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3.
J Zoo Wildl Med ; 51(4): 896-904, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33480570

RESUMO

Trazodone is an antianxiety medication commonly used in human and veterinary medicine. Stress-related trauma is the leading cause of morbidity and mortality in wild ruminant species. Trazodone could reduce stress and allow safer capture and handling, thus having a positive effect on their welfare. The objective of this study was to describe the clinical effects and pharmacokinetic profile of an oral dose of trazodone in domestic goats (Capra hircus) as a model for wild ruminants. A pilot study using ethograms and accelerometers identified an oral dose of 10 mg/kg as optimal to reduce activity levels. This dose resulted in a 502% increase in time spent sleeping (P=0.0016) and a 623% increase in time spent lying down (P=0.01). Additionally, there were reductions of 72% in time spent grooming (P=0.02), 49% in time spent moving (P=0.01), and 87% in time spent observing (P=0.0002). Activity levels were significantly decreased by 31% for 4 hr following administration (P=0.049). There were no observed adverse effects. Time spent eating or ruminating was not affected by trazodone administration (P > 0.05). The pharmacokinetics of trazodone following a single oral dose of 10 mg/kg in 7 goats was assessed. All animals achieved plasma concentrations over 130 ng/ml, a level considered therapeutic in humans and dogs, for a mean of 6.4 ± 5.0 hr. Mean terminal half-life was 10.55 ± 6.80 hr. All goats achieved maximum concentration within 5-15 min and still had detectable plasma levels at 24 hr. Trazodone appears promising to decrease stress in exotic ruminant species. Further research is warranted to establish its efficacy in other ruminant species and clinical situations.


Assuntos
Ansiolíticos/farmacocinética , Cabras/sangue , Trazodona/farmacocinética , Administração Oral , Animais , Ansiolíticos/sangue , Ansiolíticos/metabolismo , Esquema de Medicação , Masculino , Projetos Piloto , Trazodona/sangue , Trazodona/metabolismo
4.
Sr Care Pharm ; 36(2): 68-82, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33509330

RESUMO

When selecting and managing psychoactive medications in older people, it is equally important to focus on avoidance of toxicity as it is to focus on efficacy. Higher psychoactive medication load is associated with increased rate and risk of all cause hospitalization. The medication classes used to treat depression and related comorbidities include antidepressants, antipsychotics, stimulants, mood stabilizers, lithium, anxiolytics and sedative hypnotics. This discussion will examine considerations to help avoid medication related problems relevant to medications used to treat depression in the antidepressant pharmacological class.


Assuntos
Ansiolíticos/efeitos adversos , Antidepressivos/efeitos adversos , Antipsicóticos/efeitos adversos , Depressão/tratamento farmacológico , Psicotrópicos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Humanos , Hipnóticos e Sedativos/efeitos adversos
6.
Cochrane Database Syst Rev ; 12: CD009861, 2020 12 08.
Artigo em Inglês | MEDLINE | ID: mdl-33319916

