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1.
Fortschr Neurol Psychiatr ; 87(10): 577-589, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31627240

RESUMO

Tic disorders typically start in early childhood and can be classified into provisional tic disorder (tics last <12 months) and chronic tic disorders (tics last > 12 months). The widely known chronic tic disorder Tourette's syndrome is featuring multiple motor and vocal tics. Tics are typically waxing and waning in frequency and intensity. Concentration and relaxation might decrease tics, whereas stress and excitement might increase tics. Psychiatric comorbidities, like obsessive-compulsive disorder, ADHD, depression and anxiety are common. The etiology is multifactorial with genetic and environmental interactions leading to a dysregulation of cortico-striato-pallido-thalamo-cortical networks.A correct diagnosis and psychoeducation are essential for patients as well as their relatives. Additional therapies are needed for patients with severe tics that cause physical impairment or great psychosocial stress. It is crucial to also treat psychiatric comorbidities. Psychotherapeutic interventions for tics include progressive muscle relaxation, habit reversal training, exposure and response prevention and comprehensive behavioral intervention for tics. First-line psychopharmacological treatment in Europe contains aripiprazole, tiapride and risperidone, which are all used off-label for tic disorders. Haloperidol remains the only approved medication for the pharmacotherapy of tics in Germany, but is rarely used due to its side effects. Cannabinoids gain interest as a new pharmacological option, but are mainly offered within the frame of studies.


Assuntos
Transtornos de Tique , Tiques , Europa (Continente) , Haloperidol/uso terapêutico , Humanos , Uso Off-Label , Transtornos de Tique/terapia , Tiques/terapia , Síndrome de Tourette/terapia
2.
Psychiatr Danub ; 31(Suppl 3): 543-548, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488788

RESUMO

BACKGROUND: The attitudes of schizophrenic patients toward medications directly impact the treatment compliance. Although noncompliance represents a serious concern in long-term schizophrenia treatment, a detailed information on the factors that impair compliance is still limited. The present study aims to assess the factors related to noncompliance with antipsychotics agents, in long-term treated chronic paranoid schizophrenia patients. SUBJECTS AND METHODS: Two groups of such patients (total number n=162) were analyzed and compared: 1). patients with symptomatic remission on haloperidol (n=32), clozapine (n=40) or olanzapine (n=45), and 2). drug resistant patients (n=45). The mean duration of the disease was 19.3 years. RESULTS: Altogether, in our patient sample, a better drug attitude was found in the olanzapine and clozapine groups. Our findings have also revealed that worse attitude toward antipsychotics correlated with an earlier onset of schizophrenia, younger patient age, shorter duration of the disease, higher burden of symptoms, treatment with a typical antipsychotics, and higher severity of akathisia. CONCLUSION: Our results suggest that detecting factors that influence the patient's attitude toward medications might be helpful for designing targeted educational strategies in chronic schizophrenia patients (particularly those with the high risk of noncompliance), and further trials are warranted to explore this topic.


Assuntos
Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Cooperação do Paciente , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Clozapina/administração & dosagem , Clozapina/uso terapêutico , Haloperidol/administração & dosagem , Haloperidol/uso terapêutico , Humanos , Olanzapina/administração & dosagem , Olanzapina/uso terapêutico , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Fatores de Risco
3.
Anesthesiology ; 131(2): 328-335, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31246603

