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1.
Asian J Psychiatr ; 51: 102128, 2020 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-32380441

RESUMO

At the start of 2020, the 2019 coronavirus disease (COVID-19), originating from China has spread to the world. There have been increasing numbers of confirmed cases and deaths around the globe. The COVID-19 pandemic has paved the way for considerable psychological and psychosocial morbidity among the general public and health care providers. An array of guidelines has been put forward by multiple agencies for combating mental health challenges. This paper addresses some of the mental health challenges faced by low and middle income countries (LMIC). It is worthwhile to note that these are challenges at the current stage of the pandemic and may change with the course of the pandemic itself.

2.
Asia Pac Psychiatry ; 11(4): e12371, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31709743

RESUMO

Suicide continues to be a major health concern globally despite many initiatives to identify risk factors and methods for suicide prevention. We have carried out a detailed narrative review of the literature from 2016 to 2019 using the headings of Personal resilience (P1), People (P2), Places (P3), Prevention (P4), Promoting collaboration (P5), and Promoting research (P6) in order to support an integrated approach to suicide prevention and the promotion of personal and population resilience. We have made 10 key recommendations on how this can be moved forward.

3.
Asian J Psychiatr ; 45: 74-80, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31520884

RESUMO

OBJECTIVE: Regular surveys are important to monitor the use of psychotropic medications in clinical practice. This study examined the psychotropic prescription patterns in adult Asian schizophrenia patients based on the data of the Research on Asian Psychotropic Prescription (REAP) 2016 survey. METHODS: This cross-sectional survey across 15 Asian countries/territories collected socio-demographic and clinical data with standardized procedures between March and May 2016. The socio-demographic and clinical characteristics of the patients were recorded with a standardized questionnaire. RESULTS: Altogether 3,537 adult patients with schizophrenia were consecutively screened and enrolled in the survey. The mean age was 38.66 ±â€¯11.55 years and 59.7% of the sample were male. The mean dose of antipsychotics in chlorpromazine equivalents (CPZeq) was 424 ±â€¯376 mg/day; 31.3% and 80.8% received first- and second- generation antipsychotics, respectively and 42.6% had antipsychotic polypharmacy, 11.7% had antidepressants, 13.7% had mood stabilizers, 27.8% had benzodiazepines, and 45.6% had anticholinergics. CONCLUSIONS: Psychotropic prescription patterns in Asian adult patients with schizophrenia varied across countries. Regular surveys on psychotropic medications for schizophrenia are important to monitor pharmacotherapy practice in Asia.

4.
Asia Pac Psychiatry ; 11(2): e12366, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31199084

RESUMO

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. The multifaceted intertwined nature of optimal health, mental health, and well-being requires operational, sustainable interdisciplinary partnerships in order to improve personal and global well-being and happiness. The initial step must be the assessment of the nature and magnitude of local problems in the global context. The WHO annual reports may be an adequate departure point as they can demonstrate the global nature of stressful situations and their association with physical and mental stress-related disorders. Therein, mental health professionals should spearhead change and progress. Attitudes need to be pro-active and partnerships are essential. Pertinent data should be evaluated by local experts who will determine the needs and how best to face them and achieve solutions. Hopefully, common regional denominators will lead to the formation of Regional Interdisciplinary Collaborative Alliances (RICAs) who will share needed resources and focus particularly on vulnerable populations. The RICAs would be supported by experts and technological facilities located in developed economy centers. The long-term goal is to turn the concept of pursuit of happiness into a well-perceived reality.


Assuntos
Saúde Global , Colaboração Intersetorial , Saúde Mental , Humanos
5.
Nord J Psychiatry ; 73(6): 323-330, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31240984

