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1.
Tijdschr Psychiatr ; 63(7): 509-513, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34523700

RESUMO

It has become clear that COVID-19 can lead to neuropsychiatric complications. In this article, three cases are discussed that illustrate how neuropsychiatric complications can manifest within the COVID-19 disease course. Patients are at risk to develop a severe, hyperactive delirium, which is often accompanied by anxiety and sometimes neurological symptoms. The treatment of the neuropsychiatric complications is characterized by unusually high doses of antipsychotics and sedatives. Timely psychiatric consultation is advised for adequate recognition and effective treatment of delirium and other neuropsychiatric symptoms.


Assuntos
Antipsicóticos , COVID-19 , Antipsicóticos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Humanos , Unidades de Terapia Intensiva , SARS-CoV-2
2.
BMC Psychiatry ; 21(1): 439, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488701

RESUMO

BACKGROUND: In people with intellectual disability (ID) and challenging behaviour, antipsychotics (AP) are often used off-label and for a long period. Despite a lack of evidence for efficacy for challenging behaviour and concerns about common and clinically relevant side effects, complete withdrawal often fails. We postulate three possible hypotheses for withdrawal failure: 1. Influence of subjective interpretation of behavioural symptoms by caregivers and family; 2. Beneficial effects from AP treatment on undiagnosed psychiatric illness, through improvement in sleep or a direct effect on behaviour; and 3. Misinterpretation of withdrawal symptoms as a recurrence of challenging behaviour. METHODS: To investigate our hypotheses, we have designed a multicentre double-blind, placebo-controlled randomised trial in which AP (pipamperone or risperidone) are withdrawn. In the withdrawal group, the AP dose is reduced by 25% every 4 weeks and in the control group the dose remains unaltered. Behaviour, sleep, psychiatric disorders, withdrawal symptoms and side effects will be measured and compared between the two groups. If drop-out from the protocol is similar in both groups (non-inferiority), the first hypothesis will be supported. If drop-out is higher in the withdrawal group and an increase is seen in psychiatric disorders, sleep problems and/or behavioural problems compared to the control group, this suggests effectiveness of AP, and indications for AP use should be reconsidered. If drop-out is higher in the withdrawal group and withdrawal symptoms and side effects are more common in the withdrawal group compared to the control group, this supports the hypothesis that withdrawal symptoms contribute to withdrawal failure. DISCUSSION: In order to develop AP withdrawal guidelines for people with ID, we need to understand why withdrawal of AP is not successful in the majority of people with ID and challenging behaviour. With this study, we will bridge the gap between the lack of available evidence on AP use and withdrawal on the one hand and the international policy drive to reduce prescription of AP in people with ID and challenging behaviour on the other hand. TRIAL REGISTRATION: This trial is registered in the Netherlands Trial Register (NTR 7232) on October 6, 2018 ( www.trialregister.nl ).


Assuntos
Antipsicóticos , Deficiência Intelectual , Adulto , Antipsicóticos/uso terapêutico , Sintomas Comportamentais , Método Duplo-Cego , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/tratamento farmacológico , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Risperidona/uso terapêutico
3.
Artigo em Russo | MEDLINE | ID: mdl-34481434

RESUMO

Abstruct. OBJECTIVE: To assess the possibilities of influencing the severity of negative disorders in schizophrenic patients with cholinesterase blockade. MATERIAL AND METHODS: The study included stable 26 patients (13 of them women), average age 40.4 (SD 11.7) with paranoid schizophrenia, episodic form according to ICD-10). All patients received antipsychotic therapy, which was not changed at least for 2 months. We used psychometric scales (Positive and Negative Syndrome Assessment Scale (PANSS), Global Functioning Scale (GAF), neurocognitive techniques (Brief Assessment of Cognition in Schizophrenia-BACS), projective psychological techniques (Rorschach test). RESULTS AND CONCLUSION: The results of the study showed that augmentation of maintenance antipsychotic therapy with a cholinesterase blocker (ipidacrine at a dose of 20 mg per day) had positive impact on negative symptoms, decreasing the severity of emotional deficiency. The positive changes of cognitive impairment, measured with BACS, occurred regardless of changes in the severity of negative disorders, measured with PANSS. The Rorschach test showed an improvement in the conventional orientation of the patients' thinking. No exacerbation of psychotic symptoms was registered.


