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1.
J Clin Sleep Med ; 15(9): 1383, 2019 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-31538614

RESUMO

CITATION: SieminskiM, Zemojtel L. Akathisia is more than restlessness in the legs. J Clin Sleep Med. 2019;15(9):1383.


Assuntos
Antipsicóticos , Síndrome das Pernas Inquietas , Acatisia Induzida por Medicamentos , Serviço Hospitalar de Emergência , Humanos , Agitação Psicomotora
2.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31537609

RESUMO

This report presents a case of drug-induced severe tardive akathisia developing after the combination of a selective serotonin reuptake inhibitor and an antipsychotic, in a woman with severe major depression. The trial and combination of multiple medications is common practice in treatment-resistant patients with depression. With the increase in the prevalence of treatment-resistant depression, adverse effects of medication such as tardive akathisia are becoming more common. Tardive akathisia persists even after the withdrawal of the causative agent and is very challenging to treat. The patient did not respond to any standard medications indicated for drug-induced akathisia. As a result, the patient became suicidal and extremely distressed with all treatment options exhausted. Guidelines on the management of drug-induced tardive akathisia are non-existent. This reflects the importance of this case study, which reveals the complete remission of both tardive akathisia and all the patient's depressive symptoms after electroconvulsive therapy . This report provides evidence of an established treatment intervention used in a new situation.


Assuntos
Acatisia Induzida por Medicamentos/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Eletroconvulsoterapia/métodos , Acatisia Induzida por Medicamentos/complicações , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Indução de Remissão , Inibidores de Captação de Serotonina/efeitos adversos , Inibidores de Captação de Serotonina/uso terapêutico , Resultado do Tratamento
3.
BMC Anesthesiol ; 19(1): 138, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370793

RESUMO

BACKGROUND: The comparative efficacy of ancillary drugs on sevoflurane related emergence agitation (EA) in children undergoing ophthalmic surgery remains controversial. METHODS: The databases were retrieved in an orderly manner from the dates of their establishment to October, 2018, including PubMed, The Cochrane Library and Web of Science, to collect randomized controlled trials (RCT) of different anesthetic drugs combined with sevoflurane for ophthalmic surgery. Then a network meta-analysis was conducted using R and Stata 12.0 softwares. RESULTS: The meta-analysis showed that, in reducing sevoflurane related EA, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil and clonidine were superior to placebo (P < 0.05). The network meta-analysis showed that the effects of ancillary drugs combine with sevoflurane in reducing risk of EA in children undergoing ophthalmic surgery was superior to placebo: dexmedetomidine (OR = 0.17, 95% CrI 0.12-0.22), ketamine (OR = 0.30, 95% CrI 0.11-0.49), propofol (OR = 0.24, 95% CrI 0.09-0.63), fentanyl (OR = 0.16, 95% CrI 0.08-0.56), midazolam (OR = 0.20, 95% CrI 0.09-0.40), sufentanil (OR = 0.27, 95% CrI 0.14-0.41), remifentanil (OR = 0.18, 95% CrI 0.08-0.54) and clonidine (OR = 0.14, 95% CrI 0.07-0.41). The SUCRA of placebo, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil, clonidine were respectively 0.26, 77.93, 27.71, 42.8, 69.43, 52.89, 59.83, 57.62 and 61.53%. CONCLUSIONS: The effects of dexmedetomidine combine with sevoflurane in reducing risk of emergence agitation in children undergoing ophthalmic surgery was superior to other drugs.


Assuntos
Acatisia Induzida por Medicamentos/prevenção & controle , Período de Recuperação da Anestesia , Anestésicos Inalatórios/efeitos adversos , Sevoflurano/efeitos adversos , Analgésicos/uso terapêutico , Teorema de Bayes , Criança , Clonidina/uso terapêutico , Dexmedetomidina/uso terapêutico , Quimioterapia Combinada , Fentanila/uso terapêutico , Humanos , Ketamina/uso terapêutico , Midazolam/uso terapêutico , Metanálise em Rede , Procedimentos Cirúrgicos Oftalmológicos , Propofol/uso terapêutico , Agitação Psicomotora , Remifentanil/uso terapêutico , Sufentanil/uso terapêutico
5.
J Clin Psychopharmacol ; 39(4): 336-343, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205194

