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1.
BMJ Case Rep ; 13(10)2020 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-33012721

RESUMO

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.


Assuntos
Antipsicóticos/efeitos adversos , Betacoronavirus , Clozapina/efeitos adversos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Transtornos Psicóticos/tratamento farmacológico , Estado Epiléptico/etiologia , Clozapina/uso terapêutico , Diagnóstico Diferencial , Eletroencefalografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Estado Epiléptico/fisiopatologia
2.
Rev Prat ; 70(5): 502-506, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-33058634

RESUMO

Review of the prescription of antipsychotics in children. In France, as in the rest of the world, prescribing of antipsychotic drugs increases in children and adolescentsIndeed, antipsychotics are frequently prescribed in children and adolescents for both psychotic and non-psychotic disorders, with 36 to 93%o fprescriptionsbeingoff-label in this population. In addition, a high number of adverse events have been reported in the literature under antipsychotic treatment. The consequences of these adverse events are still poorly documented. In France, a 12-months national prospective study (ETAPE) observed a high incidence rate, severity and persistence of adverse events during first-time antipsychotic treatment in pediatric patients. Therefore, a careful and continuous clinical and biological monitoring all over the treatment period is required to adapt treatment decisions based on benefice-risk-analysis.


Assuntos
Antipsicóticos , Transtornos Mentais , Adolescente , Antipsicóticos/efeitos adversos , Criança , França/epidemiologia , Humanos , Transtornos Mentais/tratamento farmacológico , Prescrições , Estudos Prospectivos
3.
Medicine (Baltimore) ; 99(38): e22280, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957382

RESUMO

BACKGROUND: Nowadays, there are some randomized controlled trials (RCTs) to explore the effectiveness of drug therapy for bipolar disorder with anxiety disorders. However, due to lack of sufficient data, there are currently no good treatment recommendations. The purpose of this network meta-analysis is to compare the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders to provide evidence to support clinical practice and guidelines development. METHODS: A systematic literature search will be performed in the Cochrane Library, PubMed, EMBASE, and Web of Science from inception to July 2020. RCTs that compared the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders will be included. Two reviewers will independently search and select the studies, extract the data, and assess the risk of bias. We will assess the risk of bias of included RCTs using the Cochrane risk of bias tool. The WinBUGS 1.4.3 software will be used to perform the network meta-analysis, and the result figures will be generated by STATA 15.0 software. In addition, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the quality of evidence. RESULTS: This study will systematically compare the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION: Our study will provide evidence for the drug therapy of patients with bipolar disorder complicated with anxiety disorders, and provide suggestions for clinical practice or guidelines. INPLASY REGISTRATION NUMBER: INPLASY202070132.


Assuntos
Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Transtornos de Ansiedade/complicações , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Metanálise em Rede , Revisões Sistemáticas como Assunto , Transtorno Bipolar/psicologia , Humanos
6.
Psychiatr Danub ; 32(2): 176-186, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32796782

RESUMO

BACKGROUND: Although an inverse relationship between body mass index (BMI) and Parkinson disease (PD) has been repeatedly reported, to our knowledge, the relationship between BMI and antipsychotic-induced extrapyramidal symptoms (EPS) has rarely been studied in patients with schizophrenia. Our study aimed to evaluate the relationship between BMI and EPS in patients with schizophrenia. SUBJECTS AND METHODS: Using data from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP) study, we compared the prevalence of EPS in 1448 schizophrenia patients stratified as underweight, normal range, overweight pre-obese, overweight obese I, overweight obese II, and overweight obese III according to the World Health Organization (WHO) classification system for body weight status, and with underweight, normal range, overweight at risk, overweight obese I, and overweight obese II according to the Asia-Pacific obesity classification. RESULTS: In the first step of the WHO classification system for body weight status, adjusting for the potential effects of confounding factors, the multinomial logistic regression model revealed that underweight was significantly associated with greater rates of bradykinesia and muscle rigidity, and a lower rate of gait disturbance. In the second step of the Asia-Pacific obesity classification, adjusting for the potential effects of confounding factors, the multinomial logistic regression model revealed that underweight was significantly associated with a higher rate of muscle rigidity. CONCLUSION: Findings of the present study consistently revealed that underweight was associated with a greater rate of muscle rigidity in a stepwise pattern among Asian patients with schizophrenia. Although the mechanism underlying the inverse relationship between BMI and muscle rigidity cannot be sufficiently explained, it is speculated that low BMI may contribute to the development of muscle rigidity regardless of antipsychotic "typicality" and dose in patients with schizophrenia.


