research is needed to understand the association between cannabis use and mental health. The results have implications for patient substance use and mental health-related outcomes.

BACKGROUND: Mental health is considered a major public health issue. Non-psychiatric physicians often engage in the treatment of mental disorders. The aim of this study was to describe psychiatric drug prescription knowledge and practices among non-psychiatric specialists and evaluate their training needs.
METHODS: A descriptive cross-sectional study was conducted from September 1st to October 15th, 2021, in 3 Moroccan healthcare facilities and among private practitioners in Kenitra. We asked non-psychiatric specialists about their knowledge and current practices regarding psychotropic drugs, and their needs in psychiatric training.
RESULTS: The study included a total of 150 participants. The majority of participants demonstrated insufficient knowledge regarding the selection of psychotropic drugs and the duration of pharmacotherapy. Specifically, 61.3% were unaware of the average duration of treatment for depression. 22.7% of participants did not feel comfortable when prescribing psychotropic drugs. Anxiolytics were the most commonly prescribed class of psychotropic drugs, accounting for 30.7% of prescriptions. The most common indications for psychotropic drugs prescription were anxiety (35.3%), followed by insomnia (34.7%) and depression (31.3%). The majority of participants (72%) reported receiving clinical training in psychiatry, with 74.7% expressing varying levels of satisfaction with their undergraduate psychiatry training, while 7.3% expressed dissatisfaction. Regarding CME, only 11.3% of participants engaged in at least one psychiatry-related CME session in the past two years. 54.7% of participants expressed interest in expanding their knowledge of prescribing psychotropic drugs. Around 40% of participants preferred trainings in psychotropic drugs prescription related to their specialty, while 34% were not interested in receiving further training.
CONCLUSIONS: Our study shows gaps in knowledge of non-psychiatric specialists, which raises concern regarding their ability to care for mental disorders. Educational efforts should be made to improve teaching of psychiatry from the undergraduate level. Continuing Medical Education should be tailored to the specific needs and preferred learning methods of non-psychiatric physicians.

UNASSIGNED: Pulmonary embolism (PE) is a serious and potentially life-threatening condition that requires prompt diagnosis and treatment. Identifying risk factors and diagnostic markers can aid in the early detection and management of this condition.
UNASSIGNED: This case-control study examined 10,077 patients admitted to Shenzhen Kangning Hospital\'s psychiatry facility in 2020. Among these, 65 patients were diagnosed with PE, including 50 new cases. After survival sampling for controls and age-and-gender matching, the study included 41 new PE cases and 41 age-and-gender-matched controls. Data on demographics, comorbidities, and medication use were extracted from electronic records. Conditional logistic regression analyses were performed to determine the association between each predictor and PE risk. Additionally, the sensitivity and specificity of the d-dimer diagnostic tool were assessed.
UNASSIGNED: In univariable conditional logistic regression, active alcoholism was associated with a higher PE risk (OR=3.675, 95% CI 1.02-13.14, P=0.046). A history of physical restraint (OR=4.33, 95% CI 1.24-15.21, P=0.022) and chemical restraint (OR 4.67, 95% CI 1.34-16.24, p=0.015) also increased PE risk, as did benzodiazepine use (OR=3.33, 95% CI 1.34-8.30, P=0.010). Conversely, psychotropic medication before admission was associated with a lower risk of PE (OR=0.07, 95% CI 0.01-0.59, P=0.013). Stepwise multivariable forward conditional regression identified two subsets of psychiatric patients at higher risk of PE: new psychiatric cases without medication at admission who were chemically restrained, and cases without medication at admission who were started on antipsychotics and benzodiazepines. The d-dimer diagnostic tool, with an optimal threshold of 570 ng/ml determined by the Youden index (J statistic of 0.6098), showed a sensitivity of 73.17% and specificity of 87.80% for detecting PE, with an AUC of 0.833 (95% CI: 0.735-0.906).
UNASSIGNED: Our findings suggest that a history of restraint, alcoholism, and the use of antipsychotics and benzodiazepines are important predictors of PE in psychiatric inpatients. Conversely, psychotropic medications at admission may be linked to a lower PE risk. The d-dimer diagnostic tool shows good value for screening PE in psychiatric inpatients. These predictors and diagnostic markers could help clinicians identify high-risk patients and implement appropriate prevention strategies.

