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1.
Medicine (Baltimore) ; 100(12): e25248, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761720

RESUMO

INTRODUCTION: Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia and an elevated level of serum parathyroid hormone (PTH). PHPT presents with a complex set of renal, skeletal, and neuropsychological symptoms. Parathyroidectomy (PTX) is a radical treatment that is recommended for all physically symptomatic patients with PHPT. However, psychiatric symptoms are not considered as an indication for surgery. There remains an important issue from the view of perioperative management of whether PTX should be performed with the presence of uncontrolled psychiatric symptoms or deferred until severe psychiatric symptoms have been controlled. We report a case of mild hypercalcemia that caused severe psychosis in PHPT, which improved dramatically following PTX and resulted in successful postoperative management. PATIENT CONCERN: Our patient was a 68-year-old Japanese woman. She was diagnosed with PHPT, which was triggered by mild hypercalcemia. She was due to receive an operation for osteoporosis and kidney stones. She had severe psychosis, despite medication. Blood examinations revealed mild hypercalcemia (10.4 mg/dL, 8.8-10.1 mg/dL) and elevated serum levels of intact PTH (184.0 pg/mL, 10-65 pg/mL). DIAGNOSIS: She was diagnosed with severe psychosis caused by mild hypercalcemia in PHPT. INTERVENTIONS: Although she was treated with 37.5 mg quetiapine and 2 mg risperidone daily, she was excessively sedated and rejected oral treatment. Therefore, we decided to perform the operation. OUTCOMES: Immediately following surgery, serum levels of calcium, and intact PTH were normalized. Her psychotic symptoms ceased completely 5 days after surgery. CONCLUSION: We emphasize that PHPT presents with various severe psychiatric symptoms, even in mild hypercalcemia. Psychiatric symptoms may be the only salient symptoms in PHPT, and thus clinicians should suspect PHPT in patients with psychiatric symptoms and mild hypercalcemia. Furthermore, PTX is recommended for PHPT-even in the presence of severe uncontrolled psychiatric symptoms, which carries risks for postoperative management-because psychiatric symptoms are expected to improve and good postoperative management is possible.


Assuntos
Hipercalcemia , Hiperparatireoidismo Primário , Paratireoidectomia/métodos , Transtornos Psicóticos , Fumarato de Quetiapina/uso terapêutico , Risperidona/uso terapêutico , Idoso , Antipsicóticos/uso terapêutico , Feminino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Hipercalcemia/psicologia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/psicologia , Hiperparatireoidismo Primário/cirurgia , Hormônio Paratireóideo/sangue , Cooperação do Paciente/psicologia , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/terapia , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(12): e25015, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761656

RESUMO

ABSTRACT: Older adults are the leading users of medications, where this can be associated with a high number of potentially inappropriate medications (PIMs) and of potentially inappropriate prescribing (PIP) and consequent harm to health. No Brazilian study evaluating potentially inappropriate prescribing in older patients with Alzheimer's disease (AD) was found. This study determined and analyzed the prevalence of PIP and PIM prescribed for older people with AD.A cross-sectional study was carried out at the Specialty Drugs Pharmacy in the city of Sorocaba, São Paulo State, Brazil. The MEDEX system provided the register in older people with AD and data were collected during interviews with patients and/or caregivers between June and September 2017. The PIMs were identified according to the 2019 Beers Criteria. The association between PIMs and independent variables was analyzed by Poisson regression.This study included 234 older patients with AD. The prevalence of PIP prescribed was 66.7% (n = 156). Of the 1073 medications prescribed, 30.5% (n = 327) were inappropriate with most affecting the central nervous system or cardiovascular, particularly quetiapine (12.8%) and acetylsalicylic acid (11.6%), respectively. Around 45.2% of the PIMs should be avoided in older people, especially sertraline (14.2%) and clonazepam (7.4%). After adjusted analysis, the PIMs were associated with the diagnosis of depression (P = 0.010) and the number of comorbidities (P = 0.005).There was a high number of PIMs among older people, a substantial number of which should have been avoided in this population. Health care professionals can apply these findings to improve safety in the use of medications for treating patients with AD.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Prescrição Inadequada/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Aspirina/efeitos adversos , Aspirina/uso terapêutico , Brasil , Fármacos Cardiovasculares/efeitos adversos , Fármacos Cardiovasculares/uso terapêutico , Fármacos do Sistema Nervoso Central/efeitos adversos , Fármacos do Sistema Nervoso Central/uso terapêutico , Clonazepam/efeitos adversos , Clonazepam/uso terapêutico , Estudos Transversais , Interações Medicamentosas , Feminino , Humanos , Masculino , Polimedicação , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/uso terapêutico , Sertralina/efeitos adversos , Sertralina/uso terapêutico
3.
Paediatr Drugs ; 23(2): 159-169, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33634425