Assuntos
Antipsicóticos , Índice de Massa Corporal , Esquizofrenia , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Ásia , Humanos , Sobrepeso , Esquizofrenia/tratamento farmacológico , Magreza
7.
Cochrane Database Syst Rev ; 8: CD008016, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32840872

RESUMO

BACKGROUND: The symptoms and signs of schizophrenia have been linked to high levels of dopamine in specific areas of the brain (limbic system). Antipsychotic drugs block the transmission of dopamine in the brain and reduce the acute symptoms of the disorder. An original version of the current review, published in 2012, examined whether antipsychotic drugs are also effective for relapse prevention. This is the updated version of the aforesaid review. OBJECTIVES: To review the effects of maintaining antipsychotic drugs for people with schizophrenia compared to withdrawing these agents. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials including the registries of clinical trials (12 November 2008, 10 October 2017, 3 July 2018, 11 September 2019). SELECTION CRITERIA: We included all randomised trials comparing maintenance treatment with antipsychotic drugs and placebo for people with schizophrenia or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis based on a random-effects model. For continuous data, we calculated mean differences (MD) or standardised mean differences (SMD), again based on a random-effects model. MAIN RESULTS: The review currently includes 75 randomised controlled trials (RCTs) involving 9145 participants comparing antipsychotic medication with placebo. The trials were published from 1959 to 2017 and their size ranged between 14 and 420 participants. In many studies the methods of randomisation, allocation and blinding were poorly reported. However, restricting the analysis to studies at low risk of bias gave similar results. Although this and other potential sources of bias limited the overall quality, the efficacy of antipsychotic drugs for maintenance treatment in schizophrenia was clear. Antipsychotic drugs were more effective than placebo in preventing relapse at seven to 12 months (primary outcome; drug 24% versus placebo 61%, 30 RCTs, n = 4249, RR 0.38, 95% CI 0.32 to 0.45, number needed to treat for an additional beneficial outcome (NNTB) 3, 95% CI 2 to 3; high-certainty evidence). Hospitalisation was also reduced, however, the baseline risk was lower (drug 7% versus placebo 18%, 21 RCTs, n = 3558, RR 0.43, 95% CI 0.32 to 0.57, NNTB 8, 95% CI 6 to 14; high-certainty evidence). More participants in the placebo group than in the antipsychotic drug group left the studies early due to any reason (at seven to 12 months: drug 36% versus placebo 62%, 24 RCTs, n = 3951, RR 0.56, 95% CI 0.48 to 0.65, NNTB 4, 95% CI 3 to 5; high-certainty evidence) and due to inefficacy of treatment (at seven to 12 months: drug 18% versus placebo 46%, 24 RCTs, n = 3951, RR 0.37, 95% CI 0.31 to 0.44, NNTB 3, 95% CI 3 to 4). Quality of life might be better in drug-treated participants (7 RCTs, n = 1573 SMD -0.32, 95% CI to -0.57 to -0.07; low-certainty evidence); probably the same for social functioning (15 RCTs, n = 3588, SMD -0.43, 95% CI -0.53 to -0.34; moderate-certainty evidence). Underpowered data revealed no evidence of a difference between groups for the outcome 'Death due to suicide' (drug 0.04% versus placebo 0.1%, 19 RCTs, n = 4634, RR 0.60, 95% CI 0.12 to 2.97,low-certainty evidence) and for the number of participants in employment (at 9 to 15 months, drug 39% versus placebo 34%, 3 RCTs, n = 593, RR 1.08, 95% CI 0.82 to 1.41, low certainty evidence). Antipsychotic drugs (as a group and irrespective of duration) were associated with more participants experiencing movement disorders (e.g. at least one movement disorder: drug 14% versus placebo 8%, 29 RCTs, n = 5276, RR 1.52, 95% CI 1.25 to 1.85, number needed to treat for an additional harmful outcome (NNTH) 20, 95% CI 14 to 50), sedation (drug 8% versus placebo 5%, 18 RCTs, n = 4078, RR 1.52, 95% CI 1.24 to 1.86, NNTH 50, 95% CI not significant), and weight gain (drug 9% versus placebo 6%, 19 RCTs, n = 4767, RR 1.69, 95% CI 1.21 to 2.35, NNTH 25, 95% CI 20 to 50). AUTHORS' CONCLUSIONS: For people with schizophrenia, the evidence suggests that maintenance on antipsychotic drugs prevents relapse to a much greater extent than placebo for approximately up to two years of follow-up. This effect must be weighed against the adverse effects of antipsychotic drugs. Future studies should better clarify the long-term morbidity and mortality associated with these drugs.