RESUMO

BACKGROUND: Delirium incidence in intensive care unit patients is high and associated with impaired long-term outcomes. The use of prophylactic haloperidol did not improve short-term outcome among critically ill adults at high risk of delirium. This study evaluated the effects of prophylactic haloperidol use on long-term quality of life in this group of patients and explored which factors are associated with change in quality of life. METHODS: A preplanned secondary analysis of long-term outcomes of the pRophylactic haloperidol usE for DeliriUm in iCu patients at high risk for dElirium (REDUCE) study was conducted. In this multicenter randomized clinical trial, nondelirious intensive care unit patients were assigned to prophylactic haloperidol (1 or 2 mg) or placebo (0.9% sodium chloride). In all groups, patients finally received study medication for median duration of 3 days [interquartile range, 2 to 6] until onset of delirium or until intensive care unit discharge. Long-term outcomes were assessed using the Short Form-12 questionnaire at intensive care unit admission (baseline) and after 1 and 6 months. Quality of life was summarized in the physical component summary and mental component summary scores. Differences between the haloperidol and placebo group and factors associated with changes in quality of life were analyzed. RESULTS: Of 1,789 study patients, 1,245 intensive care unit patients were approached, of which 887 (71%) responded. Long-term quality of life did not differ between the haloperidol and placebo group (physical component summary mean score of 39 ± 11 and 39 ± 11, respectively, and P = 0.350; and mental component summary score of 50 ± 10 and 51 ± 10, respectively, and P = 0.678). Age, medical and trauma admission, quality of life score at baseline, risk for delirium (PRE-DELIRIC) score, and the number of sedation-induced coma days were significantly associated with a decline in long-term quality of life. CONCLUSIONS: Prophylactic haloperidol use does not affect long-term quality of life in critically ill patients at high risk for delirium. Several factors, including the modifiable factor number of sedation-induced coma days, are associated with decline in long-term outcomes.


Assuntos
Antipsicóticos/uso terapêutico , Cuidados Críticos/métodos , Delírio/tratamento farmacológico , Haloperidol/uso terapêutico , Qualidade de Vida , Idoso , Estado Terminal , Método Duplo-Cego , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Lakartidningen ; 1162019 Mar 26.
Artigo em Sueco | MEDLINE | ID: mdl-31192395

RESUMO

We present a case of hemichorea/hemiballism, a rare complication of hyperglycemia. Diagnosis is made clinically by signs of unilateral involuntary movements of the extremities combined with typical neuroradiological findings in the basal ganglia. Guidelines for treatment of the condition are lacking but in many cases correction for hyperglycemia is sufficient for full symptom relief. In other cases, symptomatic treatment with haloperidol and tetrabenazine can be used.


Assuntos
Coreia/etiologia , Discinesias/etiologia , Hiperglicemia/complicações , Idoso de 80 Anos ou mais , Antidiscinéticos/uso terapêutico , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/patologia , Coreia/tratamento farmacológico , Discinesias/tratamento farmacológico , Feminino , Haloperidol/uso terapêutico , Humanos , Hiperglicemia/diagnóstico por imagem , Hiperglicemia/terapia , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
5.
Ir J Psychol Med ; 36(2): 89-98, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31187719

RESUMO

OBJECTIVES: Improving knowledge about delirium care is a key target for health care. We describe the implementation of a four-part workshop focusing upon key aspects of delirium care. METHODS: Attitudes towards and understanding of delirium diagnosis and management amongst psychiatrists were surveyed before and immediately after an educational workshop. RESULTS: There were 62 participants. Pre-workshop, delirium was rated highly relevant to psychiatry. Overall level of confidence in diagnosis was modest, with the behavioural and psychological symptoms of dementia considered the most challenging differential diagnosis. Only nine participants (15%) correctly identified DSM-5 delirium criteria. Preferred assessment of attention varied with six different approaches endorsed. Confidence was higher for managing hyperactive compared with hypoactive delirium (p<0.001). Pharmacotherapy was more frequently endorsed for hyperactive compared with hypoactive presentations, with haloperidol the most popular agent (p<0.001). A total of 41 (66%) participants completed post-workshop assessments. Post-workshop, there were significant increases to the perceived relevance of delirium (p = 0.003), confidence in overall diagnosis (p<0.001) accuracy of awareness of DSM-5 criteria (p<0.001), and confidence in treating different presentations (p<0.001). The Months Backward Test was the preferred bedside test of attention (38/40 respondents). CONCLUSIONS: This interactive educational intervention impacted positively upon knowledge and attitudes amongst psychiatrists towards key aspects of delirium care. Further investigation can examine the impact upon longer term knowledge and behaviour.


