Associated factors and prevalence of erectile dysfunction in hemodialysis patients

Purpose: The proposal of this study was to determine the prevalence and the associated factors of erectile dysfunction (ED) among hemodialysis (HD) patients. Materials and Methods: This was a cross-sectional study based on data collected from HD male patients. Clinical, demographic and laboratory data of all patients were collected in three HD clinics from December 2010 to June 2011. Patients answered questions of erectile function domain from International Index of Erectile Function. Data were evaluated by descriptive analysis and by univariate (ULRA) and multivariate logistic regression analysis (MLRA). Results: Three hundred and five patients participated of the study. The prevalence of ED was 68.19%. ED was associated with diabetes (DM), benign prostatic hyperplasia, glomerulonephritis as cause of chronic renal failure (CRF), smoking habits, lower creatinine levels (ULRA), use of calcium channel blocker (MLRA), aging, lower education level, alcohol consumption, DM (as cause of CRF) and coronary insufficiency (ULRA and MLRA). Conclusions: ED was highly prevalent in the HD men. It was independently associated with aging, current use of alcohol, long alcohol use (even for those who do not drink more), lower education level, diabetes as cause of CRF, coronary insufficiency and use of channel blockers calcium. .

Interações medicamentosa: Tratamento da hipertensão arterial / Drugs interactions: Treatment of arterial hypertension

A hipertensão arterial é a doença cardiovascular mais prevalentee, para se atingir a meta de controle ideal, a maioriados pacientes necessita de mais de uma classe terapêutica.Além disso, devido à presença de muitas comorbidades associadas,é comum o uso de outras medicações associadas.O entendimento das interações benéficas e indesejáveisdos medicamentos anti-hipertensivos entre si e com outrostipos de medicamentos, é muito importante para se obter umtratamento adequado do paciente hipertenso. Neste artigo,abordamos as principais interações das diferentes classesde anti-hipertensivos que apresentam benefícios na melhorobtenção do efeito anti-hipertensivo e na redução de efeitoscolaterais. Também são apresentadas as interações que podematrapalhar o efeito anti-hipertensivo das medicações, assimcomo aumentar a chance de efeitos colaterais...

Hypertension is the most prevalent cardiovascular disease,and to achieve the goal of optima! contrai, most patients requiremore than one therapeutic c1ass. In addition, due to thepresence of several associated co-morbidities it is common touse other associated medications. Understanding beneficialand undesirable interactions of antihypertensive medicationsamong themselves and with other types of drugs, it is veryimportant to get a proper treatment of the hypertensive patient.In this article we discuss the main interactions of differentclasses of antihypertensive drugs which are beneficial inobtaining better antihypertensive effect and reducing sideeffects. We also presented the interactions that could disruptthe antihypertensive effect of the drugs as well as increasethe risk of side effects...

Preference of patient information leaflets over standard drug monographs by patients prescribed hydrochlorothiazide, nifedipine and enalapril / Preferencia por los prospectos de información al paciente en lugar de las monografías estándar sobre medicamentos, por parte de los pacientes a quienes se les ha prescrito hidroclorotiazida, nifedipina y analapril

Standard drug monographs (SDMs) have been described as deficient in providing information in a manner simplified enough for patient reading. The aim of this study was to design patient information leaflets for hydrochlorothiazide, nifedipine and enalapril with content indicated by patients as relevant and to evaluate them against the SDM. Patient information leaflet (PIL) for each drug was designed to contain information on name, use of drug, how it works, how it is to be taken, common side effects, storage, missed dose action, things to avoid and when to contact the physician. Appropriateness was assessed by 10 practising pharmacists. For each drug, 40 patients were recruited, of which 20 were given SDM and 20 PIL. The knowledge of each participant was examined before and after exposure to SDM or PIL, as well as opinion on ease of reading and attractiveness using Pearson's Chi-square analysis. The results showed that both SDM and PIL improved knowledge of common side effects when compared with responses before exposure (χ² = 24.26for SDM and 27.64 for PIL, p < 0.001) with no difference between the groups. Respondents receiving PILs were better able to recall "things to avoid" after exposure to PIL (χ² =10.85, p < 0.001). After exposure to SDM or PIL, the respondents who received PIL were more aware of when to contact the physician, compared to the SDM group (χ² = 8.41, p < 0.01). When compared with SDM, respondents receiving PIL were more likely to indicate that PIL was easy to read (χ² = 20.00, p < 0.001), attractive (χ² = 12.45, p < 0.001) and they were more likely to recommend distribution of their reading material to other patients (χ² = 22.11, p < 0.001). We conclude that there is benefit in designing information leaflets that simplify language and medication information contained in SDMs, including better understanding of precautions to take while on medication and when to consult physicians.