RESUMO

BACKGROUND: Anxiety in relation to surgery is a well-known problem. Melatonin offers an alternative treatment to benzodiazepines for ameliorating this condition in the preoperative and postoperative periods. OBJECTIVES: To assess the effects of melatonin on preoperative and postoperative anxiety compared to placebo or benzodiazepines. SEARCH METHODS: We searched the following databases on 10 July 2020: CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science. For ongoing trials and protocols, we searched clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform. SELECTION CRITERIA: We included randomized, placebo-controlled or standard treatment-controlled (or both) studies that evaluated the effects of preoperatively administered melatonin on preoperative or postoperative anxiety. We included adult patients of both sexes (15 to 90 years of age) undergoing any kind of surgical procedure for which it was necessary to use general, regional, or topical anaesthesia. DATA COLLECTION AND ANALYSIS: One review author conducted data extraction in duplicate. Data extracted included information about study design, country of origin, number of participants and demographic details, type of surgery, type of anaesthesia, intervention and dosing regimens, preoperative anxiety outcome measures, and postoperative anxiety outcome measures. MAIN RESULTS: We included 27 randomized controlled trials (RCTs), involving 2319 participants, that assessed melatonin for treating preoperative anxiety, postoperative anxiety, or both. Twenty-four studies compared melatonin with placebo. Eleven studies compared melatonin to a benzodiazepine (seven studies with midazolam, three studies with alprazolam, and one study with oxazepam). Other comparators in a small number of studies were gabapentin, clonidine, and pregabalin. No studies were judged to be at low risk of bias for all domains. Most studies were judged to be at unclear risk of bias overall. Eight studies were judged to be at high risk of bias in one or more domain, and thus, to be at high risk of bias overall. Melatonin versus placebo Melatonin probably results in a reduction in preoperative anxiety measured by a visual analogue scale (VAS, 0 to 100 mm) compared to placebo (mean difference (MD) -11.69, 95% confidence interval (CI) -13.80 to -9.59; 18 studies, 1264 participants; moderate-certainty evidence), based on a meta-analysis of 18 studies. Melatonin may reduce immediate postoperative anxiety measured on a 0 to 100 mm VAS compared to placebo (MD -5.04, 95% CI -9.52 to -0.55; 7 studies, 524 participants; low-certainty evidence), and may reduce delayed postoperative anxiety measured six hours after surgery using the State-Trait Anxiety Inventory (STAI) (MD -5.31, 95% CI -8.78 to -1.84; 2 studies; 73 participants; low-certainty evidence). Melatonin versus benzodiazepines (midazolam and alprazolam) Melatonin probably results in little or no difference in preoperative anxiety measured on a 0 to 100 mm VAS (MD 0.78, 95% CI -2.02 to 3.58; 7 studies, 409 participants; moderate-certainty evidence) and there may be little or no difference in immediate postoperative anxiety (MD -2.12, 95% CI -4.61 to 0.36; 3 studies, 176 participants; low-certainty evidence). Adverse events Fourteen studies did not report on adverse events. Six studies specifically reported that no side effects were observed, and the remaining seven studies reported cases of nausea, sleepiness, dizziness, and headache; however, no serious adverse events were reported. Eleven studies measured psychomotor and cognitive function, or both, and in general, these studies found that benzodiazepines impaired psychomotor and cognitive function more than placebo and melatonin. Fourteen studies evaluated sedation and generally found that benzodiazepine caused the highest degree of sedation, but melatonin also showed sedative properties compared to placebo. Several studies did not report on adverse events; therefore, it is not possible to conclude with certainty, from the data on adverse effects collected in this review, that melatonin is better tolerated than benzodiazepines. AUTHORS' CONCLUSIONS: When compared with placebo, melatonin given as premedication (as tablets or sublingually) probably reduces preoperative anxiety in adults (measured 50 to 120 minutes after administration), which is potentially clinically relevant. The effect of melatonin on postoperative anxiety compared to placebo (measured in the recovery room and six hours after surgery) was also evident but was much smaller, and the clinical relevance of this finding is uncertain. There was little or no difference in anxiety when melatonin was compared with benzodiazepines. Thus, melatonin may have a similar effect to benzodiazepines in reducing preoperative and postoperative anxiety in adults.


Assuntos
Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Melatonina/uso terapêutico , Procedimentos Cirúrgicos Operatórios/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alprazolam/uso terapêutico , Ansiolíticos/efeitos adversos , Viés , Clonidina/uso terapêutico , Esquema de Medicação , Humanos , Melatonina/efeitos adversos , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Oxazepam/uso terapêutico , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/psicologia , Cuidados Pré-Operatórios , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
BMJ Case Rep ; 13(12)2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33328211