Assuntos
Antipsicóticos , Inibidores da Colinesterase , Transtornos Psicóticos , Adulto , Antipsicóticos/uso terapêutico , Inibidores da Colinesterase/uso terapêutico , Colinesterases , Cognição , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/tratamento farmacológico
4.
J Korean Med Sci ; 36(34): e245, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34463066

RESUMO

Since February 26, 2021, when vaccination against coronavirus disease 2019 (COVID-19) began in South Korea, patients who visited the Korea University Guro Hospital with suspected adverse events after COVID-19 vaccination were monitored actively with interest. We encountered five unusual cases of polyarthralgia and myalgia syndrome in patients who received the ChAdOx1 nCOV-19 (AstraZeneca) vaccine. The patients (median age 67 years) were not previously diagnosed with arthropathy and rheumatologic diseases. They developed fever, myalgia, joint pain, and swelling three to seven days after vaccination. The symptoms persisted for up to 47 days despite antipyretic treatment. Arthralgia occurred in multiple joints, including small and large joints. A whole-body Technetium-99m methylene diphosphonate bone scan revealed unusual uptakes in the affected joints. Non-steroidal anti-inflammatory drugs with or without prednisolone relieved the symptoms of all patients. Further monitoring is required to clarify the long-term prognosis of this syndrome.


Assuntos
Artralgia/etiologia , Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Mialgia/etiologia , Vacinação/efeitos adversos , Adulto , Idoso , Antipsicóticos/uso terapêutico , Artralgia/tratamento farmacológico , COVID-19/virologia , Feminino , Humanos , Articulações/diagnóstico por imagem , Articulações/patologia , Mialgia/tratamento farmacológico , República da Coreia , SARS-CoV-2/isolamento & purificação , Tomografia Computadorizada por Raios X
5.
Expert Opin Pharmacother ; 22(13): 1651-1660, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34404290

RESUMO

Introduction: Pimavanserin is FDA-approved to treat hallucinations and delusions associated with Parkinson's disease psychosis. As a potent 5-HT2A inverse agonist/antagonist, it could be efficacious in other psychiatric disorders. Recently, several studies have investigated this potential.Areas covered: The authors review the efficacy and adverse effects of pimavanserin for hallucinations in dementia, major depression, and schizophrenia.Expert opinion: Two controlled studies suggest pimavanserin has potential as a treatment for hallucinations in dementia. In patients with depression who did not respond to antidepressant treatment, pimavanserin augmentation was efficacious in a phase 2 study. Pimavanserin augmentation also alleviated sexual side effects of SSRI and SSNI. However, Acadia Pharmaceuticals stated in a press release that it does not plan further antidepressant trials based on its phase 3 trial, which showed a nonsignificant trend toward an antidepressant effect. Since almost all existing antipsychotics fail to substantially benefit negative symptoms, better treatments are needed. Pimavanserin augmentation of antipsychotics did benefit negative symptoms (effect size≈0.2) but failed to reduce the total PANSS score significantly in two large, well-controlled double-blind studies. Pimavanserin has a good safety profile.


