Prescriptions hors autorisation de mise sur le marché en psychiatrie publique hospitalière

Andréoli, Laura; Gaudoneix, M.; Beauverie, P.; Beaurepaire, Renaud de

doi:10.2515/therapie/2013054

Cited by 6 publications

(1 citation statement)

References 23 publications

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“…Off-label prescription of psychoactive drugs is emerging as a widespread phenomenon in many countries. 1 – 4 Whereas antipsychotic medications are indicated for the alleviation of psychotic symptoms of schizophrenia, mood disorders, and delirium, ~20% of all antipsychotic prescriptions in a US nationally representative survey were off-label. 4 The most common off-label indications are for relief of insomnia, pain, and agitation.…”

Section: Introductionmentioning

confidence: 99%

Antidopaminergic medication in healthy subjects provokes subjective and objective mental impairments tightly correlated with perturbation of biogenic monoamine metabolism and prolactin secretion

Veselinović

Vernaleken

Cumming

et al. 2018

NDT

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ObjectivesOff-label prescription of antipsychotics to patients without psychotic symptoms has become a routine matter for many psychiatrists and also some general practitioners. Nonetheless, little is known about the possibly detrimental effects of antidopaminergic medications on general psychopathology, subjective mental state, or a possible association with physiological parameters in nonpsychotic individuals.MethodsIn this randomized, single-blinded study, groups of healthy volunteers (n=18) received low doses of reserpine, aripiprazole, haloperidol, or placebo on 7 successive days. Relevant physiological parameters (plasma prolactin, concentrations of catecholamine metabolites in plasma, and 24-hour urine) and each subject’s mental state (Positive and Negative Syndrome Scale, Hamilton Rating Scale for Depression, visual analogue scale, Beck Depression Inventory II) were assessed at the start and end of the trial.ResultsOf the three active treatments, only reserpine caused a significant increase in some plasma- and urine-catecholamine metabolites, but all three medications evoked objective and subjective changes in general psychopathology scores, which correlated with individual increases in plasma homovanillic acid concentrations. Both objective and subjective impairments were significantly more pronounced in the subgroup with greatest increase of plasma prolactin. Subjects experiencing the most pronounced side effects under haloperidol, which compelled them to drop out, showed significantly higher prolactin concentration increases than those who tolerated haloperidol well.ConclusionWe found consistent associations between altered markers of dopamine transmission and several objective and subjective mental impairments in healthy volunteers after 1 week’s treatment with antidopaminergic medications. These findings should draw attention to a more intensive risk–benefit evaluation in cases of off-label prescription of antipsychotic medications.

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Section: Introductionmentioning

confidence: 99%