RESUMO
We report the case of a 37-year-old female patient suffering from schizophrenia, disorganized type. Adherence to treatment was always a major problem. During the last 2 years the patient was disorganized and was refusing treatment. Since the patient was already receiving a very high (double) dose per os, it was decided to administer two 50 ml ampoules of long-acting, injectable risperidone plus 5 mg of haloperidol per os daily. After 80 days of treatment, all positive, negative and even neurocognitive symptoms improved markedly. Extrapyramidal side effects did not appear at any stage of treatment. The most impressive neurocognitive improvement concerned the clock drawing test, which was in parallel with her improvement in both the positive and negative symptoms of the PANSS.
Assuntos
Antipsicóticos/administração & dosagem , Risperidona/administração & dosagem , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Feminino , Humanos , Injeções Intramusculares , Cooperação do Paciente , Escalas de Graduação Psiquiátrica , Risperidona/uso terapêuticoAssuntos
Anorexia/tratamento farmacológico , Fluoxetina/uso terapêutico , Mianserina/análogos & derivados , Adulto , Antidepressivos de Segunda Geração/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Mianserina/uso terapêutico , Mirtazapina , Olanzapina , Inibidores Seletivos de Recaptação de Serotonina/uso terapêuticoRESUMO
Our aim was to evaluate the efficacy and tolerability of anticonvulsant agents for the treatment of acute bipolar mania and ascertain if their effects on mania are a "class" effect. We conducted a systematic review of randomized controlled trials (RCTs) with placebo or active comparator, in acute bipolar mania in order to summarize available data on anticonvulsant treatment of mania/mixed episodes. We searched (PubMed/MEDLINE) with the combination of the words "acute mania" and "clinical trials" with each one of the following words: "anticonvulsants/antiepileptics,""valproic/valproate/divalproex,""carbamazepine,""oxcarbazepine,""lamotrigine,""gabapentin,""topiramate,""phenytoin,""zonisamide,""retigabine,""pregabalin,""tiagabine,""levetiracetam,""licarbazepine,""felbamate," and "vigabatrin." Original articles were found until November 1, 2008. Data from 35 randomized clinical trials suggested that not all anticonvulsants are efficacious for the treatment of acute mania. Valproate showed greater efficacy in reducing manic symptoms, with response rates around 50% compared to a placebo effect of 20-30%. It appears to have a more robust antimanic effect than lithium in rapid cycling and mixed episodes. As valproate, the antimanic effects of carbamazepine have been demonstrated. Evidences did not support the efficacy of the gabapentin, topiramate as well as lamotrigine as monotherapy in acute mania and mixed episodes. Oxcarbazepine data are inconclusive and data regarding other anticonvulsants are not available. Anticonvulsants are not a class when treating mania. While valproate and carbamazepine are significantly more effective than placebo, gabapentin, topiramate, and lamotrigine are not. However, some anticonvulsants may be efficacious in treating some psychiatric comorbidities that are commonly associated to bipolar illness.
Assuntos
Anticonvulsivantes/uso terapêutico , Antimaníacos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Aminas/efeitos adversos , Aminas/uso terapêutico , Anticonvulsivantes/efeitos adversos , Antimaníacos/efeitos adversos , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Carbamazepina/efeitos adversos , Carbamazepina/análogos & derivados , Carbamazepina/uso terapêutico , Ácidos Cicloexanocarboxílicos/efeitos adversos , Ácidos Cicloexanocarboxílicos/uso terapêutico , Interações Medicamentosas , Quimioterapia Combinada , Frutose/efeitos adversos , Frutose/análogos & derivados , Frutose/uso terapêutico , Gabapentina , Humanos , Lamotrigina , Compostos de Lítio/efeitos adversos , Compostos de Lítio/uso terapêutico , Oxcarbazepina , Ensaios Clínicos Controlados Aleatórios como Assunto , Topiramato , Triazinas/efeitos adversos , Triazinas/uso terapêutico , Ácido Valproico/efeitos adversos , Ácido Valproico/uso terapêutico , Ácido gama-Aminobutírico/efeitos adversos , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
Suicide and suicide attempts are significant and costly public health problems. In order to prevent suicidal and other self-injurious behavior, research on the multiple factors involved in these behaviors with comprehensive and user-friendly instruments is necessary. The aim of the current study was to construct a self-report instrument with emphasis on the items which describe suicide-related behavior itself rather than strongly related clinical features on the basis of a general population study. Twelve items comprising a new scale were applied to 734 subjects from the general population (40.6% males and 59.4% females) aged 40.8 +/- 11.5, along with the STAI and the CES-D. The scoring method was developed on the basis of frequency table of responses to the individual scale items. The factor analysis returned 3 factors explaining 59.19% of total variance (Intention, Life, and History). The Cronbach's alpha was 0.85 for the Intention, 0.69 for the Life and 0.52 for the History subscale. The RASS is a reliable and valid instrument which might prove valuable in the assessment of suicidal risk in the general population as well as in mental patients.