RESUMO

A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos Psicóticos/psicologia , Adulto , Ansiolíticos/administração & dosagem , Antipsicóticos/administração & dosagem , Transtornos de Ansiedade/tratamento farmacológico , Humanos , Lorazepam/administração & dosagem , Masculino , Mirtazapina/administração & dosagem , Pandemias , Transtornos Psicóticos/tratamento farmacológico , Catar , Quarentena/psicologia , Risperidona/administração & dosagem
9.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(10): 137-142, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33244970

RESUMO

Treatment resistance is a persistent neurochemical condition characterized by the presence of «hybrid¼ metabolism, which combines both pathological and drug-dependent metabolisms. The difficulties in management and prevention of treatment resistance are associated with a lack of understanding of neurochemical aspects of the development of higher mental functions. The authors suggest that the basic types of species-preserving behavior are associated with the activity of monoaminergic systems while the modulation of their activity is predetermined by local neuronal networks in the rostral parts of the brain, where a variety of co-transmitters play an important role. It is emphasized that the mechanisms of the development of resistance after previous treatment with agonists (antidepressants, anxiolytics) or antagonists (antipsychotics) are different. Depending on drug actions on synaptic transmission, methodological aspects of treatment resistance management by means of «polar therapy¼, «sensitization¼ and combination strategies are considered.


Assuntos
Ansiolíticos , Antipsicóticos , Psiquiatria , Ansiolíticos/farmacologia , Ansiolíticos/uso terapêutico , Antidepressivos , Antipsicóticos/uso terapêutico , Encéfalo , Psicotrópicos/farmacologia , Psicotrópicos/uso terapêutico
10.
Am J Vet Res ; 81(9): 739-746, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33112166

RESUMO

OBJECTIVE: To determine the pharmacokinetics and efficacy of trazodone following rectal administration of a single dose to healthy dogs. ANIMALS: 6 healthy adult dogs. PROCEDURES: Each dog received a single dose of trazodone (approx 8 mg/kg) per rectum. Trazodone tablets were crushed into a powder, mixed with 5 mL of tap water, and injected into the rectum via a red rubber catheter. Sedation scores were assigned, and blood samples were collected for determination of plasma trazodone concentration at predetermined times before and after drug administration. Pharmacokinetic parameters were estimated by noncompartmental analysis. RESULTS: Plasma trazodone concentration remained below the detection limit for 1 dog even though it became moderately sedate. Median (interquartile [25th to 75th percentile] range [IQR]) maximum plasma trazodone concentration and volume of distribution and clearance corrected for bioavailability were 1.00 µg/mL (0.66 to 1.40 µg/mL), 10.3 L/kg (7.37 to 14.4 L/kg), and 639 mL/kg/h (594 to 719 mL/kg/h), respectively. Median time to maximum plasma trazodone concentration and elimination half-life were 15 minutes (range, 15 to 30 minutes) and 12 hours (IQR, 7.99 to 12.7 hours), respectively. All dogs became mildly or moderately sedate, and the extent of sedation was maximal at a median of 30 minutes (IQR, 30 to 60 minutes) after trazodone administration. No adverse effects were observed. CONCLUSIONS AND CLINICAL RELEVANCE: Rectal administration of trazodone may be a viable option for sedation and treatment of anxiety in dogs for which administration of sedatives and anxiolytics by other routes is contraindicated. Further research is necessary to better elucidate the pharmacokinetics and efficacy of trazodone following rectal administration and determine optimal dosing.


Assuntos
Ansiolíticos , Trazodona , Administração Oral , Administração Retal , Animais , Área Sob a Curva , Cães , Meia-Vida
11.
Psychiatr Danub ; 32(Suppl 1): 33-35, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890359