Assuntos
Antipsicóticos/uso terapêutico , Quimioterapia de Manutenção/métodos , Esquizofrenia/prevenção & controle , Antipsicóticos/efeitos adversos , Viés , Antagonistas de Dopamina/efeitos adversos , Antagonistas de Dopamina/uso terapêutico , Emprego/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Placebos/uso terapêutico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Esquizofrenia/tratamento farmacológico , Prevenção Secundária
8.
Rinsho Shinkeigaku ; 60(8): 520-526, 2020 Aug 07.
Artigo em Japonês | MEDLINE | ID: mdl-32641633

RESUMO

A 46 year-old man with schizophrenia had taken several anti-psychotic drugs since 25 years of age. From ~35 years of age, he noticed occasional neck torsion to the left, and later an ataxic gait; both symptoms gradually worsened. On admission, the patient was taking olanzapine (5 mg/day) and biperiden hydrochloride (1 mg/day) because his schizophrenia was well controlled. His parents were not consanguineous, and there was no family history of neuropsychiatric diseases. On neurological examination, he showed mild cognitive impairment, saccadic eye pursuit with horizontal gaze nystagmus, mild dysarthria, dystonic posture and movement of the neck, incoordination of both hands, and an ataxic gait. Deep tendon reflexes were normal except for the patellar tendon reflex, which was exaggerated bilaterally. Pathological reflexes were negative and there was no sign of rigidity, sensory disturbance or autonomic dysfunction. Ophthalmological examinations detected thinning of the outer macula lutea in both eyes, indicative of macular dystrophy. After admission, all anti-psychotic drugs were ceased, but his dystonia was unchanged. Levodopa and trihexyphenidyl hydrochloride were not effective. General blood, urine and cerebrospinal fluid examinations showed no abnormalities. Brain MRI showed cerebellar atrophy and bilateral symmetrical thalamic lesions without brainstem atrophy or abnormal signals in the basal ganglia. I123-IMP SPECT also revealed a decreased blood flow in the cerebellum. Genetic screening, including whole exome sequencing conducted by the Initiative on Rare and Undiagnosed Disease identified no possible disease-causing variants. The patient's dystonia worsened and choreic movements manifested on his right hand and foot. We suspected dystonia with marked cerebellar atrophy (DYTCA), but could not exclude drug-induced dystonia. Macular dystrophy and bilateral thalamic lesions on brain MRI have not been previously described in DYTCA. Whether these features might be primarily associated with dystonia or cerebellar ataxia now remains to be determined.


Assuntos
Antipsicóticos/efeitos adversos , Ataxia Cerebelar/etiologia , Cerebelo/patologia , Distonia Muscular Deformante/etiologia , Distonia/etiologia , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológico , Atrofia/diagnóstico por imagem , Atrofia/etiologia , Biperideno/efeitos adversos , Ataxia Cerebelar/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Distonia/diagnóstico por imagem , Distonia Muscular Deformante/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pescoço , Olanzapina/efeitos adversos
10.
J Clin Psychiatry ; 81(4)2020 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-32609960