RESUMO

PURPOSE/BACKGROUND: Dopamine receptor blocking agents (DRBAs), also known as antipsychotics, are medications widely used to treat a growing number of mental health diagnoses. However, their utility is limited by the potential to cause serious adverse movement reactions. Akathisia, dystonia, parkinsonism, and tardive dyskinesia (collectively known as extrapyramidal symptoms or EPSs) are associated with reduced social and occupational functioning, negative patient attitudes toward treatment, and nonadherence to pharmacotherapy. Neuroleptic malignant syndrome is a life-threatening reaction that can result from DRBA use and cause musculoskeletal dysfunction. The aim of this study is to profile patients who have developed DRBA-related movement adverse effects and identify risk factors significantly associated with each subtype of EPSs or other movement disorders (OMDs) such as neuroleptic malignant syndrome. METHODS/PROCEDURES: A report of all potential DRBA-related EPSs or OMDs occurrences within a large community hospital network was generated using International Classification of Diseases, Ninth Revision (ICD-9) and 10th Revision (ICD-10) billing codes. Each patient encounter was manually reviewed to confirm that a documented case of DRBA-related EPSs or OMDs had indeed occurred and subsequently determine the likely causative agent(s). FINDINGS/RESULTS: The resultant cohort of 148 patients experiencing unique DRBA-related EPS or OMD events was analyzed. The average patient was female, middle-aged, and overweight. The most common DRBAs precipitating EPSs or OMDs were haloperidol and quetiapine. In the population studied, age was significantly associated with the subtype of EPSs experienced such that those patients with akathisia and dystonia tended to be younger, whereas those with tardive dyskinesia tended to be older. Body mass index (BMI) category was also negatively correlated with the incidence of dystonia. In addition, it was observed that exposure to specific DRBAs, classes, and routes of administration significantly affected the risk of developing different subtypes of EPSs or OMDs in the study population. IMPLICATIONS/CONCLUSIONS: To our knowledge, this is the first study to describe an association between age and BMI with the risk of akathisia and dystonia, respectively, in patients taking DRBAs. Other trends observed with age and BMI in patients developing DRBA-related EPSs support previously reported findings. Expanding the knowledge base of individual characteristics associated with the risk of developing different subtypes of EPSs or OMDs can help providers and patients anticipate and attempt to mitigate these reactions, and may ultimately improve adherence to DRBA therapy.


Assuntos
Antipsicóticos/efeitos adversos , Doenças dos Gânglios da Base/induzido quimicamente , Doenças dos Gânglios da Base/etiologia , Antagonistas de Dopamina/efeitos adversos , Síndrome Maligna Neuroléptica/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Acatisia Induzida por Medicamentos/etiologia , Antipsicóticos/uso terapêutico , Estudos de Coortes , Antagonistas de Dopamina/uso terapêutico , Distonia/induzido quimicamente , Distonia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos , Razão de Chances , Transtornos Parkinsonianos/induzido quimicamente , Transtornos Parkinsonianos/etiologia , Pacientes , Fatores de Risco , Discinesia Tardia/induzido quimicamente , Discinesia Tardia/etiologia
7.
J Anal Toxicol ; 43(5): e1-e7, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30843073

RESUMO

4-Fluoromethylphenidate (4F-MPH) is an halogenated derivative of methylphenidate (MPH), a re-uptake inhibitor for dopamine and norepinephrine used for the treatment of attention deficit hyperactivity disorders. In the last few years, several compounds structurally related to MPH have been marked as new psychoactive substances (NPS) with stimulating and euphoric effects similar to the parent drug, but with more dopaminergic activity. This report represents the first case of an analytically confirmed non-fatal intoxication by 4F-MPH. A 26-year-old female was admitted to the emergency department with neuropsychiatric and cardiologic symptoms that lasted for a week, during which she sniffed a powder named 4F-MPH acquired as entactogen on the Internet. The patient required sedation with intravenous diazepam and was discharged two days later with a prescription of promazine and quetiapine. The seized product was analytically characterized by gas chromatography-mass spectrometry, liquid chromatography high-resolution mass spectrometry and nuclear magnetic resonance. These analyses confirmed the composition of the product as a 4F-MPH diastereomeric (±)-threo and (±)-erythro mixture, with a large preponderance of the active (±)-threo isomer. A minimal validation, intended for rare analytes, was performed for the quantification of 4F-MPH in the biological samples by liquid chromatography-tandem mass spectrometry. Accuracy (bias) and precision were within ±15% for both blood and urine. The blood and urine concentration of (±)-threo 4F-MPH were 32 ng/mL and 827 ng/mL, respectively. Analyses for classic drugs (opiates, methadone, cocaine, cannabis metabolites, amphetamines, ecstasy and LSD), ethanol, qualitative full screen by gas chromatography-mass spectrometry and targeted analysis for 50 NPS by liquid chromatography-tandem mass spectrometry tested negative; comorbidities were excluded, too. Based on these data, it can be assumed that the clinical manifestations were due to 4F-MPH only.