RESUMO

BACKGROUND: Bruxism is excessive teeth grinding or jaw clenching. Several symptoms are commonly associated with bruxism, including hypersensitive teeth, aching jaw muscles, headaches, tooth wear, and damage to dental restorations. There are two types of bruxism, awake bruxism and sleep bruxism. Awake bruxism is generally treated by dentists and maxilla-facial surgeons through several treatment modalities such as, counselling about triggers, relaxation, occlusal splints and botulinum toxin type A injections. METHODS: We will present the case of a 21-year-old woman presenting mood swings with a high level of anxiety and concentration difficulties since childhood. She also complained of awake bruxism. Intelligence was evaluated using The Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV). Attention-deficit hyperactivity disorder (ADHD) was investigated through a neuropsychology test. RESULTS: Intelligence evaluation showed normal intellectual function. Neuropsychology test showed a profile corresponding to ADHD. Bupropion XR 300 mg was initiated for ADHD. Pregabalin was prescribed for general anxiety syndrome. The patient reported a complete disappearance of awake bruxism at a daily dose of 375 mg, with no occlusal appliances. Following the improvement of the anxiety symptoms, the attempt to reduce the dose twice leading to the recurrence of bruxism. CONCLUSIONS: A 21 years old female treated with 375 mg daily doses of pregabalin for generalized anxiety disorder experienced a significant reduction of daytime bruxism. More studies are needed to determine whether pregabalin has a long term effect against awake bruxism.


Assuntos
Ansiolíticos , Bruxismo , Vigília , Ansiolíticos/uso terapêutico , Ansiedade , Transtornos de Ansiedade , Bruxismo/tratamento farmacológico , Feminino , Humanos , Pregabalina/uso terapêutico , Adulto Jovem
12.
AAPS PharmSciTech ; 21(6): 213, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32737624

RESUMO

The acceptability and palatability of a dosage form are extremely important to improve patient compliance. Mixing oral solid dosage forms with food carriers is often necessary to ease swallowing and provide the taste-masking effect. The present research investigated how a liquid or semisolid carrier influences the disintegration time and drug dissolution rate of pellets and minitablets with diazepam. The disintegration of pellets and minitablets in liquid carriers (water, milk and apple juice) was determined using a texture analyser. Dissolution tests were performed for the dosage forms dispersed in gel vehicles (2% carmellose and 0.5% carbomer gels) or applesauce. The disintegration of minitablets in water and apple juice was fast (1 min), but it slowed to 3 and 5 min in milk and gel vehicles, respectively. The pellets disintegrated in liquid carriers within 3 min. The drug dissolution rate in 0.1 M HCl depended on the gel viscosity in this medium. The preserved high viscosity of a carmellose gel inhibited the dissolution of diazepam. On the other hand, the viscosity of the carbomer gel decreased rapidly, and in effect, the dissolution rate of diazepam from the incorporated pellets or minitablets was comparable to the dissolution from loose pellets or minitablets. Graphical abstract.


Assuntos
Ansiolíticos/administração & dosagem , Diazepam/administração & dosagem , Excipientes/administração & dosagem , Comprimidos , Administração Oral , Carboximetilcelulose Sódica , Formas de Dosagem , Humanos , Solubilidade , Viscosidade
13.
Life Sci ; 261: 118359, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-32861795

RESUMO

AIMS: The aim of this study is to investigate the anxiolytic activity of perampanel, a non-competitive antagonist of alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA)-type glutamate receptors, which is approved for partial-onset seizures in patients with epilepsy, and its mechanism of action. MAIN METHODS: The anxiolytic activity of perampanel at the doses of 0.25, 0.5, 1, 2, and 4 mg/kg intraperitoneally (i.p.) was investigated in mice using elevated plus-maze, hole-board, and open-field tests. The findings were compared to the anxiolytic activity of gamma-aminobutyric acid type A benzodiazepine (GABAA/BZ) receptor allosteric modulator diazepam (1 mg/kg, i.p.) and AMPA antagonist GYKI-53655 (5 mg/kg, i.p.). The mechanisms of action of perampanel were evaluated by pre-treatment with GABAA/BZ receptor antagonist flumazenil (3 mg/kg, i.p.), serotonin 5-hydroxytryptamine 1A (5-HT1A) antagonist WAY-100635 (1 mg/kg, i.p.), and α2-adrenoreceptor antagonist yohimbine (5 mg/kg, i.p.). KEY FINDINGS: In the elevated plus-maze and open-field tests, perampanel at the dose of 0.5 mg/kg, and in the hole-board test, at the doses of 0.25, 0.5, and 1 mg/kg demonstrated an anxiolytic effect without altering the locomotor activity. The effect of perampanel was comparable to the effect of diazepam. Stimulation of GABAA/BZ and α2-adrenergic receptors contributed to the anxiolytic effect of perampanel, since significant antagonisms were determined in various behavioral parameters by the antagonist pre-treatments. SIGNIFICANCE: AMPA antagonism is believed to provide the determined anxiolytic activity of perampanel. Increased GABAergic tonus induced by AMPA receptor antagonism along with other systems, especially the noradrenergic system, might be involved in the anxiolytic activity.