Las monografías de medicamentos estandarizadas se han considerado deficientes a la hora de proporcionar información de manera suficientemente simple para que el paciente pueda entenderlas. El objetivo de este estudio fue disenar prospectos con información sobre la hidroclorotiazida, la nifedipina y el analapril con contenidos indicados como relevantes por los pacientes, y evaluarlos en comparación con las monografías estandarizadas de medicamentos (MEM). El prospecto de información para el paciente (PIP) fue disenado de modo que apareciera información sobre el nombre del medicamento, su uso, modo de operar, manera de tomarse, efectos secundarios comunes, almacenamiento, qué hacer en caso de perder una dosis, cosas que deben evitarse, y cuando debe contactarse el médico. Se evaluó la adecuación por parte de 10 farmacéuticos practicantes. Para cada medicamento, se reclutaron 40 pacientes, a 20 de los cuales se les dio monografías (MEM), en tanto que a 20 se les ofreció prospectos (PIP). El conocimiento de cada participante se examinó antes y después de la exposición a MEM o PIP, así como la opinión en cuanto a facilidad de lectura y grado de atracción, usando el análisis del Chi-cuadrado de Pearson. Los resultados mostraron que tanto MEM como PIP mejoraron el conocimiento sobre los efectos secundarios comunes, cuando se hacía una comparación con las respuestas antes de la exposición (χ² = 24.26para MEMy 27.64para PIP, p < 0.001) sin diferencia entre los grupos. Los encuestados que recibieron prospectos pudieron recordar mejor las "cosas a evitar" luego de la exposición a PIP (χ² =10.85, p < 0.001). Después de la exposición a MEM o PIP, los encuestados con PIP tenían mayor conciencia en cuanto a cuando contactar a un médico, en comparación con el grupo MEM (χ² = 8.41, p < 0.01). Cuando se les comparó con el grupo MEM, los encuestados que recibieron PIP mostraron por una parte mayor probabilidad de indicar que PIP era más fácil de leer (χ² = 20.00, p < 0.001) y atractivo (χ² = 12.45, p < 0.001), y por otra, una mayor tendencia a recomendar la distribución de su material de lectura a otros pacientes (χ² = 22.11, p < 0.001). Se llegó a la conclusión de que es beneficioso disenar prospectos que simplifiquen el lenguajey la información médica contenida en las monografias estándar del medicamento, incluyendo una mejor comprensión de las precauciones a tomar mientras se está bajo medicación, y sobre cuándo consultar al médico.

Effects of pharmaceutical medications on male fertility

The number of couples seeking consultation for infertility problems has steadily increased over the past decade, affecting 10%-15% of the sexually active population. Abnormal semen production, a male factor infertility [MFI], is thought to be the cause of up to 50% of all infertilities in developed countries. There are potentially many different causes of male infertility, including hormonal, anatomical, and secondary to exposure to exogenous substances. In many cases of MFI, a definitive cause for abnormalities is never identified. Recently, the research community has given greater attention to identifying causes of MFI ranging from genetic Y chromosome microdeletions to mechanisms of environmental damage on sperm production. Still evolving, is a clear understanding of how many pharmaceutical medications may cause MFI, which is often treatable and reversible. In this review we will out-line the data regarding various pharmaceutical medications that have been investigated as possible causes of MFI

Farmacovigilancia activa en pacientes afiliados al sistema general de seguridad social en salud / Active pharmacosurveillance of patients affiliated to the Colombian general social security/health system