RESUMO

PURPOSE: The aim of this study was to evaluate outcomes of pediatric intensive care unit (PICU) patients with delirium treated with haloperidol or quetiapine compared with propensity-matched, untreated patients. MATERIALS AND METHODS: A single-center retrospective cohort study was conducted including PICU admissions of ≥ 48 h for children ≥ 2 months old with a positive delirium screening score (Cornell Assessment of Pediatric Delirium ≥ 9). We generated propensity scores for the likelihood of receiving treatment with haloperidol or quetiapine using logistic regression, and matched untreated to treated patients 2:1 to compare outcomes between groups. RESULTS: Among 846 eligible admissions, 27 were treated with haloperidol or quetiapine (3.2%). Time to first delirium-free score was similar for treated versus untreated patients. Treated patients had no significant change in delirium scores following treatment, while untreated patients' scores improved after the comparable matching time. Compared with untreated patients, haloperidol-treated patients had more subsequent days of delirium and exposure to neuromuscular blockade. Quetiapine-treated patients had more subsequent days of mechanical ventilation and exposure to neuromuscular blockade, longer PICU length of stay, and higher likelihood of functional decline at ICU discharge. CONCLUSIONS: In our small, single-center study, patients treated with haloperidol or quetiapine showed no short-term improvement in delirium screening scores after starting treatment when compared with untreated, propensity score-matched patients. In addition, clinical outcomes were not improved or were worse among treated patients. A prospective trial is needed to evaluate whether antipsychotic medications benefit PICU patients with delirium.


Assuntos
Delírio/tratamento farmacológico , Haloperidol/administração & dosagem , Fumarato de Quetiapina/uso terapêutico , Antipsicóticos/uso terapêutico , Criança , Estudos de Coortes , Feminino , Haloperidol/efeitos adversos , Humanos , Unidades de Terapia Intensiva Pediátrica , Masculino , Pontuação de Propensão , Respiração Artificial , Estudos Retrospectivos
4.
Psicosom. psiquiatr ; (14): 33-38, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198800

RESUMO

Se presenta el caso clínico de un paciente de 72 años sin antecedentes psiquiátricos previos que ingresa en el Servicio de Neurología por infarto cerebral en territorio vertebrobasilar. Durante el ingreso presenta elevada ansiedad secundaria a una ideación obsesiva de contenido erótico con intensa repercusión emocional y conductual. Se inicia tratamiento sintomático con Quetiapina, observándose mejoría progresiva del cuadro hasta la total recuperación del paciente. En el presente artículo se revisa la relación entre las diferentes áreas anatómicas cerebrales y la aparición de clínica obsesiva


A 72 year old male without previous psychiatric history is admitted to the neurology department due to vertebrobasilar stroke. During the stay, the patient manifests a high level of anxiety related to the onset of an erotic obsessive idea with an intense emotional and behavioural repercussion. Symptomatic treatment with quetiapine was started, with a progressive improvement of the symptoms until it's complete resolution. In the present article, we aim to review the relationship between the different brain anatomical areas and the onset of obsessive symptoms


Assuntos
Humanos , Masculino , Idoso , Infarto Cerebral/complicações , Infarto Cerebral/psicologia , Transtornos de Ansiedade/diagnóstico , Transtorno da Personalidade Compulsiva/fisiopatologia , Trombose/diagnóstico por imagem , Fumarato de Quetiapina/uso terapêutico , Transtorno da Personalidade Compulsiva/diagnóstico , Fibrinolíticos/administração & dosagem , Fumarato de Quetiapina/administração & dosagem
5.
Clin Drug Investig ; 40(9): 861-871, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32648201