Assuntos
Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Piridonas/uso terapêutico , Animais , Ansiolíticos/farmacologia , Ansiedade/fisiopatologia , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Camundongos , Atividade Motora/efeitos dos fármacos , Piridonas/farmacologia , Receptores Adrenérgicos alfa 2/metabolismo , Receptores de GABA/metabolismo
14.
J Clin Psychiatry ; 81(5)2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32857933

RESUMO

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat pediatric anxiety disorders, including generalized anxiety disorder (GAD); however, their efficacy and tolerability are difficult to predict. This study evaluated the efficacy and tolerability of escitalopram in adolescents with GAD (DSM-IV-TR) and the impact of variants in HTR2A and serotonin transporter (SLC6A4) genes and cytochrome P450 2C19 (CYP2C19) phenotypes on response as well as CYP2C19 phenotype on escitalopram pharmacokinetics from February 2015 through November 2018. METHODS: Patients were treated with escitalopram (forced titration to 15 mg/d, then flexible titration to 20 mg/d) (n = 26, mean ± SD age: 14.8 ± 1.7 years) or placebo (n = 25, mean ± SD age: 14.9 ± 1.6 years) for 8 weeks. Outcomes were the change in scores on the Pediatric Anxiety Rating Scale (PARS) and Clinical Global Impressions (CGI) scales as well as vital signs and adverse events. Plasma escitalopram and desmethylcitalopram area under the curve during 24 hours (AUC0-24) and maximum concentration (Cmax) were determined and compared across CYP2C19 phenotypes. RESULTS: Escitalopram was superior to placebo for mean ± SD baseline-to-endpoint change in PARS (-8.65 ± 1.3 vs -3.52 ± 1.1, P = .005) and CGI scores, and increasing CYP2C19 metabolism was associated with decreases in escitalopram Cmax (P = .07) and AUC0-24 (P < .05). Vital signs, corrected QT interval, and adverse events were similar in patients who received escitalopram and placebo. CONCLUSIONS: Escitalopram reduces anxiety symptoms, and pharmacogenetics variables influence the trajectory and magnitude of improvement. Variation in CYP2C19 metabolism accounts for significant differences in escitalopram pharmacokinetics, raising the possibility that CYP2C19 phenotype should be considered when prescribing escitalopram. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02818751.


Assuntos
Ansiolíticos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Citalopram/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico , Adolescente , Área Sob a Curva , Criança , Citalopram/análogos & derivados , Citalopram/sangue , Citalopram/farmacocinética , Citocromo P-450 CYP2C19/genética , Citocromo P-450 CYP2C19/metabolismo , Método Duplo-Cego , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Inibidores de Captação de Serotonina/sangue , Inibidores de Captação de Serotonina/farmacocinética , Resultado do Tratamento
15.
Sci Total Environ ; 737: 140257, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32783852