Objetivos Determinar los posibles resultados negativos asociados a la medicación mediante la metodología de búsqueda activa de posibles interacciones medicamentosas en bases de datos de pacientes afiliados al Sistema General de Seguridad Social en Salud. Métodos A partir de las bases de datos de dispensación de medicamentos de Audifarma S.A a unos 4 millones de usuarios del país, se hizo una revisión sistemática de estadísticas de una serie de medicamentos identificados por presentar interacciones de riesgo, dosis diferentes a las recomendadas o dispensación irregular. Los casos son socializados con las EPS responsables. Resultados Se encontró un caso de nefrotoxicidad por ácido zoledrónico; el 37,0 por ciento de los usuarios de clopidogrel recibían concomitantemente omeprazol, que reduce la efectividad del primero; el 29,9 por ciento de los pacientes que toman losartan están recibiendo dosis superiores a las recomendadas para su indicación; el 2,0 por ciento de los pacientes que toman metoprolol o verapamilo, los recibe simultáneamente, con riesgo de generar bradicardia sinusal, bloqueos auriculoventriculares o disfunción sistólica. Todos los casos fueron notificados a los responsables en la EPS que atienden estos pacientes. Discusión La farmacovigilancia activa permite optimizar recursos, prevenir eventos adversos que puedan potencialmente causar morbilidad importante o incluso letalidad o determinar problemas que podrían ser responsables del fracaso terapéutico. Este tipo de estrategia se anticipa a la aparición de posibles riesgos para el paciente por lo que se recomienda considerarla para reforzar los programas de vigilancia de uso de medicamentos en el país.

Objectives Determining negative results associated with medication through an active search of possible drug interactions in databases for patients affiliated to the Colombian general social security/health system. Methods Statistics related to Audifarma S.A. dispensation drug databases for about 4 million Colombian users were systematically reviewed for identifying drugs having known interactions involving risk, doses different from recommended ones or irregular dispensation. The pertinent health-care providing services were made aware of the above. Results There was one case of nephrotoxicity being caused by zoledronic acid. 37 percent of clopidogrel users concomitantly received omeprazole which reduces the former's effectiveness. 29.9 percent of patients who were taking losartan were receiving doses higher than the recommended ones. 2.0 percent of patients who were taking metoprolol or verapamil were simultaneously receiving them, at the risk of generating first-degree heart block, bradycardia, or systolic dysfunction. All these cases were notified to the pertinent health-care services. Conclusions Active pharmacosurveillance leads to resources being optimised, adverse events which can potentially cause morbidity or lethality being prevented or even determining problems which could be responsible for therapeutic failure. This type of strategy anticipates the appearance of possible risks for patients, meaning that drug use monitoring programmes in Colombia should be reinforced.

Hepatotoxicidad por verapamil: reporte de un caso / Liver injury due to treatment with verapamil: case report

Drug induced liver injury is an infrequent adverse effect of Verapamil. It has been reported in about ten cases since 1981. We report a case of a middle-aged woman who received Verapamil in a dose of 120mg/d for eight weeks, developing a mixed hepatocellular and cholestatic pattern of liver injury without any symptoms. There was no evidence of eosinophilia. Liver function tests returned quickly to normal levels after discontinuation. As in previously reported cases, we hypothesize that this is an idiosyncratic mechanism of liver injury.

La hepatotoxicidad es un efecto adverso infrecuente de verapamil, existiendo alrededor de 10 casos reportados desde 1981. Relatamos el caso de una mujer de edad media que presenta una alteración de las pruebas hepáticas con patrón mixto asociado al uso de verapamil 120 mg/d por 8 semanas sin síntomas asociados, la cual responde rápidamente a la suspensión de este fármaco. Al igual que en casos reportados previamente, planteamos como mecanismo de injuria una hepatotoxicidad idiosincrática por este medicamento.

Risk Factors for Recurrent Hypoglycemia in Hospitalized Diabetic Patients Admitted for Severe Hypoglycemia

PURPOSE: Severe hypoglycemia can result in neural damage, impaired cognitive function, coma, seizures, or death. The decision to admit diabetic patients after initial treatment in the emergency department remains unclear. Our purpose is to identify risk factors for developing recurrent hypoglycemia in diabetic patients admitted for severe hypoglycemia. MATERIALS AND METHODS: We reviewed the records of 233 subjects (92 males, 141 females; mean age, 74.1 +/- 9.8 years) with type 2 diabetes treated at a tertiary care teaching hospital and hospitalized for severe hypoglycemia. RESULTS: Seventy-four (31.8%) patients were categorized with recurrent hypoglycemia and 159 (68.2%) with non-recurrent. Multivariate logistic regression analysis revealed that patients with loss of a recent meal, coronary artery disease, infection, and poor renal function (lower estimated glomerular filtration rate) were at risk for recurrent hypoglycemia. The use of calcium-channel blockers appeared to be a protective factor for the development of recurrent hypoglycemia. CONCLUSION: There may be a subset of patients with severe hypoglycemia and certain risk factors for recurrent hypoglycemia that should be admitted.