Assuntos
Delírio/tratamento farmacológico , Haloperidol/uso terapêutico , Psiquiatria/educação , Idoso , Atitude do Pessoal de Saúde , Delírio/diagnóstico , Demência , Diagnóstico Diferencial , Humanos , Irlanda , Inquéritos e Questionários
6.
Medicine (Baltimore) ; 98(22): e15816, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145316

RESUMO

BACKGROUND: Aripiprazole is widely used in the management of tic disorders (TDs), we aimed to assess the safety of aripiprazole for TDs in children and adolescents. METHODS: A systematic literature review was performed in the databases of MEDLINE, Embase, the Cochrane Library and 4 Chinese databases, from inception to February 2019. All types of studies evaluating the safety of aripiprazole for TDs were included. The quality of studies was assessed using the Cochrane Risk of Bias tool, the Newcastle-Ottawa Scale tool, the National Institute of Clinical Excellence, the CARE (Case Report) guidelines according to types of studies. Risk ratio (RR) and incidence rate with a 95% confidence interval (CI) were used to summarize the results. RESULTS: A total 50 studies involving 2604 children met the inclusion criteria. The result of meta-analysis of randomized controlled trials showed that there was a significant difference between aripiprazole and haloperidol with respect to rate of somnolence (RR = 0.596, 95% CI: 0.394, 0.901), extrapyramidal symptoms (RR = 0.236, 95% CI: 0.111, 0.505), tremor (RR = 0.255, 95% CI: 0.114, 0.571), constipation (RR = 0.148, 95% CI: 0.040, 0.553), and dry mouth (RR = 0.141, 95% CI: 0.046, 0.425). There was a significant difference between aripiprazole and placebo in the incidence rate of adverse events (AEs) for somnolence (RR = 6.565, 95% CI: 1.270, 33.945). The meta-analysis of incidence of AEs related to aripiprazole for case series studies revealed that the incidence of sedation was 26.9% (95% CI: 16.3%, 44.4%), irritability 25% (95% CI: 9.4%, 66.6%), restlessness 31.3% (95% CI: 13%, 75.1%), nausea and vomiting 28.9% (95% CI: 21.1%, 39.5%), and weight gain 31.3% (95% CI: 10.7%, 91.3%). CONCLUSION: Aripiprazole was generally well tolerated in children and adolescents. Common AEs were somnolence, headache, sedation, nausea, and vomiting. Further high-quality studies are needed to confirm the safety of aripiprazole for children and adolescents with TDs.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Transtornos de Tique/tratamento farmacológico , Adolescente , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Aripiprazol/administração & dosagem , Aripiprazol/efeitos adversos , Criança , Haloperidol/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Cochrane Database Syst Rev ; 4: CD011408, 2019 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-31006114

RESUMO

BACKGROUND: Schizophrenia is a disabling serious mental illness that can be chronic. Haloperidol, one of the first generation of antipsychotic drugs, is effective in the treatment of schizophrenia but can have adverse side effects. The effects of stopping haloperidol in people with schizophrenia who are stable on their prescription are not well researched in the context of systematic reviews. OBJECTIVES: To review the effects of haloperidol discontinuation in people with schizophrenia who are stable on haloperidol. SEARCH METHODS: On 20 February 2015, 24 May 2017, and 12 January 2019, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials including trial registers. SELECTION CRITERIA: We included clinical trials randomising adults with schizophrenia or related disorders who were receiving haloperidol, and were stable. We included trials that randomised such participants to either continue their current treatment with haloperidol or discontinue their haloperidol treatment. We included trials that met our selection criteria and reported usable data. DATA COLLECTION AND ANALYSIS: We independently checked all records retrieved from the search and obtained full reports of relevant records for closer inspection. We extracted data from included studies independently. All usable data were dichotomous, and we calculated relative risks (RR) and their 95% confidence intervals (95% CI) using a fixed-effect model. We assessed risk of bias within the included studies and used GRADE to create a 'Summary of findings' table. MAIN RESULTS: We included five randomised controlled trials (RCTs) with 232 participants comparing haloperidol discontinuation with haloperidol continuation. Discontinuation was achieved in all five studies by replacing haloperidol with placebo. The trials' size ranged between 23 and 87 participants. The methods of randomisation, allocation concealment and blinding were poorly reported.Participants allocated to discontinuing haloperidol treatment were more likely to show no improvement in global state compared with those in the haloperidol continuation group (n = 49; 1 RCT; RR 2.06, 95% CI 1.33 to 3.20; very low quality evidence: our confidence in the effect estimate is limited due to relevant methodological shortcomings of included trials). Those who continued haloperidol treatment were less likely to experience a relapse compared to people who discontinued taking haloperidol (n = 165; 4 RCTs; RR 1.80, 95% CI 1.18 to 2.74; very low quality evidence). Satisfaction with treatment (measured as numbers leaving the study early) was similar between groups (n = 43; 1 RCT; RR 0.13, 95% CI 0.01 to 2.28; very low quality evidence).No usable mental state, general functioning, general behaviour or adverse effect data were reported by any of the trials. AUTHORS' CONCLUSIONS: This review provides limited evidence derived from small, short-term studies. The longest study was for one year, making it difficult to generalise the results to a life-long disorder. Very low quality evidence shows that discontinuation of haloperidol is associated with an increased risk of relapse and a reduction in the risk of 'global state improvement'. However, participant satisfaction with haloperidol treatment was not different from participant satisfaction with haloperidol discontinuation as measured by leaving the studies early. Due to the very low quality of these results, firm conclusions cannot be made. In addition, the available studies did not report usable data regarding the adverse effects of haloperidol treatment.Considering that haloperidol is one of the most widely used antipsychotic drugs, it was surprising that only a small number of studies into the benefit and harm of haloperidol discontinuation were available. Moreover, the available studies did not report on outcomes that are important to clinicians and to people with schizophrenia, particularly adverse effects and social outcomes. Better designed trials are warranted.