RESUMO

BACKGROUND AND OBJECTIVE: Schizophrenia is a low-prevalence mental disorder with a global age-standardized prevalence of 21 million people (2016). Second-generation antipsychotics (lurasidone and quetiapine XR) are recommended as the first-line treatment for schizophrenia. It is interesting to investigate how the results of clinical studies translate into direct medical costs. The objective of this analysis was to assess the direct medical costs related to pharmaceutical treatments and the management of relapses in patients affected with schizophrenia treated with lurasidone (74 mg) vs quetiapine XR (300 mg) assuming the Italian and Spanish National Health Service perspective. METHODS: A health economic model was developed based on a previously published model. The analysis considered direct medical costs related to the pharmacological therapies and inpatient or outpatient management of relapses (direct medical costs referred to 2019). The probability of relapses and related costs were derived from two systematic reviews. A deterministic sensitivity analysis was implemented to test the robustness of the results. RESULTS: The use of lurasidone (74 mg) compared with quetiapine XR (300 mg) would lead to a reduction in direct medical costs in Italy and Spain, with a lower cost per patient of - 163.7 € (- 9.0%) and - 327.2 € (- 22.7%), respectively. In detail, it would lead to an increase in the cost of therapy of + 53.8% and of + 30.5% in Italy and Spain, respectively, to a decrease in the cost of relapses with hospitalization of - 135.7%, and to an increase in the cost of relapses without hospitalization of + 24.5%. CONCLUSIONS: The use of lurasidone (74 mg) for the treatment of patients affected with schizophrenia, compared with quetiapine XR (300 mg), would be a cost-saving strategy in the two contexts investigated assuming the National Health Service point of view.


Assuntos
Antipsicóticos/uso terapêutico , Cloridrato de Lurasidona/uso terapêutico , Fumarato de Quetiapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/economia , Doença Crônica , Análise Custo-Benefício , Feminino , Hospitalização/economia , Humanos , Itália , Cloridrato de Lurasidona/economia , Pessoa de Meia-Idade , Modelos Econômicos , Fumarato de Quetiapina/economia , Recidiva , Espanha , Medicina Estatal
6.
Can J Physiol Pharmacol ; 98(4): 236-242, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228235

RESUMO

Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder, of unknown etiology, that affects 2.5% of the population. An appropriate therapeutic response to conventional treatment is seen. Some studies use augmentative treatment by antipsychotics, glutamatergic, lithium, buspirone, and others agents to improve the therapeutic response. In this study, we aimed to evaluate the efficacy and tolerability of aripiprazole and quetiapine as augmentative treatments in patients with selective serotonin reuptake inhibitor (SSRI) refractory OCD. The OCD patients were initially treated for 12 weeks with a SSRI. If after 12 weeks their Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score was more than 16, they were randomly assigned to either the aripiprazole or the quetiapine augmentation group for an additional 12 weeks. There were no significant differences in age, sex, education, marital status, or score of Y-BOCS and Clinical Global Impression-Severity Scale (CGI-S) between groups (p > 0.05) at the outset of the study. Significant differences were noted after 1 month when compared with results at 2, 3, and 4 months in both groups (p < 0.001). Both quetiapine and aripiprazole may be effective and well-tolerated augmentative agents in the treatment of SSRI-refractory OCD. Because of positive results, aripiprazole may be considered more effective and may have a more rapid onset in terms of therapeutic response.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Fumarato de Quetiapina/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico , Serotonina/metabolismo , Adulto , Quimioterapia Combinada/métodos , Feminino , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/metabolismo , Método Simples-Cego
7.
J Clin Psychiatry ; 81(3)2020 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-32237292

