الملخص
ABSTRACT Chlorpromazine is a medication widely used in psychiatry for the treatment of psychoses, especially schizophrenia. Since 1964, published articles have been correlating this medication with the appearance of ocular alterations. In this paper, we report the case of a 65-year-old patient with ocular effects due to long-term therapy with chlorpromazine. Biomicroscopy of both eyes presented diffuse granular brown deposits, most prominent at the deep stroma and corneal endothelium level. Also showed anterior subcapsular brown deposits with a stellate pattern in the lens. The total amount exceeds 2.000g (significant for the ocular alterations described) considering the patient's daily dosage of chlorpromazine of 300mg for ten years. After performing complete ophthalmic evaluation and discarding other causes for the ocular deposits, we diagnosed a secondary corneal deposit and cataract due to the use of chlorpromazine. This case reinforces the importance of periodic follow-up with an ophthalmologist for chlorpromazine users to trace ocular changes, heeding the exposure time and its dosage.
RESUMO A clorpromazina é uma medicação muito empregada na psiquiatria para tratamento de psicoses, especialmente em casos de esquizofrenia. Desde 1964 existem artigos publicados que correlacionam o uso dessa medicação com o aparecimento de alterações oculares. Neste trabalho, relatamos o caso de um paciente de 65 anos com efeitos oculares devido à terapia de longo prazo com clorpromazina. A biomicroscopia de ambos os olhos apresentou depósitos granulares difusos e de cor marrom, mais proeminente ao nível do estroma profundo e do endotélio da córnea, além de depósitos castanhos subcapsulares anteriores centrais em um padrão estrelado no cristalino. Considerando a dose diária de clorpromazina de 300mg por 10 anos usada pelo paciente, a quantidade total ultrapassa 2.000g (dose considerada significativa para as alterações oculares descritas). Após avaliação oftalmológica completa e descartado outras causas desses depósitos oculares, foram diagnosticados depósito corneano e catarata secundários ao uso de clorpromazina. O caso apresentado reforça a importância do acompanhamento oftalmolÓgico periÓdico de usuários de clorpromazina para o rastreio de alteraçÕes oculares, atentando-se ao tempo de exposição à droga e à posologia da mesma.
الموضوعات
Humans , Male , Aged , Cataract/chemically induced , Chlorpromazine/adverse effects , Chlorpromazine/toxicity , Cornea/drug effects , Corneal Diseases/chemically induced , Corneal Opacity/chemically induced , Pigmentation Disorders/chemically induced , Antipsychotic Agents/adverse effects , Antipsychotic Agents/toxicity , Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , Visual Acuity , Chlorpromazine/administration & dosage , Chlorpromazine/therapeutic use , Corneal Diseases/diagnosis , Corneal Opacity/diagnosis , Slit Lamp , Slit Lamp Microscopyالملخص
Abstract Substance use disorder is one of the major social and public health problems in the world. The present study analyzed the pharmacoepidemiological profile of patients treated at the Psychosocial Treatment Center for Alcohol and Substance Use Disorders (CAPS-AD) for treatment of alcohol use disorders (AUD), cocaine use disorders (CUD) and concomitant alcohol and cocaine use disorders (A-CUD) in the city of Betim-MG. The study used quantitative and descriptive data and was based on the evaluation of medical records of patients attended from January to December 2016. After analyzing 295 medical records, the majority of study participants were male (83.7 %) with an average age of 46.26 for AUD, 28.88 for CUD and 34.29 for A-CUD. The most prescribed drugs for AUD were diazepam (54.1 %), thiamine (37 %), complex B vitamins (29.5 %), and disulfiram (2.7 %); for CUD, diazepam (26.9 %) and haloperidol (23.1 %). It should be noticed that although contraindicated by the guidelines, chlorpromazine (42.3 %, 25.3 %, 20.3 %) was prescribed for CUD, AUD, and A-CUD respectively. Knowing the pharmacoepidemiological profile of CAPS-AD patients is extremely important for making decisions regarding which medicines to make available to the population.
