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1.
J Clin Psychopharmacol ; 39(4): 312-317, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205192

RESUMO

PURPOSE/BACKGROUND: Quetiapine is a relatively new atypical antipsychotic with fewer adverse effects. It is increasingly prescribed to patients. The purpose of this study was to describe the cases of poisoning observed at the western France Poison Control Centre and identify potential risk factors that increase the severity of the cases. METHODS: This was a retrospective study of self-poisoning with quetiapine as reported by the western France Poison Control Centre between 2007 and 2017. RESULTS: There were 372 cases of quetiapine poisoning. Circumstances are known in 367 of 372 cases. There were 75 cases of null severity (grade 0), 133 cases of mild severity (grade 1), 85 cases of moderate severity (grade 2), and 79 cases of high severity (grade 3). Five deaths were listed in this series. The most commonly observed symptoms were neurological and cardiovascular in nature (drowsiness, coma, tachycardia, hypotension). Of these cases, 79.8% included voluntary ingestions. Among 302 cases with coagents, the most common coagents were benzodiazepines (56%), other psychotropic drugs (41%), and antidepressants (37%). An evaluated ingested dose 1500 mg or greater and 2 or more coagents increase the risk of severe poisoning. In particular, concomitant ingestion of benzodiazepines and antidepressants with quetiapine was associated with high severity (odds ratio, 2.478 [confidence interval, 1.3-4.723]; odds ratio, 1.820 [confidence interval, 1.010-3.316]). CONCLUSIONS: Quetiapine may lead to severe poisoning for which there is currently no specific treatment. Patients and practitioners should be aware of this when quetiapine is prescribed, particularly when used in combination with other medications, and in order to deal with cases of poisoning.


Assuntos
Antipsicóticos/envenenamento , Dibenzotiazepinas/envenenamento , Fumarato de Quetiapina/envenenamento , Adulto , Antipsicóticos/uso terapêutico , Coma/induzido quimicamente , Dibenzotiazepinas/uso terapêutico , Overdose de Drogas/mortalidade , Feminino , França , Humanos , Hipotensão/induzido quimicamente , Masculino , Centros de Controle de Intoxicações , Fumarato de Quetiapina/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Taquicardia/induzido quimicamente
2.
Psychopharmacology (Berl) ; 235(1): 245-255, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29075885

RESUMO

INTRODUCTION: The use of second-generation antipsychotics (SGA) has been associated with metabolic changes. However, there are differences in the metabolic profile between SGAs. We have previously observed that ziprasidone had a more benign early metabolic profile compared to aripiprazole and quetiapine. However, a long-term follow-up is preferred to detect clinically relevant impairment in metabolic parameters. We aimed to compare the effect of aripiprazole, ziprasidone, and quetiapine on metabolic measures in first-episode non-affective psychosis patients after 1 year of treatment. MATERIAL AND METHODS: One hundred and sixty-five drug-naïve patients, suffering from a first episode of non-affective psychosis, were randomly assigned to receive quetiapine, ziprasidone, or aripiprazole. Weight and glycemic/lipid parameters were recorded at baseline and after 1 year of treatment. RESULTS: After 1 year of antipsychotic treatment, we found significant increments in weight, BMI, total cholesterol, LDL-cholesterol, triglycerides, and the triglyceride/HDL index in the sample as a whole. These changes produced a significant rise in the percentage of patients with obesity, hypercholesterolemia, and hypertriglyceridemia. However, when comparing the differential effect of each antipsychotic medication, we found no significant differences in any of the metabolic parameters between antipsychotics groups after 1 year of treatment. CONCLUSION: We concluded that the antipsychotics studied present similar metabolic profiles. However, the primary exposure to SGAs during the first year of psychosis was associated with significant increases in weight and metabolic parameters, leading to increments in obesity, hypertriglyceridemia, and hypercholesterolemia.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Piperazinas/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Fumarato de Quetiapina/uso terapêutico , Tiazóis/uso terapêutico , Adulto , Antipsicóticos/efeitos adversos , Antipsicóticos/farmacologia , Aripiprazol/efeitos adversos , Aripiprazol/farmacologia , Glicemia/efeitos dos fármacos , Índice de Massa Corporal , Peso Corporal/efeitos dos fármacos , Colesterol/metabolismo , Dibenzotiazepinas/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Piperazinas/efeitos adversos , Piperazinas/farmacologia , Transtornos Psicóticos/metabolismo , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/farmacologia , Quinolonas/uso terapêutico , Tiazóis/efeitos adversos , Tiazóis/farmacologia , Triglicerídeos/metabolismo , Adulto Jovem
3.
Cochrane Database Syst Rev ; 8: CD008559, 2017 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-28791693