RESUMO

OBJECTIVE: To compare longitudinal metabolic effects of 7 antipsychotics, including body mass index (BMI), waist circumference (WC), blood pressure (BP), glucose, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C); to investigate risk factors for metabolic syndrome (MetS); and to make recommendations on frequency and timing of monitoring metabolic measurements. METHODS: This randomized, open-label, pharmacologic trial was conducted among patients with schizophrenia (DSM-IV) in 32 hospitals across China. Patients were randomly assigned to 7 groups and assessed at baseline, 2, 4, and 6 weeks. Linear mixed-effect models were used to assess changes of metabolic measures over time. Multivariable logistic regression analysis was performed to investigate the risk factors for MetS. RESULTS: In total, 2,550 (718 drug-naïve) of 2,774 patients finished the study between July 6, 2010, and November 30, 2011. We found significant (P < .05) changes for BMI, WC, TG, and LDL-C, with TG and LDL-C reaching a plateau. Interactions between baseline metabolic condition and changes over time were observed for BMI (χ² = 43.11, P < .001), WC (χ² = 36.34, P < .001), systolic BP (χ² = 11.92, P = .002), glucose (χ² = 6.09, P = .01), and TG (χ² = 6.01, P = .01). Antipsychotics generally had greater adverse effects on patients who were initially screened as metabolically normal. After controlling for other associated factors, we found that antipsychotics resulted in differing risk for incident MetS, with a similar pattern to findings in other populations: olanzapine (odds ratio [OR] = 3.36, P < .001) > quetiapine (OR = 3.29, P < .001) > perphenazine (OR = 2.73, P = .007) > risperidone (OR = 2.21, P = .02) > aripiprazole (OR = 1.74, P = .15) ≈ haloperidol (OR = 1.75, P = .22) ≈ ziprasidone (OR = 1, reference). CONCLUSIONS: Metabolic traits should be monitored frequently in early stages of antipsychotic treatment due to rapid and substantial changes. Clinicians should not assume low risk for patients with normal metabolic parameters at baseline. TRIAL REGISTRATION: Chinese Clinical Trial Registry identifier: ChiCTR-TRC-10000934.


Assuntos
Antipsicóticos/efeitos adversos , Síndrome Metabólica/induzido quimicamente , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Aripiprazol/efeitos adversos , Aripiprazol/uso terapêutico , Glicemia/efeitos dos fármacos , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Humanos , Masculino , Olanzapina/efeitos adversos , Olanzapina/uso terapêutico , Piperazinas/efeitos adversos , Piperazinas/uso terapêutico , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/uso terapêutico , Fatores de Risco , Risperidona/efeitos adversos , Risperidona/uso terapêutico , Esquizofrenia/metabolismo , Tiazóis/efeitos adversos , Tiazóis/uso terapêutico , Triglicerídeos/sangue
9.
Nervenarzt ; 91(3): 216-221, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31932883

RESUMO

BACKGROUND: German S3 guidelines are subject to the highest methodological standards. This includes that they are only valid for a certain time period. Following the first edition in 2012 the first update of the S3 guidelines on bipolar disorder has now been published (2019). OBJECTIVE: What has changed in the field of pharmacological recommendations comparing the first edition with the update in 2019? MATERIAL AND METHODS: Comparison of the 1st edition from 2012 with the update from 2019 of the S3 guidelines for the diagnostics and treatment of bipolar disorders. RESULTS: The three principle treatment targets of acute treatment of bipolar depression, acute treatment of mania and phase prophylaxis (maintenance treatment) can be distinguished. For acute treatment of bipolar depression, for the first time a medication has received a level A recommendation: quetiapine. For the acute treatment of mania, several drugs are still recommended with the same level of recommendation (B). Asenapine has been added as the tenth substance. Lithium is still the only drug with a level A recommendation for maintenance and prophylactic treatment and is also the only drug approved for this indication without restrictions. A new recommendation is that in the absence of contraindications, phase prophylaxis with a serum level of at least 0.6 mmol/l should be carried out. With a B recommendation, quetiapine has been added to the drugs for phase prophylactic treatment. CONCLUSION: The S3 guidelines make recommendations at the highest scientific level. In view of these findings, lithium is clearly underutilized for maintenance therapy. In the absence of clear contraindications (advanced renal insufficiency), every patient with bipolar disease should be given the chance of lithium prophylaxis for an adequately long period.