RESUMO

OBJECTIVE: INP105 is a drug-device combination of olanzapine and technology that delivers a powder formulation of olanzapine to the vascular-rich upper nasal space. This study evaluated the pharmacokinetics, pharmacodynamics, safety, and tolerability of single ascending doses of INP105, olanzapine intramuscular (OLZ IM), and olanzapine oral disintegrating tablet (OLZ ODT). METHODS: This was a phase 1, active and double-blind placebo comparator-controlled, ascending-dose, 2-period, incomplete-block, 1-way crossover study in 40 healthy subjects, randomized to single doses of OLZ IM (5 or 10 mg) or OLZ ODT (10 mg) in Period 1 and then 1 of 3 doses (5 mg, 10 mg, or 15 mg) of INP105 or placebo in Period 2 between July and October 2018. Sedation and attention were evaluated by visual analog scale (VAS), the Agitation/Calmness Evaluation Scale (ACES), and the Digit Symbol Substitution Test (DSST). RESULTS: At equivalent doses, INP105 provided similar area under the drug concentration-time curve (AUC) from time 0 to the last measurable concentration, AUC from time 0 to infinity, and maximum observed concentration (Cmax) as OLZ IM and greater Cmax than but similar AUCs to OLZ ODT. Median time to maximum concentration was less for INP105 (15, 10, and 9.5 min for 5 mg, 10 mg, and 15 mg, respectively) than for OLZ IM (20 and 15 min for 5 mg and 10 mg, respectively) or OLZ ODT (120 min). Effects as measured with the VAS, ACES, and DSST with INP105 5 mg were comparable to those with OLZ IM 5 mg, with earlier onset for INP105 10 mg and 15 mg and greater effects than placebo and OLZ ODT. The incidence of treatment-emergent adverse events with INP105 5 mg, 10 mg, and 15 mg was 80%, 66.7%, and 75%, respectively, compared to 90% and 100% for OLZ IM 5 mg and 10 mg, respectively, and 83.3% for OLZ ODT; most common were dizziness, hypotension, and orthostatic symptoms. CONCLUSIONS: INP105 has rapid absorption and pharmacodynamic effects and may represent an effective, convenient, noninvasive, and well-tolerated alternative for treating acutely agitated patients by self- or caregiver administration in the home, community, or hospital environments. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03624322.


Assuntos
Olanzapina/efeitos adversos , Olanzapina/farmacocinética , Administração Intranasal , Administração Oral , Adolescente , Adulto , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Antipsicóticos/farmacocinética , Antipsicóticos/farmacologia , Atenção/efeitos dos fármacos , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Voluntários Saudáveis , Humanos , Hipnóticos e Sedativos/farmacologia , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Olanzapina/administração & dosagem , Olanzapina/farmacologia , Adulto Jovem
11.
PLoS One ; 15(7): e0235365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614868

RESUMO

OBJECTIVE: To determine the magnitude and factors associated with psychotropic drug-induced parkinsonism and akathisia among mentally ill patients. METHODS: A hospital-based cross-sectional study was conducted with a total of 410 participants attending a follow-up treatment service at Jimma Medical Center, a psychiatry clinic from April to June 2019. Participants were recruited using a systematic random sampling method. Drug-induced parkinsonism and akathisia were assessed using the Extra-pyramidal Symptom Rating Scale. Substance use was assessed using the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test. Data entry was done using EpiData version 3.1, and analysis done by the Statistical Package for Social Sciences version 22. Statistically, the significant association was declared by adjusted odds ratio, 95% confidence interval, and p-value less than or equal to 0.05. RESULTS: The mean age of the respondents was 33.3 years (SD ± 8.55). Most of the participants 223 (54.4%) had a diagnosis of schizophrenia. The prevalence of drug-induced parkinsonism was 14.4% (95% CI: 11.0 to 18.0) and it was 12.4% (95% CI: 9.3 to 15.4) for drug-induced akathisia. The result of the final model found out drug-induced parkinsonism was significantly associated with female sex, age, type of antipsychotics, physical illness, and anti-cholinergic medication use. Similarly, female sex, chlorpromazine equivalent doses of 200 to 600 mg, combined treatment of sodium valproate with antipsychotic, and severe khat/Catha edulis use risk level was significantly associated with akathisia. CONCLUSION: One of seven patients developed drug-induced parkinsonism and akathisia. Careful patient assessment for drug-induced movement disorders, selection of drugs with minimal side effects, screening patients for physical illness, and psycho-education on substance use should be given top priority.


