RESUMEN
Non-selective and irreversible MAOI have become as third or fourth-line strategy for the management of treatment-resistant depression. Non-selective and irreversible MAOI requires careful monitoring of drug interactions and dietary restrictions. Nutritional supplements such as omega-3 have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment. The glutamate antagonist ketamine has been found to produce beneficial effects in the management of treatment-resistant depression while administered alone. Dopamine and/or norepinephrine agonists, such as methylphenidate, modafinil or pramipexole, have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment.
Asunto(s)
Agonistas alfa-Adrenérgicos/uso terapéutico , Antidepresivos/uso terapéutico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Suplementos Dietéticos , Agonistas de Dopamina/uso terapéutico , Antagonistas de Aminoácidos Excitadores/uso terapéutico , Ketamina/uso terapéutico , Inhibidores de la Monoaminooxidasa/uso terapéutico , Antidepresivos/farmacocinética , Método Doble Ciego , Interacciones Farmacológicas , Resistencia a Medicamentos , Quimioterapia Combinada , Ácidos Grasos Omega-3/uso terapéutico , Ácido Fólico/uso terapéutico , Interacciones Alimento-Droga , Humanos , Inhibidores de la Monoaminooxidasa/farmacocinética , Ensayos Clínicos Controlados Aleatorios como Asunto , S-Adenosilmetionina/uso terapéuticoRESUMEN
BACKGROUND: The medical care of elderly patients with psychotic disorders is a matter of major concern. The aim of the study was to investigate health conditions and treatment of elderly patients with psychotic disorders in France. METHODS: The SAGE (Schizophrenia AGEd) study (observational, cross-sectional) was a survey conducted among 123 physicians in France, regarding prescriptions of antipsychotic drugs in elderly patients (≥60 years) suffering from psychotic disorders. The survey was based on a questionnaire addressing the mental and somatic health management of the patients. RESULTS: Data from 930 patients (mean age: 70.4 years) were collected. Most patients (58.5%) suffered from schizophrenia, 20.8% had delusional disorder and 20.6% hallucinatory chronic psychosis (very-late-onset schizophrenia-like psychosis). 70.8% of them were outpatients, while 29.2% were inpatients. The severity of psychotic symptoms was assessed in 97.8% of patients, but cognitive function was only evaluated in 41.6%. Some 46.5% of patients were treated with atypical antipsychotics alone, 36.2% with classical antipsychotics alone and 17.3% received a combination of both, atypical and classical antipsychotics; 36.3% patients were given antiparkinsonian medication, of whom only 17.8% as preventive treatment; 51.1% of patients had somatic comorbidities, particularly cardiovascular disorders (34.0%). Evaluation of renal and/or liver function to adjust the dose of treatment was done in only 32.1% of patients. Over the previous 12 months, almost half of the patients had had no ECG, glycemia or creatininemia investigated and HDL-cholesterol and triglycerides were available for less than one-third of them. CONCLUSIONS: Antipsychotic and antiparkinsonian drug prescriptions in French aged psychotic patients follow only partially the clinical guidelines and recommendations of consensus conferences. Moreover, cognitive, cardiac and metabolic aspects are not fully managed as expected.
Asunto(s)
Antipsicóticos/uso terapéutico , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/epidemiología , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Antiparkinsonianos/efectos adversos , Antiparkinsonianos/uso terapéutico , Antipsicóticos/efectos adversos , Enfermedades Cardiovasculares/epidemiología , Enfermedad Crónica , Comorbilidad , Estudios Transversales , Quimioterapia Combinada , Femenino , Francia , Adhesión a Directriz , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Encuestas Epidemiológicas , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Escala del Estado Mental , Persona de Mediana Edad , Grupo de Atención al Paciente/estadística & datos numéricos , Revisión de Utilización de RecursosRESUMEN
BACKGROUND: Severe, refractory obsessive-compulsive disorder (OCD) is a disabling condition. Stimulation of the subthalamic nucleus, a procedure that is already validated for the treatment of movement disorders, has been proposed as a therapeutic option. METHODS: In this 10-month, crossover, double-blind, multicenter study assessing the efficacy and safety of stimulation of the subthalamic nucleus, we randomly assigned eight patients with highly refractory OCD to undergo active stimulation of the subthalamic nucleus followed by sham stimulation and eight to undergo sham stimulation followed by active stimulation. The primary outcome measure was the severity of OCD, as assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), at the end of two 3-month periods. General psychopathologic findings, functioning, and tolerance were assessed with the use of standardized psychiatric scales, the Global Assessment of Functioning (GAF) scale, and neuropsychological tests. RESULTS: After active stimulation of the subthalamic nucleus, the Y-BOCS score (on a scale from 0 to 40, with lower scores indicating less severe symptoms) was significantly lower than the score after sham stimulation (mean [+/-SD], 19+/-8 vs. 28+/-7; P=0.01), and the GAF score (on a scale from 1 to 90, with higher scores indicating higher levels of functioning) was significantly higher (56+/-14 vs. 43+/-8, P=0.005). The ratings of neuropsychological measures, depression, and anxiety were not modified by stimulation. There were 15 serious adverse events overall, including 1 intracerebral hemorrhage and 2 infections; there were also 23 nonserious adverse events. CONCLUSIONS: These preliminary findings suggest that stimulation of the subthalamic nucleus may reduce the symptoms of severe forms of OCD but is associated with a substantial risk of serious adverse events. (ClinicalTrials.gov number, NCT00169377.)
Asunto(s)
Terapia por Estimulación Eléctrica , Trastorno Obsesivo Compulsivo/terapia , Núcleo Subtalámico , Adulto , Hemorragia Cerebral/etiología , Estudios Cruzados , Método Doble Ciego , Terapia por Estimulación Eléctrica/efectos adversos , Femenino , Humanos , Infecciones/etiología , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: Through event-related potential (ERP) recording, to better understand the perceptive-motor slowness in adults with Down syndrome (DS); in particular, to assess whether motor preparation influences the speed of allocation of perceptual attention as reflected by the P3 latency. PATIENTS AND METHODS: ERPs were obtained in adults with and without DS through an auditory oddball paradigm under a passive and two active (simple vs. complex motor response) conditions. Reaction times (RTs) were recorded in the two active conditions. RESULTS: There was no influence of movement complexity on either RT or P3b latency in the control group. In the DS group, RT was delayed under simple vs. complex conditions whereas P3b latency was not affected. N2a and N2b were often missing in DS individuals. CONCLUSION: Motor preparation processes per se rather than interaction with perceptual attention could be defective in individuals with DS when the motor component of the response is minimal.