Novel Psychoactive Substances (NPS) derived from tryptamines has been detected in aquatic environments, leading to environmental toxicology concerns. However, the specific toxicological mechanism, underlying these NPS, remains unclear. In our previous work, we used 5-Methoxy-N-isopropyl-N-methyltryptamine (5-MeO-MiPT) as the representative drug for NPS, and found that, 5-MeO-MiPT led to obvious behavioral inhibition and oxidative stress responses in zebrafishes model. In this study, Zebrafish were injected with varying concentrations of 5-MeO-MiPT for 30 days. RNA-seq, qPCR, metabolomics, and histopathological analyses were conducted to assess gene expression and tissue integrity. This study confirms that 5-MeO-MiPT substantially influences the transcription and expression of 13 selected genes, including ucp1, pet100, grik3, and grik4, mediated by the Gαq/11-PLCβ signaling pathway. We elucidate the molecular mechanism that 5-MeO-MiPT can inhibit DAG-Ca2+/Pkc/Erk, Pkc/Pla2/PLCs and Ca2+/Camk Ⅱ/NMDA, while enhance Ca2+/Creb. Those secondary signaling pathways may be the mechanisms mediating 5-MeO-MiPT inhibiting normal behavior in zebrafish. These findings offer novel insights into the toxicological effects and addiction mechanisms of 5-MeO-MiPT. Moreover, it presents promising avenues for investigating other tryptamine-based NPS and offers a new direction for diagnosing and treating liver-brain pathway-related diseases.

This study investigates the presence of new psychoactive substances (NPS) and their metabolites in two wastewater treatment plants (WWTPs) situated in South Wales, UK (WWTP-1 and WWTP-2). Analysis was conducted for 35 NPS and metabolites, along with the inclusion of benzoylecgonine (main cocaine metabolite) and cannabis, the most detected illicit substances. Benzoylecgonine was identified as the predominant substance in both WWTPs. Epidemiological calculations revealed the average population consumption of cocaine to be 3.88 mg/d/1000 inhabitants around WWTP-1 and 1.97 mg/d/1000 inhabitants for WWTP-2. The removal efficiency of benzoylecgonine across both WWTPs was observed at an average of 73%. Subsequent qualitative analyses on randomly selected wastewater samples detected medicinal compounds including buprenorphine, methadone, and codeine in both WWTPs. An additional experiment employing enzymatic hydrolysis revealed the presence of morphine, an increased presence of codeine, and 11-Nor-9-Carboxy-THC (THC-COOH) post-hydrolysis. These findings underscore the significant presence of illicit substances and medicinal compounds in wastewater systems with the absence of NPS within the South Wales area, highlighting the necessity for enhanced monitoring and treatment strategies to address public health and environmental concerns.

Introduction Substance use among resident physicians is an underestimated, poorly understood, and serious problem because of its negative consequences for the health of physicians and also for the health and safety of the patients in their care. Objective To estimate the prevalence and identify factors associated with addictive behaviors among resident physicians at different university hospitals in Morocco. Method We conducted a multicenter cross-sectional descriptive and analytical study involving resident doctors from the 7 university hospital centers in Morocco. Resident doctors were invited to participate voluntarily in the study by completing an anonymous self-questionnaire created on Google Forms and sent via email. Results The questionnaire was completed by 310 resident physicians, representing 11.07% of the total population of resident physicians in Morocco. Among the participants, 16.1% (n=50) reported consuming one or more psychoactive substances, including 11.1% (n=37) for tobacco, 10% (n=31) for alcohol, and 6.1% (n=19) for cannabis. The consumption of ecstasy and cocaine was observed in 0.7% (n=2) for each substance. Additionally, 11.9% (n=37) of resident physicians had psychiatric disorders, and 3.2% (n=10) had attempted suicide at least once. The consumption of psychoactive substances among resident physicians was statistically significantly associated with the male gender (4.59 [2.20-9.57]; p=0.000), as well as with surgical specialty (0.48 [0.26-0.88]; p=0.017). Conclusion At the end of this work, we found that the use of psychoactive substances is frequent among resident doctors, which explains the need for preventive measures and appropriate management.

OBJECTIVE: To analyze the contribution of alcohol and drug intoxication to fatal occupational injuries and sudden death at the workplace in Moscow.
METHODS: A number of death cases of various organizations\' employees equal 357 in Moscow in 2023 were investigated. The mean age of the deceased was 48.29±13.9 years, 92.4% of them were men.
RESULTS: Ethanol in blood has been determined in 15% of the deceased. Narcotic drugs and psychotropic medications have been found in 6.7% of cases. Signs of chronic intoxication have been established in 16.5% of the deceased. Chronic intoxication accompanied or aggravated the course of 70% of cardiomyopathies. The proportion of deceased in an accident at an industry or construction site equal 23.9%, as well as 1/2 of the deceased in an accident on the street and in a residential building were impaired by alcohol.
CONCLUSIONS: The study of the contribution of alcohol and drug consumption to occupational mortality will allow to plan measures for reducing the mortality of working-age population.
UNASSIGNED: Анализ вклада алкогольной и наркотической интоксикации в смертельный производственный травматизм и внезапную смерть на рабочем месте в Москве.
UNASSIGNED: Исследованы 357 случаев смерти работников различных организаций на территории Москвы в 2023 г. Средний возраст погибших составил 48,29±13,9 года, 92,4% погибших — мужчины.
UNASSIGNED: У 15% погибших в крови обнаружен этанол. В 6,7% случаев были выявлены наркотические вещества и психотропные лекарственные препараты. У 16,5% погибших установлены признаки хронической интоксикации. Хроническая интоксикация сопутствовала или отягощала течение 70% кардиомиопатий. В состоянии опьянения находились 23,9% погибших в результате происшествия на производстве и стройке, 1/2 погибших в результате происшествия на улице и в жилом здании.
UNASSIGNED: Изучение вклада употребления алкоголя и наркотиков в смертность на производстве позволит планировать меры по снижению смертности трудоспособного населения.