الموضوعات
Humans , Male , Female , Adult , Substance-Related Disorders/drug therapy , Alcohol-Related Disorders/drug therapy , Cocaine-Related Disorders/drug therapy , Drug Therapy/instrumentation , Patients/classification , Chlorpromazine/adverse effects , Public Health/instrumentation , Diazepam/adverse effects , Disulfiram/adverse effects , Disulfiram/agonistsالملخص
El tratamiento farmacológico de demostrada eficacia en la esquizofrenia es el antipsicótico. Sin embargo, en muchas ocasiones se requiere medicación concomitante que depende de comorbilidades y efectos adversos. Se realizó un estudio cuantitativo, longitudinal, retrospectivo, considerando el año 2006 y 2016, en una población de usuarios con esquizofrenia de la Policlínica del Hospital Vilardebó, analizando los tratamientos con psicofármacos. Se diferenciaron los tratamientos según monoterapia antipsicótica y polifarmacia con 2 antipsicóticos, y polifarmacia con más de 2 antipsicóticos, antidepresivos, estabilizantes del humor, benzodiacepinas y anticolinérgicos. La población inicial en 2006 fue de 621 pacientes y 398 pacientes continuaban en tratamiento en 2016. Mantuvieron el trata-miento con antipsicóticos 377 pacientes; 184 mantuvieron benzodiacepinas; 59 se mantuvieron con anticolinérgicos; 49, con estabilizantes del humor y 47, con antidepresivos. La monoterapia antipsicótica se presentó en torno al 50 % de la población estudiada. Se deberían revisar aquellas prácticas que se infieren a partir de este estudio, como el uso prolongado de anticolinérgicos, benzodiacepinas, y polifarmacia con más de 2 antipsicóticos, que está extendida en los usuarios con esquizofrenia. El tratamiento con clozapina fue el más estable y no parece aumentar la mortalidad en estos pacientes
Antipsychotics are the proved effective therapy for schizophrenia. However, on many occasions, associated drugs are required depending on comorbidities and side effects. A retrospective longitudinal quantitative study of drug prescription for 2006 and 2016 in patients with schizophrenia diagnosis was carried out in an outpatient clinic at Hospital Vilardebó. Treatments were classified as antipsychotic monotherapy, two antipsychotic drugs polypharmacy and polypharmacy with two antipsychotic drugs, antidepressants, mood stabilizers, benzodiazepines and anticholinergic drugs. Initial population in 2006 included 621 patients, 398 were still being treated in 2016. Antipsychotic drugs were still being received in 377 patients, benzodiazepines in 184, anticholinergic drugs in 59, mood stabilizers in 49, and anti-depressants in 47. Antipsychotic monotherapy was 50% of the population. Those practices that can be inferred from this study, with lengthy use of anticholinergic drugs, benzodiazepines, and the use of more than 2 antipsychotic drugs in patients with schizophrenia diagnosis should be revised. Clozapine therapy was the most stable and does not seem to increase mortality.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Aged , Schizophrenia/drug therapy , Antipsychotic Agents/therapeutic use , Drug Therapy/statistics & numerical data , Phenothiazines/therapeutic use , Chlorpromazine/therapeutic use , Epidemiology, Descriptive , Retrospective Studies , Cohort Studies , Clozapine/therapeutic use , Risperidone/therapeutic use , Polypharmacy , Age and Sex Distribution , Tiapride Hydrochloride/therapeutic use , Quetiapine Fumarate/therapeutic use , Aripiprazole/therapeutic use , Olanzapine/therapeutic use , Haloperidol/therapeutic use , Methotrimeprazine/therapeutic useالملخص
Resumen El artículo analiza la fragilidad y los problemas existentes en la tesis que afirma la existencia de una verdadera revolución en el campo de la psiquiatría biológica, que se habría operado entre 1952 y 1954, con el descubrimiento de la clorpromazina. Para eso se analizan los discursos y las estrategias que posibilitaron el descubrimiento de esta droga que servirá de modelo para la producción de nuevos psicofármacos. Se intenta entender, también, qué es lo que se considera como "eficacia terapéutica" de la droga.
Abstract This article analyzes the shortcomings and problems of the thesis that a true revolution took place in the field of biological psychiatry between 1952 and 1954 thanks to the discovery of chlorpromazine. To do so, it analyzes the discourses and strategies that led to the discovery of this drug, which became a model for the production of new psychopharmaceuticals. It seeks to understand, also, what is meant by "therapeutic efficacy" with regard to this drug.