Assuntos
Acatisia Induzida por Medicamentos/diagnóstico , Estimulantes do Sistema Nervoso Central/toxicidade , Metilfenidato/análogos & derivados , Metilfenidato/toxicidade , Taquicardia/diagnóstico , Adulto , Acatisia Induzida por Medicamentos/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/sangue , Estimulantes do Sistema Nervoso Central/urina , Diazepam/uso terapêutico , Feminino , Humanos , Metilfenidato/sangue , Metilfenidato/urina , Taquicardia/induzido quimicamente , Taquicardia/tratamento farmacológico , Resultado do Tratamento
8.
Psychopharmacol Bull ; 49(1): 80-83, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30858641

RESUMO

Akathisia is a common movement disorder that occurs as a consequence of antipsychotic therapy. However, its occurrence secondary to risperidone withdrawal has been reported rarely. Reporting of such rare adverse event gains profound importance because changing the antipsychotics is very common in long term management of affective disorders. Here, we report a 17-year-old female who on withdrawal of risperidone developed akathisia. Further, we also discuss already reported cases in literature in relation to the current case.


Assuntos
Acatisia Induzida por Medicamentos , Risperidona/efeitos adversos , Síndrome de Abstinência a Substâncias , Adolescente , Feminino , Humanos
9.
Cochrane Database Syst Rev ; 3: CD003154, 2019 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-30891742