RESUMO

BACKGROUND: This is an update of the original Cochrane Review, last published in 2012 (Loy 2012). Children and youths with disruptive behaviour disorders may present to health services, where they may be treated with atypical antipsychotics. There is increasing usage of atypical antipsychotics in the treatment of disruptive behaviour disorders. OBJECTIVES: To evaluate the effect and safety of atypical antipsychotics, compared to placebo, for treating disruptive behaviour disorders in children and youths. The aim was to evaluate each drug separately rather than the class effect, on the grounds that each atypical antipsychotic has different pharmacologic binding profile (Stahl 2013) and that this is clinically more useful. SEARCH METHODS: In January 2017, we searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers. SELECTION CRITERIA: Randomised controlled trials of atypical antipsychotics versus placebo in children and youths aged up to and including 18 years, with a diagnosis of disruptive behaviour disorders, including comorbid ADHD. The primary outcomes were aggression, conduct problems and adverse events (i.e. weight gain/changes and metabolic parameters). The secondary outcomes were general functioning, noncompliance, other adverse events, social functioning, family functioning, parent satisfaction and school functioning. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors (JL and KS) independently collected, evaluated and extracted data. We used the GRADE approach to assess the quality of the evidence. We performed meta-analyses for each of our primary outcomes, except for metabolic parameters, due to inadequate outcome data. MAIN RESULTS: We included 10 trials (spanning 2000 to 2014), involving a total of 896 children and youths aged five to 18 years. Bar two trials, all came from an outpatient setting. Eight trials assessed risperidone, one assessed quetiapine and one assessed ziprasidone. Nine trials assessed acute efficacy (over four to 10 weeks); one of which combined treatment with stimulant medication and parent training. One trial was a six-month maintenance trial assessing symptom recurrence.The quality of the evidence ranged from low to moderate. Nine studies had some degree of pharmaceutical support/funding. Primary outcomesUsing the mean difference (MD), we combined data from three studies (238 participants) in a meta-analysis of aggression, as assessed using the Aberrant Behaviour Checklist (ABC) ‒ Irritability subscale. We found that youths treated with risperidone show reduced aggression compared to youths treated with placebo (MD -6.49, 95% confidence interval (CI) -8.79 to -4.19; low-quality evidence). Using the standardised mean difference (SMD), we pooled data from two risperidone trials (190 participants), which used different scales: the Overt Aggression Scale ‒ Modified (OAS-M) Scale and the Antisocial Behaviour Scale (ABS); as the ABS had two subscales that could not be combined (reactive and proactive aggression), we performed two separate analyses. When we combined the ABS Reactive subscale and the OAS-M, the SMD was -1.30 in favour of risperidone (95% CI -2.21 to -0.40, moderate-quality evidence). When we combined the ABS Proactive subscale and OAS-M, the SMD was -1.12 (95% CI -2.30 to 0.06, moderate-quality evidence), suggesting uncertainty about the estimate of effect, as the confidence intervals overlapped the null value. In summary, there was some evidence that aggression could be reduced by risperidone. Data were lacking on other atypical antipsychotics, like quetiapine and ziprasidone, with regard to their effects on aggression.We pooled data from two risperidone trials (225 participants) in a meta-analysis of conduct problems, as assessed using the Nisonger Child Behaviour Rating Form ‒ Conduct Problem subscale (NCBRF-CP). This yielded a final mean score that was 8.61 points lower in the risperidone group compared to the placebo group (95% CI -11.49 to -5.74; moderate-quality evidence).We investigated the effect on weight by performing two meta-analyses. We wanted to distinguish between the effects of antipsychotic medication only and the combined effect with stimulants, since the latter can have a counteracting effect on weight gain due to appetite suppression. Pooling two trials with risperidone only (138 participants), we found that participants on risperidone gained 2.37 kilograms (kg) more (95% CI 0.26 to 4.49; moderate-quality evidence) than those on placebo. When we added a trial where all participants received a combination of risperidone and stimulants, we found that those on the combined treatment gained 2.14 kg more (95% CI 1.04 to 3.23; 3 studies; 305 participants; low-quality evidence) than those on placebo. Secondary outcomesOut of the 10 included trials, three examined general functioning, social functioning and parent satisfaction. No trials examined family or school functioning. Data on non-compliance/attrition rate and other adverse events were available from all 10 trials. AUTHORS' CONCLUSIONS: There is some evidence that in the short term risperidone may reduce aggression and conduct problems in children and youths with disruptive behaviour disorders There is also evidence that this intervention is associated with significant weight gain.For aggression, the difference in scores of 6.49 points on the ABC ‒ Irritability subscale (range 0 to 45) may be clinically significant. It is challenging to interpret the clinical significance of the differential findings on two different ABS subscales as it may be difficult to distinguish between reactive and proactive aggression in clinical practice. For conduct problems, the difference in scores of 8.61 points on the NCBRF-CP (range 0 to 48) is likely to be clinically significant. Weight gain remains a concern.Caution is required in interpreting the results due to the limitations of current evidence and the small number of high-quality trials. There is a lack of evidence to support the use of quetiapine, ziprasidone or any other atypical antipsychotic for disruptive behaviour disorders in children and youths and no evidence for children under five years of age. It is uncertain to what degree the efficacy found in clinical trials will translate into real-life clinical practice. Given the effectiveness of parent-training interventions in the management of these disorders, and the somewhat equivocal evidence on the efficacy of medication, it is important not to use medication alone. This is consistent with current clinical guidelines.


Assuntos
Agressão/efeitos dos fármacos , Antipsicóticos/uso terapêutico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/tratamento farmacológico , Dibenzotiazepinas/uso terapêutico , Piperazinas/uso terapêutico , Fumarato de Quetiapina/uso terapêutico , Risperidona/uso terapêutico , Tiazóis/uso terapêutico , Adolescente , Antipsicóticos/efeitos adversos , Transtornos de Ansiedade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Criança , Pré-Escolar , Transtorno da Conduta/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Dibenzotiazepinas/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Risperidona/efeitos adversos , Ganho de Peso
4.
Cochrane Database Syst Rev ; 4: CD011810, 2017 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-28387925