Assuntos
Antipsicóticos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Haloperidol/efeitos adversos , Adulto , Antipsicóticos/uso terapêutico , Haloperidol/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Esquizofrenia/tratamento farmacológico
9.
J Med Case Rep ; 13(1): 63, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30837005

RESUMO

BACKGROUND: Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes, the most common maternally inherited mitochondrial disease, can present with a wide range of neurological manifestations including both central and peripheral nervous system involvement. The most frequent genetic mutation reported in mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome is A3243G in MT-TL1 gene. Stroke-like episodes, dementia, epilepsy, lactic acidemia, myopathy, recurrent headaches, hearing impairment, diabetes, and short stature constitute the known presentations in this syndrome. Among the abnormal involuntary movements in mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome, myoclonus is the commonest. Other movement disorders, including chorea, are rarely reported in this disorder. CASE PRESENTATION: A 14-year-old South Asian boy from rural Bengal (India), born of a second degree consanguineous marriage, with normal birth and development history, presented with abnormal brief jerky movements involving his trunk and limbs, with recurrent falls for 10 months. We present here a case of heteroplasmic mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome with A3251G mutation, in which the clinical picture was dominated by a host of involuntary abnormal movements including chorea-ballism, myoclonus, and oromandibular dystonia in a backdrop of cognitive decline, seizure, and stroke-like episode. A final diagnosis was established by muscle biopsy and genetic study. Haloperidol was administered to control the involuntary movements along with introduction of co-enzyme Q, besides symptomatic management for his focal seizures. Six months into follow-up his seizures and abnormal movements were controlled significantly with slight improvement of cognitive abilities. CONCLUSION: The dominance of hyperkinetic movements in the clinical scenario and the finding of a point mutation A3251G in MT-TL1 gene make this a rare presentation.


Assuntos
Antidiscinéticos/uso terapêutico , Coreia/diagnóstico , DNA Mitocondrial/genética , Haloperidol/uso terapêutico , Síndrome MELAS/diagnóstico , Mutação Puntual/genética , Adolescente , Coreia/genética , Coreia/fisiopatologia , Testes Genéticos , Humanos , Síndrome MELAS/tratamento farmacológico , Síndrome MELAS/genética , Síndrome MELAS/fisiopatologia , Masculino , Micronutrientes/uso terapêutico , Resultado do Tratamento , Ubiquinona/uso terapêutico
11.
Neuropharmacology ; 150: 1-14, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30831160

