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1.
Psychiatriki ; 32(1): 79-82, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33759811

RESUMO

The COVID-19 outbreak has affected millions of people globally and it also has a huge psychological impact. The objective of this case report is to outline the possible effect of the COVID-19 pandemic to the content of delusions in patients with psychosis. Α 34-year-old male with no history of mental disorder, involuntarily hospitalized due to agitation and aggression towards others, experienced grandiose delusions, referential delusions and delusions of passivity. The content of all his delusions was related to the COVID-19 pandemic. His symptoms were not proven to be caused by any physical condition or substance use disorder. He was prescribed olanzapine 10mg bd and lorazepam 2,5mg td and demonstrated significant improvement with a complete subsidence of his symptoms within a week. He was discharged after a total of 13 days with an ICD-10 diagnosis of brief psychotic disorder. At his 6 months follow-up, he reported no psychiatric symptoms. Existing literature indicates a strong relationship between life experiences and the content of delusions. This case report highlights how the stressful life event of the COVID-19 outbreak affected the content of our patient's delusions.


Assuntos
/psicologia , Delusões/psicologia , Pandemias , Transtornos Psicóticos/psicologia , Adulto , Agressão , Ansiolíticos/uso terapêutico , Antipsicóticos/uso terapêutico , Delusões/tratamento farmacológico , Humanos , Internação Involuntária , Acontecimentos que Mudam a Vida , Lorazepam/uso terapêutico , Masculino , Olanzapina/uso terapêutico , Agitação Psicomotora , Transtornos Psicóticos/tratamento farmacológico , Estresse Psicológico/complicações , Estresse Psicológico/psicologia
3.
Am J Psychiatry ; 178(3): 266-274, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33472389

RESUMO

OBJECTIVE: Treatment of violence in schizophrenia remains a challenging problem, especially in patients with conduct disorder. Previous clinical studies did not select patients on the basis of violence and did not focus on conduct disorder. This study is a head-to-head comparison of clozapine, olanzapine, and haloperidol in the treatment of violent schizophrenia patients with and without conduct disorder. METHODS: Physically assaultive schizophrenia patients (N=99) were randomly assigned to receive clozapine, olanzapine, or haloperidol in a 12-week double-blind trial. They were characterized on the basis of the presence or absence of conduct disorder before age 15. Assaults were recorded; their frequency and severity were scored on the Modified Overt Aggression Scale. Psychiatric symptoms were evaluated through the Positive and Negative Syndrome Scale. RESULTS: Patients with a history of conduct disorder had more frequent and severe assaults than those without conduct disorder during the 12-week trial. Clozapine was superior to haloperidol and olanzapine in reducing assaults; olanzapine was superior to haloperidol. Clozapine's greater antiaggressive efficacy over haloperidol was substantially more pronounced in patients with conduct disorder than in patients without conduct disorder. In patients with conduct disorder, clozapine was four times more likely than haloperidol to result in lower violence; in patients without conduct disorder, it was three times more likely to do so. Olanzapine's superiority over haloperidol was also more pronounced in patients with conduct disorder. CONCLUSIONS: This study is the first to examine the effect of clozapine in violent schizophrenia patients with conduct disorder. When conduct disorder is present, clozapine is the optimal treatment.


Assuntos
Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Transtorno da Conduta/tratamento farmacológico , Haloperidol/uso terapêutico , Olanzapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Violência/prevenção & controle , Adulto , Transtorno da Conduta/complicações , Transtorno da Conduta/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Esquizofrenia/complicações , Violência/psicologia
4.
Neurosci Lett ; 746: 135669, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33485989