RESUMO

Background: Although cannabis use has been linked with schizophrenia in a dose-response pattern, to our knowledge, the relationship between cannabis and schizophrenia has rarely been reported in Asian population. Aim: We compared the clinical characteristics and psychotropic prescription patterns between cannabis users and non-users among Asian patients with schizophrenia. Moreover, we aimed to identify the independent correlates of cannabis use in these subjects. Methods: We performed the analysis of the data from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP), a collaborative consortium survey used to collate the prescription patterns for antipsychotic and other psychotropic medications in patients with schizophrenia in Asia. We included 132 schizophrenia patients in the group of lifetime cannabis use and 1756 in the group that had never used cannabis. A binary logistic model was fitted to detect the clinical correlates of lifetime cannabis use. Results: Adjusting for the effects of age, sex, geographical region, income group, duration of untreated psychosis, and Charlson comordity index level, a binary logistic regression model revealed that lifetime cannabis use was independently associated with aggressive behavior [adjusted odds ratio (aOR) = 1.582, 95% confidence interval (CI) = 1.006-2.490, p = .047] and with long-acting injectable antipsychotic treatment (aOR = 1.796, 95% CI = 1.444-2.820, p = .001). Conclusion: Our findings indicate a close link between lifetime cannabis use and aggressive behavior. The use of long-acting, injectable antipsychotics preferentially treats the aggressive behavior cannabis users among patients with schizophrenia in Asia, especially, the South or Southeast Asia.


Assuntos
Agressão , Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Cannabis/efeitos adversos , Fumar Maconha/efeitos adversos , Esquizofrenia/tratamento farmacológico , Adulto , Ásia/epidemiologia , Grupo com Ancestrais do Continente Asiático/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Fumar Maconha/epidemiologia , Fumar Maconha/psicologia , Razão de Chances , Psicotrópicos/administração & dosagem , Psicotrópicos/uso terapêutico , Esquizofrenia/epidemiologia , Inquéritos e Questionários
6.
Neurol Ther ; 8(2): 215-230, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31098889

RESUMO

INTRODUCTION: Lurasidone is an atypical antipsychotic that was approved in Europe in 2014 for the treatment of schizophrenia in adults aged ≥ 18 years. Clinical experience with lurasidone in Europe is currently limited, and there is therefore a need to provide practical guidance on using lurasidone for the treatment of adults with schizophrenia. METHODS: A panel of European psychiatrists with extensive experience of prescribing lurasidone was convened to provide recommendations on using lurasidone to treat adults with schizophrenia. RESULTS: Extensive evidence from clinical trials and the panel's clinical experience suggest that lurasidone is as effective as other atypical agents, with the possible exception of clozapine. Lurasidone is associated with a lower propensity for metabolic side effects (in particular, weight gain) and hyperprolactinaemia than most other atypical antipsychotics and has a relatively benign neurocognitive side effect profile. Patients switching to lurasidone from another antipsychotic may experience weight reduction and/or improvements in the ability to focus/concentrate. Most side effects with lurasidone (such as somnolence) are transitory, easily managed and/or ameliorated by dose adjustment. Akathisia and extrapyramidal symptoms may occur in a minority of patients, but these can be managed effectively with dose adjustment, adjunctive therapy and/or psychosocial intervention. CONCLUSIONS: Given the crucial importance of addressing the physical as well as mental healthcare needs of patients, lurasidone is a rational therapeutic choice for adults with schizophrenia, both in the acute setting and over the long term. FUNDING: Sunovion Pharmaceuticals Europe Ltd.

7.
Psychiatry Res ; 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30885383

RESUMO

Clozapine is an effective antipsychotic medication for treatment resistant schizophrenia and is widely used in Asian countries. This study investigated clozapine prescription patterns and their associated factors in Asian countries and territories based on the database of the Research on Asian Psychotropic prescription study (REAP) conducted in 2016. Demographic and clinical information of 3744 schizophrenia patients in 15 Asian countries and territories was collected with a standardized data collection form. In total, 18.4% of the sample received clozapine, ranging from 2.6% in Japan to 32.3% in Hong Kong. Binary logistic regression analysis revealed that higher antipsychotic dose (OR = 1.002, P < 0.001), less frequent first admission in the sample (OR = 0.6, P < 0.001), more severe negative symptoms (OR = 1.4, P = 0.001) and less first generation antipsychotics (FGAs) (OR = 0.2, P < 0.001) were independently and significantly associated with clozapine prescription. Clozapine is frequently and increasingly prescribed for schizophrenia in Asia, with large variation across countries and territories. Given the diverse prescription patterns of clozapine found in Asian countries/territories, the clinical rationale of clozapine prescription needs careful consideration in Asia with more local input.