RESUMO

Methylazoxymethanol (MAM)-treated pregnant rat at gestation day (GD) 17 has been shown to be a valuable developmental animal model for schizophrenia. Yet, this model remains to be established in mice. In the present study, we examined behavioral, cytoarchitectural, and neurochemical changes in the offspring of MAM-treated mice and validated the model's face, construct and predictive validities. We found that in contrast to a single injection of MAM to dams at GD 15, 16 or 17, its daily administration from GD 15 to 17 led to deficits in prepulse inhibition (PPI) of startle in the post-pubertal offspring. In addition, we observed behavioral deficits in working memory and social interactions, as well as an increase in locomotor activity induced by the NMDA antagonist MK-801 in GD15-17 MAM offspring. These animals also showed a reduction in the volume of the prefrontal cortex (PFC) and hippocampus, neuroanatomical changes such as discontinuities and heterotopias in the hippocampus, and an increase of DA level and DOPAC/DA ratio in the medial PFC. Atypical antipsychotic drugs clozapine, risperidone, and aripiprazole, but not the typical drug haloperidol, reversed the deficit in PPI and social withdrawal in the offspring of MAM-treated dams. In contrast, MK-801-induced hyperactivity in MAM mice was reversed by both and typical or atypical antipsychotic drugs. Taken together, the treatment of pregnant mice with MAM during GD 15-17 offers a new approach to study neurobiological mechanisms involved in the pathogenesis of schizophrenia.


Assuntos
Comportamento Animal/efeitos dos fármacos , Hipocampo/efeitos dos fármacos , Hipocampo/fisiopatologia , Acetato de Metilazoximetanol/administração & dosagem , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Esquizofrenia/fisiopatologia , Animais , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Aripiprazol/farmacologia , Aripiprazol/uso terapêutico , Clozapina/farmacologia , Clozapina/uso terapêutico , Modelos Animais de Doenças , Feminino , Haloperidol/farmacologia , Haloperidol/uso terapêutico , Camundongos , Atividade Motora/efeitos dos fármacos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/tratamento farmacológico , Inibição Pré-Pulso/efeitos dos fármacos , Risperidona/farmacologia , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico
12.
JAAPA ; 32(4): 1-5, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30913155

RESUMO

Cannabis has long been used for medical and recreational purposes because of its antiemetic, analgesic, and mood effects. Ironically, chronic use of cannabis can result in paradoxical effects, including a condition known as cannabinoid hyperemesis syndrome. Patients with this syndrome often are seen in the ED with cyclic vomiting, nausea, and epigastric pain. Although the definitive treatment of cannabinoid hyperemesis syndrome is discontinuing the causative agent, medical management that includes rehydration is important to prevent complications. Common antiemetic medications are ineffective, but some studies have shown haloperidol and lorazepam to be effective in treating acute symptoms.


Assuntos
Canabinoides/efeitos adversos , Náusea/etiologia , Vômito/etiologia , Doença Aguda , Antieméticos/uso terapêutico , Haloperidol/uso terapêutico , Humanos , Lorazepam/uso terapêutico , Náusea/tratamento farmacológico , Síndrome , Vômito/tratamento farmacológico
14.
Eur Psychiatry ; 57: 78-100, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30721802

RESUMO

INTRODUCTION: Non-pharmacological interventions preferably precede pharmacological interventions in acute agitation. Reviews of pharmacological interventions remain descriptive or compare only one compound with several other compounds. The goal of this study is to compute a systematic review and meta-analysis of the effect on restoring calmness after a pharmacological intervention, so a more precise recommendation is possible. METHOD: A search in Pubmed and Embase was done to isolate RCT's considering pharmacological interventions in acute agitation. The outcome is reaching calmness within maximum of 2 h, assessed by the psychometric scales of PANSS-EC, CGI or ACES. Also the percentages of adverse effects was assessed. RESULTS: Fifty-three papers were included for a systematic review and meta-analysis. Most frequent studied drug is olanzapine. Changes on PANNS-EC and ACES at 2 h showed the strongest changes for haloperidol plus promethazine, risperidon, olanzapine, droperidol and aripiprazole. However, incomplete data showed that the effect of risperidon is overestimated. Adverse effects are most prominent for haloperidol and haloperidol plus lorazepam. CONCLUSION: Olanzapine, haloperidol plus promethazine or droperidol are most effective and safe for use as rapid tranquilisation. Midazolam sedates most quickly. But due to increased saturation problems, midazolam is restricted to use within an emergency department of a general hospital.