RESUMO

Ecotoxicological effects of psychiatric drugs and drug metabolites released by the human population are of increasing environmental concern. In this study we evaluate behavioral responses to visual predator cues in wild caught three-spined stickleback (Gasterosteus aculeatus) after exposure to water-born citalopram, a widely prescribed selective serotonin reuptake inhibitor with antidepressant and anxiolytic effects. Fish were exposed to ecological relevant concentrations of citalopram (0.15 or 1.5 µg L-1) for 10 or 20 days. After drug exposure, individual fish were moved to a test arena where they were exposed to two naturalistic visual predator cues; a shadow from beneath, which simulated an approaching fish, and an overhead silhouette of a passing gull. Both visual cues resulted in decreased locomotor activity after post cue presentation. Notably, citalopram exposure resulted in a dose dependent suppression in response to the overhead stimulus. These results show that an ecologically relevant stimulus elicits a robust avoidance behavioral in wild caught fish after 25 min of acclimatization in the test arena. This suggests that the gull stimulus can be utilized as a behavioral endpoint in high flow through assays of ecotoxicological effects of psychiatric drugs and drug metabolites. Furthermore, the short acclimation time of wild caught fish in the test arena, opens for behavioral screening by fish living or kept in water bodies which are potentially impacted by psychiatric drugs.


Assuntos
Ansiolíticos , Smegmamorpha , Animais , Citalopram , Sinais (Psicologia) , Inibidores de Captação de Serotonina
16.
Life Sci ; 259: 118271, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32798553

RESUMO

AIMS: Cannabidiolic acid (CBDA) is one of the most abundant phytocannabinoid acids in the Cannabis sativa plant. It has been shown that it is able to exert some therapeutic effects such as antiemetic, anti-inflammatory, anxiolytic or antidepressant, although some of them remain under debate. In the present study we aim to assess the potential behavioural effects of CBDA as well as its modulation of neuroinflammatory markers in the prefrontal cortex (PFC). MAIN METHODS: The effects of acute and repeated CBDA (0.001-1 mg/kg i.p.) treatments were evaluated on cognitive, emotional, motivational and nociceptive behaviours in male CD1 mice. For this, Y-maze and elevated plus maze paradigms, spontaneous locomotor activity, social interaction, hot-plate, formalin and tail suspension tests were used. We also studied the effects of CBDA on the rewarding responses of cocaine in the conditioned place preference (CPP) paradigm. Finally, PFC was dissected after acute and repeated CBDA treatments to evaluate inflammatory markers. KEY FINDINGS: Acute CBDA treatment induced antinociceptive responses in the hot-plate test. A 10-day CBDA treatment reduced despair-like behaviour in the tail suspension test. CBDA did not alter the results of the remaining behavioural tests assayed, including cocaine-induced reward in the CPP. Regarding the biochemical analysis, repeated CBDA treatment diminished the level of peroxisome proliferator-activated receptor gamma (PPAR-γ) and increased that of interleukin-6 (IL-6) protein in PFC. SIGNIFICANCE: These results show that CBDA has limited in vivo effects on the modulation of mice behaviour, supporting the current skepticism regarding its therapeutic potential.


Assuntos
Comportamento Animal/efeitos dos fármacos , Canabinoides/farmacologia , Córtex Pré-Frontal/efeitos dos fármacos , Animais , Ansiolíticos/farmacologia , Antieméticos/farmacologia , Canabinoides/metabolismo , Cannabis/efeitos dos fármacos , Cognição/efeitos dos fármacos , Condicionamento Psicológico/efeitos dos fármacos , Dronabinol/farmacologia , Emoções/efeitos dos fármacos , Cloreto de Lítio/farmacologia , Masculino , Camundongos , Motivação/efeitos dos fármacos , Nociceptores/efeitos dos fármacos
17.
PLoS One ; 15(8): e0237061, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790718