الموضوعات
Psychiatry , Biological Psychiatry , Chlorpromazine/therapeutic useالملخص
Objective: Patients with schizophrenia have visual processing impairments. The main findings from the literature indicate that these deficits may be related to differences in paradigms, medications, and illness duration. This study is part of a large-scale study investigating visual sensitivity in schizophrenia. Here we aimed to investigate the combined effects of illness duration and antipsychotic use on contrast sensitivity function. Methods: Data were collected from 50 healthy controls and 50 outpatients with schizophrenia (classified according to illness duration and medication type) aged 20-45 years old. The contrast sensitivity function was measured for spatial frequencies ranging from 0.2 to 20 cycles per degree using linear sine-wave gratings. Results: Patients with an illness duration > 5 years had more pronounced deficits. Differences in the combined effects of illness duration and antipsychotic use were marked in patients on typical antipsychotics who had been ill > 10 years. No significant differences were found between typical and atypical antipsychotics in patients with an illness duration < 5 years. Conclusion: Visual impairment was related to both long illness duration and medication type. These results should be tested in further studies to investigate pharmacological mechanisms.
الموضوعات
Humans , Male , Female , Adult , Young Adult , Schizophrenia/drug therapy , Antipsychotic Agents/adverse effects , Vision Disorders/chemically induced , Psychiatric Status Rating Scales , Schizophrenia/complications , Time Factors , Vision, Ocular/drug effects , Contrast Sensitivity/drug effects , Case-Control Studies , Chlorpromazine/adverse effects , Treatment Outcome , Middle Agedالموضوعات
Humans , Female , Pregnancy , Morning Sickness , Hyperemesis Gravidarum/diagnosis , Hyperemesis Gravidarum/etiology , Hyperemesis Gravidarum/drug therapy , Promethazine/therapeutic use , Chlorpromazine/therapeutic use , Ondansetron/therapeutic use , Dimenhydrinate/therapeutic use , Histamine Antagonists/therapeutic use , Meclizine/therapeutic use , Metoclopramide/therapeutic useالملخص
Objective: Schizophrenia is a chronic mental illness characterized by positive and negative symptoms. Cognitive impairment continues to be a core and consistent deficit. Previous studies have shown that physical activity (PA) is positively associated with cognitive performance. Thus, it may play a supportive role in mitigating cognitive impairments among individuals with schizophrenia. The aim of this study was to analyze the relationship between moderate-to-vigorous physical activity (MVPA) and executive function among adults with schizophrenia. Methods: The weekly amount of MVPA (assessed using accelerometers) and executive function (as per Brief Neurocognitive Assessment for Schizophrenia) of 78 adults with schizophrenia (mean [SD] age 42.4 [11.4] years; illness duration 17.0 [11.0] years; 58.2% male) were assessed in this cross-sectional study. Pearson correlations were calculated, followed by a linear regression. Participants were first analyzed together and then dichotomized on the basis of illness duration. Results: There was no significant association between MVPA and executive function, independent of the duration of illness. For individuals with < 15 years of illness, there was a significant association between weekly MVPA and working memory performance. Conclusion: PA appears to be associated with executive function in some, but not all, individuals with schizophrenia.
الموضوعات
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Schizophrenia/physiopathology , Exercise/physiology , Executive Function/physiology , Schizophrenia/drug therapy , Antipsychotic Agents/therapeutic use , Chlorpromazine/therapeutic use , Cross-Sectional Studies , Educational Status , Executive Function/drug effects , Neuropsychological Testsالملخص
Objetivo: Hacer una puesta al día de los elementos más relevantes del manejo de esta patología e incorporar algunos avances que se han producido desde esa fecha al presente año. Muchas de las recomendaciones de la Guía del año 2009 siguen siendo válidas y han sido revisadas, pero no han requerido ser actualizadas. Tipo de pacientes y escenarios clínicos a los que se refiere la guía: Abarca tanto a pacientes con sospecha de un primer episodio de esquizofrenia como a pacientes ya diagnosticados con la enfermedad. Usuarios a los que está dirigida la guía: Profesionales y técnicos que se desempeñan en los distintos niveles de atención del sistema de salud público y privado, médicos generales, médicos de familia, médicos psiquiatras, médicos especialistas no psiquiatras, psicólogos, químicos farmacéuticos, terapeutas ocupacionales, nutricionistas, enfermeras, kinesiólogos, matronas, tecnólogos médicos, asistentes sociales, técnicos paramédicos, técnicos en rehabilitación y otros profesionales de la Salud. Esta guía de práctica clínica no está dirigida a paciente ni familiares. Métodos: Dado que la presente guía constituye una actualización de la guía del año 2009, se utilizó una metodología mixta entre la adaptación y el desarrollo de búsquedas abreviadas de nuevas preguntas clínicas.