RESUMO

BACKGROUND: Memantine is a moderate affinity uncompetitive antagonist of glutamate NMDA receptors. It is licensed for use in moderate and severe Alzheimer's disease (AD); in the USA, it is also widely used off-label for mild AD. OBJECTIVES: To determine efficacy and safety of memantine for people with dementia. To assess whether memantine adds benefit for people already taking cholinesterase inhibitors (ChEIs). SEARCH METHODS: We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register of trials (http://www.medicine.ox.ac.uk/alois/) up to 25 March 2018. We examined clinical trials registries, press releases and posters of memantine manufacturers; and the web sites of the FDA, EMEA and NICE. We contacted authors and companies for missing information. SELECTION CRITERIA: Double-blind, parallel group, placebo-controlled, randomised trials of memantine in people with dementia. DATA COLLECTION AND ANALYSIS: We pooled and analysed data from four clinical domains across different aetiologies and severities of dementia and for AD with agitation. We assessed the impact of study duration, severity and concomitant use of ChEIs. Consequently, we restricted analyses to the licensed dose (20 mg/day or 28 mg extended release) and data at six to seven months duration of follow-up, and analysed separately results for mild and moderate-to-severe AD.We transformed results for efficacy outcomes into the difference in points on particular outcome scales. MAIN RESULTS: Across all types of dementia, data were available from almost 10,000 participants in 44 included trials, most of which were at low or unclear risk of bias. For nearly half the studies, relevant data were obtained from unpublished sources. The majority of trials (29 in 7885 participants) were conducted in people with AD.1. Moderate-to-severe AD (with or without concomitant ChEIs). High-certainty evidence from up to 14 studies in around 3700 participants consistently shows a small clinical benefit for memantine versus placebo: clinical global rating (CGR): 0.21 CIBIC+ points (95% confidence interval (CI) 0.14 to 0.30); cognitive function (CF): 3.11 Severe Impairment Battery (SIB) points (95% CI 2.42 to 3.92); performance on activities of daily living (ADL): 1.09 ADL19 points (95% CI 0.62 to 1.64); and behaviour and mood (BM): 1.84 Neuropsychiatric Inventory (NPI) points (95% CI 1.05 to 2.76). There may be no difference in the number of people discontinuing memantine compared to placebo: risk ratio (RR) 0.93 (95% CI 0.83 to 1.04) corresponding to 13 fewer people per 1000 (95% CI 31 fewer to 7 more). Although there is moderate-certainty evidence that fewer people taking memantine experience agitation as an adverse event: RR 0.81 (95% CI 0.66 to 0.99) (25 fewer people per 1000, 95% CI 1 to 44 fewer), there is also moderate-certainty evidence, from three additional studies, suggesting that memantine is not beneficial as a treatment for agitation (e.g. Cohen Mansfield Agitation Inventory: clinical benefit of 0.50 CMAI points, 95% CI -3.71 to 4.71) .The presence of concomitant ChEI does not impact on the difference between memantine and placebo, with the possible exceptions of the BM outcome (larger effect in people taking ChEIs) and the CF outcome (smaller effect).2. Mild AD (Mini Mental State Examination (MMSE) 20 to 23): mainly moderate-certainty evidence based on post-hoc subgroups from up to four studies in around 600 participants suggests there is probably no difference between memantine and placebo for CF: 0.21 ADAS-Cog points (95% CI -0.95 to 1.38); performance on ADL: -0.07 ADL 23 points (95% CI -1.80 to 1.66); and BM: -0.29 NPI points (95% CI -2.16 to 1.58). There is less certainty in the CGR evidence, which also suggests there may be no difference: 0.09 CIBIC+ points (95% CI -0.12 to 0.30). Memantine (compared with placebo) may increase the numbers of people discontinuing treatment because of adverse events (RR 2.12, 95% CI 1.03 to 4.39).3. Mild-to-moderate vascular dementia. Moderate- and low-certainty evidence from two studies in around 750 participants indicates there is probably a small clinical benefit for CF: 2.15 ADAS-Cog points (95% CI 1.05 to 3.25); there may be a small clinical benefit for BM: 0.47 NOSGER disturbing behaviour points (95% CI 0.07 to 0.87); there is probably no difference in CGR: 0.03 CIBIC+ points (95% CI -0.28 to 0.34); and there may be no difference in ADL: 0.11 NOSGER II self-care subscale points (95% CI -0.35 to 0.54) or in the numbers of people discontinuing treatment: RR 1.05 (95% CI 0.83 to 1.34).There is limited, mainly low- or very low-certainty efficacy evidence for other types of dementia (Parkinson's disease and dementia Lewy bodies (for which CGR may show a small clinical benefit; four studies in 319 people); frontotemporal dementia (two studies in 133 people); and AIDS-related Dementia Complex (one study in 140 people)).There is high-certainty evidence showing no difference between memantine and placebo in the proportion experiencing at least one adverse event: RR 1.03 (95% CI 1.00 to 1.06); the RR does not differ between aetiologies or severities of dementia. Combining available data from all trials, there is moderate-certainty evidence that memantine is 1.6 times more likely than placebo to result in dizziness (6.1% versus 3.9%), low-certainty evidence of a 1.3-fold increased risk of headache (5.5% versus 4.3%), but high-certainty evidence of no difference in falls. AUTHORS' CONCLUSIONS: We found important differences in the efficacy of memantine in mild AD compared to that in moderate-to-severe AD. There is a small clinical benefit of memantine in people with moderate-to-severe AD, which occurs irrespective of whether they are also taking a ChEI, but no benefit in people with mild AD.Clinical heterogeneity in AD makes it unlikely that any single drug will have a large effect size, and means that the optimal drug treatment may involve multiple drugs, each having an effect size that may be less than the minimum clinically important difference.A definitive long-duration trial in mild AD is needed to establish whether starting memantine earlier would be beneficial over the long term and safe: at present the evidence is against this, despite it being common practice. A long-duration trial in moderate-to-severe AD is needed to establish whether the benefit persists beyond six months.


Assuntos
Demência/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Memantina/uso terapêutico , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Acatisia Induzida por Medicamentos/etiologia , Doença de Alzheimer/tratamento farmacológico , Transtornos Cognitivos/tratamento farmacológico , Demência Vascular/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios/efeitos adversos , Humanos , Memantina/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Suspensão de Tratamento
10.
Mol Psychiatry ; 24(6): 795-807, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30700803

RESUMO

Selective serotonin reuptake inhibitors (SSRIs) are the most prescribed antidepressants. They regulate serotonergic neurotransmission, but it remains unclear how altered serotonergic neurotransmission may contribute to the SSRI resistance observed in approximately 30% of major depressive disorder (MDD) patients. Patient stratification based on pharmacological responsiveness and the use of patient-derived neurons may make possible the discovery of disease-relevant neural phenotypes. In our study from a large cohort of well-characterized MDD patients, we have generated induced pluripotent stem cells (iPSCs) from SSRI-remitters and SSRI-nonremitters. We studied serotonergic neurotransmission in patient forebrain neurons in vitro and observed that nonremitter patient-derived neurons displayed serotonin-induced hyperactivity downstream of upregulated excitatory serotonergic receptors, in contrast to what is seen in healthy and remitter patient-derived neurons. Our data suggest that postsynaptic forebrain hyperactivity downstream of SSRI treatment may play a role in SSRI resistance in MDD.