Assuntos
Ansiolíticos/uso terapêutico , Antipsicóticos/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Agitação Psicomotora/tratamento farmacológico , Transtornos Psicóticos/tratamento farmacológico , Agressão/efeitos dos fármacos , Benzodiazepinas/efeitos adversos , Quimioterapia Combinada , Haloperidol/uso terapêutico , Humanos , Lorazepam/uso terapêutico , Midazolam/uso terapêutico , Olanzapina/uso terapêutico , Prometazina/uso terapêutico , Agitação Psicomotora/psicologia , Transtornos Psicóticos/psicologia , Resultado do Tratamento
15.
Eur J Cancer Care (Engl) ; 28(3): e13019, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30773765

RESUMO

OBJECTIVE: To investigate whether and when palliative sedation was discussed with hospice patients with cancer and/or with their families and factors associated with patient involvement in such discussions. METHODS: Medical records of all patients with cancer who died in an Italian hospice in 2014-2015 (N = 326) were retrospectively reviewed. Multiple logistic regression was used to assess the association between patients' characteristics and palliative sedation discussion with the patient versus palliative sedation discussion only with the family. RESULTS: Palliative sedation discussion was in 51.8% of the cases reported in the record. In most of the cases, discussions were conducted pre-emptively. Palliative sedation was used for 67.3% of the patients who were involved in the discussion and for 32.7% of the patients when the topic was discussed only with the family. Patient involvement in palliative sedation discussions was negatively associated with living with others (OR 0.34, CI 0.15; 0.77), and positively associated with awareness of prognosis (OR 5.61, CI 2.19; 14.33) and days of survival after hospice admission (OR 3.41, CI 1.55; 7.51). CONCLUSION: Policies encouraging patient involvement in palliative care decision-making, including palliative sedation, should be implemented and their adoption should be carefully examined. Prospective studies addressing this topic are needed.


Assuntos
Dispneia/tratamento farmacológico , Família , Hipnóticos e Sedativos/uso terapêutico , Dor/tratamento farmacológico , Cuidados Paliativos/métodos , Participação do Paciente , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Antipsicóticos/uso terapêutico , Delírio/tratamento farmacológico , Feminino , Haloperidol/uso terapêutico , Hospitais para Doentes Terminais , Humanos , Masculino , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Morfina/uso terapêutico , Agitação Psicomotora/tratamento farmacológico
16.
J Emerg Med ; 56(5): 484-490, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30745194

RESUMO

BACKGROUND: Rapid treatment of agitation in the emergency department (ED) is critical to avoid injury to patients and providers. Treatment with intramuscular antipsychotics is often utilized, but there is a paucity of comparative effectiveness evidence available. OBJECTIVE: The purpose of this investigation was to compare the effectiveness of droperidol, olanzapine, and haloperidol for treating agitation in the ED. METHODS: This was a retrospective observational study of adult patients who received intramuscular medication to treat agitation. Patients were classified based on the initial antipsychotic they received. The primary effectiveness outcome was the rate of additional sedation administered (rescue medication) within 1 h. Secondary outcomes included rescue sedation for the entire encounter and adverse events. RESULTS: There were 15,918 patients included (median age 37 years, 75% male). Rescue rates at 1 h were: 547/4947 for droperidol (11%, 95% confidence interval [CI] 10-12%), 988/8825 olanzapine (11%, 95% CI 10-12%), and 390/2146 for haloperidol (18%, 95% CI 17-20%). Rescue rates for the entire ED encounter were: 832/4947 for droperidol (17%, 95% CI 16-18%), 1665/8825 for olanzapine (19%, 95% CI 18-20%), and 560/2146 for haloperidol (26%, 95% CI 24-28%). Adverse events were uncommon: intubation (49, 0.3%), akathisia (7, 0.04%), dystonia (5, 0.03%), respiratory arrest (1, 0.006%), and torsades de pointes (0), with no significant differences between drugs. CONCLUSIONS: Olanzapine and droperidol lead to lower rates of rescue sedation at 1 h and overall, compared with haloperidol. There were no significant differences in major adverse events.