Assuntos
Antipsicóticos , Transtorno Depressivo Maior , Transtornos Psicóticos , Antipsicóticos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Piperidinas/farmacologia , Piperidinas/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Ureia/análogos & derivados , Ureia/uso terapêutico
6.
Neuropsychopharmacol Hung ; 23(2): 272-280, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34342419

RESUMO

Dopamine D3 receptors belong to the dopamine D2-like receptor family, which also includes D2 and D4 receptors. These receptors have limited anatomical distribution and are mainly expressed in brain regions and pathways that typically mediate the actions of antipsychotic drugs and medication used against Parkinson's disease (PD). The development of cariprazine, the fi rst D2/D3 partial agonist with prominent affi nity and preferential activity at D3 receptors over other dopamine receptor subtypes was a landmark that provided new insights into the neurochemical and physiological functions of D3 receptors. Preclinical studies and clinical trials provided evidence for the clinical advantages of cariprazine in the treatment of schizophrenia and bipolar disorder. Cariprazine became the fi rst antipsychotic drug approved for the treatment of manic, mixed and depressive episodes in bipolar I disorder. Antagonism of D3 receptors may play a role in ameliorating symptoms of levodopa-induced dyskinesia and psychosis in PD patients treated with levodopa/carbidopa. Accordingly, D3 receptors constitute attractive targets for developing novel drugs for the improved treatment of different psychiatric and neurological disorders. (Neuropsychopharmacol Hung 2021; 23(2): 272-280).


Assuntos
Antipsicóticos , Transtorno Bipolar , Esquizofrenia , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Humanos , Receptores de Dopamina D2 , Receptores de Dopamina D3/uso terapêutico , Esquizofrenia/tratamento farmacológico
7.
Medicine (Baltimore) ; 100(32): e26912, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397928

RESUMO

ABSTRACT: It is essential to monitor pharmacological treatment for schizophrenic outpatients regularly in clinical practice. Especially in China, the situation of common prescribing patterns remains unclear. The objective of this study is to reveal real-world treatment prescription patterns of antipsychotics for schizophrenia patients in a representative large tertiary hospital in China.This study is a cross-sectional observational analysis of outpatients with schizophrenia in a large tertiary psychiatric hospital in Beijing, China, from May 11th to 24th, 2019. Data on subjects' socio-demographic and clinical characteristics, prescriptions of psychotropic drugs were collected from the electronic medical record (EMR) system with a standardized protocol. A multivariate analysis was performed to explore the potential association between antipsychotics treatments and subjects' characteristics.Of the 1940 patients included in this study, only 1470 (75.77%) patients were prescribed antipsychotic medications. 1228 (83.53%) patients were prescribed second-generation antipsychotics (SGAs), 202 (13.74%) patients were treated only with first-generation antipsychotics (FGAs), 40 (2.72%) were prescribed both SGAs and FGAs. The proportion of single SGAs prescriptions was significantly higher than that of single FGAs antipsychotics in each course of monotherapy group, especially among patients with the course less than 2 years (96.08%). Risperidone was most frequently prescribed antipsychotic medication during the study (29.86%, 439 out of 1470). Intermediate-acting sedative benzodiazepines were the most commonly co-prescribed psychotropic class at 23.66%. Long-acting injectable antipsychotics (LAIs) could be the prescribing trend in clinics. Disease course, self-paying cost and LAI antipsychotic use were independently associated with antipsychotics treatments.Second-generation antipsychotics showed domination in prescriptions. More concerns should be paid with concomitant psychiatric medications in clinics.


Assuntos
Antipsicóticos/uso terapêutico , Pacientes Ambulatoriais , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Retrospectivos , Esquizofrenia/epidemiologia , Adulto Jovem
8.
JAMA Netw Open ; 4(8): e2118441, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34338794