Oral drugs for hypertensive urgencies: systematic review and meta-analysis / Drogas orais para urgências hipertensivas: revisão sistemática e metanálise

CONTEXT AND OBJECTIVE: Hypertensive urgencies are defined as severe elevations in blood pressure without evidence of acute or progressive target-organ damage. The need for treatment is considered urgent but allows for slow control using oral or sublingual drugs. If the increase in blood pressure is not associated with risk to life or acute target-organ damage, blood pressure control must be implemented slowly over 24 hours. For hypertensive urgencies, it is not known which class of antihypertensive drug provides the best results and there is controversy regarding when to use antihypertensive drugs and which ones to use in these situations. The aim of this review was to assess the effectiveness and safety of oral drugs for hypertensive urgencies. METHODS: This systematic review of the literature was developed at the Brazilian Cochrane Center, and in the Discipline of Emergency Medicine and Evidence-Based Medicine at the Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp-EPM), in accordance with the methodology of the Cochrane Collaboration. RESULTS: Sixteen randomized clinical trials including 769 participants were selected. They showed that angiotensin-converting enzyme inhibitors had a superior effect in treating hypertensive urgencies, evaluated among 223 participants. The commonest adverse event for calcium channel blockers were headache (35/206), flushing (17/172) and palpitations (14/189). For angiotensin-converting enzyme inhibitors, the principal side effect was bad taste (25/38). CONCLUSIONS: There is important evidence in favor of the use of angiotensin-converting enzyme inhibitors for treating hypertensive urgencies, compared with calcium channel blockers, considering the better effectiveness and the lower frequency of adverse effects (like headache and flushing).

CONTEXTO E OBJETIVO: Urgências hipertensivas são definidas como elevações graves na pressão arterial sem evidência de danos agudos ou progressivos a órgãos-alvo. A necessidade de tratamento é considerada urgente, mas permite um controle gradual, utilizando-se drogas orais ou sublinguais. Se o aumento na pressão arterial não está associado a risco de vida ou danos a órgãos alvo, o controle pressórico deve ser feito lentamente durante 24 horas. Em relação às urgências hipertensivas, não é conhecida qual a classe de drogas anti-hipertensivas que promove os melhores resultados e há controvérsia em relação a quando e quais as drogas devem ser utilizadas nestas situações. O objetivo desta revisão foi avaliar a efetividade e a segurança de drogas orais para urgências hipertensivas. METODOS: Esta revisão sistemática da literatura foi desenvolvida no Centro Cochrane do Brasil, e na Disciplina de Medicina de Urgência e Medicina Baseada em Evidências da Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp-EPM), de acordo com a metodologia da Colaboração Cochrane. RESULTADOS: Os 16 ensaios clínicos aleatórios selecionados incluíram 769 participantes e demonstraram um efeito superior dos inibidores da enzima conversora de angiotensina no tratamento da urgência hipertensiva, avaliada em 223 participantes. Os efeitos adversos mais frequentes para os bloqueadores de canal de cálcio foram cefaleia (35/206), rubor (17/172) e alterações do ritmo cardíaco (14/189); para os inibidores da enzima conversora de angiotensina, o efeito colateral mais frequente foi disgeusia (25/38). CONCLUSÕES: Há evidências importantes a favor do uso de inibidores da enzima conversora da angiotensina para o tratamento de urgências hipertensivas, quando comparados aos bloqueadores dos canais de cálcio, devido a maior efetividade e à menor frequência de efeitos adversos, como cefaléia e rubor facial.

Effects of amlodipine besylate on spermatogenesis in sprague dawley rats

To determine the effects of chronic treatment with amlodipine besylate on spermatogenesis in Sprague Dawley rats. Quasi experimental study. The study carried out in the department of Physiology, Army Medical College Rawalpindi in collaboration with the department of Pathology, Army Medical College and National Institute of Health, Islamabad during April 2007 and March 2008. Thirty male Sprague Dawley rats were divided into two groups; each comprising of 15 rats. Group A was given vehicle whereas group B was given amlodipine besylate [norvasc] by oral and gavage for 50 days along with standard rat diet. Testes were removed 24 h after the last experimental day and sectioned. The sections were stained by hematoxylin and eosin and examined microscopically. Results were analyzed on SPSS version 13. There were significant differences in mean tubular diameter and height of germinal epithelium of testes between amlodipine and vehicle treated rats. Long term treatment with amlodipine besylate [norvasc] results in suppression of spermatogenesis in male rats

