Impairment of the cardiac ejection fraction by blocking dopamine D2 receptors induced by long-acting injectable antipsychotic treatment.

INTRODUCTION: Atypical antipsychotics have numerous benefits compared to conventional ones in respect to the possible adverse effects. However, like the other ones, they may induce direct cardiovascular alterations, probably through the apoptotic effect of dopamine receptor D2 (DRD2) blockade. The main objective of the study was to assess the cardiac ejection fraction (EF) using transthoracic speckle tracking echocardiography (TSTE) in patients treated with long-acting injectable (LAI) atypical antipsychotics. PATIENTS, MATERIALS AND METHODS: This cross-sectional study was conducted on 123 patients with schizophrenia or schizoaffective disorder divided in four samples according to their treatment: Aripiprazole, Olanzapine, Paliperidone and Risperidone. We analyzed socio-demographic data, the intensity of psychiatric symptoms, the duration of psychosis and of LAI treatment, and the cardiac EF measured with TSTE. RESULTS: We found no statistically significant differences between the four antipsychotics regarding the values of the EF. Nevertheless, we observed a trend indicating that patients treated with an antipsychotic associated with a lower affinity for the DRD2, such as Olanzapine, have higher EF values than patients treated with antipsychotics with a stronger binding to the DRD2, such as Paliperidone and Risperidone. Patients receiving Aripiprazole, which has the strongest affinity for the DRD2 from all four antipsychotics but is also a partial DRD2 agonist, display higher EF values than those on Paliperidone and Risperidone. CONCLUSIONS: Antipsychotics with a lower affinity for the DRD2 or a partial agonism for it may be associated with higher EF. Cardiac monitoring should be performed periodically in patients on LAI antipsychotic therapy.

The link between personality dimensions and pain perception in patients with diabetes mellitus or cancer.

BACKGROUND AND AIMS: Diabetes mellitus and cancer are two diseases with a strong psychological impact. Personality traits modulate the perception of pain and the response to disease. The specificity of this study consists of the assessment of personality, pain and emotional impact in the two diseases. METHOD: The study included 130 participants assigned to 3 groups: patients with diabetes mellitus, patients with cancer disease, and a control group. The personality traits of all the participants were analyzed using Cloninger's Temperament and Character Inventory (TCI). For the evaluation of pain, as well as associated anxiety and depression in the diabetes and cancer groups, the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression Scale (HADS) were used. RESULTS: Patients with diabetes mellitus and cancer disease had significantly higher total values on the Harm Avoidance scale (HA) (p<0.001) and lower total values on the Self-Directedness scale (SD), Reward Dependence scale (RD), Cooperativeness scale (CO) (p<0.001) compared to the control group. Major anxiety was predominant in patients with diabetes mellitus (34%), and major depression was prevalent in cancer patients (17.5%). Patients with diabetes mellitus obtained a significantly higher severity score at BPI scale than patients with cancer disease (p=0.03). CONCLUSIONS: The existence of a mutual personality profile featuring high levels of Harm Avoidance and low levels of Self-Directedness in patients with diabetes mellitus and cancer who experience pain has great implications for the therapeutic approach. A potential future avenue of management in these diseases may lie in targeting particular personality aspects of chronic pain patients.

Treatment adherence and social functioning in patients diagnosed with schizophrenia and treated with antipsychotic depot medication.

BACKGROUND AND AIM: Some of the most significant problems encountered in the treatment of schizophrenia are non-adherence to the treatment with oral neuroleptics and difficult recovery of social functioning, after its impairment by negative psychotic symptoms and the progression of the disease with episodes of remission and relapse. METHODS: This study comparatively assesses the parameters "social functioning" and "treatment adherence" in 34 outpatients diagnosed with schizophrenia at the Adult Psychiatry Clinic III and the Adult Mental Health Center of Cluj-Napoca, using the "Medication Adherence Rating Scale" (MARS) and the "Social Adaptation Self-evaluation Scale". RESULTS: The two scales revealed that patients on depot medication tend to have better social functioning and social integration rates than patients for whom oral medication was prescribed. Despite the fact that most patients participating in the study had intellectual preoccupations and, to some extent, enjoyed working, 82% of them did not have a job. The percentage of those who did was higher in the cohort of patients on depot medication (63%) than in the cohort of patients for whom orally administered medication was prescribed (53%). CONCLUSIONS: Treatment adherence in patients with schizophrenia is thus significantly improved by depot medication, whereas treatment effectiveness and the frequency of adverse effects are similar for the two treatment options.

A dimensional approach of suicidal personality.

UNLABELLED: Although the last decade research has shown that personality disorders (PD) represent a major risk in suicidal behavior, the role of personality dimensions in determining this type of behavior hasn't been yet studied thoroughly. AIM: we intend to highlight some personality traits that may induce a suicidal behavior in patients diagnosed with PD. METHODS: the sample consisted of 131 patients with PD, 46 of them presenting both a personality disorder and suicide behavior (suicidal ideation/suicide attempt). The personality dimensions were studied using the Temperament and Character Inventory (T.C.I.) developed by Robert Cloninger. Suicide risk was assessed using the Mini-International Neuropsychiatric Interview (M.I.N.I.), Module C- Suicide Ideas. RESULTS: although the sample was analyzed in Clusters DSM type A, B, C and an analyze of co morbidities with the Axe I was also made, the analyze was taken further in our attempt to find a common factor that would differentiate the non-suicidal patients from the suicidal ones. The evident result appeared in two character dimensions that are highly related with suicide attempts. CONCLUSION: self-conducting and cooperativeness could be considered marker-dimensions in a quick evaluation of suicide risk.