Assuntos
Antipsicóticos , Transtorno Bipolar , Guias como Assunto , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Tratamento Farmacológico/tendências , Alemanha , Humanos , Fumarato de Quetiapina/uso terapêutico
10.
Pediatr Emerg Care ; 36(2): e96-e98, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31929391

RESUMO

Radiopaque densities can be observed on imaging after the ingestion of either foreign bodies or some medications. Our case report discusses an 11-year-old boy with autism spectrum disorder and attention deficient disorder who presented to the emergency department because of concerns for constipation and dehydration. Incidentally, an abdominal x-ray showed numerous radiopaque densities throughout his intestines in addition to his constipation. He was admitted, and his home regimen was reviewed to attempt to identify a potential source for these radiopaque densities. This case presented an interesting teaching opportunity in the identification of the radiopaque densities and review of pharmacokinetics.


Assuntos
Abdome/diagnóstico por imagem , Bezoares/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Fumarato de Quetiapina/efeitos adversos , Abdome/patologia , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/tratamento farmacológico , Bezoares/complicações , Criança , Constipação Intestinal/complicações , Diagnóstico Diferencial , Corpos Estranhos/complicações , Humanos , Dimesilato de Lisdexanfetamina/efeitos adversos , Dimesilato de Lisdexanfetamina/uso terapêutico , Masculino , Fumarato de Quetiapina/uso terapêutico , Radiografia Abdominal , Tomografia Computadorizada por Raios X
11.
Clin Ther ; 42(1): 77-93, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31928831

RESUMO

PURPOSE: Brexpiprazole is an oral atypical antipsychotic (OAA) for the treatment of schizophrenia (SCZ). This study compared all-cause and psychiatric inpatient hospitalization and medical costs in adult patients with SCZ newly treated with brexpiprazole versus other US Food and Drug Administration-approved OAAs in a real-world setting. METHODS: This retrospective cohort study analyzed data from: (1) the IBM MarketScan Commercial and Medicare Supplemental databases, and the MarketScan Multi-State Medicaid database; and (2) the de-identified Optum Clinformatics Datamart. Adult patients were identified if they had SCZ and initiated either brexpiprazole or another OAA during the study identification period (July 1, 2015, to September 30, 2016, for MarketScan Commercial and Medicare Supplemental and for Optum; July 1, 2015, to June 30, 2016, for MarketScan Multi-State Medicaid) and had ≥12 months of continuous enrollment before (baseline) and after (follow-up) the first treatment date. Linear regression analyses were performed to test associations between treatment groups (brexpiprazole vs another OAA) and costs (total and medical); negative binomial regression models were used to estimate number of hospitalizations per year, adjusting for baseline characteristics and medication adherence to index treatment during the 12-month follow-up. FINDINGS: The final study sample consisted of 6254 patients with SCZ: 176 initiated brexpiprazole; 391, ziprasidone; 453, paliperidone; 523, lurasidone; 786, aripiprazole; 1234, quetiapine; 1264, olanzapine; and 1427, risperidone. Controlling for baseline characteristics and medication adherence, the adjusted number of hospitalizations (both all-cause and psychiatric), all-cause total costs, and all-cause medical costs did not differ across groups. Brexpiprazole users had the lowest mean psychiatric costs among all OAA users ($12,013; 95% bootstrap CI, 7488-16,538). Compared with brexpiprazole users, paliperidone (incidence rate ratio [95% CI], 1.52 [1.05-2.19]; P = 0.027) and quetiapine (incidence rate ratio [95% CI], 1.47 [1.04-2.07]; P = 0.029) users had more psychiatric hospitalizations per year. Paliperidone had higher psychiatric costs than brexpiprazole (total, $32,066 [95% bootstrap CI, 28,779-35,353] vs $23,851 [18,907-28,795]; medical, $19,343 [16,294-22,392] vs $12,013 [7488-16,538]). Psychiatric medical costs were also $6744 higher in olanzapine users (95% bootstrap CI, 1694-11,795; P = 0.009) than in brexpiprazole users. IMPLICATIONS: Patients with SCZ treated with brexpiprazole had fewer psychiatric hospitalizations and lower psychiatric costs than those treated with paliperidone. Differences in the number of all-cause hospitalizations and medical costs among treatments were not statistically significant. Although treatment decisions are driven by a number of factors (eg, clinical circumstances and drug costs), choice of OAA may affect health care costs.