Assuntos
Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/fisiopatologia , Serotonina/metabolismo , Adulto , Acatisia Induzida por Medicamentos/fisiopatologia , Antidepressivos/uso terapêutico , Estudos de Coortes , Transtorno Depressivo Maior/tratamento farmacológico , Feminino , Humanos , Células-Tronco Pluripotentes Induzidas/efeitos dos fármacos , Pessoa de Meia-Idade , Neurônios , Agitação Psicomotora/metabolismo , Inibidores de Captação de Serotonina/farmacologia , Inibidores de Captação de Serotonina/uso terapêutico , Transmissão Sináptica
11.
Medicine (Baltimore) ; 98(3): e13688, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653088

RESUMO

OBJECTIVE: This post hoc analysis of an open-label, single-arm, multicenter study was designed to assess the efficacy, safety, and tolerability of paliperidone extended release (ER) in Chinese patients with non-acute schizophrenia, after switching from olanzapine. METHODS: Patients with schizophrenia who were dissatisfied with prior olanzapine treatment switched to flexible paliperidone ER (3-12 mg/day) based on clinical judgment. Change from baseline to week 12 in Positive and Negative Syndrome Scale (PANSS) total scores (primary endpoint), PANSS subscale scores, response rate, Clinical Global Impression-Severity (CGI-S) score, personal and social performance (PSP) scores, patient satisfaction with treatment score, change in sleep quality, level of daytime sleepiness and safety were evaluated. RESULTS: Out of 118 enrolled patients, 95 (81%) completed the study. Mean duration of study was 76.9 (23.85) days. The primary endpoint, mean (SD) PANSS total score changed significantly from baseline to endpoint (-19.6 [18.71], P <.0001). Secondary endpoints including PANSS subscale score, PSP, patient satisfaction and daytime drowsiness also significantly improved (P <.001). Most commonly reported (≥1%) treatment-emergent adverse events were akathisia (n = 14 [12%]) and insomnia (n = 9 [8%]). CONCLUSIONS: Switching to flexible-dosed paliperidone ER in patients dissatisfied with prior olanzapine treatment achieved good efficacy and tolerability consistently over 12 weeks.


Assuntos
Antipsicóticos/uso terapêutico , Palmitato de Paliperidona/uso terapêutico , Satisfação do Paciente/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Adulto , Acatisia Induzida por Medicamentos/epidemiologia , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , China/epidemiologia , Substituição de Medicamentos/métodos , Feminino , Humanos , Masculino , Olanzapina/efeitos adversos , Palmitato de Paliperidona/administração & dosagem , Palmitato de Paliperidona/efeitos adversos , Prevalência , Estudos Prospectivos , Esquizofrenia/epidemiologia , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(1): e14035, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30608457

RESUMO

This retrospective study investigated the application of the sedation-agitation scale (SAS) in pediatric bronchoscopy by observing its effects on sedative dosages and adverse reactions.Children who underwent sedation before bronchoscopy, during the period from January 2014 to June 2017, were divided into control and SAS groups. Patients in the control group were administered a single dose of 0.1 to 0.3 mg/kg midazolam, based on physicians' clinical experience. The initial dose of midazolam in the SAS group was 0.1 mg/kg, and was adjusted based on the SAS score, as evaluated by physicians. Between-group comparisons were made of midazolam dose; adverse reactions of midazolam, such as agitation, delirium, excessive sedation, and respiratory depression; operating time of bronchoscopy; and number of participants.No statistically significant differences in gender, age distribution, weight, or disease composition were observed between the groups. The midazolam dose, operating time, and number of participants at different ages were all lower in the SAS group than in the control group. Fewer adverse drug reactions, such as intraoperative agitation and delirium, were noted in the SAS group. Moreover, the overall number of participants was reduced, and the overall operating time was less than that in the control group.Application of SAS for assessment of sedation during pediatric bronchoscopy can guide individualized administration of midazolam, reduce midazolam dose while achieving an ideal sedative effect, reduce adverse reactions, and improve operator experience. Hence, its use should be promoted for pediatric patients undergoing bronchoscopy under local anesthesia and conscious sedation.


