Psychiatric Drugs

Outline of Lecture

"I"

5 Major Classes of Psych Drugs

"II"

Question #1

Question #1
Most Common Disease (point prevalence)

Question #1
Most Common Disease

Somatic vs. Psychiatric
Lifetime Prevalence - USA

Question #2

Question #2
Top Selling Drug Class in the U.S.A.

Question #2
Top Selling Drug Class in the U.S.A.

U.S. Drug Sales 2009
[IMS Health]

# of U.S. Prescriptions - 2009
[IMS Health]

U.S. = 4.5 % of world population

U.S.A.:  Psychiatric Drugs 2009
[Source: Express Scripts 2009 Drug Trend Report]

Question #3

Question #3
Leading Cause of Death in the U.S.A.

"1"

Question #3
Leading Cause of Death in the U.S.A.

Institute of Medicine (1999)
44,000 to 98,000 dead from errors

             JAMA (2000)

Reality Check:  # of deaths (2006)

"III"


Morbidity and Mortality in Public MH Patients
 [Sources:  2006 - Colton & Manderscheid & NASMHPD 13th Technical Report]

Slide 26

Causes of death 1997-2000…

Slide 28

Swedish SMR Trends

Public MH patients = 5.9 million per year

High Rate of Health Disorders
 SMI Compared to Non-SMI Groups 
Maine Medicaid – 2004

Burden of Medical Illness:
Maine Medicaid 2004

"IV"

Psychiatric Drugs á the Odds of Disease

Dementia defined:

Features of Dementia

"≥ 65 with dementia"

Slide 38

≥ 65 years of age
12% to 18% to 21%

Drug-Induced Dementia

A perfect crime…

Antipsychotic Timeline

U.S. Drug Sales – 2009 ($ billions)

Dept. of Veterans Affairs
Kales et al (2007)

"12,821 avoided psychiatric drugs"

"Other folks started to notice..."

Black Box Warnings
“not for dementia-related psychosis”

"In England"

U.K. - DART-AD
Dementia AP Reduction Trial

DART-AD
Ballard et al (2009)

Outcomes Based Upon Continuing
Use of Drugs vs. Placebo

Antipsychotic drugs are deadly for
dementia patients…

Slide 53

Slide 54

Slide 55

Slide 56

How Do Doctors Diagnose Alzheimer’s Disease?

Postmortem Pathology

Do Antipsychotic Drugs Cause Alzheimer’s Disease ?

Postmortem Studies of Humans

"2002 Bozikas – 18 schizophrenia..."

apoD is marker of neuropathology

Thomas et al (2001)
autopsy study of brain levels of apoD (ug/mg)

apoD in Animals

Other Postmortem Studies
rabbits, rats, monkeys, guinea pigs

University of Pittsburgh
(2005, 2007, 2008)

Experiment

Changes in Behavior and Brain

f/u Studies of Parietal Lobe

Parietal Lobe Cell Loss

  Biomarkers in Humans

Old and new antipsychotics
all increase Alzheimer’s proteins…

Neuroimaging
(brain scans)

Numerous studies…


What about children ?

NIMH / UCLA study
child onset schizophrenia

Multiple brain scans > age 13.5 to 18

Slide 78


Gray Matter Loss Due to “Disease”
Thompson et al (2001) – multiple scans of teens (aged 13.9 to 18.6)
UCLA & NIMH

Reduced Exposure to APs
no gray matter deficit in temporal lobe

Recap of Lecture