甲卡西酮概述及其分析方法

甲卡西酮吸食后具有精神刺激剂作用,有时候作为娱乐药物,具有成瘾性,长期高剂量使用可能导致急性神经紊乱。甲卡西酮R位的碳氧双键具有极性,因此像安非他明一样可以通过血脑屏障。它是潜在的中枢神经系统刺激剂和多巴胺再吸收抑制剂。甲卡西酮在美国是I类精神管制药物,任何情况下都是非法使用。本文还综述了甲卡西酮的检验分析方法,包括物理分析方法和仪器分析方法。仪器分析方法主要是气相色谱／质谱法（GC／MS）、高效液相色谱法（HPLC）,此外还有紫外光谱法（uV）,红外光谱法（IR）,核磁共振光谱法（NMR）以及毛细管电泳（CE）等方法。     

A study of the use of sedative PRN medication in patients at a secure hospital

We have investigated the use of ‘as required’ (PRN), sedative psychotropic medication in 242 forensic rehabilitation patients at a UK secure psychiatric hospital. In total, 176 (73%) patients were prescribed PRN medication and 90 (37%) received a total of 542 doses in the preceding two weeks. The principle indication for use was agitation. Oral benzodiazepines, particularly Lorazepam, were most commonly prescribed and administered followed by Haloperidol. Although high-dose antipsychotics and polypharmacy due to PRN prescribing were common (11 and 20%, respectively), on only 6% of the days studied did patients actually receive PRN antipsychotic medication. Using univariate analyses, PRN administration was associated with younger age, female gender, emotionally unstable personality disorder, shorter length of stay and detention in medium security. Case note documentation of PRN administration was often absent (44%) or vague. Further research, both quantitative and qualitative, is needed into the precise circumstances under which PRN is administered.     

Psychotropic Medication Experiences of Incarcerated Women: A Qualitative Inquiry into Conundrums of Access and Identity

The study examines narrative data from in-depth, semi-structured interviews with 25 women in a medium security prison with the hope of deepening the knowledge base related to women’s beliefs about their mental health problems, mental health care during incarceration, and especially their experiences with psychotropic medication. The findings highlight the functional role of psychotropic medication in the lives of incarcerated women, while also emphasizing problems with limited access to prescribers, preferred medications, and other forms of mental health treatment. Trauma, substance use, and the impact of medication use on sense of self all emerged as interfacing with quality of life.     

Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Patients suffering from psychiatric disorders have an excess mortality and a shorter life span expectancy compared to the general population. Furthermore, they are treated with multiple drugs and are known to have an increased risk of drug abuse. In this study, we aimed at investigating the pharmaceutical drug and drug of abuse profiles of the deceased included in the Danish prospective autopsy‐based forensic study on psychiatric patients, SURVIVE. Using the postmortem systematic toxicological analysis results, we identified 129 different consumed compounds in our population (n = 443). Polypharmacy (≥5 compounds) was detected in 39.5% of the deceased. Deceased with a psychiatric diagnosis or who died from a fatal intoxication had significantly more compounds at the time of their death compared to having either no psychiatric diagnosis or another cause of death, respectively. Evidence of drug abuse was present, as 29.8% of our total population had consumed either methadone or illicit drugs of abuse, excluding tetrahydrocannabinol. Of those deceased with a psychiatric diagnosis, 33.6% had either consumed methadone or illicit drugs of abuse, a greater number than those without a psychiatric diagnosis. Fatal intoxication was the most frequent cause of death (40.6%) with methadone as the major intoxicant. Here, we found that those without a psychiatric diagnosis had fewer fatal pharmaceutical drug intoxications compared to the psychiatric diagnosis groups. Our findings add further context to understanding the excess mortality of psychiatric patents, since there is an increased occurrence of fatal intoxication, polypharmacy, and drug abuse in this population.     

LC-MS/MS法快速测定全血中25种精神药物的研究

目的建立人全血中25种精神药物快速测定的LC-MS/MS方法,并应用于分析杭州地区药物影响下驾驶(driving under the inference of drugs,DUID)情况。方法以乙腈沉淀蛋白,离心后取上清液,氮气流下吹干,残渣以初始流动相复溶,离心后取上清分析;采用C18色谱柱(50mm×3.0mm,2.6μm)分离,流动相:0.1%甲酸水(A相),乙腈:甲醇=1:1(B相),梯度洗脱;质谱检测,采用串联质谱电喷雾离子源,正电离扫描,多反应监测(MRM)。结果 25种精神药物在0.05~20ng/m L范围内线性良好,R=0.994 4~0.999 6;定量下限为0.05ng/m L;提取回收率为83.0%~99.7%;方法回收率为80.2%~97.4%;日内精密度(RSD)为1.6%~14%;日间精密度(RSD)为3.1%~14%。以该法测定杭州市公安司法鉴定中心留存的全血样品3140例,25种精神药物至少一种的检出率为3.7%。结论本方法灵敏、快捷、准确,适用于全血中25种精神药物快速检测。     

Patient-centered psychiatric care for youth in foster care: a systematic and critical review

Youth in the U.S. foster care system are prescribed risky psychotropic medications at high rates. In response, state child welfare agencies have developed policies, yet there is little research to inform patient-centered care (PCC) approaches. To fill this gap, we aimed to identify (1) the perspectives of youth in or formerly in foster care and their caregivers and providers regarding how psychiatric care aligns or does not align with PCC, and (2) effectiveness of interventions aiming to improve PCC within this context. We conducted a systematic review of the literature based on PRISMA-P guidelines, searching four databases and gray literature. Eleven studies met inclusion criteria and quality appraisal benchmarks, none of which were interventions. We applied narrative synthesis techniques to six studies that described youth/former youth perspectives. They described a pervasive lack of knowledge, perceived little voice in decision-making, and described imbalanced power between patients and providers and weak therapeutic relationships, whereas feeling understood by providers and being provided autonomy in decisions were helpful. Systemic barriers also contributed to many concerns. We make a limited number of recommendations to leaders and policy-makers based on our synthesis, however, many critical research steps are needed.     

GC/MS/Xcalibur技术自动分析疑似固体中管制药物

目的建立疑似含毒检材中国家管制药品的自动筛选方法。方法以我国2007年公布的精神药品和麻醉药品的品种目录为检测目标物,建立质谱用户库;以此为基础,设置气质联用仪自动分析方法对疑拟检材进行常见管制药品的快速筛选。结果建立了库名含多种实用信息、包括230种管制药品的质谱用户库;建立管制药品的质谱自动分析方法,实现＂一针分析出结果＂。结论方法简单、快速、准确可靠,省时省力,能有效提高可疑检材中管制药品筛选分析的速度。