الموضوعات
Schizophrenia, Catatonic , Schizophrenia, Disorganized , Schizophrenia, Paranoid , Therapeutics , Antipsychotic Agents , Chlorpromazine , Practice Guideline , Haloperidol , Chile , Clozapine , Electroconvulsive Therapyالملخص
The use of Psychoactive Substances brings problems in several areas of the subject's life such as: health, psychological and social. It´s necessary evaluate the factors involved in drug use and potential drug interactions (PDI) in adolescents using psychoactive substances. It was a Cross-sectional, analytical and quantitative study. The research was carried out at the Center for Psychosocial Care and other drugs for children and adolescents 24h, with adolescents under 18 years of age, using medication. The data were obtained by reviewing the charts and the potential interactions were evaluated through the database Micromedex® and Medscape®. Of the 159 records used, there were 815 PDI. By gravity were 59.4% moderate, 23.8% secondary, 15.7% severe and 1.1% contraindicated. The drugs that presented the most PDI were Chlorpromazine (32.3%) and Diazepam (19.6%). The factors involved in polypharmacy were total PDI and those involved in the occurrence of total PDI were studying and the quantity diagnostic hypotheses. Due to the high PDI index, the relationship with polypharmacy and a high number of diagnostic hypotheses, it is necessary to increase the attention of health professionals regarding the topic and the development of protocols to support decision making.(AU)
الموضوعات
Humans , Male , Female , Child , Adolescent , Psychotropic Drugs/therapeutic use , Drug Interactions , Chlorpromazine , Adolescent , Diazepam , Drug Therapy, Combinationالملخص
ABSTRACT PURPOSE: To analyze the influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury. METHODS: Sixteen Wistar rats - split in two groups - have been used: control group, receiving 3 mg/kg isotonic saline solution through caudal vein, and, the chlorpromazine group, receiving 3 mg/kg-IV of such medication. The nephrectomy of the left kidney lower third was carried out; immediately, the test-drug was administrated. After 15 minutes of test-drug administration, the renal pedicle was clamped; in 60 minutes of ischemia it was released. After 24 hours of the renal reperfusion, the rats were, once more, anesthetized and submitted to total left nephrectomy, and, afterwards, to euthanasia. Histological findings regarding ischemia have been evaluated and compared between the groups. RESULTS: There was no statistical difference related to inferior renal pole histological analysis. Regarding 60-minute renal ischemia, chlorpromazine has statistically reduced the accrual of leucocytes within the vasa recta renis (p=0.036) and the congestion of peritubular capillaries (p=0.041). When conducting joint analysis of histological patterns, the control group showed a median score of 11 and chlorpromazine group of 5.5 (p=0.036). CONCLUSION: Chlorpromazine significantly reduced the occurrence of secondary damage to ischemia and reperfusion process in the overall histological analysis.