Assuntos
Antipsicóticos/economia , Hospitalização/economia , Quinolonas/economia , Esquizofrenia/economia , Tiofenos/economia , Administração Oral , Adulto , Antipsicóticos/uso terapêutico , Aripiprazol/economia , Aripiprazol/uso terapêutico , Feminino , Custos de Cuidados de Saúde , Humanos , Cloridrato de Lurasidona/economia , Cloridrato de Lurasidona/uso terapêutico , Masculino , Medicaid/economia , Medicare/economia , Pessoa de Meia-Idade , Olanzapina/economia , Olanzapina/uso terapêutico , Palmitato de Paliperidona/economia , Palmitato de Paliperidona/uso terapêutico , Piperazinas/economia , Piperazinas/uso terapêutico , Fumarato de Quetiapina/economia , Fumarato de Quetiapina/uso terapêutico , Quinolonas/uso terapêutico , Risperidona/economia , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Tiazóis/economia , Tiazóis/uso terapêutico , Tiofenos/uso terapêutico , Estados Unidos
13.
Psychiatry Res Neuroimaging ; 295: 111007, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-31760336

RESUMO

While 5-HT6 receptor is a potential therapeutic target for cognitive impairment in schizophrenia (SCZ), in vivo 5-HT6 receptor availability following antipsychotic treatment has not been examined to-date. We examined the availability of 5-HT6 and 5-HT2A receptors following treatment with olanzapine, risperidone, aripiprazole and quetiapine in male patients with SCZ vs unmedicated age-matched healthy male controls (HC) using positron emission tomography (PET) imaging with [11C]GSK215083. [11C]GSK215083 has been shown to have selectivity for 5-HT6 in the striatum and 5-HT2A in the cortex. Patients with SCZ (n = 9) were scanned with [11C]GSK215083 on HR+ PET scanner at presumed steady-state trough and peak serum levels following 7 days of confirmed inpatient antipsychotic treatment. Time-activity curves in regions-of-interest were fitted with multilinear analysis-1 (MA1). Regional nondisplaceable binding potential (BPND) values were calculated using cerebellum as the reference region and corrected for partial volume effects. Compared to HCs (n = 9), olanzapine was associated with significantly lower BPND (range: 53%-95%) in ventral striatum, putamen, caudate and frontal cortex at both trough and peak scans. Risperidone was associated with significantly lower BPND in frontal cortex at both trough and peak scans. The study provides preliminary evidence that treatment with different second-generation antipsychotics results in differing profiles of 5-HT2A and 5-HT6 availability.


Assuntos
Antipsicóticos/uso terapêutico , Tomografia por Emissão de Pósitrons/métodos , Quinolinas/metabolismo , Receptor 5-HT2A de Serotonina/metabolismo , Receptores de Serotonina/metabolismo , Esquizofrenia/metabolismo , Sulfonas/metabolismo , Adulto , Radioisótopos de Carbono/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Olanzapina/uso terapêutico , Putamen/diagnóstico por imagem , Putamen/metabolismo , Fumarato de Quetiapina/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/diagnóstico por imagem , Esquizofrenia/tratamento farmacológico , Serotonina/metabolismo , Adulto Jovem
14.
Subst Use Misuse ; 55(2): 304-313, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31573374

RESUMO

Background: Quetiapine, an atypical antipsychotic endowed with weak dopamine antagonist, potent 5-HT2A-blocking, partial 5-HT1A-agonist, anti-H1 histamine, adrenolytic, and sigma1 receptor agonist activities, since an original 2004 report is increasingly misused. Although some of its pharmacodynamics might explain some motives for voluptuary use, most of its actions are directed at setting-off those motives. Hence, it is possible that its popularity in special populations is due to the fact that the unpleasant or unwanted effects of addiction substances are somehow soothed by quetiapine. Currently, quetiapine is tested in substance use disorders, showing some promise, but it is likely to be misused in certain contexts. Objectives: To review the evidence for the use of quetiapine as addiction substance and investigate the characteristics of populations involved in such addiction. Methods: A systematic review of literature on various databases retrieved on September 7, 2018 87 records to comment. Results. We reviewed the evidence for quetiapine's addictive potential in the light of its pharmacodynamics properties and presented two cases of recreational quetiapine use, by a 35-year old male patient with past addictive behavior and by a 50-year-old woman with major depressive disorder and conversion disorder. We found quetiapine to be abused mainly by addict populations and people with law involvement. Conclusions/Importance: There is no reason to include quetiapine among regulated substances, but monitoring of its use in selected populations is warranted. Psychiatrists and physicians working in the penitentiary system should be aware of the addictive potential of quetiapine and adopt measures restricting its use.