Assuntos
Acatisia Induzida por Medicamentos/epidemiologia , Antipsicóticos/efeitos adversos , Doença de Parkinson Secundária , Esquizofrenia/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Assistência ao Convalescente , Instituições de Assistência Ambulatorial , Antipsicóticos/uso terapêutico , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson Secundária/induzido quimicamente , Doença de Parkinson Secundária/epidemiologia , Prevalência , Psiquiatria , Esquizofrenia/epidemiologia , Adulto Jovem
12.
Medicine (Baltimore) ; 99(26): e20981, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590809

RESUMO

BACKGROUND: Bipolar disorder (BD) is a chronic and disabling psychiatric disorder. The treatment of BD still remains a significant clinical challenge due to the complex nature of the disease. Nutraceutical therapy as adjunctive role is a promising therapy for BD. Sulforaphane (SFN), a broccoli extract, was reported to be effective for emotional problems and cognitive impairment. However, clinical research of SFN in the treatment of BD was rare. Therefore, this study is designed to evaluate the adjuvant role of SFN in the treatment of BD. METHODS: This is a randomized, double-blinded, placebo-controlled, parallel-group clinical trial. A total of 100 patients who meet inclusion criteria will be assigned to receive quetiapine plus SFN or quetiapine plus placebo in a 1:1 ratio. The total duration of the study will be 12 weeks including 5 follow ups. The primary outcome is in the Montgomery-Asberg depression rating scale. The secondary outcomes are the quick inventory of depressive symptomatology-self report, Hamilton anxiety rating scale, young mania rating scale, cognitive function, inflammatory factors, and intestinal flora. Any adverse events will be recorded throughout the trial. DISCUSSION: This trial will provide evidences to evaluate the efficacy and safety of SFN combined with quetiapine in the treatment of BD patients, as well as the adjuvant role of SFN in combination. TRIAL REGISTRATION: This study protocol was registered at the Chinese clinical trial registry (ChiCTR2000028706).


Assuntos
Adjuvantes Farmacêuticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Protocolos Clínicos , Isotiocianatos/normas , Adjuvantes Farmacêuticos/efeitos adversos , Adjuvantes Farmacêuticos/normas , Adulto , Antipsicóticos/efeitos adversos , Antipsicóticos/normas , Antipsicóticos/uso terapêutico , Método Duplo-Cego , Humanos , Isotiocianatos/efeitos adversos , Isotiocianatos/uso terapêutico , Placebos , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
13.
14.
Encephale ; 46(3S): S126-S127, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32475694
15.
Eur J Endocrinol ; 183(3): C11-C13, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32508315

RESUMO

There can potentially be a number of clinical interactions that could adversely affect patient outcomes in a patient with a prolactinoma and psychiatric disease that might require antipsychotic and dopamine agonist treatment. Dopamine agonists stimulate the dopamine D2 receptor, resulting in a decrease in prolactin (PRL) levels and in prolactinoma size but action on dopamine receptors in the meso-limbic system may rarely cause psychosis and more commonly cause impulse control disorders. The psychiatric benefits of antipsychotic agents involve blocking the D2 and other dopamine receptors but this blockade often also causes hyperprolactinemia. In patients with macroprolactinomas and psychosis, observation, estrogen/progestin replacement, and surgery can be considered in addition to dopamine agonists. In those who require dopamine agonists for PRL and tumor size control, the introduction of antipsychotics may blunt this effect, so that higher doses of the dopamine agonists may be needed. Alternatively, antipsychotics that have less of a blocking effect at the D2 receptor, such as aripiprazole, can be tried, if appropriate. For patients already on antipsychotic drugs who are found to have a macroprolactinoma for which dopamine agonists are required, dopamine agonists can be initiated at low dose and the dose escalated slowly. However, such patients require careful monitoring of psychiatric status to avoid the rare complication of exacerbation of the underlying psychosis. Again, if appropriate, use of antipsychotics that have less of a blocking effect at the D2 receptor may allow lower doses of dopamine agonists to be used in this situation.