الموضوعات
Animals , Male , Rats , Reperfusion Injury/pathology , Chlorpromazine/pharmacology , Ischemic Preconditioning/methods , Kidney/blood supply , Kidney Diseases/pathology , Rats, Wistar , Disease Models, Animal , Ischemia/pathology , Kidney/pathologyالملخص
RESUMO Objetivo: O objetivo desde estudo foi avaliar a efetividade da triancinolona intra-vítrea e da clorpromazina retrobulbar como alternativas no manejo da dor ocular em olhos cegos. Métodos: Este foi um estudo prospectivo intervencionista não-randomizado de pacientes com olho cego doloroso não responsivo ao tratamento tópico e sem indicação de evisceração atendidos no Serviço de Oftalmologia do Hospital Governador Celso Ramos no ano de 2010. Após exame oftalmológico e ultrassonografia ocular modo B, os pacientes foram divididos em dois grupos. Pacientes do Grupo 1 possuíam glaucoma intratável e receberam injeção retrobulbar de clorpromazina 2,5ml, e pacientes do Grupo 2 possuíam olhos phthisicos com componente inflamatório e receberam injeção intra-vítrea de triancinolona 0,3ml. Foram realizadas avaliações com 1, 3 e 6 meses após o procedimento e a dor quantificada de forma subjetiva em uma escala de 0 a 10 (sem dor e com o máximo de dor, respectivamente). Resultados: Foram incluídos 38 olhos, sendo 15 no Grupo 1 e 21 no Grupo 2. Houve predomínio do sexo masculino e idade média de 54 anos. A causa mais prevalente de olho cego doloroso foi o glaucoma neovascular. Tanto a injeção de clorpromazina retrobulbar quanto a de triancinolona intra-vítrea mostraram-se eficazes no controle da dor ocular em olhos cegos no período do estudo (p<0,001). Ocorreu uma redução de 77,1% no uso de colírios (p<0,01) após a aplicação das medicações. Conclusão: Tanto a injeção de clorpromazina retrobulbar quanto a de triancinolona intra-vítrea mostraram resultados significativos no controle da dor ocular em olhos cegos, além de uma redução no uso de colírios. A clorpromazina é um medicamento de baixo custo, com melhor perfil de efeitos adversos e mostrou resultados discretamente melhores relação à triancinolona. Possíveis viéses identificados no estudo são o de tempo e seleção.
ABSTRACT Objective: The objective of this study was to evaluate the efficacy of intravitreal triamcinolone and retrobulbar chlorpromazine as alternatives in the management of ocular pain in blind eyes. Methods: This was a non-randomized interventional prospective study of patients with painful blind eye unresponsive to topical treatment and without indication of evisceration treated at the Hospital Governador Celso Ramos Ophthalmology Service in 2010. After ocular examination and ocular B mode ultrasound, patients were divided into two groups. Group 1 patients had intractable glaucoma and received retrobulbar injection of chlorpromazine 2.5ml, and Group 2 patients had phthisics eyes with inflammatory component and received intravitreal triamcinolone injection 0.3ml. Evaluations were performed at 1, 3 and 6 months after the procedure and quantified pain subjectively on a scale from 0 to 10 (no pain and maximum pain, respectively). Results: 38 eyes were included, 15 in Group 1 and 21 in Group 2. There was a predominance of males with a mean age of 54 years. The most prevalent cause of painful blind eye was the neovascular glaucoma. Any retrobulbar injection of chlorpromazine as the intravitreal triamcinolone shown to be effective in the control of ocular pain in the eye blind study period (p <0.001). There was a 77.1% reduction in eye drops (p <0.01) after application of medication. Conclusion: Both the retrobulbar injection chlorpromazine as the intravitreal triamcinolone showed significant results in the control of ocular pain in blind eyes, and a reduction in the use of eye drops. Chlorpromazine is a low cost product, with a better adverse effect profile and showed slightly better results compared to triamcinolone. Potential bias identified in the study are the time and selection.