RESUMO

Importance: COVID-19 has had devastating effects on the health and well-being of older adult residents and health care professionals in nursing homes. Uncertainty about the associated consequences of these adverse effects on the use of medications common to this care setting remains. Objective: To examine the association between the COVID-19 pandemic and prescription medication changes among nursing home residents. Design, Setting, and Participants: This population-based cohort study with an interrupted time-series analysis used linked health administrative data bases for residents of all nursing homes (N = 630) in Ontario, Canada. During the observation period, residents were divided into consecutive weekly cohorts. The first observation week was March 5 to 11, 2017; the last observation week was September 20 to 26, 2020. Exposures: Onset of the COVID-19 pandemic on March 1, 2020. Main Outcomes and Measures: Weekly proportion of residents dispensed antipsychotics, benzodiazepines, antidepressants, anticonvulsants, opioids, antibiotics, angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors. Autoregressive integrated moving average models with step and ramp intervention functions tested for level and slope changes in weekly medication use after the onset of the pandemic and were fit on prepandemic data for projected trends. Results: Across study years, the annual cohort size ranged from 75 850 to 76 549 residents (mean [SD] age, 83.4 [10.8] years; mean proportion of women, 68.9%). A significant increased slope change in the weekly proportion of residents who were dispensed antipsychotics (parameter estimate [ß] = 0.051; standard error [SE] = 0.010; P < .001), benzodiazepines (ß = 0.026; SE = 0.003; P < .001), antidepressants (ß = 0.046; SE = 0.013; P < .001), trazodone hydrochloride (ß = 0.033; SE = 0.010; P < .001), anticonvulsants (ß = 0.014; SE = 0.006; P = .03), and opioids (ß = 0.038; SE = 0.007; P < .001) was observed. The absolute difference in observed vs estimated use in the last week of the pandemic period ranged from 0.48% (for anticonvulsants) to 1.52% (for antipsychotics). No significant level or slope changes were found for antibiotics, ARBs, or ACE inhibitors. Conclusions and Relevance: In this population-based cohort study, statistically significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids followed the onset of the COVID-19 pandemic, although absolute differences were small. There were no significant changes for antibiotics, ARBs, or ACE inhibitors. Studies are needed to monitor whether changes in pharmacotherapy persist, regress, or accelerate during the course of the pandemic and how these changes affect resident-level outcomes.


Assuntos
COVID-19 , Prescrições de Medicamentos/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antibacterianos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Ontário , SARS-CoV-2
9.
BMC Psychiatry ; 21(1): 390, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348680

RESUMO

BACKGROUND: Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners (GPs) have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support. AIM: To explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health input. DESIGN & SETTING: Realist review in general practice settings. METHOD: A realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews. RESULTS: Meaningful Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to conducting such reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, perceived risk and uncertainty regarding antipsychotic medication and illness trajectory. CONCLUSIONS: The review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.


Assuntos
Antipsicóticos , Clínicos Gerais , Transtornos Psicóticos , Esquizofrenia , Antipsicóticos/uso terapêutico , Humanos , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Confiança
10.
BMC Psychiatry ; 21(1): 404, 2021 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-34391393

RESUMO

BACKGROUND: Cannabis use is an important risk factor for development of psychosis and further transition to schizophrenia. The prevalence of patients with psychosis and comorbid cannabis use (dual diagnosis) is rising with no approved specialized pharmacological treatment option. Cannabidiol, a constituent of the Cannabis sativa plant, has potential both as an antipsychotic and as a cannabis substituting agent. The aim of this study is to evaluate the efficacy of cannabidiol versus a first-choice second-generation antipsychotic (risperidone) in patients with early psychosis and comorbid cannabis use. METHODS: The study is a phase II randomized, double-blinded, parallel-group, active-comparator clinical trial. We plan to include 130 patients aged between 18 and 64 years with a recent diagnosis of psychosis, comorbid cannabis use, and currently not treated with antipsychotics. The participants will be randomized to seven weeks of treatment with either cannabidiol 600 mg (300 mg BID) or risperidone 4 mg (2 mg BID). Participants will undergo clinical assessment after 1, 3, 5 and 7 weeks, telephone assessment the weeks in between, and a safety visit two weeks after end of treatment. The primary outcomes are cessation of cannabis use (self-reported) and psychotic symptom severity. The secondary outcomes include frequency and quantity of cannabis use, global illness severity, psychosocial functioning, subjective well-being, cognition, sleep, circadian rhythmicity, and metabolomics. DISCUSSION: The results of this trial can potentially contribute with a new treatment paradigm for patients suffering from dual diagnosis. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04105231 , registered April 23rd, 2021.