RESUMO

BACKGROUND: Schizophrenia is a chronic, disabling and severe mental disorder, characterised by disturbance in perception, thought, language, affect and motor behaviour. Chlorpromazine and clotiapine are among antipsychotic drugs used for the treatment of people with schizophrenia. OBJECTIVES: To determine the clinical effects, safety and cost-effectiveness of chlorpromazine compared with clotiapine for adults with schizophrenia. SEARCH METHODS: We searched Cochrane Schizophrenia's Trials Register (last update search 16/01/2016), which is based on regular searches of CINAHL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the Register. SELECTION CRITERIA: All randomised clinical trials focusing on chlorpromazine versus clotiapine for schizophrenia. We included trials meeting our selection criteria and reporting useable data. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE. MAIN RESULTS: We have included four studies, published between 1974 and 2003, randomising 276 people with schizophrenia to receive either chlorpromazine or clotiapine. The studies were poor at concealing allocation of treatment and blinding of outcome assessment. Our main outcomes of interest were clinically important change in global and mental state, specific change in negative symptoms, incidence of movement disorder (dyskinesia), leaving the study early for any reason, and costs. All reported data were short-term (under six months' follow-up).The trials did not report data for the important outcomes of clinically important change in global or mental state, or cost of care. Improvement in mental state was reported using the Positive and Negative Syndrome Scale (PANSS). When chlorpromazine was compared with clotiapine the average improvement scores for mental state using the PANSS total was higher in the clotiapine group (1 RCT, N = 31, MD 11.50 95% CI 9.42 to 13.58, very low-quality evidence). The average change scores on the PANSS negative sub-scale were similar between treatment groups (1 RCT, N = 21, MD -0.97 95% CI -2.76 to 0.82, very low-quality evidence). There was no clear difference in incidence of dyskinesia (1 RCT, N = 68, RR 3.00 95% CI 0.13 to 71.15, very low-quality evidence). Similar numbers of participants left the study early from each treatment group (3 RCTs, N = 158, RR 0.68 95% CI 0.24 to 1.88, very low-quality evidence). AUTHORS' CONCLUSIONS: Clinically important changes in global and mental state were not reported. Only one trial reported the average change in overall mental state; results favour clotiapine but these limited data are very difficult to trust due to methodological limitations of the study. The comparative effectiveness of chlorpromazine compared to clotiapine on change in global state remains unanswered. Results in this review suggest chlorpromazine and clotiapine cause similar adverse effects, although again, the quality of evidence for this is poor, making firm conclusions difficult.


Assuntos
Antipsicóticos/uso terapêutico , Clorpromazina/uso terapêutico , Dibenzotiazepinas/uso terapêutico , Esquizofrenia/tratamento farmacológico , Antipsicóticos/efeitos adversos , Clorpromazina/efeitos adversos , Dibenzotiazepinas/efeitos adversos , Discinesia Induzida por Medicamentos/epidemiologia , Humanos , Análise de Intenção de Tratamento , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco
6.
Cochrane Database Syst Rev ; 3: CD006324, 2017 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-28333365

RESUMO

BACKGROUND: Between 40% and 70% of people with treatment-resistant schizophrenia do not respond to clozapine, despite adequate blood levels. For these people, a number of treatment strategies have emerged, including the prescription of a second anti-psychotic drug in combination with clozapine. OBJECTIVES: To determine the clinical effects of various clozapine combination strategies with antipsychotic drugs in people with treatment-resistant schizophrenia both in terms of efficacy and tolerability. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (to 28 August 2015) and MEDLINE (November 2008). We checked the reference lists of all identified randomised controlled trials (RCT). For the first version of the review, we also contacted pharmaceutical companies to identify further trials. SELECTION CRITERIA: We included only RCTs recruiting people of both sexes, aged 18 years or more, with a diagnosis of treatment-resistant schizophrenia (or related disorders) and comparing clozapine plus another antipsychotic drug with clozapine plus a different antipsychotic drug. DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CI) on an intention-to-treat basis using a random-effects meta-analysis. For continuous data, we calculated mean differences (MD) and 95% CIs. We used GRADE to create 'Summary of findings' tables and assessed risk of bias for included studies. MAIN RESULTS: We identified two further studies with 169 participants that met our inclusion criteria. This review now includes five studies with 309 participants. The quality of evidence was low, and, due to the high degree of heterogeneity between studies, we were unable to undertake a formal meta-analysis to increase the statistical power.For this update, we specified seven main outcomes of interest: clinical response in mental state (clinically significant response, mean score/change in mental state), clinical response in global state (mean score/change in global state), weight gain, leaving the study early (acceptability of treatment), service utilisation outcomes (hospital days or admissions to hospital) and quality of life.We found some significant differences between clozapine combination strategies for global and mental state (clinically significant response and change), and there were data for leaving the study early and weight gain. We found no data for service utilisation and quality of life. Clozapine plus aripiprazole versus clozapine plus haloperidolThere was no long-term significant difference between aripiprazole and haloperidol combination strategies in change of mental state (1 RCT, n = 105, MD 0.90, 95% CI -4.38 to 6.18, low quality evidence). There were no adverse effect data for weight gain but there was a benefit of aripiprazole for adverse effects measured by the LUNSERS at 12 weeks (1 RCT, n = 105, MD -4.90, 95% CI -8.48 to -1.32) and 24 weeks (1 RCT, n = 105, MD -4.90, 95% CI -8.25 to -1.55), but not 52 weeks (1 RCT, n = 105, MD -4.80, 95% CI -9.79 to 0.19). Similar numbers of participants from each group left the study early (1 RCT, n = 106, RR 1.27, 95% CI 0.72 to 2.22, very low quality evidence). Clozapine plus amisulpride versus clozapine plus quetiapine One study showed a significant benefit of amisulpride over quetiapine in the short term, for both change in global state (Clinical Global Impression (CGI): 1 RCT, n = 50, MD -0.90, 95% CI -1.38 to -0.42, very low quality evidence) and mental state (Brief Psychiatric Rating Scale (BPRS): 1 RCT, n = 50, MD -4.00, 95% CI -5.86 to -2.14, low quality evidence). Similar numbers of participants from each group left the study early (1 RCT, n = 56, RR 0.20, 95% CI 0.02 to 1.60, very low quality evidence) Clozapine plus risperidone versus clozapine plus sulpirideThere was no difference between risperidone and sulpiride for clinically significant response, defined by the study as 20% to 50% reduction in Positive and Negative Syndrome Scale (PANSS) (1 RCT, n = 60, RR 0.82, 95% CI 0.40 to 1.68, very low quality evidence). There were similar equivocal results for weight gain (1 RCT, n = 60, RR 0.40, 95% CI 0.08 to 1.90, very low quality evidence) and mental state (PANSS total: 1 RCT, n = 60, MD -2.28, 95% CI -7.41 to 2.85, very low quality evidence). No-one left the study early. Clozapine plus risperidone versus clozapine plus ziprasidoneThere was no difference between risperidone and ziprasidone for clinically significant response (1 RCT, n = 24, RR 0.80, 95% CI 0.28 to 2.27, very low quality evidence), change in global state CGI-II score (1 RCT, n = 22, MD -0.30, 95% CI -0.82 to 0.22, very low quality evidence), change in PANSS total score (1 RCT, n = 16, MD 1.00, 95% CI -7.91 to 9.91, very low quality evidence) or leaving the study early (1 RCT, n = 24, RR 1.60, 95% CI 0.73 to 3.49, very low quality evidence). Clozapine plus ziprasidone versus clozapine plus quetiapineOne study found, in the medium term, a superior effect for ziprasidone combination compared with quetiapine combination for clinically significant response in mental state (> 50% reduction PANSS: 1 RCT, n = 63, RR 0.54, 95% CI 0.35 to 0.81, low quality evidence), global state (CGI - Severity score: 1 RCT, n = 60, MD -0.70, 95% CI -1.18 to -0.22, low quality evidence) and mental state (PANSS total score: 1 RCT, n = 60, MD -12.30, 95% CI -22.43 to -2.17, low quality evidence). There was no effect for leaving the study early (1 RCT, n = 63, RR 0.52, CI 0.05 to 5.41, very low quality evidence). AUTHORS' CONCLUSIONS: The reliability of results from this review is limited, evidence is of low or very low quality. Furthermore, due to the limited number of included studies, we were unable to undertake formal meta-analyses. As a consequence, any conclusions drawn from these findings are based on single, small-sized RCTs with high risk of type II error. Properly conducted and adequately powered RCTs are required. Future trialists should seek to measure patient-important outcomes such as quality of life, as well as clinical response and adverse effects.