الموضوعات
Humans , Male , Female , Middle Aged , Triamcinolone/administration & dosage , Chlorpromazine/administration & dosage , Blindness/complications , Eye Pain/etiology , Eye Pain/drug therapy , Retinal Vein Occlusion/complications , Retinal Detachment/complications , Triamcinolone/therapeutic use , Chlorpromazine/therapeutic use , Glaucoma, Open-Angle/complications , Glaucoma, Neovascular/complications , Prospective Studies , Diabetic Retinopathy/complications , Intravitreal Injections , Injections , Intraocular Pressureالملخص
A esquizofrenia, síndrome neuropsiquiátrica caracterizada por comprometimento das funções cerebrais, apresenta, além de sintomas comportamentais, alterações eletroencefalográficas, está associada a uma desregulação das respostas imunológicas e componente oxidativo. No entanto, o papel do dano oxidativo nas alterações eletroencefalográficas presentes na esquizofrenia não está completamente esclarecido. Desta maneira, este estudo teve como objetivo avaliar os efeitos antipsicóticos da associação de clorpromazina (CP) e ácido lipóico (ALA), em modelo de esquizofrenia induzido por cetamina (KET), em ratos. Foram utilizados ratos Wistar machos (200-300 g), tratados durante 10 dias e divididos em dois protocolos experimentais. No primeiro, os animais foram divididos em quatro grupos (n = 10) e tratados com solução salina (controle) ou cetamina (10, 50 ou 100 mg/kg). No segundo, os animais foram divididos em nove grupos (n = 10), tratados com solução salina (controle), ácido lipóico (100 mg/kg), cetamina (10 mg/kg), clorpromazina (1 ou 5 mg/kg) sozinha ou associada a cetamina (CP1 ou CP5+KET) ou associada ao ácido lipóico (ALA+CP1 ou CP5+KET)...
Schizophrenia, a neuropsychiatric syndrome characterized by brain functions impairment, presents besides the behavioral symptoms, electroencephalographic changes and it is associated with a dysregulation of immune responses and oxidative component. However, the role of the inflammatory and oxidative damage on the electroencephalographic alterations present in schizophrenia was not completely clarified. Thus, this study aimed to investigate the electroencephalographic, behavioural and neurochemical effects in the hippocampus of rats treated with chlorpromazine alone or associated with lipoic acid in the model of schizophrenia induced by ketamine. However, the role of oxidative damage in electroencephalographic changes present in schizophrenia is not fully understood. As a result, this study aimed to evaluate the effects of the antipsicotics association of chlorpromazine (CP) and lipoic acid (ALA) in the schizophrenia model induced by ketamine (KET) in rats. Wistar male rats (200-300 g) were tested. They were treated for 10 days and divided into two experimental protocols: At first the animals were divided into 4 groups (n = 10) and treated with saline (control) or ketamine (10, 50, or 100 mg/kg). In the second, the animals were divided into 9 groups (n = 10) treated with saline (control), lipoic acid (100mg/kg), ketamine (10mg/kg) and chlorpromazine (1 or 5 mg/kg) alone or and ketamine (CP1 and CP5+KET) or associated with lipoic acid (ALA+CP1 and CP5+KET)...
الموضوعات
Humans , Schizophrenia , Hippocampus , Oxidative Stress , Electroencephalography , Ketamine , Chlorpromazine , Thioctic Acidالملخص
This study was conducted to investigate whether agmatine (AGM) provides protection against oxidative stress induced by treatment with chlorpromazine (CPZ) in Wistar rats. In addition, the role of reactive oxygen species and efficiency of antioxidant protection in the brain homogenates of forebrain cortexes prepared 48 h after treatment were investigated. Chlorpromazine was applied intraperitoneally (i.p.) in single dose of 38.7 mg/kg body weight (BW) The second group was treated with both CPZ and AGM (75 mg/kg BW). The control group was treated with 0.9% saline solution in the same manner. All tested compounds were administered i.p. in a single dose. Rats were sacrificed by decapitation 48 h after treatment Treatment with AGM significantly attenuated the oxidative stress parameters and restored antioxidant capacity in the forebrain cortex. The data indicated that i.p. administered AGM exerted antioxidant action in CPZ-treated animals. Moreover, reactive astrocytes and microglia may contribute to secondary nerve-cell damage and participate in the balance of destructive vs. protective actions involved in the pathogenesis after poisoning.