Assuntos
Antipsicóticos , Canabidiol , Cannabis , Transtornos Psicóticos , Adolescente , Adulto , Antipsicóticos/uso terapêutico , Canabidiol/uso terapêutico , Humanos , Pessoa de Meia-Idade , Transtornos Psicóticos/complicações , Transtornos Psicóticos/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Risperidona/uso terapêutico , Adulto Jovem
12.
N Engl J Med ; 385(4): 309-319, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-34289275

RESUMO

BACKGROUND: Patients with dementia due to neurodegenerative disease can have dementia-related psychosis. The effects of the oral 5-HT2A inverse agonist and antagonist pimavanserin on psychosis related to various causes of dementia are not clear. METHODS: We conducted a phase 3, double-blind, randomized, placebo-controlled discontinuation trial involving patients with psychosis related to Alzheimer's disease, Parkinson's disease dementia, dementia with Lewy bodies, frontotemporal dementia, or vascular dementia. Patients received open-label pimavanserin for 12 weeks. Those who had a reduction from baseline of at least 30% in the score on the Scale for the Assessment of Positive Symptoms-Hallucinations and Delusions (SAPS-H+D, with higher scores indicating greater psychosis) and a Clinical Global Impression-Improvement (CGI-I) score of 1 (very much improved) or 2 (much improved) at weeks 8 and 12 were randomly assigned in a 1:1 ratio to continue receiving pimavanserin or to receive placebo for up to 26 weeks. The primary end point, assessed in a time-to-event analysis, was a relapse of psychosis as defined by any of the following: an increase of at least 30% in the SAPS-H+D score and a CGI-I score of 6 (much worse) or 7 (very much worse), hospitalization for dementia-related psychosis, stopping of the trial regimen or withdrawal from the trial for lack of efficacy, or use of antipsychotic agents for dementia-related psychosis. RESULTS: Of the 392 patients in the open-label phase, 41 were withdrawn for administrative reasons because the trial was stopped for efficacy; of the remaining 351 patients, 217 (61.8%) had a sustained response, of whom 105 were assigned to receive pimavanserin and 112 to receive placebo. A relapse occurred in 12 of 95 patients (13%) in the pimavanserin group and in 28 of 99 (28%) in the placebo group (hazard ratio, 0.35; 95% confidence interval, 0.17 to 0.73; P = 0.005). During the double-blind phase, adverse events occurred in 43 of 105 patients (41.0%) in the pimavanserin group and in 41 of 112 (36.6%) in the placebo group. Headache, constipation, urinary tract infection, and asymptomatic QT prolongation occurred with pimavanserin. CONCLUSIONS: In a trial that was stopped early for efficacy, patients with dementia-related psychosis who had a response to pimavanserin had a lower risk of relapse with continuation of the drug than with discontinuation. Longer and larger trials are required to determine the effects of pimavanserin in dementia-related psychosis. (Funded by Acadia Pharmaceuticals; HARMONY ClinicalTrials.gov number, NCT03325556.).


Assuntos
Antipsicóticos/uso terapêutico , Demência/psicologia , Alucinações/tratamento farmacológico , Piperidinas/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Ureia/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Demência/tratamento farmacológico , Método Duplo-Cego , Feminino , Alucinações/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/psicologia , Modelos de Riscos Proporcionais , Transtornos Psicóticos/etiologia , Recidiva , Ureia/uso terapêutico
13.
Int J Mol Sci ; 22(14)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34299076

RESUMO

Cognitive impairment is currently considered a core feature of schizophrenia (SZ) and is gaining attention as a fundamental therapeutic target. Standard treatment for SZ involves the use of antipsychotics that are successfully used to control positive symptoms and disorganized behaviour. However, it is still unclear whether they are effective on social cognition (SC) impairment. Furthermore, different medications are currently being studied to improve SC in patients with SZ. A literature search on this topic was conducted using the PubMed database. All kinds of publications (i.e., reviews, original contributions and case reports) written in English and published in the last 15 years were included. The aim of our literature review is to draw a picture of the current state of the pharmacological treatment of SC impairment in SZ.


