ORAL HALOPERIDOL PREMEDICATION TO REDUCE CAPTURE STRESS PRIOR TO XYLAZINE-KETAMINE ANESTHESIA IN CAPTIVE SPOTTED DEER (AXIS AXIS).

A prospective clinical trial was performed to evaluate the efficacy of haloperidol premedication prior to xylazine-ketamine anesthesia with a goal of reducing capture stress in adult male captive spotted deer (Axis axis). On the morning of the study, deer were fed a banana either containing haloperidol tablets (1 mg/kg) (haloperidol group, n = 10) or without haloperidol (placebo group, n = 10). Six hours postadministration, xylazine (3 mg/kg) and ketamine (2 mg/kg) was administered intramuscularly via a dart. Rectal temperature, heart rate, respiratory rate, and SpO2 (percent hemoglobin saturation) were recorded at 5-min intervals. Blood gas analysis was performed at time 0 (venous blood) and 10 and 20 min (arterial blood) postinduction. Serum cortisol was determined from venous blood (35 min postinduction), following which yohimbine was administered at a dose of 0.15 mg/kg intramuscular and 0.15 mg/kg intravenous. Statistical analysis of repeated measures data was performed with a two-way analysis of variance. Paired data were analyzed with a Wilcoxon rank-sum test (categorical data) or a paired t-test (continuous data). Significance was set at P ≤ 0.05, and results were expressed as mean ± SEM. There was no significant difference in induction time or recovery time between treatment groups. Rectal temperature and heart rate were significantly lower in the haloperidol group. Both groups demonstrated acidosis with venous pH being significantly lower in the placebo group when compared to the haloperidol group. Serum cortisol and arterial plasma lactate were lower in the haloperidol group indicative of reduced stress and physical exertion. Haloperidol premedication proved to be beneficial in reducing capture stress, when administered prior to xylazine-ketamine anesthesia, in spotted deer.

A History of the Pharmacological Treatment of Bipolar Disorder.

In this paper, the authors review the history of the pharmacological treatment of bipolar disorder, from the first nonspecific sedative agents introduced in the 19th and early 20th century, such as solanaceae alkaloids, bromides and barbiturates, to John Cade's experiments with lithium and the beginning of the so-called "Psychopharmacological Revolution" in the 1950s. We also describe the clinical studies and development processes, enabling the therapeutic introduction of pharmacological agents currently available for the treatment of bipolar disorder in its different phases and manifestations. Those drugs include lithium salts, valproic acid, carbamazepine, new antiepileptic drugs, basically lamotrigine and atypical antipsychotic agents (olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole, asenapine, cariprazine and lurasidone). Finally, the socio-sanitary implications derived from the clinical introduction of these drugs are also discussed.

Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically.

OBJECTIVES: Previous studies have found a negative population-level correlation between medical marijuana availability in US states, and trends in medical and nonmedical prescription drug use. These studies have been interpreted as evidence that use of medical marijuana reduces medical and nonmedical prescription drug use. This study evaluates whether medical marijuana use is a risk or protective factor for medical and nonmedical prescription drug use. METHODS: Simulations based upon logistic regression analyses of data from the 2015 National Survey on Drug Use and Health were used to compute associations between medical marijuana use, and medical and nonmedical prescription drug use. Adjusted risk ratios (RRs) were computed with controls added for age, sex, race, health status, family income, and living in a state with legalized medical marijuana. RESULTS: Medical marijuana users were significantly more likely (RR 1.62, 95% confidence interval [CI] 1.50-1.74) to report medical use of prescription drugs in the past 12 months. Individuals who used medical marijuana were also significantly more likely to report nonmedical use in the past 12 months of any prescription drug (RR 2.12, 95% CI 1.67-2.62), with elevated risks for pain relievers (RR 1.95, 95% CI 1.41-2.62), stimulants (RR 1.86, 95% CI 1.09-3.02), and tranquilizers (RR 2.18, 95% CI 1.45-3.16). CONCLUSIONS: Our findings disconfirm the hypothesis that a population-level negative correlation between medical marijuana use and prescription drug harms occurs because medical marijuana users are less likely to use prescription drugs, either medically or nonmedically. Medical marijuana users should be a target population in efforts to combat nonmedical prescription drug use.