BACKGROUND: In addition to the drugs that have been known for decades, several hundred mainly synthetic substances have been identified as drugs for the first time in the last 20 years.
OBJECTIVE: Presentation of the various groups of substances and their psychotropic effects, the epidemiology of their use and the legal and social background of this development.
METHODS: Narrative literature review.
RESULTS: The most important new psychoactive substances (NPS) are synthetic cannabinoids, synthetic stimulants (cathinones), halluginogens and new synthetic opioids (NSO), in particular fentanyl and related substances. The new substances do not have any qualitatively new psychotropic effects. They were brought onto the market in particular as substitutes for substances subject to the Narcotics Act but are often associated with dangerous side effects and even mortality. The increasing availability of these substances has gone hand in hand with the establishment of the Internet as a source of knowledge (e.g. for synthesis routes) and as a marketplace. Substance group-related regulations have also been established in Germany (New Psychoactive Substances Act). In Germany the prevalence of NPS use is significantly lower than that of cannabis; however, there are indications that the production and distribution of synthetic drugs is more profitable for drug dealers than with conventional plant-based drugs, such as heroin. In the USA, for example, NSOs are the primarily drugs used for opioid addiction.
CONCLUSIONS: It remains to be seen whether NPS and NSOs will replace conventional drugs. The availability of synthetic drugs is more difficult to reduce than that of plant-based drugs. Harm reduction measures should be expanded, e.g., early warning systems for new drugs, drug checking and naloxone programs.
UNASSIGNED: HINTERGRUND: Zusätzlich zu den seit Jahrzehnten bekannten Drogen sind in den letzten 20 Jahren mehrere hundert synthetische Substanzen als Drogen erstmals festgestellt worden.
UNASSIGNED: Darstellung der verschiedenen Stoffgruppen und ihrer psychotropen Wirkungen, der Epidemiologie ihres Konsums sowie der rechtlichen und sozialen Hintergründe dieser Entwicklung.
METHODS: Narrative Literaturübersicht.
UNASSIGNED: Die wichtigsten neuen psychoaktiven Substanzen (NPS) betreffen synthetische Cannabinoide, Stimulanzien und Halluzinogene sowie neue synthetische Opioide (NSO), insbesondere Fentanyl und verwandte Substanzen. Die neuen Substanzen weisen keine qualitativ neuen psychotropen Wirkungen auf. Sie wurden unter anderem als Ersatzstoffe für dem Betäubungsmittelgesetz unterliegende Substanzen auf den Markt gebracht, sind aber oft mit gefährlicheren Nebenwirkungen bis hin zu Mortalität belastet. Die steigende Verfügbarkeit dieser Substanzen ging parallel zur Etablierung des Internets als Wissensquelle (z. B. für Synthesewege) wie als Handelsplatz. Stoffgruppenbezogene Regularien wurden auch in Deutschland etabliert (Neue-Psychoaktive-Stoffe-Gesetz). In Deutschland ist die Prävalenz des Konsums von NPS z. B. im Vergleich zu Cannabis deutlich niedriger. Es gibt allerdings Hinweise, dass Produktion und Vertrieb synthetischer Drogen für Drogenhändler profitabler sind als Produktion und Vertrieb herkömmlicher pflanzlich basierter Drogen wie Heroin. In den USA sind NSO die vorrangig konsumierten Drogen bei Opioidabhängigkeit.
CONCLUSIONS: Es bleibt abzuwarten, ob NPS und NSO die herkömmlichen Drogen verdrängen. Die Verfügbarkeit synthetischer Drogen ist schwieriger zu reduzieren als die pflanzlich basierter Drogen. Maßnahmen zur Schadensminderung sollten ausgebaut werden, z. B. Frühwarnsysteme für neue Drogen, Drug Checking sowie Naloxon-Programme.