Assuntos
Antipsicóticos/uso terapêutico , Cognição/efeitos dos fármacos , Cognição Social , Animais , Humanos
14.
J Psychosoc Nurs Ment Health Serv ; 59(7): 7-12, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34228570

RESUMO

The positive symptoms of schizophrenia are usually treated with oral antipsychotics despite high rates of nonadherence leading to relapse and rehospitalization. Seven long-acting injectable (LAI) antipsychotics are currently approved by the U.S. Food and Drug Administration for maintenance treatment of schizophrenia. These medications reduce the risk for nonadherence and relapse, yet relatively few clinicians prescribe them. All LAI anti-psychotics are equally effective in treating the positive symptoms of schizophrenia. Dosing requirements, dosing frequencies, and what clinicians should consider in choosing a LAI antipsychotic for a specific patient are discussed. Communication strategies that help patients and families understand what they need to know about schizophrenia and its treatment to share in the decision-making process are also provided. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 7-12.].


Assuntos
Antipsicóticos , Serviços de Saúde Mental , Esquizofrenia , Antipsicóticos/uso terapêutico , Preparações de Ação Retardada/uso terapêutico , Humanos , Injeções , Esquizofrenia/tratamento farmacológico
15.
J Psychiatr Res ; 141: 206-213, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34246975

RESUMO

Brain-derived neurotrophic factor (BDNF) and the immune-inflammatory response system (IRS) have been implicated in the pathophysiology of schizophrenia. However, no research examined the associations between BDNF and immune activation both before and after treatment in antipsychotic-naïve first episode psychosis (AN-FEP). This study aims to examine serum BDNF levels and their association with IRS and the compensatory immune-regulatory reflex system (CIRS) in AN-FEP before and after risperidone treatment. We included 31 AN-FEP and 22 healthy controls. AN-FEP showed reduced levels of BDNF as compared to controls, and BDNF levels normalized after treatment with risperidone. BDNF levels were inversely correlated with a greater IRS response. Higher levels of IRS/CIRS biomarkers were associated with lower levels of BDNF including M1 macrophage, T-helper (Th)-1, Th-2, and Th-17, and T-regulatory (Treg) cell responses. Our findings indicate that AN-FEP is characterized by decreased levels of BDNF, which are normalized after treatment with risperidone. BDNF levels were inversely associated with activated immune-inflammatory pathways. The findings support the hypothesis that, increased IRS is linked to neurotoxicity, and that a decrease in BDNF may be part of the IRS/CIRS responses in FEP and, thus, be involved in the development of psychosis.


Assuntos
Antipsicóticos , Transtornos Psicóticos , Esquizofrenia , Antipsicóticos/uso terapêutico , Fator Neurotrófico Derivado do Encéfalo , Humanos , Transtornos Psicóticos/tratamento farmacológico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico
16.
J Psychiatr Res ; 141: 346-352, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34304039

RESUMO

Treatment-resistant schizophrenia (TRS) represents a main clinical issue, associated with worse functional outcome and higher healthcare costs. Clozapine is the most effective antipsychotic for TRS, although 40% of resistant patients, defined as ultra-treatment resistant (UTR), are clozapine-refractory. Previous literature suggests that TRS is characterized by worse cognitive functioning and a more disrupted neurobiological substrate, but only few studies focused on UTR schizophrenia. Moreover, despite this evidence and the central role of cognition, to date no study has investigated long-term cognitive outcome in TRS. Based on these premises, this study aims to analyze cross-sectional and long-term cognitive functioning of patients with schizophrenia, stratified according to antipsychotic response: first-line responders (FLRs), clozapine responders (CRs) and UTRs. We analyzed cross-sectional and retrospective cognitive evaluations of 93 patients with schizophrenia (32 FLRs, 42 CRs, 19 UTRs) over a mean follow-up period of 9 years, also taking into account possible influencing factors such as clinical severity and antipsychotic load. Analyses showed that UTR is associated with overall impaired cognitive functioning and represents the main predictor of long-term cognitive decline. We observed no significant differences between FLR and CR patients, which showed moderate cognitive improvement over time. This is the first study to report an association of treatment resistance with longitudinal cognitive course in schizophrenia, indicating that UTR is correlated with cognitive decline over time. This decline may either be a consequence of the persistence of psychotic symptoms or depend on a distinct and more disrupted neurobiological substrate affecting both cognition and antipsychotic response.