Medical use, nonmedical use of prescription medication and risk behaviour among Croatian adolescents.

BACKGROUND: At the drug scene some major shifts were observed, more and more reports highlighted the abuse of prescription medication. Despite the importance of controlled medication in treatment child and adolescent disorders, this increase may be a factor which influence misuse and nonmedical use of prescribed drugs among adolescents. SUBJECT AND METHODS: Croatian data from ESPAD survey in 2003, 2007 and 2011 were used, and variables selected from the international ESPAD questionnaire. Dependent variable was taking tranquilizers or sedatives prescribed by doctor in the past 12 months. Independent variables were nonmedical use of tranquilizers/sedatives, use of other psychoactive substances, school performance, truancy, delinquent behaviour, satisfaction with relationships with parents, friends, health, self-perception, financial situation and symptoms of depression. The respondents were 8849 students (4393 boys and 4456 girls) in three consecutive ESPAD surveys (2003, 2007 and 2011). RESULTS: In multivariate analysis for all three survey years the strongest predictor for prescription medication use was use of sedatives/tranquilizers without prescription (OR 6.14; CI 4.08-9.23; OR 8.16; CI4.65-14.32; OR 9.77; CI5.92-15.13). Frequent drinking and excessive drinking or drunkenness also predicted prescription medication use, (OR 1.85; CI1.10-3.10; OR 2.01: CI 1.20-3.39). Among other problem behaviours lower school performance (OR 2.92; CI 1.41-6.05; OR 2.56; CI 1.12-5.87), missed school days OR 1.59; OR1.01-2.51; OR1.72; CI 1.03-2.87), aggressive behaviour (OR 1.532; CI 1.01-2.28; OR1.65; CI 1.04-2.62), depressive symptoms (OR 2.19; CI 1.24-3.85) and poorer financial situation were connected with prescription medication use. CONCLUSION: Prescription use of tranquilizers/sedatives was predicted by nonmedical tranquilizers/sedatives use, alcohol abuse, symptoms of depression and variables indicating maladjusted behaviour. Although there is sufficient evidence that prescription medication abuse might went unobserved, the further analysis which could better explain its' role and impact is still needed.

[Burning mouth syndrome: pathogenic and therapeutic concepts]. / Zespól pieczenia w jamie ustnej (burning mouth syndrome)--koncepcje patogenetyczne i terapeutyczne.

Burning mouth syndrome (BMS) is a chronic pain condition characterized by pain, burning sensations and dryness within an oral mucosa, without any clinical changes of the latter. It occurs approximately seven times more frequently in women, mostly in perimenopausal age. The psychiatric aspect of BMS is significant: the most frequent co-morbidities are depression and anxiety disorders, and a number of psychotropic drugs play an essential role in its treatment. In the present review, the most important pathogenic and treatment concepts of BMS have been discussed. The BMS may be similar to neuropathic pain and has some related pathogenic elements with fibromyalgia and the restless leg syndrome. In primary BMS, the features of presynaptic dysfunction of dopaminergic neurons and deficiency of endogenous dopamine levels have been demonstrated. Other neurotransmitters such as serotonin, noradrenaline, histamine as well as hormonal and inflammatory factors may also play a role in the pathogenesis of BMS. In the pharmacological treatment of BMS a variety of drugs have been used including benzodiazepines, anticonvulsants, antidepressants and atypical antipsychotic drugs. In the final part of the paper, the possibility of using atypical antipsychotic drug, olanzapine, in the treatment of BMS has been discussed. In the context of the recent studies on this topic, a case of female patient with the BMS lasting more than ten years has been mentioned, in whom the treatment with olanzapine brought about a rapid and significant reduction of symptoms. The probable mechanism of the therapeutic effect of olanzapine in BMS can include its effect on dopaminergic receptors and probably also on histaminergic, noradrenergic and serotonergic ones.

Treatment of sleep disturbances in posttraumatic stress disorder: a review.

Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitive-behavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects. Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms. Pharmacotherapy continues to be an important treatment choice for PTSD sleep disturbances as an adjunct to CBT, when CBT is ineffective or not available, or when the patient declines CBT. Great need exists for more investigation into the effectiveness of specific pharmacologic agents for PTSD sleep disturbances and the dissemination of the findings to prescribers. The studies of prazosin and the findings of its effectiveness for PTSD sleep disturbance are examples of studies of pharmacologic agents needed in this area. Despite the progress made in developing more specific treatments for sleep disturbances in PTSD, insomnia and nightmares may not fully resolve.

Effect of "rose essential oil" inhalation on stress-induced skin-barrier disruption in rats and humans.

In stressed animals, several brain regions (e.g., hypothalamic paraventricular nucleus [PVN]) exhibit neuronal activation, which increases plasma adrenocorticotropic hormone (ACTH) and glucocorticoids. We previously reported that so-called "green odor" inhibits stress-induced activation of the hypothalamo-pituitary-adrenocortical axis (HPA axis) and thereby prevents the chronic stress-induced disruption of the skin barrier. Here, we investigated whether rose essential oil, another sedative odorant, inhibits the stress-induced 1) increases in PVN neuronal activity in rats and plasma glucocorticoids (corticosterone [CORT] in rats and cortisol in humans) and 2) skin-barrier disruption in rats and humans. The results showed that in rats subjected to acute restraint stress, rose essential oil inhalation significantly inhibited the increase in plasma CORT and reduced the increases in the number of c-Fos-positive cells in PVN. Inhalation of rose essential oil significantly inhibited the following effects of chronic stress: 1) the elevation of transepidermal water loss (TEWL), an index of the disruption of skin-barrier function, in both rats and humans and 2) the increase in the salivary concentration of cortisol in humans. These results suggest that in rats and humans, chronic stress-induced disruption of the skin barrier can be limited or prevented by rose essential oil inhalation, possibly through its inhibitory effect on the HPA axis.

Effect of visual art on patient anxiety and agitation in a mental health facility and implications for the business case.

There is a growing body of evidence on the impact of the environment on health and well-being. This study focuses on the impact of visual artworks on the well-being of psychiatric patients in a multi-purpose lounge of an acute care psychiatric unit. Well-being was measured by the rate of pro re nata (PRN) medication issued by nurses in response to visible signs of patient anxiety and agitation. Nurses were interviewed to get qualitative feedback on the patient response. Findings revealed that the ratio of PRN/patient census was significantly lower on the days when a realistic nature photograph was displayed, compared to the control condition (no art) and abstract art. Nurses reported that some patients displayed agitated behaviour in response to the abstract image. This study makes a case for the impact of visual art on mental well-being. The research findings were also translated into the time and money invested on PRN incidents, and annual cost savings of almost $US30,000 a year was projected. This research makes a case that simple environmental interventions like visual art can save the hospital costs of medication, and staff and pharmacy time, by providing a visual distraction that can alleviate anxiety and agitation in patients.

Outpatient utilization of drugs acting on nervous system: a study from the Republic of Srpska, Bosnia & Herzegovina.

PURPOSE: The aim of this study was to analyse the utilization patterns of drugs acting on the nervous system in the Republic of Srpska, Bosnia & Herzegovina between 2002 and 2008. METHODS: This was a retrospective study aimed at analysing outpatient utilization of drugs reimbursed by the Health Insurance Fund, with a focus on the utilization of drugs acting on the nervous system. Anatomical therapeutic chemical/defined daily dose methodology was used to monitor drug utilization, and the drug utilization 90% (DU90%) method was used to assess drug prescribing. RESULTS: The most highly used drug subgroups were psycholeptics and antiepileptics followed by the psychoanaleptics. Anxyolitics comprised the most prescribed pharmacological subgroup over the whole study period, but a decrease was observed in 2007 and 2008. Following updating of the list with selective serotonin re-uptake inhibitor drugs, particularly sertraline, antidepressant use increased fivefold in 2008 compared to 2006. Tramadol was the predominant opioid analgesics in terms of utilization, while the use of oral morphine was low. Diazepam was the most highly prescribed drug, followed by phenobarbital and carbamazepine. The list update with the new generation drugs was immediately reflected in the DU90% profile. CONCLUSIONS: The observed tendency toward increased total drug utilization observed in our study is comparable to worldwide trends. Implementation of new clinical guidelines for nervous diseases and updating of the list of reimbursable drugs with the addition of new ones contributed to the observed improvement in prescribing patterns in primary healthcare during the study period. The DU90% is shown to be a simple rough method for assessing prescribing quality. More stratified analyses should be performed on a routine basis to ensure a rational use of medicines and a cost-efficient use of limited healthcare resources.

