Monitorización de niveles plasma de antipsicóticos atípicos / Atypical antipsychotics plasma level monitoring

Introducción: El estudio de la concentración de psicofármaco en sangre o en suero permite individualizar el perfil farmacocinético del sujeto tratado. Esto se conoce como monitorización de fármacos. Actualmente se pueden analizar antidepresivos, antipsicóticos, estabilizadores del ánimo, fármacos sustitutivos de los opioides, ansiolíticos e hipnóticos. Objetivos: Revisar el estado actual del conocimiento sobre monitorización de antipsicóticos, de utilidad tanto para evaluar la adherencia terapéutica como para conocer la concentración del fármaco en plasma. Metodología: Se revisaron los trabajos publicados sobre monitorización de antipsicóticos desde 1975 hasta 2010. Como fuente de información se empleó:Embase, Medline y Pubmed. Conclusiones: La monitorización de antipsicóticos, así como de otros psicofármacos, es una práctica establecida que debe conocerse y ser objeto de actualización por parte del psiquiatra interesado en un ejercicio terapéutico basado en datos objetivos(AU)

Introduction: Analysis of psychotropic drug concentration in blood or serum is a mean to ascertain the pharmacokinetic profile of the treated subject. This is known as drug monitoring. Currently plasma antidepressants, antipsychotics, mood stabilizers, drugs substitutes for opioids, anxiolytics and hypnotics can be monitorized. Methodology: We reviewed all published articles on monitoring of psychotropic drugs in general from 1975 to 2010. As a source of information used: Embase, Medline and Pubmed. Objetive: To review the current state of science in relation to the monitoring of atypical antipsychotics. Antipsychotic plasma level monitoring is crucial both to assess adherence and to determine the plasma drug concentration. Conclusions: The monitoring of antipsychotics and other psychotropic drugs, is an established practice must be known and be maintained by a psychiatrist, like other aspects of psychopharmacology, for a therapeutic exercise based on the current state of science(AU)

Effectiveness and risks of combining antipsychotic drugs with electroconvulsive treatment.

INTRODUCTION: The simultaneous application of electroconvulsive therapy (ECT) and psychotropic drugs is based on sparse data. Despite this, and the restrictive approach of the Guidelines and Consensus is widespread in the usual care, it is widely practiced in routine clinical. METHOD: We reviewed the results of search on the topic in MEDLINE, PsychINFO, EMBASE and Cochrane, and the main guidelines on the subject and analyzed for drug groups. RESULTS: Except some reservation with regard to classical MAOIs, antidepressants are safe and effective enhancers of the TEC. It is desirable to discontinuation of BZD whenever clinically possible before the course of ECT for risk of interference, if not possible will have to use proper technique to ensure effective incentives. It is advisable to stop or reduce the dose of lithium prior to ECT based on a cost-benefit analysis of the risk of relapse, if maintained will be adjusted lower levels and cognitive effects minimizing techniques. The combination with "classic" and "atypical" antipsychotics power positive clinical effects and the risk of combined use is low. The positive data are collected with clozapine and ECT-resistant psychosis, with little presence of effects of the decrease of seizure threshold by clozapine, and important effect of empowerment, but of limited duration. CONCLUSIONS: Although it is strictly necessary to identify situations in terms of drugs, patient and ECT technique, and care necessary to develop tests that provide methodologically sound data, the combined use of ECT and psychotropic drugs in general presents an acceptable risk level and efficacy data by encouraging empowerment.

Electroconvulsive therapy as treatment for malignant neuroleptic syndrome.

In the era of new antipsychotic drugs the severe symptomatology known by the name of neuroleptic malignant syndrome (NMS) continues to have a high incidence and mortality. We review its origin, pathophysiology, diagnostic criteria and staging, particularly with electroconvulsive therapy (ECT), and proposing a less restrictive use and more adjusted to the updated knowledge of this technique. In particular, we consider the justified use of bilateral lead placement, a frequency of three sessions per week, and loads calculated for age, which would ensure effective seizures with an early response, thus avoiding the use of repeated sub-seizure stimuli to calculate the threshold by titration. We believe there is little evidence on the fear of the risk of increasing malignant hyperthermia in NMS due to the substances used in anaesthesia, but is justified to use non-depolarising relaxants due to the risk of hyperkalaemia on being exposed to succinylcholine. Finally we believe it is essential to familiarise the other specialists involved in the treatment with ECT, to increase the availability of the technique and our training in this to the currently available complexity.