Assuntos
Antipsicóticos , Clozapina , Esquizofrenia , Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Cognição , Estudos Transversais , Humanos , Estudos Retrospectivos , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológico
17.
Med J Aust ; 215(3): 130-136, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34198357

RESUMO

OBJECTIVE: To examine relationships between changing general practitioner after entering residential aged care and overall medicines prescribing (including polypharmacy) and that of psychotropic medicines in particular. DESIGN: Retrospective data linkage study. SETTING, PARTICIPANTS: 45 and Up Study participants in New South Wales with dementia who were PBS concession card holders and entered permanent residential aged care during January 2010 - June 2014 and were alive six months after entry. MAIN OUTCOME MEASURES: Inverse probability of treatment-weighted numbers of medicines dispensed to residents and proportions of residents dispensed antipsychotics, benzodiazepines, and antidepressants in the six months after residential care entry, by most frequent residential care GP category: usual (same as during two years preceding entry), known (another GP, but known to the resident), or new GP. RESULTS: Of 2250 new residents with dementia (mean age, 84.1 years; SD, 7.0 years; 1236 women [55%]), 625 most frequently saw their usual GPs (28%), 645 saw known GPs (29%), and 980 saw new GPs (44%). The increase in mean number of dispensed medicines after residential care entry was larger for residents with new GPs (+1.6 medicines; 95% CI, 1.4-1.9 medicines) than for those attended by their usual GPs (+0.7 medicines; 95% CI, 0.4-1.1 medicines; adjusted rate ratio, 2.42; 95% CI, 1.59-3.70). The odds of being dispensed antipsychotics (adjusted odds ratio [aOR], 1.59; 95% CI, 1.18-2.12) or benzodiazepines (aOR, 1.69; 95% CI, 1.25-2.30), but not antidepressants (aOR, 1.32; 95% CI, 0.98-1.77), were also higher for the new GP group. Differences between the known and usual GP groups were not statistically significant. CONCLUSIONS: Increases in medicine use and rates of psychotropic dispensing were higher for people with dementia who changed GP when they entered residential care. Facilitating continuity of GP care for new residents and more structured transfer of GP care may prevent potentially inappropriate initiation of psychotropic medicines.


Assuntos
Demência/tratamento farmacológico , Clínicos Gerais/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Polimedicação , Psicotrópicos/provisão & distribuição , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/provisão & distribuição , Antidepressivos/uso terapêutico , Antipsicóticos/provisão & distribuição , Antipsicóticos/uso terapêutico , Benzodiazepinas/provisão & distribuição , Benzodiazepinas/uso terapêutico , Feminino , Humanos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Masculino , New South Wales/epidemiologia , Psicotrópicos/uso terapêutico , Estudos Retrospectivos
19.
BMC Psychiatry ; 21(1): 348, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253169