Assuntos
Antipsicóticos/efeitos adversos , Agonistas de Dopamina/efeitos adversos , Transtornos Mentais/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Antipsicóticos/administração & dosagem , Agonistas de Dopamina/administração & dosagem , Interações Medicamentosas , Humanos , Hiperprolactinemia/induzido quimicamente , Transtornos Mentais/induzido quimicamente , Prolactina/metabolismo , Prolactinoma/patologia , Receptores de Dopamina D2/efeitos dos fármacos
16.
PLoS One ; 15(6): e0234864, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555706

RESUMO

The purpose of this study was to develop the Glasgow Antipsychotic Side effects Scale for Clozapine Japanese version (GASS-C-J) and examine its reliability to assess clozapine-related side effects. We developed the GASS-C-J using forward and backward translation. Semantic equivalence of the GASS-C-J to the GASS-C was confirmed by the original author. We then administered the GASS-C-J twice to 109 patients on clozapine treatment at two psychiatric hospitals in Japan. We assessed the internal consistency and test-retest reliability of the GASS-C-J using Cronbach's alpha and weighted kappa coefficient, respectively. We also examined if discrepancies in each GASS-C-J item score between the first and second rating were correlated with items of the Brief Evaluation of Psychosis Symptom Domains (BE-PSD). The Cronbach's alpha coefficient of the GASS-C-J at the first and second rating was 0.78 (95% CI: 0.72 to 0.84) and 0.82 (95% CI: 0.76 to 0.88), respectively. The weighted kappa coefficient of individual and total GASS-C-J item scores ranged from 0.45 to 0.88. Some symptom domains were correlated with discrepancies in specific items of the GASS-C-J: psychotic symptoms and nausea/vomiting (rs = 0.27), thirst (rs = 0.31), and appetite/weight gain (rs = 0.27); disorganized thinking and urinary incontinence (rs = 0.26); depression/anxiety and myoclonus (rs = 0.25), hypersalivation (rs = -0.27), and blurred vision (rs = -0.22). These findings demonstrate that the GASS-C-J can be used in clinical and research settings as a reliable scale to assess clozapine-related side effects.


Assuntos
Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Escala de Resultado de Glasgow/normas , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/sangue , Antipsicóticos/uso terapêutico , Clozapina/sangue , Clozapina/uso terapêutico , Estudos Transversais , Resistência a Medicamentos/efeitos dos fármacos , Feminino , Hospitais Psiquiátricos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários
18.
J Clin Psychiatry ; 81(4)2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32526104

RESUMO

OBJECTIVE: Antipsychotic drugs are known to increase mortality among patients with dementia. Many patients receive concomitant treatment with other psychotropic agents. The aim of this retrospective cohort study was to investigate the impact of benzodiazepines and antidepressants on the risk of death in patients with dementia initiating antipsychotic drug treatment. METHODS: Nationwide registry data on all incident dementia cases among individuals aged 65 years and older in Denmark between 2009 and 2013 for which antipsychotic treatment was initiated were used. The 180-day mortality was evaluated by crude and adjusted hazard ratios (HRs, including adjustment for somatic and psychiatric comorbidity, other prescription drugs, nursing home residency, and time since diagnosis), comparing periods of antipsychotic treatment with periods of concomitant treatment with benzodiazepines or antidepressants. RESULTS: Among 41,494 incident dementia cases, antipsychotic treatment was initiated for 10,291 (24.8%). After 3,140 people were excluded due to recent antipsychotic drug use or hospitalization, 7,151 people were included in the analysis. The total follow-up time during current antipsychotic treatment was 1,146 person-years, and 831 died during antipsychotic treatment. Compared with antipsychotic treatment alone, the risk of death increased during antipsychotic treatment in combination with benzodiazepines (adjusted HR = 2.19; 95% CI, 1.83-2.63), while there was a decreased risk of death during antipsychotic treatment in combination with antidepressants (adjusted HR = 0.61; 95% CI, 0.50-0.74). CONCLUSIONS: The diverse impact of concomitant use of benzodiazepines and antidepressants on mortality may be due to a direct drug-related effect. Alternatively, the findings could reflect differential mortality associated with different indications for therapy. Although the results cannot prove causality, and there may be residual confounding, clinicians should be cautious when considering the combination of antipsychotics and benzodiazepines in patients with dementia.


Assuntos
Antidepressivos/efeitos adversos , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Demência/mortalidade , Quimioterapia Combinada/mortalidade , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Demência/tratamento farmacológico , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
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