RESUMO

Stepped-care (SC) models for anxiety disorders are implemented on a large scale and are assumed to be as effective for the greater majority of patients as more intensive treatment schemes. To compare the outcomes of SC and international guideline-based treatment (Treatment as Usual: TAU) for panic disorder, a total of 128 patients were randomized to either SC or TAU (ratio 2: 1, respectively) using a computer generated algorithm. They were treated in four mental health care centres in the Netherlands after therapists had been trained in SC by a senior expert therapist. SC comprised 10-week guided self-help (pen-and-paper version) followed, if indicated, by 13-week manualized face-to-face cognitive behavioural therapy (CBT), with medication- if prescribed- kept constant. TAU consisted of 23-week regular face-to-face CBT (RCBT) with medication -when prescribed- also kept constant. The means of the attended sessions in the SC condition was 5.9 (SD = 4.8) for ITT and 9.6 (SD = 9.6) for the RCBT condition. The difference in the number of attended sessions between the conditions was significant (t(126) = -3.87, p < .001). Remission rates between treatment conditions did not differ significantly (SC: 44.5%; RCBT: 53.3%) and symptom reduction was similar. Stepping up SC treatment to face-to-face CBT showed a minimal additional effect. Importantly, drop-out rates differed significantly for the two conditions (SC: 48.2%; RCBT: 26.7%). SC was effective in the treatment of panic disorder in terms of symptom reduction and remission rate, but dropout rates were twice as high as those seen in RCBT, with the second phase of SC not substantially improving treatment response. However, SC required significantly less therapist contact time compared to RCBT, and more research is needed to explore predictors of success for guided self-help interventions to allow treatment intensity to be tailored to patients' needs and preferences.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno de Pânico/terapia , Autocuidado/métodos , Adulto , Agorafobia/complicações , Agorafobia/tratamento farmacológico , Agorafobia/terapia , Ansiolíticos/uso terapêutico , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Avaliação de Resultados em Cuidados de Saúde , Transtorno de Pânico/complicações , Transtorno de Pânico/tratamento farmacológico , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
18.
Am J Geriatr Psychiatry ; 28(10): 1040-1045, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32718855

RESUMO

BACKGROUND: We aim to assess COVID-19 outbreak-related emotional symptoms, identify gender differences, and study the relationship between the emotional state and environmental features in the elderly. METHODS: We conducted a cross-sectional study starting on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory) and acute stress (Acute Stress Disorder Inventory) were compared between people over and under 60 years old. Gender differences and the relationship of loneliness, regular exercise, economic losses and use of anxiolytics on the mental state were evaluated. RESULTS: One thousand six hundred thirty-nine (150 [9.2%] aged ≥60) participants completed the survey. The greater than or equal to 60 group showed lower mean (SD) BDI levels than the less than 60 group (3.02 [3.28] versus 4.30 [4.93]); and lower mean (SD) acute stress disorder inventory scores than the less than 60 group (3.68 [3.20] versus 4.45 [3.06]). There were no gender differences in any of the clinical measures. The presence of economic losses as well as the increase in the use of anxiolytics was significantly associated with higher emotional distress in the elderly compared to the younger group. CONCLUSIONS: Older people have shown less emotional distress, with no differences between men and women. Economic loss and substance use should be monitored to guarantee the emotional well-being of the elderly.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus/epidemiologia , Depressão/epidemiologia , Pneumonia Viral/epidemiologia , Transtornos de Estresse Traumático Agudo/epidemiologia , Fatores Etários , Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/psicologia , Betacoronavirus , Depressão/psicologia , Surtos de Doenças , Status Econômico , Exercício Físico/psicologia , Feminino , Humanos , Renda , Solidão/psicologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pandemias , Angústia Psicológica , Espanha/epidemiologia , Transtornos de Estresse Traumático Agudo/tratamento farmacológico , Transtornos de Estresse Traumático Agudo/psicologia
19.
J Affect Disord ; 274: 1062-1067, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32663933