Assuntos
Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adulto , Amissulprida , Antipsicóticos/efeitos adversos , Aripiprazol/efeitos adversos , Aripiprazol/uso terapêutico , Clozapina/efeitos adversos , Dibenzotiazepinas/uso terapêutico , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Haloperidol/efeitos adversos , Haloperidol/uso terapêutico , Humanos , Masculino , Piperazinas/uso terapêutico , Fumarato de Quetiapina , Ensaios Clínicos Controlados Aleatórios como Assunto , Risperidona/uso terapêutico , Sulpirida/efeitos adversos , Sulpirida/análogos & derivados , Sulpirida/uso terapêutico , Tiazóis/uso terapêutico , Ganho de Peso
7.
Cochrane Database Syst Rev ; 3: CD011655, 2017 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-28349512

RESUMO

BACKGROUND: Chlorpromazine, a widely available and inexpensive antipsychotic drug, is considered the benchmark treatment for schizophrenia worldwide. Metiapine, a dibenzothiazepine derivative, has been reported to have potent antipsychotic characteristics. However, no evidence currently exists on the effectiveness of chlorpromazine in treatment of people with schizophrenia compared to metiapine, a newer antipsychotic. OBJECTIVES: To compare the effect of chlorpromazine versus metiapine for the treatment of people with schizophrenia SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials in November 2015 and 2016. SELECTION CRITERIA: All randomised controlled trials (RCTs) focusing on chlorpromazine versus metiapine for adults with schizophrenia. We included trials meeting our selection criteria and reporting useable data. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference between groups and its 95% CI. We employed a random-effects model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS: We included three studies randomising 161 people with schizophrenia. Data were available for only two of our seven prestated main outcomes. Clinically important improvement in global state was measured using the Clinical Global Impression (CGI). There was no clear difference between chlorpromazine and metiapine groups (2 RCTs, n = 120, RR 1.11, 95% CI 0.84 to 1.47, very low quality evidence) and numbers of participants with parkinsonism at eight weeks were similar (2 RCTs, n = 70, RR 0.97, 95% CI 0.46 to 2.03, very low quality evidence). There were no useable data available for the other key outcomes of clinically important improvement in mental state, readmission due to relapse, satisfaction with treatment, aggressive or violent behaviour, or cost of care. AUTHORS' CONCLUSIONS: Chlorpromazine has been the mainstay treatment for schizophrenia for decades, yet available evidence comparing this drug to metiapine fails to provide high-quality trial based data. However, the need to determine whether metiapine is more or less effective than chlorpromazine seems to be lacking in clinical relevance and future research on this comparison seems unlikely.