RESUMO

This study attempted to analyze the alterations in the mRNA expression levels of autophagy- and apoptosis-related genes in the forkhead box transcription factor O (FOXO) pathway in schizophrenia patients before and after olanzapine treatment. For a total of 32 acute schizophrenic inpatients, clinical data with PANSS were obtained before and after four weeks of olanzapine treatment (mean dose 14.24 ± 4.35 mg/d) along with data from 32 healthy volunteers. The mRNA expression levels of the FOXO pathway genes were measured by real-time qPCR after fasting venous blood was collected and analyzed. The mRNA expression levels of FOXO1, FOXO3A, FASLG, and BCL2L11 were observed to be significantly decreased in acute schizophrenia patients. After four weeks of olanzapine treatment, the expression levels of the first three genes were further reduced, but BCL2L11 expression levels were not significantly changed. The pairwise correlations between the mRNA expression level of FASLG and those of the other three genes were not observed in acute schizophrenia patients, while these relationships were observed in healthy controls. After olanzapine treatment, the FASLG mRNA expression level was restored and exhibited a pairwise correlation with the FOXO3A and BCL2L11 mRNA expression levels but not with the FOXO1 mRNA expression level, and FASLG mRNA expression was also correlated with the duration of the disease. The statuses and correlations of the mRNA expression levels of FOXO pathway-related genes were altered in schizophrenia patients and were affected by olanzapine treatment and the duration of the disease.


Assuntos
Antipsicóticos/uso terapêutico , Apoptose/fisiologia , Autofagia/fisiologia , Fatores de Transcrição Forkhead/biossíntese , Olanzapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Antipsicóticos/farmacologia , Apoptose/efeitos dos fármacos , Autofagia/efeitos dos fármacos , Proteína 11 Semelhante a Bcl-2/biossíntese , Proteína 11 Semelhante a Bcl-2/genética , Proteína Ligante Fas/biossíntese , Proteína Ligante Fas/genética , Feminino , Proteína Forkhead Box O1/biossíntese , Proteína Forkhead Box O1/genética , Proteína Forkhead Box O3/biossíntese , Proteína Forkhead Box O3/genética , Fatores de Transcrição Forkhead/genética , Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Olanzapina/farmacologia , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Esquizofrenia/sangue , Esquizofrenia/genética , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia , Resultado do Tratamento , Adulto Jovem
5.
Expert Rev Clin Pharmacol ; 14(2): 269-279, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33331189

RESUMO

Introduction: Antipsychotics are widely prescribed for patients with schizophrenia. The Brazilian public health system provides these patients free of charge to patients and it is pertinent to evaluate their benefits.Objective: To evaluate the effectiveness of olanzapine and risperidone in the treatment of patients with schizophrenia in the real-world and assessing risk factors for their discontinuation through a national non-concurrent cohort with 16 years of follow-up.Methods: Three SUS administrative databases were integrated by deterministic-probabilistic linkage. After patients were matched (1:1) for psychiatric hospitalization, year of receiving the antipsychotic, sex, and age, considering either olanzapine or risperidone at study entry. Kaplan-Meier was used to estimate the cumulative probabilities of discontinuation of treatment and associated factors were identified. Sensitivity analyses were performed.Results: 3416 pairs of patients were included. Olanzapine had a longer time until discontinuation of treatment (p = 0.021), and risperidone had a higher risk of discontinuation (p = 0.021). Among patients persistent for at least 24 months, there was no statistically significant difference.Conclusion: Olanzapine demonstrated superior real-world effectiveness over risperidone, in terms of survival and psychiatric hospitalization. This superiority was not sustained in all analyses.


Assuntos
Antipsicóticos/uso terapêutico , Olanzapina/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Idoso , Brasil , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Psiquiatr. biol. (Internet) ; 27(3): 122-125, sept.-dic. 2020.
Artigo em Espanhol | IBECS | ID: ibc-198679

RESUMO

OBJETIVO: Embarazo y puerperio son periodos de especial vulnerabilidad en la mujer para presentar trastornos psiquiátricos. Sin embargo, la evidencia es menor respecto a la salud mental del varón, especialmente en relación a episodios de psicosis perinatal. PRESENTACIÓN DEL CASO: Se presenta el caso de un varón de 34 años que experimenta un episodio psicótico breve tras el nacimiento de su hijo. Se inicia tratamiento con olanzapina, consiguiéndose una remisión total de la sintomatología. RESULTADOS: La mayor parte de la literatura se centra en la presentación en la madre, sin considerar que muchos de los factores estresantes psicológicos, sociales y ambientales propios del puerperio están igualmente presentes en el progenitor masculino y pueden desencadenar una psicosis reactiva breve en ambos sexos. CONCLUSIÓN: Si bien se precisan más estudios, sería importante valorar los perfiles de riesgo también en los varones, de forma que se pueda realizar una intervención precoz en caso de psicopatología aguda