[Therapeutical strategies for essential tremor]. / Estrategias terapéuticas en el temblor esencial.

Essential tremor is the most common adult movement disorder. Traditionally considered as a benign disease, it can cause an important physical and psychosocial disability. Drug treatment remains poor and often unsatisfactory. Current therapeutical strategies are reviewed according to the level of discomfort caused by tremor: mild tremor, non-pharmacological strategies, alcohol, acute pharmacological therapy; moderate tremor, pharmacological therapies (propranolol, gabapentin, primidone, topiramate, alprazolam and other drugs), and severe tremor, the role of functional surgery is emphasized (thalamic deep brain stimulation, thalamotomy). It is also described the more specific treatment of head tremor with the use botulinum toxin. Finally, several points are exposed to guide the immediate research of this disease in near future.

[Brief review about compatibility and their pharmacological effects of Chinese material medica as tranquilizer].

The paper summarized the sedative pharmacological effects of CMM, which were reported in the past 10 years. Those sedative CMMs were found in several type of Chinese medicine, such as tranquilizing the mind, calming the liver to stop the wind, general tonic, blood-activating and stasis-resolving drugs, heat-clearing drugs, exterior-releasing drugs, drugs for resuscitation, diuresis-inducing and dampness-draining drugs, ect. Out of them, the general tonic drugs were used in many occasions. Two Chinese herbs, jujube seed and polygala were used popularly as sedative drugs. And their effects have something to do with heart Meridian and liver Meridian. The Locomotor activity, sleeping test and forcing swimming were used commonly to detect the sedative effects. The sedative mechanisms of those CMM were related with neuro-transmitters such as Dopamine (DA), 5-HT and gamma-GABA, etc.

Acquired perforating dermatosis in patients with chronic renal failure and diabetes mellitus.

Acquired perforating dermatosis (APD) is a skin disorder occurring in the patients with chronic renal failure (CRF), diabetes mellitus (DM) or both. The purpose of this study was to clarify the clinical and histopathological features of APD, and evaluate role of scratching in the pathogenesis of APD. Twelve patients with APD associated with CRF and DM were enrolled in the study. In six patients who required hemodialysis, the lesions appeared 2-5 yr (mean 3 yr) after the initiation of dialysis, 18-22 yr (mean 19.3 yr) after the occurrence of DM. The other patients who did not receive hemodialysis noted the lesions 4-17 yr (mean 9.5 yr) after the onset of DM. All patients had an eruption of generally pruritic keratotic papules and nodules, primarily on the extensor surface of the extremities and the trunk. The histologic features of our cases showed a crateriform invagination of the epidermis filled by a parakeratotic plug and basophilic cellular debris. The period of treatment for patients who suffered from severe (7 cases) or very severe (3 cases) on the pruritus intensity was longer than that of patients who had mild pruritus (2 cases). These data showed that scratching appear to play a critical part in the pathogenesis of APD.

Acquired Perforating Dermatosis in Patients with Chronic Renal Failure and Diabetes Mellitus

Acquired perforating dermatosis (APD) is a skin disorder occurring in the patients with chronic renal failure (CRF), diabetes mellitus (DM) or both. The purpose of this study was to clarify the clinical and histopathological features of APD, and evaluate role of scratching in the pathogenesis of APD. Twelves patients with APD associated with CRF and DM were enrolled in the study. In six patients who required hemodialysis, the lesions appeared 2-5 yr (mean 3 yr) after the initiation of dialysis, 18-22 yr (mean 19.3 yr) after the occurrence of DM. The other patients who did not receive hemodialysis noted the lesions 4-17 yr (mean 9.5 yr) after the onset of DM. All patients had an eruption of generally pruritic keratotic papules and nodules, primarily on the extensor surface of the extremities and the trunk. The histologic features of our cases showed a crateriform invagination of the epidermis filled by a parakeratotic plug and basophilic cellular debris. The period of treatment for patients who suffered from severe (7 cases) or very severe (3 cases) on the pruritus intensity was longer than that of patients who had mild pruritus (2 cases). These data showed that scratching appear to play a critical part in the pathogenesis of APD.