8.
Saudi Pharm J ; 27(2): 246-253, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30766437

RESUMO

Background: Although disorganized speech is seen as one of the nuclear features of schizophrenia, there have been few reports of disorganized speech-associated psychotropic drug-prescribing patterns in large samples of schizophrenia patients. Objective: We aimed to examine the prevalence of disorganized speech and its correlates in terms of psychotropic drug prescribing, using the data from the Research on Asian Psychotropic Patterns for Antipsychotics (REAP-AP) study. Method: A total of 3744 patients with the ICD-10 diagnosis of schizophrenia were enrolled from 71 survey centers in 15 Asian countries/areas. An essential criterion of disorganized speech was that it was "severe enough to impair substantially effective communication" as defined in the DSM-5. A binary logistic model was fitted to identify the psychotropic drug-prescribing correlates of disorganized speech. Results: After adjusting for the potential effects of confounding variables, the binary logistic regression model showed that the presence of disorganized speech was directly associated with adjunctive use of mood stabilizers (P < 0.001) and cumulative diazepam equivalent dose (P < 0.0001), and inversely associated with adjunctive use of anti-Parkinson drugs (P < 0.0001). Conclusion: The association between disorganized speech and adjunctive use of mood stabilizers could perhaps be understood in the context of a relationship with impulsiveness/aggressiveness, or in terms of deconstructing the Kraepelinian dualism.

9.
Psychiatry Clin Neurosci ; 72(8): 572-579, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29761577

RESUMO

AIM: The aim of the present study was to survey the prevalence of antipsychotic polypharmacy and combined medication use across 15 Asian countries and areas in 2016. METHODS: By using the results from the fourth survey of Research on Asian Prescription Patterns on antipsychotics, the rates of polypharmacy and combined medication use in each country were analyzed. Daily medications prescribed for the treatment of inpatients or outpatients with schizophrenia, including antipsychotics, mood stabilizers, anxiolytics, hypnotics, and antiparkinson agents, were collected. Fifteen countries from Asia participated in this study. RESULTS: A total of 3744 patients' prescription forms were examined. The prescription patterns differed across these Asian countries, with the highest rate of polypharmacy noted in Vietnam (59.1%) and the lowest in Myanmar (22.0%). Furthermore, the combined use of other medications, expressed as highest and lowest rate, respectively, was as follows: mood stabilizers, China (35.0%) and Bangladesh (1.0%); antidepressants, South Korea (36.6%) and Bangladesh (0%); anxiolytics, Pakistan (55.7%) and Myanmar (8.5%); hypnotics, Japan (61.1%) and, equally, Myanmar (0%) and Sri Lanka (0%); and antiparkinson agents, Bangladesh (87.9%) and Vietnam (10.9%). The average psychotropic drug loading of all patients was 2.01 ± 1.64, with the highest and lowest loadings noted in Japan (4.13 ± 3.13) and Indonesia (1.16 ± 0.68), respectively. CONCLUSION: Differences in psychiatrist training as well as the civil culture and health insurance system of each country may have contributed to the differences in these rates. The concept of drug loading can be applied to other medical fields.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Polimedicação , Padrões de Prática Médica/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adulto , Ásia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
Front Psychiatry ; 9: 157, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29740360

RESUMO

Social cognition has become recognized as an important driver of functional outcomes and overall recovery in patients with schizophrenia, mediating the relationship between neurocognition and social functioning. Since antipsychotic therapy targeting remission of clinical symptoms has been shown to have a limited impact on social cognition, there has been an increasing drive to develop therapeutic strategies to specifically improve social cognition in schizophrenia. We sought to review current evidence relating to social cognition in schizophrenia and its clinical implications, including interventions designed to target the core domains of social cognition (emotion processing, theory of mind, attributional bias, and social perception) as a means of improving functional outcomes and thereby increasing the likelihood of recovery. Relevant articles were identified by conducting a literature search in PubMed using the search terms "schizophrenia" AND "cognition" AND "social functioning," limited to Title/Abstract, over a time period of the past 10 years. Current evidence demonstrates that schizophrenia is associated with impairments in all four core domains of social cognition, during the pre-first-episode, first-episode, early, and chronic phases of the disease, and that such impairments are important determinants of functional outcome. Interventions targeting the four core domains of social cognition comprise psychosocial approaches (social cognition training programs) and pharmacological therapies. Social cognition training programs targeting multiple and specific core domains of social cognition have shown promise in improving social cognition skills, which, in some cases, has translated into improvements in functional outcomes. Use of some psychosocial interventions has additionally resulted in improvements in clinical symptoms and/or quality of life. Pharmacological therapies, including oxytocin and certain antipsychotics, have yielded more mixed results, due in part to the confounding impact of factors including variation in receptor genetics, bioavailability, pharmacokinetics, and drug-drug interactions, and inconsistencies between study designs and medication dosages. Additional research is required to advance our understanding of the role of social cognition in schizophrenia, and to further establish the utility of targeted interventions in this setting.