RESUMO

BACKGROUND: Severity of symptoms in patients with schizophrenia is a determinant of patient's well-being, but evidence in low- and middle-income countries is limited. We aimed to measure the symptom severity using objective measurements, the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression-Severity scale (CGI-S), and their associations with well-being in patients with schizophrenia. METHODS: Patients with schizophrenia aged ≥18 years, without active psychosis including no history of hospitalization within the last 6 months, were included. Symptom severity was measured by the clinicians using BPRS and CGI-S. The patients' well-being was assessed by self-report using the Subjective Well-being under Neuroleptic treatment scale (SWN) as continuous and binary outcomes (categorized into adequate or poor well-being). Correlations between symptom severity (BPRS and CGI-S scores) and well-being (SWN score) were analyzed using Pearson's correlation. Association between well-being status and BPRS was analyzed using multivariate logistic regression. RESULTS: Of 150 patients, BPRS and CGI-S were inversely correlated with SWN score (r = - 0.47; p < 0.001 and - 0.21; p < 0.01, respectively). BPRS Affect domain had the highest correlation with SWN (r = - 0.51, p < 0.001). In multivariate logistic regression, BPRS score and being unemployed were associated with poor well-being status (adjusted OR 1.08; 95%CI 1.02-1.14; p = 0.006, and 4.01; 95%CI 1.38-11.7; p = 0.011, respectively). CONCLUSION: Inverse relationships between symptom severity and well-being score were found. Higher BPRS Affect domain was significantly associated with lower patients' well-being. The use of BPRS tool into routine clinical practice could serve as an adjunct to physician's clinical evaluation of patients' symptoms and may help improve patient's well-being. Further research on negative symptoms associated with well-being is required.


Assuntos
Antipsicóticos , Esquizofrenia , Adolescente , Adulto , Antipsicóticos/uso terapêutico , Estudos Transversais , Humanos , Escalas de Graduação Psiquiátrica , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Tailândia
20.
BMC Psychiatry ; 21(1): 375, 2021 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-34315410

RESUMO

BACKGROUND: The off-label use of antipsychotic medications is common in many countries, and the extent of such use in psychiatric inpatients in China has not been sufficiently studied. The purpose of this study was to survey the incidence and examine the correlates of off-label antipsychotic use in a large, nationally-representative sample in China. METHODS: This study included discharged psychiatric patients between March 19 and 31, 2019 from 41 tertiary psychiatric hospitals across 29 provinces in China. Their socio-demographic and clinical data were collected and analyzed. RESULTS: After excluding patients with schizophrenia spectrum disorder or bipolar disorder, 981 patients were included in the analysis. Overall, antipsychotics were prescribed to 63.2% (95%CI 60.2-66.2%) of the sample. Antipsychotics were used in a wide spectrum of psychiatric disorders, with the rate being the highest among patients with dissociative (conversion) disorders (89.9, 95%CI 83.0-94.8%), organic mental disorders (81.7, 95%CI 73.1-88.7%), dementia (79.0,95%CI 67.8-87.9%), obsessive-compulsive disorder (77.8, 95%CI 55.7-92.5%), mental disorders due to psychoactive substances (75.3,95%CI 64.7-84.2%), behavioural and emotional disorders with onset usually occurring in childhood and adolescence (71.4, 95%CI 45.5-90.1%), somatoform disorders (63.2, 95%CI 40.8%-82..2%), major depression disorder (53.7,95%CI 48.8-58.6%), anxiety disorder (38.8,95%CI 30.5-47.7%), and insomnia (25.0, 95%CI 8.5-28.9%). The top three most commonly used antipsychotics were olanzapine (29.1%), quetiapine (20.3%) and risperidone (6.8%), and their corresponding average doses were 9.04 ± 5.80 mg/day, 185.13 ± 174.72 mg/day, and 2.98 ± 1.71 mg/day, respectively. A binary logistic regression showed that younger age, having the Employee Health Insurance or Residents Health Insurance, having psychotic symptoms and requiring restraint during hospitalization were significantly associated with off-label use of antipsychotics. CONCLUSION: Off-label use of antipsychotics is very common in psychiatric inpatients in China, mainly with moderate-dose use of single agents. However, the efficacy and safety of this practice is uncertain for many diagnoses and for the elderly. Clinicians should be cautious about this practice while waiting for more research data.


Assuntos
Antipsicóticos , Adolescente , Idoso , Antipsicóticos/uso terapêutico , China/epidemiologia , Humanos , Pacientes Internados , Uso Off-Label , Risperidona
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