Assuntos
Ansiedade/tratamento farmacológico , Broncoscopia/normas , Sedação Consciente/efeitos adversos , Midazolam/efeitos adversos , Acatisia Induzida por Medicamentos , Anestesia Local/métodos , Ansiolíticos/administração & dosagem , Ansiolíticos/efeitos adversos , Ansiolíticos/uso terapêutico , Criança , Pré-Escolar , Sedação Consciente/métodos , Delírio/induzido quimicamente , Relação Dose-Resposta a Droga , Feminino , Humanos , Hipnóticos e Sedativos/normas , Lactente , Masculino , Midazolam/administração & dosagem , Midazolam/uso terapêutico , Duração da Cirurgia , Estudos Retrospectivos
13.
Psychopharmacology (Berl) ; 236(2): 723-730, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30443794

RESUMO

RATIONALE: In the antipsychotic treatment of schizophrenia with little medication history, especially in drug-naïve cases, predictors of side effects are important. However, predictors of antipsychotic-induced akathisia remain unclear. OBJECTIVES: This study aimed to investigate the incidence and predictors of acute akathisia in severely ill patients with first-episode schizophrenia spectrum disorders (FES). METHODS: This is a secondary analysis of our retrospective observational study. Data were obtained from 129 consecutive patients with FES involuntarily hospitalized in a tertiary psychiatric public hospital and treated with aripiprazole or risperidone. The primary outcome was the presence of acute akathisia during the first 1 month. A Cox proportional hazard model was used to examine significant predictors of the onset of akathisia. RESULTS: Acute akathisia was diagnosed in 54 patients (42%). Neither antipsychotics (aripiprazole or risperidone), duration of untreated psychosis, iron deficiency, sex, age nor baseline symptomatic severity was identified as an independent predictor of akathisia. Rapid risperidone initiation significantly increased the onset of akathisia (adjusted hazard ratio [HR], 6.47; 95%; 95% confidence interval [CI], 1.94-21.65; p = 0.002), but rapid aripiprazole initiation did not (adjusted HR, 1.08; 95% CI, 0.50-2.31; p = 0.84). A significant interaction was found between rapid antipsychotic initiation and the risk of akathisia with aripiprazole versus risperidone (p = 0.027). CONCLUSIONS: Severely ill patients with FES initiating aripiprazole or risperidone could have a high risk for akathisia. Rapid risperidone initiation should be avoided because of the risk for akathisia, and careful monitoring of akathisia may be necessary for all patients initiating aripiprazole.


Assuntos
Acatisia Induzida por Medicamentos/epidemiologia , Antipsicóticos/efeitos adversos , Aripiprazol/efeitos adversos , Risperidona/efeitos adversos , Esquizofrenia/tratamento farmacológico , Índice de Gravidade de Doença , Doença Aguda , Adulto , Acatisia Induzida por Medicamentos/diagnóstico , Feminino , Humanos , Incidência , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Esquizofrenia/diagnóstico , Resultado do Tratamento
15.
Bosn J Basic Med Sci ; 19(2): 125-129, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-30501608

RESUMO

Phenibut is a glutamic acid derivative with activity on the γ-aminobutyric acid (GABA)B, A, and B-phenethylamine receptors. It is prescribed in former Communist Bloc countries for anxiolysis and related psychiatric disorders. It can be easily obtained in Western countries and is thought to have abuse potential. Abrupt discontinuation has been reported to precipitate an abstinence syndrome. A review of the literature identified 22 reported cases, many of which were notable for severe psychomotor agitation and requirements for aggressive pharmacologic treatment. Neurologic and autonomic signs and symptoms may mimic serotonin or neuroleptic malignant syndrome. Patients were typically younger and had coexisting substance abuse disorders to other drugs. Also presented is a case of a 23-year-old male with an acute phenibut abstinence syndrome. This patient exhibited severe psychomotor agitation requiring physical restraints, dexmedetomidine, lorazepam, haloperidol, diphenhydramine, cyproheptadine, melatonin, olanzapine, and baclofen for symptom control.