11.
World Psychiatry ; 17(1): 117-118, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29352528
12.
BJPsych Int ; 14(1): 1-4, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29093923

RESUMO

This paper focuses on the importance of involving patients, families and other carers when offering and deciding on treatment and care options. It highlights the activities of international and national organisations in facilitating collaboration with patients and families in treatment, research, teaching and training related to mental healthcare.

13.
World Psychiatry ; 16(2): 222, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28498577
14.
Proc Natl Acad Sci U S A ; 113(38): E5598-607, 2016 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-27601654

RESUMO

Mutations that cause neurological phenotypes are highly informative with regard to mechanisms governing human brain function and disease. We report autosomal recessive mutations in the enzyme glutamate pyruvate transaminase 2 (GPT2) in large kindreds initially ascertained for intellectual and developmental disability (IDD). GPT2 [also known as alanine transaminase 2 (ALT2)] is one of two related transaminases that catalyze the reversible addition of an amino group from glutamate to pyruvate, yielding alanine and α-ketoglutarate. In addition to IDD, all affected individuals show postnatal microcephaly and ∼80% of those followed over time show progressive motor symptoms, a spastic paraplegia. Homozygous nonsense p.Arg404* and missense p.Pro272Leu mutations are shown biochemically to be loss of function. The GPT2 gene demonstrates increasing expression in brain in the early postnatal period, and GPT2 protein localizes to mitochondria. Akin to the human phenotype, Gpt2-null mice exhibit reduced brain growth. Through metabolomics and direct isotope tracing experiments, we find a number of metabolic abnormalities associated with loss of Gpt2. These include defects in amino acid metabolism such as low alanine levels and elevated essential amino acids. Also, we find defects in anaplerosis, the metabolic process involved in replenishing TCA cycle intermediates. Finally, mutant brains demonstrate misregulated metabolites in pathways implicated in neuroprotective mechanisms previously associated with neurodegenerative disorders. Overall, our data reveal an important role for the GPT2 enzyme in mitochondrial metabolism with relevance to developmental as well as potentially to neurodegenerative mechanisms.


Assuntos
Encéfalo/crescimento & desenvolvimento , Mitocôndrias/enzimologia , Doenças do Sistema Nervoso/genética , Transaminases/genética , Sequência de Aminoácidos/genética , Animais , Encéfalo/metabolismo , Encéfalo/patologia , Ciclo do Ácido Cítrico/genética , Homozigoto , Humanos , Ácidos Cetoglutáricos/metabolismo , Camundongos , Mitocôndrias/patologia , Mutação de Sentido Incorreto , Doenças do Sistema Nervoso/patologia , Fenótipo , Ácido Pirúvico/metabolismo , Transaminases/metabolismo
15.
World Psychiatry ; 15(2): 191-2, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27265720
17.
Pak J Med Sci ; 31(5): 1269-71, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26649027

RESUMO

The QT interval represents ventricular depolarisation and repolarisation. Prolongation of this interval can lead to life-threatening complications. These can include arrhythmias such as Torsades de Pointes and Ventricular Fibrillation, which may ultimately lead to death. Many risk factors have been identified in prolonging the QT interval, one of which is medication commonly used in the treatment of Psychiatric ailments. This article describes Antipsychotic drugs causing prolonged QT interval and the possible underlying mechanisms alongside the current best practice on the management of this potentially fatal complication.

18.
World Psychiatry ; 14(2): 255-6, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26043352
19.
World Psychiatry ; 13(2): 205, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24890078
20.
World Psychiatry ; 12(3): 278, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24096798
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