Assuntos
Antipsicóticos/uso terapêutico , Clorpromazina/uso terapêutico , Dibenzotiazepinas/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/efeitos adversos , Clorpromazina/efeitos adversos , Dibenzotiazepinas/efeitos adversos , Humanos , Doença de Parkinson Secundária/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Tijdschr Psychiatr ; 59(3): 175-180, 2017.
Artigo em Holandês | MEDLINE | ID: mdl-28350145

RESUMO

BACKGROUND: In Flemish emergency psychiatry, clotiapine is still one of the options available for the treatment of agitation. However, there is a lack of evidence concerning the efficacy of this practice.
AIM: To find out whether there is sufficient evidence to justify the continued use of clotiapine in the treatment of agitation.
METHOD: On searching the literature systematically, we identified controlled trials of clotiapine.
RESULTS: The efficacy and safety of clotiapine were studied in two randomised controlled trials. Clotiapine (administered intramuscularly) was compared with zuclopenthixol acetate and lorazepam. Clotiapine was found to be just as efficient as the control treatments, causing fewer anticholinergic side-effects than zuclopenthixol but more extrapyramidal side-effects than lorazepam. The study population comprised only 102 patients, 51 of whom were treated with clotiapine. Because the quality of the reported data was low, straightforward conclusions were difficult to draw.
CONCLUSION: Scientific evidence to support the use of clotiapine in the treatment of agitation ranges from meagre to practically non-existent. Since alternative treatment options are available, the contained use of clotiapine should be questioned.


Assuntos
Antipsicóticos/uso terapêutico , Dibenzotiazepinas/uso terapêutico , Agitação Psicomotora/tratamento farmacológico , Medicina Baseada em Evidências , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
9.
J Geriatr Psychiatry Neurol ; 29(4): 227-36, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27056066

RESUMO

We performed a systematic review of randomized controlled trials to assess the high-level evidence regarding the role of quetiapine in the treatment of psychosis in patients with neurodegenerative parkinsonian disorders. Studies were included in the qualitative review if they (1) enrolled participants with diagnosis of Parkinson disease, Lewy body dementia, or any other neurodegenerative parkinsonian disorders; (2) assessed the efficacy of quetiapine; and (3) evaluated psychotic and motor outcomes using validated tools. Of the 341 manuscripts identified, 7 studies fulfilled our inclusion criteria. The studies' risk of bias was considered low. A total of 241 participants enrolled in these trials. Heterogeneity was high due to inclusion criteria, user definitions, assessment tools, and study design. Although not causing any motor deterioration, quetiapine failed to significantly reduce psychotic symptoms compared to placebo when objectively assessed on the Brief Psychotic Rating Scale, the most frequently reported scale in these studies. High loss to follow-up and dropout rates as well as significant improvement in psychotic symptoms in the placebo groups may have affected measurements of possible positive medication effects.


Assuntos
Antipsicóticos/uso terapêutico , Doença por Corpos de Lewy/complicações , Doença de Parkinson/complicações , Transtornos Psicóticos/tratamento farmacológico , Fumarato de Quetiapina/uso terapêutico , Idoso , Dibenzotiazepinas/uso terapêutico , Feminino , Humanos , Doença por Corpos de Lewy/psicologia , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/psicologia , Transtornos Psicóticos/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Eur Psychiatry ; 31: 20-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26655594

RESUMO

BACKGROUND: Cognitive deficits have been reported during the early stages of bipolar disorder; however, the role of medication on such deficits remains unclear. The aim of this study was to compare the effects of lithium and quetiapine monotherapy on cognitive performance in people following first episode mania. METHODS: The design was a single-blind, randomised controlled trial on a cohort of 61 participants following first episode mania. Participants received either lithium or quetiapine monotherapy as maintenance treatment over a 12-month follow-up period. The groups were compared on performance outcomes using an extensive cognitive assessment battery conducted at baseline, month 3 and month 12 follow-up time-points. RESULTS: There was a significant interaction between group and time in phonemic fluency at the 3-month and 12-month endpoints, reflecting greater improvements in performance in lithium-treated participants relative to quetiapine-treated participants. After controlling for multiple comparisons, there were no other significant interactions between group and time for other measures of cognition. CONCLUSION: Although the effects of lithium and quetiapine treatment were similar for most cognitive domains, the findings imply that early initiation of lithium treatment may benefit the trajectory of cognition, specifically verbal fluency in young people with bipolar disorder. Given that cognition is a major symptomatic domain of bipolar disorder and has substantive effects on general functioning, the ability to influence the trajectory of cognitive change is of considerable clinical importance.


Assuntos
Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Cognição/efeitos dos fármacos , Compostos de Lítio/uso terapêutico , Fumarato de Quetiapina/uso terapêutico , Adolescente , Adulto , Dibenzotiazepinas/uso terapêutico , Feminino , Seguimentos , Humanos , Inteligência , Masculino , Memória , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Aprendizagem Verbal , Adulto Jovem
12.
J Nerv Ment Dis ; 203(7): 486-92, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26075840

RESUMO

No large-scale randomized trial has compared the effect of different second-generation antipsychotic drugs and any first-generation drug on alcohol, drug and nicotine use in patients with schizophrenia. The Clinical Antipsychotic Trial of Intervention Effectiveness study randomly assigned 1432 patients formally diagnosed with schizophrenia to four second-generation antipsychotic drugs (olanzapine, risperidone quetiapine, and ziprasidone) and one first-generation antipsychotic (perphenazine) and followed them for up to 18 months. Secondary outcome data documented cigarettes smoked in the past week and alcohol and drug use severity ratings. At baseline, 61% of patients smoked, 35% used alcohol, and 23% used illicit drugs. Although there were significant effects of time showing reduction in substance use over the 18 months (all p < 0.0001), this study found no evidence that any antipsychotic was robustly superior to any other in a secondary analysis of data on substance use outcomes from a large 18-month randomized schizophrenia trial.