الموضوعات
Animals , Rats , Agmatine/pharmacology , Antioxidants/pharmacology , Chlorpromazine/toxicity , Oxidative Stress/drug effects , Prosencephalon/drug effects , Rats, Wistarالملخص
PURPOSE: The response to haloperidol as a first-line neuroleptic and the pattern of neuroleptic rotation after haloperidol failure have not been well defined in palliative care. The purpose of this study was to determine the efficacy of haloperidol as a first-line neuroleptic and the predictors associated with the need to rotate to a second neuroleptic. MATERIALS AND METHODS: We conducted a retrospective review of the charts of advanced cancer patients admitted to our acute palliative care unit between January 2012 and March 2013. Inclusion criteria were a diagnosis of delirium and first-line treatment with haloperidol. RESULTS: Among 167 patients with delirium, 128 (77%) received only haloperidol and 39 (23%) received a second neuroleptic. Ninety-one patients (71%) who received haloperidol alone improved and were discharged alive. The median initial haloperidol dose was 5 mg (interquartile ranges [IQR], 3 to 7 mg) and the median duration was 5 days (IQR, 3 to 7 days). The median final haloperidol dose was 6 mg (IQR, 5 to 7 mg). A lack of treatment efficacy was the most common reason for neuroleptic rotation (87%). Significant factors associated with neuroleptic rotation were inpatient mortality (59% vs. 29%, p=0.001), and being Caucasian (87% vs. 62%, p=0.014). Chlorpromazine was administered to 37 patients (95%) who were not treated successfully by haloperidol. The median initial chlorpromazine dose was 150 mg (IQR, 100 to 150 mg) and the median duration was 3 days (IQR, 2 to 6 days). Thirteen patients (33%) showed reduced symptoms after the second neuroleptic. CONCLUSION: Neuroleptic rotation from haloperidol was only required in 23% of patients with delirium and was associated with inpatient mortality and white race.
الموضوعات
Humans , Chlorpromazine , Racial Groups , Delirium , Diagnosis , Haloperidol , Inpatients , Mortality , Palliative Care , Retrospective Studies , Treatment Outcomeالملخص
Hyperprolactinemia is a common side effect of antipsychotic drugs that requires further investigation. The current study was designed to evaluate dose-dependent effect of chlorpromazine [CPZ] on hormonal changes and uterine horn histological structure in rats. Moreover, the mammary glands were analyzed to show hyperprolactinemia-induced histological changes. Albino Wistar rats [n = 32] were divided into four groups. The first group was set as a control. In the three drug-treated groups [eight rats in each group], CPZ was administered by a gavage at doses of 3, 10, and 30 mg/kg/day for 28 days. One day after the last administration of the drug, the animals were sacrificed. Histopathological and histomorphometrical analyses of the uterine horns and mammary glands were carried out to evaluate dose-dependent effect of CPZ on histological structure. Serum levels of prolactin [PRL], estradiol, progesterone, follicle-stimulating hormone [FSH], and luteinizing hormone [LH] were also evaluated. Remarkable [P < 0.05] elevation was observed in CPZ-administrated animals' uterine horn endometrium, myometrium, and perimetrium thicknesses, and the mammary glands were observed with galactorrhea features. The serum level of progesterone and PRL significantly [P < 0.05] increased, while the serum concentration of LH, FSH, and estradiol was notably [P < 0.05] decreased depending on administrated CPZ dose. No histological and biological changes were occurred in the control animals. The present findings suggest that CPZ-induced disturbances not only depend on PRL level and increased PRL level largely depends on administrated doses of the CPZ
الموضوعات
Animals, Laboratory , Chlorpromazine , Uterus , Rats, Wistarالملخص
Background: Isokinetic dynamometry allows the measurement of several variables related to muscular performance, many of which are seldom used, while others are redundantly applied to the characterization of muscle function. Objectives: The present study aimed to establish the particular features of muscle function that are captured by the variables currently included in isokinetic assessment and to determine which variables best represent these features in order to achieve a more objective interpretation of muscular performance. Method: This study included 235 male athletes. They performed isokinetic tests of concentric knee flexion and extension of the dominant leg at a velocity of 60º/s. An exploratory factor analysis was performed. Results: The findings demonstrated that isokinetic variables can characterize more than muscle torque production and pointed to the presence of 5 factors that enabled the characterization of muscular performance according to 5 different domains or constructs. Conclusions: The constructs can be described by torque generation capacity; variation of the torque generation capacity along repetitions; movement deceleration capacity; mechanical/physiological factors of torque generation; and acceleration capacity (torque development). Fewer than eight out of sixteen variables are enough to characterize these five constructs. Our results suggest that these variables and these 5 domains may lead to a more systematic and optimized interpretation of isokinetic assessments. .