Hemodynamic effects of anesthetic induction in patients treated with beta and calcium channel blockers

The response to anesthetic induction and airway manipulation in the presence of cardiovascular disease and anti-hypertensive therapy has not been adequately investigated. The blood pressure, pulse pressure and heart rate changes at induction and following tracheal intubation were compared in patients who were on either preoperative beta-adrenergic blocker therapy [BB group, n = 20] or a combination of beta-adrenergic blocker and calcium channel blocker therapy [BB + CCB group, n = 20]. A standardized anesthesia induction protocol was followed, in the two gourps. No statistical difference was observed in the hemodynamic parameters between the two groups. The total number of hypotensive patients [SAP 90

Hiperplasia gingival por ciclosporina: A propósito de un caso / Cyclosporine-induced gingival hyperplasia: Report of one case

Gingival enlargement can be an adverse effect of ciclosporine A and nifedipine use. It has a high relapse rate if the drugs are not discontinued. There is a genetic predisposition to the development of this condition and dental biofilm can also play a role. We report a 64 years old male who received a renal allograft and was treated with cyclosporine and nifedipine. He required six surgical interventions for generalized gingival enlargement. After the sixth relapse, the patient was subjected to a periodontal treatment to eliminate the dental biofilm, which decreased the rate of recurrence of gingival enlargement.

Reações adversas a drogas em idosos / Adverse drug reactions in aged

O envelhecimento populacional é um fato. As mudanças relacionadas à idade e a presença de múltiplas patologias contribuem para o uso de um maior número de medicamentos pelos idosos, o que por sua vez facilita a ocorrência de reações adversas a drogas (RADs), a quarta causa de óbito nos EUAA. A incidência de RADs varia de 3 por cento a 24 por cento na população geriátrica que procura cuidados médicos de emergência. O número de drogas usadas, o sexo feminino, o número de co-morbidades e a desobediência ao tratamento podem ser considerados fatores relacionados. Antiinflamatórios não-hormonais, diuréticos, inibidores da agregação plaquetária e bloqueadores de canais de cálcio foram as principais drogas associadas. Apesar da heterogeneidade dos dados encontrados, as RADs representa um importante problema, não somente clínico, mas também socioeconômico.

Drug related crisis in myasthenia gravis.

Myasthenia gravis is an autoimmune disorder where antibodies against the nicotinic Ach receptor resulting in impaired transmission at the NM junction. A number of drugs have been reported to cause neuromuscular blockade and/or to increase weakness in myasthenia gravis. We report a case of myasthenia gravis in which the calcium channel blocker-nifedipine caused the worsening of the symptoms.

The effects of a sodium and a calcium channel blocker on lethality of mice injected with the yellow scorpion (Leiurus quinquestriatus) venom

Scorpion venom toxins generally produce similar effects by mainly acting on sodium channels, and to a lesser extent, on potassium, calcium, and chloride channels. This leads to increased release of neurotransmitters and mediators, resulting in a cascade of pathological events, involving the central nervous system, the autonomic nervous system, the cardiovascular and the respiratory system, eventually leading to death. The objective of this paper was to discover whether a sodium channel blocker, lidocaine, or a calcium channel blocker, verapamil, would prolong the survival of mice injected with the venom from the common yellow scorpion Leiurus quinquestriatus quinquestriatus (LQQ). For this purpose, mice were divided into 2 groups, each injected with a different venom dose (250 or 300 µg.kg-1, s.c.). Subgroups (n=10) from each group were given venom alone; different doses of lidocaine (4, 10, 15, or 20 mg.kg-1); or several doses of verapamil (0.01, 0.03, 0.1, 0.3, or 1 mg.kg-1). All doses of lidocaine and verapamil were intravenously administered 3 minutes before, 1, 5, and 15 minutes after venom injection. Percent surviving after 24 hours was recorded in addition to the time of death. In general, lidocaine significantly prolonged survival at the dose of 10 mg.kg-1 (P<0.05 and P<0.01, versus low and high dose of venom, respectively) or 15 mg.kg-1 (P<0.01 and P<0.001, versus low and high dose of venom, respectively; Covariance Wilcoxon survival statistics), especially when injected before the venom or in the early stages of envenomation. On the other hand, in all doses administered, verapamil was either toxic or showed non-significant results. Lidocaine, the sodium channel blocker, appears to play an important role in the protection from lethality of mice injected with LQQ venom, and significantly prolonged the survival time of mice whether injected before or in the early stages of envenomation.(AU)