Assuntos
Antipsicóticos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Agitação Psicomotora/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Droperidol/efeitos adversos , Droperidol/uso terapêutico , Serviço Hospitalar de Emergência/organização & administração , Feminino , Haloperidol/efeitos adversos , Haloperidol/uso terapêutico , Humanos , Hipnóticos e Sedativos/farmacologia , Injeções Intramusculares , Masculino , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Minnesota , Olanzapina/efeitos adversos , Olanzapina/uso terapêutico , Estudos Retrospectivos
17.
Riv Psichiatr ; 54(1): 37-39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30760936

RESUMO

In this paper we present the case of a female teenager patient who was diagnosed with bipolar affective disorder and during psychotropic treatment with risperidone, the prolactin levels ranged between 55 ng/mL and 85 ng/mL at monthly repeated dosing. During this period, the patient presented somatic alterations in her state of health. The patient benefited from brain imaging, which revealed that in sella turcica is distinguished a well-defined and relatively homogeneous formation, measuring approximately 11/8 mm, suggestive of a pituitary adenoma. After changing the antipsychotic treatment, the pituitary formation resolved to a subsequent imaging re-evaluation.


Assuntos
Antipsicóticos/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Hiperprolactinemia/induzido quimicamente , Neoplasias Hipofisárias/induzido quimicamente , Prolactinoma/induzido quimicamente , Risperidona/efeitos adversos , Adolescente , Antipsicóticos/uso terapêutico , Transtorno Bipolar/complicações , Clomipramina/uso terapêutico , Substituição de Medicamentos , Feminino , Haloperidol/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Olanzapina/uso terapêutico , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Prolactina/sangue , Prolactinoma/complicações , Prolactinoma/diagnóstico por imagem , Indução de Remissão , Risperidona/uso terapêutico
18.
Early Interv Psychiatry ; 13(3): 589-597, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29498481

RESUMO

AIM: Early clinical response predicts symptomatic remission and recovery in the maintenance treatment phase of first-episode schizophrenia (FES). However, little is known about predictors of symptomatic remission during acute treatment of severely ill patients with FES. Here, we conducted a secondary analysis of our retrospective observational study, which examined response, remission and treatment-resistance rates in seriously ill patients with FES spectrum disorders involuntarily hospitalized and treated with algorithm-based pharmacotherapy. METHODS: We performed a retrospective chart review of 131 involuntarily admitted patients with schizophrenia or schizoaffective disorder. Our algorithm aimed to delay olanzapine treatment, standardize medications and suggest initiation of clozapine after failure of third-line antipsychotic treatment. The duration of each adequate antipsychotic treatment at an optimal dosage was 4 weeks or more. Remission was defined using the symptom-severity component of consensus remission criteria. A logistic regression model was applied to identify significant predictors of remission at discharge. RESULTS: Overall, 74 patients (56%) were in remission at discharge. Non-remitters were hampered from becoming remitters mainly by the presence of negative symptoms. There were no differences in first-line antipsychotics, dosage of antipsychotics at time of response and adherence rates to algorithm-based pharmacotherapy between remitters and non-remitters. Shorter duration of untreated psychosis, favourable early response and less negative symptoms at baseline were identified as independent predictors of remission at discharge. CONCLUSIONS: The importance of early intervention and specific and adequate treatments of negative symptoms is highlighted.


Assuntos
Algoritmos , Antipsicóticos/uso terapêutico , Internação Compulsória de Doente Mental , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Administração Oral , Adulto , Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Clozapina/uso terapêutico , Quimioterapia Combinada , Feminino , Haloperidol/efeitos adversos , Haloperidol/uso terapêutico , Humanos , Injeções Intramusculares , Masculino , Metotrimeprazina/efeitos adversos , Metotrimeprazina/uso terapêutico , Olanzapina/efeitos adversos , Olanzapina/uso terapêutico , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/uso terapêutico , Estudos Retrospectivos , Risperidona/efeitos adversos , Risperidona/uso terapêutico , Esquizofrenia/diagnóstico , Falha de Tratamento , Resultado do Tratamento
19.
Psychosomatics ; 60(1): 18-26, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30181002