Assuntos
Alcoolismo/epidemiologia , Alcoolismo/reabilitação , Antipsicóticos/uso terapêutico , Drogas Ilícitas , Esquizofrenia/epidemiologia , Esquizofrenia/reabilitação , Prevenção do Hábito de Fumar , Fumar/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Adulto , Idoso , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Benzodiazepinas/uso terapêutico , Doença Crônica , Comorbidade , Estudos Transversais , Dibenzotiazepinas/efeitos adversos , Dibenzotiazepinas/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Olanzapina , Perfenazina/efeitos adversos , Perfenazina/uso terapêutico , Piperazinas/efeitos adversos , Piperazinas/uso terapêutico , Escalas de Graduação Psiquiátrica , Fumarato de Quetiapina , Risperidona/efeitos adversos , Risperidona/uso terapêutico , Psicologia do Esquizofrênico , Tiazóis/efeitos adversos , Tiazóis/uso terapêutico , Adulto Jovem
13.
Artigo em Russo | MEDLINE | ID: mdl-26120982

RESUMO

OBJECTIVE: To study correlations between parameters of lipid metabolism and ECG in patients with schizophrenia in light of therapy with atypical antipsychotics. MATERIAL AND METHODS: We examined 42 patients with paranoid schizophrenia. All patients received atypical neuroleptics - seroquel, zyprexa, and rispolept. A group of controls included 25 healthy people. RESULTS: There was a significant increase (p=0.0002) in body mass (in average by 1.5 kg) in 88% patients. A significant increase in the concentration of serum triglycerides was identified as well. The concentration of VLDL in the patients with schizophrenia was 2 times higher compared to controls. After treatment, VLDL concentration increased even more considerably An increase in atherogenic index (AI) was up to 3.1 in patients with schizophrenia compared to 2.2 in controls. After treatment, Al increased up to 4 that demonstrated the high risk of development of atherosclerosis. A significant increase in QT interval in the ECG and heart rate (p=0.03) was revealed only in patients receiving rispolept. In patients receiving zyprexa and seroquel only heart rate was increased. CONCLUSION: The antipsychotics studied increase the risk of development of cardiovascular pathology.


Assuntos
Antipsicóticos/efeitos adversos , Aterosclerose/induzido quimicamente , Benzodiazepinas/efeitos adversos , Dibenzotiazepinas/efeitos adversos , Metabolismo dos Lipídeos/efeitos dos fármacos , Risperidona/efeitos adversos , Esquizofrenia Paranoide/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Aterosclerose/sangue , Benzodiazepinas/uso terapêutico , Dibenzotiazepinas/uso terapêutico , Eletrocardiografia , Feminino , Humanos , Lipoproteínas VLDL/sangue , Masculino , Pessoa de Meia-Idade , Olanzapina , Fumarato de Quetiapina , Risperidona/uso terapêutico , Esquizofrenia Paranoide/sangue , Esquizofrenia Paranoide/fisiopatologia , Ganho de Peso , Adulto Jovem
14.
Expert Opin Pharmacother ; 16(9): 1335-45, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26001182

RESUMO

INTRODUCTION: Antipsychotic medications are being prescribed for a growing number of women with mental illnesses. However, evidence regarding their safety in pregnancy is still insufficient to provide adequate support for clinical practice, creating increasing concern among pregnant women and clinicians. AREAS COVERED: The aim of this article is to review published data regarding the safety of antipsychotic medications in pregnancy with a focus on the most commonly used atypical antipsychotics. EXPERT OPINION: Given the potential harm of not treating severe psychiatric illnesses during pregnancy, careful administration of antipsychotics is recommended for pregnant women who suffer from severe mental disorders. The most frequently used antipsychotics in pregnancy are olanzapine, risperidone and quetiapine, and do not appear to cause consistent, congenital harm to the fetus. No specific patterns of fetal limb or organ malformation related to these drugs have been reported. There is some evidence suggesting an association between antipsychotic use in pregnancy and the development of gestational diabetes. Also there appears to be an association between antipsychotic medication use in pregnancy and increased neonatal respiratory distress and withdrawal symptoms. Further studies are needed for clinicians to balance good maternal mental health, healthy pregnancies and good infant health outcomes.


Assuntos
Antipsicóticos/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/prevenção & controle , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Benzodiazepinas/uso terapêutico , Dibenzotiazepinas/efeitos adversos , Dibenzotiazepinas/uso terapêutico , Feminino , Humanos , Troca Materno-Fetal , Olanzapina , Gravidez , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Estudos Prospectivos , Fumarato de Quetiapina , Risperidona/efeitos adversos , Risperidona/uso terapêutico
15.
BMC Psychiatry ; 15: 73, 2015 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-25886646

RESUMO

BACKGROUND: Capgras delusion is a delusional misidentification syndrome, in which the patient is convinced that someone that is well known to them, usually a close relative, has been replaced by an impostor or double. Although it has been frequently described in psychotic syndromes, including paranoid schizophrenia, over a third of the documented cases of Capgras delusion are observed in patients with organic brain lesions or neurodegenerative disease, including Parkinson's Disease. Variants of Capgras involving animals or inanimate objects have also been described. The etiology of Capgras in Parkinson's remains unclear, but may arise from a combination of factors, such as frontal lobe dysfunction and dopaminergic medication. CASE PRESENTATION: We present the case of a 53-year old right-handed female with Parkinson's disease who developed Capgras delusion during treatment with dopamine agonists and Levodopa/Carbidopa. She became convinced that her pet dogs and the plants in her garden had been substituted by identically looking ones. Our patient was initially treated with Quetiapine, with no improvement, and subsequently treated with Clozapine, which lead to partial regression of her symptoms. Neuropsychological Evaluation showed Mild Cognitive Impairment in Executive Functions. CONCLUSIONS: Given the clinical history, onset and evolution of symptoms we believe our patient's delusion resulted from the overlap of dopaminergic medication and Mild Cognitive Impairment in executive functions. Zoocentric Capgras, the variant we describe, has been rarely described in scientific literature, and we believe it is of interest due to its unusual characteristics.