Assuntos
Acatisia Induzida por Medicamentos/diagnóstico , Síndrome de Abstinência a Substâncias , Ácido gama-Aminobutírico/análogos & derivados , Baclofeno/farmacologia , Ciproeptadina/farmacologia , Dexmedetomidina/farmacologia , Difenidramina/farmacologia , Antagonistas de Receptores de GABA-A/farmacologia , Agonistas dos Receptores de GABA-B/farmacologia , Haloperidol/farmacologia , Humanos , Lorazepam/farmacologia , Masculino , Melatonina/farmacologia , Síndrome Maligna Neuroléptica/diagnóstico , Olanzapina/farmacologia , Receptores de GABA/metabolismo , Transtornos Relacionados ao Uso de Substâncias , Adulto Jovem , Ácido gama-Aminobutírico/efeitos adversos , Ácido gama-Aminobutírico/farmacologia
16.
Clin Toxicol (Phila) ; 57(2): 112-116, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30117325

RESUMO

INTRODUCTION: The second largest group of new drugs monitored by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is synthetic cathinones. Substances that are controlled by the law are immediately replaced by new uncontrolled derivatives that cause constant and dynamic changes on the drug market. Some of the most recent synthetic cathinones that have appeared on the "legal highs" market are 3,4-methylenedioxy-α-pyrrolidinohexanophenone (3,4-MDPHP) and α-pyrrolidinohexanophenone (α-PHP). CASE HISTORY: A 21-year-old woman in the 36th week of pregnancy presented with psychomotor agitation. Fetal demise was demonstrated and a caesarean delivery performed. METHODS: The analyses were carried out by liquid chromatography with mass spectrometry (LC-MS/MS). The analytes were isolated from the biological material by liquid-liquid extraction with n-butyl chloride. RESULTS: 3,4-MDPHP and α-PHP were detected and quantified in both the fetus' and the mothers blood, as well as in the mothers urine samples. The determined concentrations of 3,4-MDPHP and α-PHP were, 76 ng/mL and 12 ng/mL in the fetal blood sample, 16 ng/mL and traces in the mothers blood, and 697 mg/mL and 136 ng/mL in the mothers urine, respectively. DISCUSSION: The presented case demonstrates that 3,4-MDPHP and α-PHP transfers from maternal blood to fetal blood. Blood concentrations of these compounds were higher in the fetus than in the mother. Based on the known effects of these substances and the patient's presentation and clinical course, it would seem that these substances contributed to the fetal death. CONCLUSIONS: The detected substances transfer from maternal to fetal circulation, and synthetic cathinone blood concentration can be higher in the fetus than in the mother. This along with the fact immature metabolic ability makes a fetus more vulnerable to cathinones intoxication than adults.


Assuntos
Morte Fetal/etiologia , Drogas Ilícitas/toxicidade , Pirrolidinas/toxicidade , Acatisia Induzida por Medicamentos/etiologia , Feminino , Sangue Fetal/química , Humanos , Drogas Ilícitas/sangue , Gravidez , Complicações na Gravidez/induzido quimicamente , Pirrolidinas/sangue , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto Jovem
17.
Nervenarzt ; 90(1): 1-11, 2019 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30128734

RESUMO

Acute antipsychotic-induced movement disorders (AIMD) are clinically relevant since they are frequently associated with high subjective distress, and since over the long-term they can negatively impact treatment adherence of patients with schizophrenic psychoses. This review article summarizes the relevant studies on the prevalence, risk factors, prevention and treatment options and instruments for early prediction of acute AIMD in schizophrenic psychoses. The current evidence and treatment recommendations are divided into three main areas: acute dystonia, akathisia, and parkinsonism. For the treatment of acute dystonia trihexyphenidyl and biperiden have shown their efficacy. Considering pharmacological treatment of akathisia, there is some preliminary evidence for medication with lipophilic beta-receptor blockers (propranolol and pindolol), clonidine, benzodiazepines, mianserin, mirtazapine und trazodone. The treatment options for drug-induced parkinsonism include reduction or switching from one antipsychotic to another with a lower affinity for dopamine D2 receptors, amantadine or in the regular administration of anticholinergic drugs. In conclusion, acute AIMD is easily to recognize but is not always effectively and durably treated. Early recognition and treatment of acute AIMD could be associated with improved treatment outcomes.