RESUMO

BACKGROUND: Although haloperidol is the most widely used drug in the treatment of delirium, evidence on the relevance of atypical antipsychotics (AAPs) is growing. OBJECTIVE: To review the literature on the efficacy and tolerability of AAPs in the treatment of delirium. METHODS: A systematic search of the literature published before April 2018 was performed on PubMed using the following search strings: "Delirium" and "Atypical antipsychotics", "Novel antipsychotics", "New antipsychotics", "Quetiapine", "Olanzapine", "Aripiprazole", "Risperidone", "Paliperidone", "Clozapine", "Asenapine", "Iloperidone", "Amisulpiride", "Ziprasidone", "Zotepine", "Sertindole", "Lurasidone" or "Perospirone". RESULTS: Twelve randomized controlled trials (RCTs) and 22 open trials were considered. Despite an overall lack of large-scale RCTs, there is some evidence supporting the efficacy of olanzapine and quetiapine in placebo controlled trials. In a recent and large RCT in elderly patients, risperidone and/or haloperidol were associated with a significantly worse outcome than placebo. While preliminary, the current comparative studies suggest that haloperidol and the AAPs olanzapine, quetiapine and risperidone are similarly effective, although treatment with AAPs is associated with a reduced incidence of extrapyramidal symptoms. Ziprasidone was not shown to be effective. No RCTs are available for other AAPs. CONCLUSIONS: Although the current evidence of the efficacy and tolerability of AAPs in the treatment of delirium is limited and the heterogeneity of the data precluded a meta-analysis, olanzapine and quetiapine seem to be adequate alternatives to haloperidol, especially in patients who are vulnerable for extrapyramidal symptoms, who require sedation or who have a history of haloperidol intolerance. Evidently, larger-scale RCTs are urgently required.


Assuntos
Antipsicóticos/uso terapêutico , Delírio/tratamento farmacológico , Doenças dos Gânglios da Base/induzido quimicamente , Haloperidol/uso terapêutico , Humanos , Olanzapina/uso terapêutico , Piperazinas/uso terapêutico , Fumarato de Quetiapina/uso terapêutico , Risperidona/uso terapêutico , Tiazóis/uso terapêutico , Resultado do Tratamento
20.
Prehosp Emerg Care ; 23(2): 201-209, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30118360

RESUMO

OBJECTIVE: The goal of this study is to describe complications and outcomes of prehospital ketamine use for agitation as compared to other methods of physical or chemical restraint such as haloperidol plus benzodiazepine or physical restraint only. METHODS: We conducted a single-center retrospective review of patient encounters in which restraint was administered in the prehospital setting. At the beginning of our study window, only physical restraint was available to paramedics managing agitated patients but subsequently, haloperidol and benzodiazepines were introduced, followed by ketamine 2 years later. By comparing patients before and after each transition, we divided subjects into 3 cohorts based on restraint type: physical restraint, haloperidol plus benzodiazepine, and ketamine. Demographic data were collected, and outcome measures included intubation rate, need for additional physical or chemical restraint, emergency department (ED) length of stay, need for hospital admission, and employee injury. RESULTS: Of 214 subjects included in the study, 95 patients were administered ketamine, 68 received haloperidol and benzodiazepine, and 51 were physically restrained. Eleven of the patients (11.6%) who received ketamine were intubated. Compared to patients who received haloperidol plus benzodiazepine, patients who received ketamine were more likely to be intubated (odds ratio [OR] = 8.77, 95% confidence interval [CI], 1.10-69.68) and were more likely to require additional chemical restraint when compared to haloperidol/benzodiazepine or physical restraint only (OR =2.94, 95% CI, 1.49-5.80, and OR =2.15, 95% CI, 1.07-4.31, respectively). There were no differences between the 2 chemical sedation groups in terms of ED length of stay or hospital admission rate. CONCLUSIONS: This study demonstrates a lower intubation rate in patients administered ketamine than prior literature in association with a lower weight-based dosing regimen. Ketamine use was correlated with a higher frequency of intubation and a greater need for additional chemical restraint when compared with other restraint modalities, though exogenous factors such as provider preference may have impacted this result. There was no difference in ED length of stay or admission rate between the ketamine and haloperidol plus benzodiazepine groups. Further prospective study is needed to determine whether there is a subset of patients for whom ketamine would be beneficial compared to other therapies.


Assuntos
Benzodiazepinas/uso terapêutico , Serviços Médicos de Emergência , Haloperidol/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Ketamina/uso terapêutico , Restrição Física , Adulto , Idoso , Anestésicos Dissociativos/uso terapêutico , Antipsicóticos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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