Assuntos
Síndrome de Capgras/etiologia , Disfunção Cognitiva/psicologia , Doença de Parkinson/psicologia , Animais , Antiparkinsonianos/efeitos adversos , Antipsicóticos/uso terapêutico , Síndrome de Capgras/tratamento farmacológico , Carbidopa/efeitos adversos , Clozapina/uso terapêutico , Delusões/etiologia , Dibenzotiazepinas/uso terapêutico , Cães , Agonistas de Dopamina/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Levodopa/efeitos adversos , Animais de Estimação/psicologia , Plantas , Fumarato de Quetiapina
16.
Paediatr Drugs ; 17(2): 125-40, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25686575

RESUMO

The atypical antipsychotic quetiapine has been used in different psychotic and non-psychotic disorders in children and adolescents in randomized clinical trials, open-label studies and chart reviews. Most of these studies suggest that quetiapine may be a promising agent with a potential for use in young patients. The aim of this paper is to critically review available literature on quetiapine in the treatment of children and adolescents with a variety of psychiatric disorders, including psychotic disorders, bipolar disorders (manic and depressive episodes), conduct disorder, autism spectrum disorder, Tourette's syndrome and personality disorders. Furthermore, we report on possible neurochemical pathways involved during treatment with quetiapine, and discuss some issues that are clinically relevant in daily practice, such as titration strategies, safety and tolerability, and monitoring possible side effects. Controlled studies support the short-term efficacy for treating psychosis, mania, and aggression within certain diagnostic categories. However, although quetiapine seems well tolerated in various pediatric populations during acute and intermediate treatments, and hyper-prolactinemia and extra-pyramidal side effects are consistently low among studies, weight gain and alterations in lipid profile need to be closely monitored. Furthermore, the distal benefit/risk ratio during long-term treatment remains to be determined.


Assuntos
Antipsicóticos/uso terapêutico , Dibenzotiazepinas/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Adolescente , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Criança , Dibenzotiazepinas/administração & dosagem , Dibenzotiazepinas/efeitos adversos , Humanos , Fumarato de Quetiapina , Ganho de Peso/efeitos dos fármacos
17.
Pharmacotherapy ; 35(2): 175-88, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25689246

RESUMO

To evaluate the efficacy and tolerability of quetiapine for the treatment of generalized anxiety disorder (GAD), a literature search of the Medline database was conducted from inception to May 2014. The search was not restricted by language. Keywords used in the search were quetiapine and generalized anxiety disorder or anxiety. All studies assessing the use of quetiapine as monotherapy or adjunct therapy for the primary management of GAD in adults 18-65 years of age were included in this review. The nine studies included in this review were three studies evaluating the use of quetiapine extended release (XR) as monotherapy for acute GAD treatment, one study evaluating quetiapine XR monotherapy for maintenance treatment of GAD, and five studies evaluating quetiapine (2 XR, 3 immediate release) as adjunct therapy for acute GAD treatment. Quetiapine displayed both efficacy and tolerability in all monotherapy trials evaluating its use for acute and long-term treatment of GAD. Despite some limitations to and heterogeneity among the five adjunct therapy studies, three studies showed that quetiapine resulted in statistically significant changes in the Hamilton Anxiety Rating Scale or Clinical Global Impressions-Severity of Illness Scale scores. Although future studies of longer duration with broader inclusion criteria are needed to further evaluate the benefits and risks of quetiapine for GAD, in patients failing to respond to conventional antidepressant therapy, quetiapine may be a potential treatment option. With appropriate monitoring and management of adverse effects, the potential benefits of quetiapine in patients with treatment-refractory GAD may outweigh the risks associated with its use.


Assuntos
Antipsicóticos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Dibenzotiazepinas/uso terapêutico , Adolescente , Adulto , Idoso , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Preparações de Ação Retardada , Dibenzotiazepinas/efeitos adversos , Monitoramento de Medicamentos/métodos , Humanos , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fumarato de Quetiapina , Adulto Jovem
18.
Drug Alcohol Depend ; 149: 18-24, 2015 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-25682480

RESUMO

BACKGROUND: Cocaine addiction continues to be a significant healthcare issue, yet there are no FDA approved medications for the treatment of cocaine use disorder within the United States. METHODS: This 12-week, prospective, double-blind, randomized, placebo-controlled study examined the effectiveness of quetiapine (Seroquel XR™) versus matched placebo for the treatment of DSM-IV cocaine dependence in non-psychotic individuals. Subjects randomized to quetiapine (N = 29) were titrated up to a target dose of 400mg/day of quetiapine, while those in the placebo arm (N = 31) were given a matched placebo. All subjects had weekly clinic visits and a cognitive-behavioral therapy group session. Outcome measures included self-report of cocaine use and money spent on cocaine as well as urine drug screens (UDS). RESULTS: The drop-out rate was substantial at 68%. Logistic regression analysis did not find significant differences between groups in predicting end-of trial abstinence, defined as three consecutive weekly negative UDS (13.7% in the quetiapine group versus 12.9% in the placebo group; p = .92). Based upon a repeated measures analysis of variance, subjects in this study, as a whole, demonstrated reductions in their self-reported use of cocaine, self-reported money spent on cocaine, and number of days per week using cocaine. However, the quetiapine group did not differ significantly from the placebo group. CONCLUSIONS: This study did not find group differences between the quetiapine and placebo arms, suggesting that quetiapine is not an efficacious treatment for DSM-IV cocaine dependence.