RESUMO

BACKGROUND: The management of coronavirus disease 2019 (COVID-19) in patients with comorbid psychiatric disorders poses several challenges, especially regarding drug interactions. METHODS: We report three representative case-scenarios on patients with psychiatric disorders and COVID-19 to provide a practical approach based on the existing literature and the clinical experience of an expert team in consultation-liaison psychiatry. CASE-CENTERED RECOMMENDATIONS: Psychopharmacological ongoing treatments should be prioritized and most doses should be reduced 25-50% of original dose if the patient receives lopinavir/ritonavir, with some exceptions including quetiapine, asenapine, olanzapine, sertraline, lamotrigine, bupropion, and methadone. If the psychopharmacological usual doses are in the low-to-median range levels, a dose change during COVID-19 drugs co-administration is not recommended, but only ECG and clinical monitoring of adverse effects and drug levels if required. Furthermore, when introducing a psychopharmacological drug, dose titration should be progressive, with ECG monitoring if cardiotoxic interactions are present. (A) In agitated delirium, olanzapine is recommended as first-line antipsychotic and quetiapine should be avoided. (B) In severe mental illness (SMI), essential treatments should be maintained. (C) In non-SMI with depressive/anxiety symptoms, psychological support should be provided and symptoms identified and treated. LIMITATIONS: Most recommendations on pharmacological interactions provide only a limited qualitative approach and quantitative recommendations are lacking. CONCLUSIONS: Patients with psychiatric disorders and COVID-19 should be managed on a personalized basis considering several clinical criteria and, should not be excluded from receiving COVID-19 treatments. Risks of pharmacological interaction are not absolute and should be contextualized, and most psychopharmacological treatments should include an ECG with special attention to QTc interval.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pacientes Internados/psicologia , Transtornos Mentais/complicações , Transtornos Mentais/terapia , Pneumonia Viral/complicações , Encaminhamento e Consulta , Idoso , Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Infecções por Coronavirus/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/psicologia , Psiquiatria
20.
Artigo em Inglês | MEDLINE | ID: mdl-32605096

RESUMO

The available arable land is unable to fulfill the food production need of rapidly the exponentially growing human population in the world. Pesticides are one of those different measures taken to meet this demand. As a plant growth regulator to block gibberellin, paclobutrazol (PBZ) is used excessively throughout the world to promote early fruit setting, and to increase seed setting which might be harmful because PBZ is a very stable compound; therefore, it can bioaccumulate into the food chain of an ecosystem. In the present study, we discovered unexpected effects of PBZ on zebrafish larvae and adult behaviors by challenging them with low dose exposure. Zebrafish larvae aged 4 days post-fertilization (dpf) were exposed for 24 h at 10 µg/L (0.01 ppm) and 100 µg/L (0.1 ppm) of PBZ, respectively, and adults were incubated at 100 µg/L (0.1 ppm) and 1000 µg/L (1 ppm) concentrations of PBZ, respectively, for fourteen days. After incubation, the locomotor activity, burst, and rotation movement for the larvae; and multiple behavioral tests such as novel tank exploration, mirror biting, shoaling, predator avoidance, and social interaction for adult zebrafish were evaluated. Brain tissues of the adult fish were dissected and subjected to biochemical analyses of the antioxidant response, oxidative stress, superoxide dismutase (SOD), and neurotransmitter levels. Zebrafish larvae exposed to PBZ exhibited locomotion hyperactivity with a high burst movement and swimming pattern. In adult zebrafish, PBZ resulted in anxiolytic exploratory behavior, while no significant results were found in social interaction, shoal making, and predator avoidance behaviors. Interestingly, high dose PBZ exposure significantly compromised the innate aggressive behavior of the adult fish. Biochemical assays for oxidative stress, antioxidant response, and superoxide dismutase (SOD) showed significant reductions in their relative contents. In conclusion, for the first time, our behavior assays revealed that chronic PBZ exposure induced behavioral alterations in both larvae and the adult zebrafish. Because PBZ is a widely-used plant growth regulator, we suggest that it is necessary to conduct more thorough tests for its biosafety and bioaccumulation.


Assuntos
Ansiolíticos , Comportamento Exploratório/efeitos dos fármacos , Peixe-Zebra , Animais , Ansiolíticos/toxicidade , Comportamento Animal , Ecossistema , Larva/efeitos dos fármacos , Locomoção , Atividade Motora , Triazóis
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