الموضوعات
Animals , Male , Rabbits , Indenes/toxicity , Motor Neurons/drug effects , Spinal Cord/drug effects , Chlorpromazine/pharmacology , Pentobarbital/pharmacology , Reflex/drug effects , Spinal Cord/cytologyالملخص
La enfermedad hepática inducida por drogas es un fenómeno multifacético y su espectro morfológico es muy variado imitando cualquier patrón de daño hepático, tanto en pacientes expuestos en forma aguda o crónica, en aquellos susceptibles en forma idiosincrática a una dosis terapéutica o por toxicidad intrínseca, a su vez puede estar afectada por otros factores como son los genéticos, la edad o el sexo, el estado nutricional, la exposición a otros fármacos o la existencia de una enfermedad de base; puede ser la única manifestación clínica del efecto adverso de una droga o estar acompañado de manifestaciones sistémicas o de otros órganos, e incluso puede llegar a ser fatal (1). Su incidencia no está bien definida, algunos estudios afirman que la incidencia global es variable encontrándose entre 1-15 x 100.000 personas/año, en USA ocurren 20 nuevos casos x 100.000 habitantes/año. Se han descrito como causantes de lesión hepática más de 900 drogas, productos herbales, homeopáticos, suplementos dietéticos o toxinas, sean productos naturales o de la industria farmacéutica, utilizados o no en dosis terapéuticas, que son las responsables de aproximadamente 15% de consultas y hospitalizaciones por ictericia, hepatitis aguda o crónica; en la población adulta, por encima de los 50 años, llega a 40% de todos los casos de hepatitis. Es también la causante de 11-50% de casos de falla hepática aguda. Los datos publicados indican que los antibióticos son responsables entre un 27-46% de los casos, seguidos por medicamentos para enfermedades del sistema nervioso central entre 13-17%, antiinflamatorios y analgésicos de 5-17% y los productos herbales 9%. Nuevos biomarcadores y el uso de microRNA se están estudiando y serán prometedores en un futuro cercano para identificar pacientes que puedan presentar hepatotoxicidad inducida por medicamentos. Son tantos los tipos de lesión hepática atribuidos a estos agentes que solo podremos dar algunos ejemplos en este artículo, basados en los patrones de daño hepático y enfatizando la importancia de una adecuada y profunda correlación clínica (2, 3).
Drug-induced liver disease is a multifaceted phenomenon which has a varied morphological spectrum that mimics other patterns of liver damage both in cases of acute drug exposure and in cases of chronic exposure to drugs. Those patients who are idiosyncratically susceptible at the therapeutic dose or to intrinsic toxicity may also be affected by other factors including genetic factors, age, sex, nutritional status, exposure to other drugs and the existence of an underlying disease. The only clinical manifestation of the disease may be the adverse effect of a drug, but it can also be accompanied by systemic manifestations and manifestations in other organs, and it can even be fatal (1). The incidence of drug-induced liver disease is not well defined, but some studies claim that its overall annual incidence varies between 1/100,000 people and 15/100,000 people. In the United States, twenty new cases per 100,000 inhabitants occur every year. More than 900 natural and pharmaceutical drugs, herbal medicines, homeopathic products, dietary supplements and toxins have been reported to cause liver damage. This can occur whether or not they are used at normal therapeutic doses. These cases are responsible for about 15% of consultations and hospitalizations for jaundice, acute hepatitis, and chronic hepatitis in adults above the age of 50, and in up to 40% of all cases of hepatitis. Drug-induced liver disease also accounts for 11% to 50% of all cases of acute liver failure. Published data indicate that antibiotics are responsible for between 27% and 46% of cases, that drugs for diseases of the central nervous system are responsible for between 13% and 17%, anti-inflammatory and analgesic agents are responsible for between 5% and 17%, and herbal products are responsible for 9%. New biomarkers and the use of microRNA are being studied and may become promising alternatives in the near future for identifying patients susceptible to drug-induced hepatotoxicity. There are so many types of liver damage attributed to these agents that only give some examples can be provided in this article. These examples have been chosen on the basis ofn the patterns of liver damage with emphasis on the importance of proper and thorough clinical correlation (2, 3).