Assuntos
Antipsicóticos/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/terapia , Dibenzotiazepinas/uso terapêutico , Adolescente , Adulto , Idoso , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Terapia Cognitivo-Comportamental/métodos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Dibenzotiazepinas/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Estudos Prospectivos , Fumarato de Quetiapina , Resultado do Tratamento , Adulto Jovem
19.
World J Biol Psychiatry ; 16(2): 76-95, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25677972

RESUMO

These guidelines for the treatment of unipolar depressive disorders systematically review available evidence pertaining to the biological treatment of patients with major depression and produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians assessing and treating patients with these conditions. The relevant data have been extracted primarily from various treatment guidelines and panels for depressive disorders, as well as from meta-analyses/reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into five levels of evidence (CE A-F) and five levels of recommendation grades (RG 1-5). This second part of the WFSBP guidelines on depressive disorders covers the management of the maintenance phase treatment, and is primarily concerned with the biological treatment (including pharmacological and hormonal medications, electroconvulsive therapy and other brain stimulation treatments) of adults and also, albeit to a lesser extent, children, adolescents and older adults.


Assuntos
Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Depressivo Maior/terapia , Psiquiatria Biológica , Carbamazepina/uso terapêutico , Dibenzotiazepinas/uso terapêutico , Quimioterapia Combinada , Eletroconvulsoterapia , Medicina Baseada em Evidências , Humanos , Lítio/uso terapêutico , Extratos Vegetais/uso terapêutico , Psicoterapia , Fumarato de Quetiapina
20.
Rev. latinoam. enferm ; 23(1): 44-50, Jan-Feb/2015. tab, graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: lil-742028

RESUMO

OBJECTIVE: to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire. METHODS: in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered. RESULTS: overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001); and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001). The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01), but weak and non significant at visit 4. CONCLUSION: the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument. .


OBJETIVO: verificar o conhecimento dos pacientes sobre insuficiência cardíaca, por meio de dois Resultados de Enfermagem em ambiente domiciliar, durante um seguimento de seis meses e, correlacionar a média dos seus indicadores com um Questionário de Conhecimento sobre insuficiência cardíaca. MÉTODOS: neste estudo tipo antes-depois, pacientes com insuficiência cardíaca receberam quatro visitas domiciliares, durante seis meses, após a alta hospitalar. Em cada visita foram implementadas Intervenções de Enfermagem, mensurados os Resultados e aplicado o Questionário do Conhecimento. RESULTADOS: vinte e três pacientes receberam visitas em domicílio. Na visita um, o Resultado Conhecimento: Medicação obteve média de 2,27±0,14 e na visita quatro, 3,55±0.16 (P<0,001), e o Resultado Conhecimento: Regime Terapêutico 2,33±0,13 na visita um e 3,59±0,14 na visita quatro (P<0,001). A correlação entre o Questionário do Conhecimento e os escores da Classificação dos Resultados de Enfermagem foi de forte magnitude na visita domiciliar um (r=0.7, P<0,01), mas fraca e não significativa na visita quatro. CONCLUSÃO: os resultados indicaram progresso do conhecimento sobre insuficiência cardíaca e correlação forte entre a Classificação dos Resultados de Enfermagem e os escores do Questionário do Conhecimento. A Classificação dos Resultados de Enfermagem mostrou-se efetiva na avaliação do conhecimento quando comparada ao instrumento validado. .


OBJETIVO: verificar el conocimiento de los pacientes sobre insuficiencia cardíaca mediante dos Resultados de Enfermería en ambiente domiciliario durante un seguimiento de seis meses y correlacionar el promedio de sus indicadores con un Cuestionario de Conocimiento sobre insuficiencia cardíaca. MÉTODOS: en este estudio tipo antes-después, pacientes con insuficiencia cardíaca recibieron cuatro visitas en domicilio durante un período de seis meses tras el alta hospitalario. En cada visita fueron implementadas Intervenciones de Enfermería, mensurados los Resultados y aplicado el Cuestionario del Conocimiento. RESULTADOS: veinte y tres pacientes recibieron visitas en domicilio. En la visita 1, el Resultado Conocimiento: Medicación alcanzó promedio de 2,27±0,14 y, en la visita 4 3,55±0.16 (P<0,001), y el Resultado Conocimiento: Régimen Terapéutico 2,33±0,13 en la visita 1 y 3,59±0,14 en la visita 4 (P<0,001). La correlación entre el Cuestionario del Conocimiento y los scores de la Clasificación de los Resultados de Enfermería fue de magnitud fuerte en la visita en domicilio 1 (r=0.7, P<0,01), pero débil y no significativa en la visita 4. CONCLUSIÓN: los resultados indicaron mejora del conocimiento sobre insuficiencia cardíaca y correlación fuerte entre la Clasificación de los Resultados de Enfermería y los scores del Cuestionario del Conocimiento. La Clasificación de los Resultados de Enfermería se mostró efectiva en la evaluación del conocimiento cuando comparados al instrumento validado. .


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Antipsicóticos/uso terapêutico , Dibenzotiazepinas/uso terapêutico , Potencial Evocado Motor/efeitos dos fármacos , Córtex Motor/fisiopatologia , Inibição Neural/efeitos dos fármacos , Esquizofrenia/tratamento farmacológico , Eletromiografia , Escalas de Graduação Psiquiátrica , Esquizofrenia/fisiopatologia , Estimulação Magnética Transcraniana/métodos
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