Assuntos
Comportamento Aditivo/etiologia , Uso Indevido de Medicamentos sob Prescrição/psicologia , Fumarato de Quetiapina/efeitos adversos , Adulto , Antipsicóticos/efeitos adversos , Transtorno Depressivo Maior/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumarato de Quetiapina/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico
15.
Int J Psychiatry Med ; 55(2): 67-73, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30913942

RESUMO

Objective: Schizophrenia is a chronic psychotic disorder in which patients experience positive and negative symptoms for over six months. Schizophrenia is associated with early mortality, with 40% of this excess mortality due to suicide. This is a case of patient with schizophrenia who was treated with quetiapine after suffering a traumatic brain injury and recovered enough to be discharged to a rehabilitation unit. This case illustrates the neuroprotective effects of quetiapine in treating neurologic deficits in a patient who recently suffered a traumatic brain injury. Method: This is a case report of a patient with schizophrenia treated in the hospital setting. He was placed on quetiapine after suffering a traumatic brain injury due to a suicide attempt in which he shot himself with a nail gun. Results: The patient initially presented with neurologic deficits suggestive of traumatic brain injury (inattention, memory loss, muscle weakness) and psychosis from schizophrenia. He was treated with quetiapine and recovered enough to be discharged to a rehabilitation unit. Conclusion: Quetiapine, a second-generation antipsychotic, has been shown to significantly decrease blood­brain barrier hyperpermeability by preserving tight junction integrity in small animal models. This anti-inflammatory effect may also help to preserve neurogenesis in patients with traumatic brain injury, as shown in this case. This case may help elucidate the nature of quetiapine's neuroprotective effects in patients who have suffered traumatic brain injury and also highlights the need to further investigate other atypical antipsychotics and their potential neuroprotective role in treating traumatic brain injury.


Assuntos
Antipsicóticos/uso terapêutico , Lesões Encefálicas Traumáticas/tratamento farmacológico , Fármacos Neuroprotetores/uso terapêutico , Fumarato de Quetiapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Tentativa de Suicídio , Adulto , Humanos , Masculino
16.
Parkinsonism Relat Disord ; 69: 119-124, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31751863

RESUMO

INTRODUCTION: Psychosis is common among patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Limited data exist on the most effective therapies. METHODS: Retrospective cohort study comparing patients with PD or DLB initiated on quetiapine or pimavanserin for psychosis. Primary outcome was time to discontinuation of pimavanserin or quetiapine using Kaplan-Meier survival analysis. We hypothesized the rate of antipsychotic discontinuation would be lower in the pimavanserin group. Subjects were included if the indication for treatment was psychosis and excluded if there was a history of major mental illness or no follow up data were available. RESULTS: Forty-seven patients were included in the quetiapine cohort and 45 in the pimavanserin cohort. Patients in the pimavanserin cohort were more likely to have a diagnosis of DLB (33% vs. 11%, P = 0.01) and to have been prescribed an antipsychotic previously (62% vs. 6%, P < 0.01); otherwise, the groups were similar. Time to discontinuation analysis, which accounts for efficacy, safety and tolerability, revealed a lower early pimavanserin discontinuation rate and a higher late pimavanserin discontinuation rate (HR < 1 before day 43, HR > 1 after day 43; P = 0.04). There was no difference in mortality in the pimavanserin group compared to the quetiapine group (HR 0.37, 95% CI 0.06 to 2.45; P = 0.88). More individuals had a documented secondary indication for taking quetiapine than pimavanserin (38% vs. 4%; P = 0.001). CONCLUSION: Accounting for efficacy, safety and tolerability, pimavanserin may be more clinically useful for promptly managing psychosis, while quetiapine may confer additional secondary benefits long-term.