Assuntos
Acatisia Induzida por Medicamentos , Antipsicóticos , Distonia , Transtornos Parkinsonianos , Transtornos Psicóticos , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Distonia/induzido quimicamente , Humanos , Transtornos Parkinsonianos/induzido quimicamente , Transtornos Psicóticos/tratamento farmacológico
18.
Curr Drug Saf ; 14(1): 21-26, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30362421

RESUMO

BACKGROUND: The signal is defined as "reported information on a possible causal relationship between an adverse event and a drug, of which the relationship is unknown or incompletely documented previously". OBJECTIVE: To detect novel adverse events of iloperidone by disproportionality analysis in FDA database of Adverse Event Reporting System (FAERS) using Data Mining Algorithms (DMAs). METHODOLOGY: The US FAERS database consists of 1028 iloperidone associated Drug Event Combinations (DECs) which were reported from 2010 Q1 to 2016 Q3. We consider DECs for disproportionality analysis only if a minimum of ten reports are present in database for the given adverse event and which were not detected earlier (in clinical trials). Two data mining algorithms, namely, Reporting Odds Ratio (ROR) and Information Component (IC) were applied retrospectively in the aforementioned time period. A value of ROR-1.96SE>1 and IC- 2SD>0 were considered as the threshold for positive signal. RESULTS: The mean age of the patients of iloperidone associated events was found to be 44years [95% CI: 36-51], nevertheless age was not mentioned in twenty-one reports. The data mining algorithms exhibited positive signal for akathisia (ROR-1.96SE=43.15, IC-2SD=2.99), dyskinesia (21.24, 3.06), peripheral oedema (6.67,1.08), priapism (425.7,9.09) and sexual dysfunction (26.6-1.5) upon analysis as those were well above the pre-set threshold. CONCLUSION: Iloperidone associated five potential signals were generated by data mining in the FDA AERS database. The result requires an integration of further clinical surveillance for the quantification and validation of possible risks for the adverse events reported of iloperidone.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Antipsicóticos/efeitos adversos , Bases de Dados Factuais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Isoxazóis/efeitos adversos , Piperidinas/efeitos adversos , United States Food and Drug Administration , Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Acatisia Induzida por Medicamentos/diagnóstico , Acatisia Induzida por Medicamentos/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Humanos , Estados Unidos/epidemiologia , United States Food and Drug Administration/estatística & dados numéricos
19.
Parkinsonism Relat Disord ; 59: 146-150, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30528171

RESUMO

We propose the use of the term tardive dyskinesia to refer to the original description of repetitive and complex oral-buccal-lingual (OBL) movements and the analogous repetitive movements of the limbs, trunk, or pelvis. The term tardive syndrome is an umbrella term to be used to refer to the spectrum of all persistent hyperkinetic, hypokinetic, and sensory phenomenologies resulting from chronic dopamine receptor blocking agent (DRBA) exposure. TD is a type of TS. The term tardive dystonia (TDyst) should be used when dystonia is the main feature of TS. Retrocollis and oromandibular dystonia appear to be the most common form of Tdyst. Tardive akathisia refers to the inability to remain still with an urge to move, giving the appearance of restlessness. In tardive tourettism, the patient has complex motor and phonic tics associated with premonitory urge and relief of tension after performing the tic behavior, thus resembling Tourette's syndrome. Tardive tremor is composed of mainly postural and kinetic tremors. It differs from the resting tremor seen in drug-induced parkinsonism. Tardive pain occurs in association with chronic use of DRBAs and involves the mouth, tongue, and genital region with no physical findings. In tardive parkinsonism, the patient has persistent parkinsonism even after discontinuation of the DRBA although this diagnosis is in question and may represent DRBA-uncovered idiopathic Parkinson's disease or coincident development of Parkinson's disease while taking DRBAs.


Assuntos
Acatisia Induzida por Medicamentos/etiologia , Doenças dos Gânglios da Base/induzido quimicamente , Antagonistas de Dopamina/efeitos adversos , Distúrbios Distônicos/induzido quimicamente , Dor/induzido quimicamente , Doença de Parkinson Secundária/induzido quimicamente , Discinesia Tardia/induzido quimicamente , Transtornos de Tique/induzido quimicamente , Acatisia Induzida por Medicamentos/diagnóstico , Acatisia Induzida por Medicamentos/fisiopatologia , Doenças dos Gânglios da Base/diagnóstico , Doenças dos Gânglios da Base/fisiopatologia , Distúrbios Distônicos/diagnóstico , Distúrbios Distônicos/fisiopatologia , Humanos , Dor/diagnóstico , Dor/fisiopatologia , Doença de Parkinson Secundária/diagnóstico , Doença de Parkinson Secundária/fisiopatologia , Discinesia Tardia/diagnóstico , Discinesia Tardia/fisiopatologia , Transtornos de Tique/diagnóstico , Transtornos de Tique/fisiopatologia
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