Hipertrofia gengival em transplantados renais / Cyclosporine induced gingival hyperplasia in kidney transplants

OBJETIVO: Avaliar os fatores associados ao crescimento gengival excessivo em transplantados renais. MÉTODOS: A pesquisa foi realizada no Hospital Cajuru de Curitiba, no período de abril a outubro de 2002, com a participacão de 60 transplantados renais, em uso diário de ciclosporina e com pelo menos um segmento dentário. O protocolo de ensaio foi observacional transversal. O exame odontológico dos indivíduos consistiu da avaliacão dos segmentos dentários com verificacão do grau de crescimento da gengiva e do índice de placa bacteriana. Todos os participantes preencheram questionário com dados relacionados ao transplante renal, realizaram coleta de material para controle do nível sérico de ciclosporina e foram avaliados quanto ao peso e altura. Na comparacão dos resultados de amostras categóricas, utilizou-se o teste do Qui-quadrado e a correlacão de classes de Spearman. O teste t foi aplicado na comparacão das variáveis contínuas. RESULTADOS: Em pacientes tratados somente com ciclosporina, 47,2 por cento não apresentavam alteracões da gengiva, enquanto 52,8 por cento cursaram com crescimento gengival, sendo 30,6 por cento com grau > 2. Nos pacientes tratados com ciclosporina e nifedipina, notou-se que 29,2 por cento tinham gengiva normal e 70,8 por cento apresentaram crescimento gengival, sendo que em 45,8 por cento o comprometimento foi grau > 2. Não foi observada diferenca significativa dos resultados entre os gêneros masculino e feminino. Foi encontrada correlacão positiva entre o índice de placa bacteriana e o volume gengival (r = 0,3295; p<0,01). CONCLUSAO: Em transplantados renais, a hipertrofia gengival está associada ao uso de ciclosporina, isoladamente ou em concomitância com bloqueadores de cálcio, e apresenta uma correlacão com o índice de placa bacteriana.

Narrow complex tachycardia: recognition and management in the emergency room.

Cardiac arrhythmias often present as urgent medical conditions requiring immediate care. Patient presenting with a tachyarrhythmia is a common finding in the emergency room. They also occur commonly in patients undergoing non-cardiovascular procedures including surgeries. It is thus pertinent that the physician handling such cases must be appropriately trained to diagnose and provide emergency management till the case is referred to a specialist. Most cases present as narrow or a wide complex tachycardia. The differential diagnosis is arrived at by deciding on the ECG morphology alongwith relevant history and physical examination where feasible. This article describes the bedside approach to diagnose and treat an arrhythmia presenting as a narrow complex.

Parkinsonism and other movement disorders in outpatients in chronic use of cinnarizine and flunarizine

O objetivo deste estudo foi determinar a prevalência e os padrões de distúrbios do movimento (DM) em pacientes ambulatoriais sob uso crônico de cinarizina (cz) ou flunarizina (fz), além de estabelecer os principais fatores de risco para o seu aparecimento. Durante três meses foram coletados dados de pacientes ambulatoriais em uso de cz ou fz. Todos esses pacientes foram submetidos a protocolo pré-estabelecido que incluía critérios diagnósticos do DSM-IV para distúrbios do movimento induzido por drogas e critérios para diagnostico de depressão maior. Parkinsonismo (PK) puro foi diagnosticado em 34% dos pacientes, PK com acatisia, PK com acatisia e síndrome mastigatória bucolingual (SMBL), SMBL isoladamente e distonia, foram encontrados em 4% dos pacientes. Os pacientes com SMBL apresentavam a média de idade mais avançada, o maior tempo médio de uso das drogas, configurando-se o grupo de maior risco ao aparecimento dos DM. O grupo dos pacientes com DM apresentou maior incidência de depressão quando comparados com os não afetados. O estudo demonstra uma relação direta entre o tempo de uso da droga, a idade avançada do paciente e o surgimento dos DM. Os resultados também sugerem que estas drogas aumentam a incidência de depressão.