Assuntos
Antipsicóticos/uso terapêutico , Doença por Corpos de Lewy/complicações , Doença de Parkinson/complicações , Piperidinas/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Fumarato de Quetiapina/uso terapêutico , Ureia/análogos & derivados , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/etiologia , Estudos Retrospectivos , Ureia/uso terapêutico
17.
Artigo em Russo | MEDLINE | ID: mdl-31626219

RESUMO

AIM: The randomized comparative study of aripiprazole and quetiapine in the treatment of patients with 'dual diagnosis' of schizophrenia and drug addiction. MATERIAL AND METHODS: Intra-group analysis of dependent variables on the scales PANSS, BPRS, VAS, SACS showed significant differences in the dinamics of the therapy in all groups. A comparative randomized study included 90 men admitted to an inpatient addiction unit. Of these, 54 (60%) had a previously established psychiatric diagnosis and 36 patients (40%) did not have an established psychiatric diagnosis. They were randomized into 3 groups of 30 patients each: group 1 received aripiprazole at a dose of up to 20 mg/day, group 2 received quetiapine at a dose of up to 600 mg/day and group 3 (controls) was treated with haloperidol at a dose of up to 30 mg/day. Treatment duration was 21 days. The efficacy of aripiprazole and quetiapine was evaluated with PANSS, BPRS, VAS and SACS on 10th, 14th and 21st day (visits 2-4). Drug safety was evaluated by recording adverse events or side-effects. RESULTS AND CONCLUSION: An analysis of independent variables showed significant differences between aripiprazole and haloperidol in PANSS and BPRS scores at visit 4, in VAS scores at visit 3, and in SACS scores at visit 2. An intergroup analysis of independent variables showed significant differences between quetiapine and haloperidol in PANSS, VAS and SACS scores at visit 4 and between aripiprazole and quetiapine in VAS and SACS scores. According to the results of the correlation analisys it has been concluded that presenting features of schizophrenia are closely correlated with drug addiction (craving).


Assuntos
Antipsicóticos , Aripiprazol , Fumarato de Quetiapina , Esquizofrenia , Transtornos Relacionados ao Uso de Substâncias , Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Diagnóstico Duplo (Psiquiatria) , Dibenzotiazepinas , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Fumarato de Quetiapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Resultado do Tratamento
20.
J Am Med Dir Assoc ; 20(12): 1488-1494.e3, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31466934

RESUMO

OBJECTIVES: To compare the accumulation of hospital days, a proposed proxy for overall drug safety, between antipsychotic initiators and noninitiators with Alzheimer's disease (AD). DESIGN: Nationwide exposure-matched cohort. SETTING AND PARTICIPANTS: Finnish community dwellers who received an incident AD diagnosis in 2005‒2011 (n = 70,718). For each antipsychotic initiator, 1 noninitiator was matched on age, sex, and time since AD diagnosis (n = 19,909 matched pairs). MEASURES: Accumulation of hospital days was measured during a 2-year follow-up from the national hospital discharge register. Antipsychotic use was ascertained from the National Prescription Register. Association between antipsychotic initiation and accumulation of hospital days was analyzed using negative binomial model. RESULTS: During the 2-year follow-up, antipsychotic initiators were hospitalized on average for 52.5 (standard deviation 97.7) days and matched noninitiators for 34.7 (standard deviation 72.4) days. Of antipsychotic initiators 23.8% and of noninitiators, 34.1% did not have any hospital days. Antipsychotic initiators had 53% more hospital days (adjusted incidence rate ratio 1.53; 95% confidence interval 1.47‒1.59) than noninitiators. Strongest associations were observed during the first 6 months. Antipsychotic initiators had more hospital days with primary diagnosis codes of dementia; mental and behavioral disorders; factors influencing health status; diseases of the respiratory, genitourinary, and circulatory system; certain infectious and parasitic diseases; and symptoms not elsewhere classified, than noninitiators. CONCLUSIONS AND IMPLICATIONS: Antipsychotic initiators accumulated more hospital days than noninitiators, especially within the first 6 months after initiation. This may indicate adverse events or difficulties in treating the most severe behavioral and psychological symptoms of dementia and health problems triggering them. After initiating antipsychotics, careful and regular monitoring is needed to assess response and decrease the risk of adverse effects and events.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Antipsicóticos/uso terapêutico , Hospitalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Seguimentos , Nível de Saúde , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Análise por Pareamento , Fumarato de Quetiapina/uso terapêutico , Sistema de Registros , Risperidona/uso terapêutico
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