Tinnitus. Diagnosis and treatment of this elusive symptom.

More than 37 million Americans experience tinnitus, and adults age 40 to 70 are most often affected. Tinnitus is a symptom, not a disease, and as such has many different causes. Tinnitus is classified as vibratory and nonvibratory and is further subdivided into objective and subjective categories. The evaluation of tinnitus always begins with a thorough history and physical examination, with further testing performed when indicated. Many medical and nonmedical treatments exist, with varying degrees of success and safety. Once the physician determines that the patient does not have a life-threatening or obviously treatable underlying condition, the patient should be counseled, reassured that the tinnitus is not a life-threatening disease, and offered appropriate treatment. The degree to which the tinnitus bothers the patient will help determine the extent of treatment necessary.

Autism: a medical primer.

Autistic disorder, a pervasive developmental disorder resulting in social, language, or sensorimotor deficits, occurs in approximately seven of 10,000 persons. Early detection and intervention significantly improve outcome, with about one third of autistic persons achieving some degree of independent living. Indications for developmental evaluation include no babbling, pointing, or use of other gestures by 12 months of age, no single words by 16 months of age, no two-word spontaneous phrases by 24 months of age, and loss of previously learned language or social skills at any age. The differential diagnosis includes other psychiatric and pervasive developmental disorders, deafness, and profound hearing loss. Autism is frequently associated with fragile X syndrome and tuberous sclerosis, and may be caused by lead poisoning and metabolic disorders. Common comorbidities include mental retardation, seizure disorder, and psychiatric disorders such as depression and anxiety. Behavior modification programs are helpful and are usually administered by multidisciplinary teams, targeted medication is used to address behavior concerns. Many different treatment approaches can be used, some of which are unproven and have little scientific support. Parents may be encouraged to investigate national resources and local support networks.

Analyses of use of tranquilizers and sleeping pills across five surveys of the same population (1985-1991): the relationship with gender, age and use of other substances.

The present study used analyses of data from five surveys of the same population over a 6-year period to examine the relationship of use of tranquilizers/sleeping pills with gender, age and use of other psychoactive substances. Part of the study involved identifying methodological issues in using surveys to study tranquilizer/sleeping pill use. Across surveys and within all age groups, females were more likely to use tranquilizers and/or sleeping pills than males, with an average ratio overall of a little higher than three to two (varying across surveys from 1.4 to 2.1; mode of 1.6). Prevalence rates for both females and males were strongly affected by timeframe over which use was measured. Use of tranquilizers/sleeping pills increased with age; however, the relationship with age was different for tranquilizers than for sleeping pills. For tranquilizers, the high correlation between age and use was largely attributable to the low rate of use by those aged 34 and younger. For sleeping pills, on the other hand, the relationship is based more on the high rate of use by those aged 65 and older. In addition, age was a major factor in nonmedical use of tranquilizers/sleeping pills, with nonmedical use decreasing dramatically with age. Use of other types of psychoactive medications was significantly higher among tranquilizer/sleeping pill users than among non-users. The results pertaining to concurrent use of tranquilizers/sleeping pills and alcohol, marijuana, and tobacco, however, showed some trends, but findings were not consistent across all surveys. Further analyses suggested that this lack of consistent findings might be attributable to survey design issues, in particular, the extent that the format of the survey question tended to exclude nonmedical users. The implications of these results for future research on tranquilizer/sleeping pill use are discussed.

[The use of holotropic breathing in the treatment of chronic alcoholism]. / Primenenie kholotropnogo dykhaniia pri lechenii khronicheskogo alkogolizma.

The present paper focuses on the effectiveness of a new psychotherapeutic technique described under the denomination of "holotropic breath" to be employed in the treatment of patients with alcohol addiction. It is a modified classical technique under the above denomination adapted to the narcological needs. Case material is presented. A conclusion is drown to the effect that the above modified psychotherapeutic modality is an effective and useful alternative in a narcological setting.