OBJECTIVE: Pregnancy and puerperium are periods of special vulnerability in women to present psychiatric disorders. However, the evidence is lower regarding the male mental health, especially in relation to episodes of postpartum psychosis. CASE PRESENTATION: The case is of a 34-year-old male who suffer a brief psychotic episode after the birth of his son. Olanzapine treatment is initiated, obtaining a full symptomatology remission. RESULTS: Most of the literature focuses on the presentation in the mother, without considering that many of the stressful psychological, social and environmental factors of puerperium are equally present in the male and could trigger a brief reactive psychosis in both sexes. CONCLUSION: Although more studies are needed, it would be important to assess risk profiles also in men, in order to perform an early intervention in case of acute psychopathology


Assuntos
Humanos , Masculino , Recém-Nascido , Adulto , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/psicologia , Relações Pai-Filho , Olanzapina/uso terapêutico , Antipsicóticos/uso terapêutico , Acontecimentos que Mudam a Vida
7.
BMJ Open ; 10(12): e041737, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334838

RESUMO

INTRODUCTION: Dexamethasone (DEX) is administered for multiple days to prevent chemotherapy-induced nausea and vomiting for patients receiving highly emetogenic chemotherapy (HEC); however, its notorious side effects have been widely reported. Although our multicentre randomised double-blind comparative study verified non-inferiority of sparing DEX after day 2 of chemotherapy when combined with neurokinin-1 receptor antagonist (NK1-RA) and palonosetron (Palo) for patients receiving HEC regimen, DEX sparing was not non-inferior in patients receiving cisplatin (CDDP)-based HEC regimens in subgroup analysis. Recently, the efficacy of the addition of olanzapine (OLZ) to standard triple antiemetic therapy on HEC has been demonstrated by several phase III trials. This study aims to confirm non-inferiority of DEX sparing when it is combined with NK-1RA, Palo and OLZ in patients receiving CDDP-based HEC regimens. METHODS AND ANALYSIS: This is a randomised, double-blind, phase III trial. Patients who are scheduled to receive CDDP ≥50 mg/m2 as initial chemotherapy are eligible. Patients are randomly assigned to receive either DEX on days 1-4 or DEX on day 1 combined with NK1-RA, Palo and OLZ (5 mg). The primary endpoint is complete response (CR) rate, defined as no emesis and no rescue medications during the delayed phase (24-120 hours post-CDDP administration). The non-inferiority margin is set at -15.0%. We assume that CR rates would be 75% in both arms. Two hundred and sixty-two patients are required for at least 80% power to confirm non-inferiority at a one-sided significance level of 2.5%. After considering the possibility of attrition, we set our final required sample size of 280. ETHICS AND DISSEMINATION: The institutional review board approved the study protocol at each of the participating centres. The trial result will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: UMIN000032269.


Assuntos
Antieméticos/uso terapêutico , Antineoplásicos/efeitos adversos , Cisplatino/efeitos adversos , Antagonistas do Receptor de Neuroquinina-1/uso terapêutico , Olanzapina/uso terapêutico , Palonossetrom/uso terapêutico , Vômito/prevenção & controle , Adulto , Idoso , Dexametasona/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Vômito/induzido quimicamente , Vômito/tratamento farmacológico , Adulto Jovem
8.
J Affect Disord ; 277: 337-340, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32858315

RESUMO

BACKGROUND: In December 2019, the novel coronavirus (SARS-CoV-2) infection was first reported in Wuhan city, central China, which has spread rapidly. The common clinical features of patients with SARS-CoV-2 infection included fever, fatigue, and damage to the respiratory or digestive system. However, it is still unclear whether SARS-CoV-2 infection could cause damage to the central nervous system (CNS) inducing psychiatric symptoms. CASE REPORT: Herein, we present the first case of SARS-CoV-2 infection with manic-like symptoms and describe the diagnosis, clinical course, and treatment of the case, focusing on the identifications of SARS-CoV-2 in the specimen of cerebrospinal fluid (CSF). The patient developed manic-like symptoms when his vital signs recovered on illness day 17. After manic-like attack, the detection of SARS-CoV-2 specific IgG antibody in CSF was positive, while the reverse transcriptase-polymerase chain reaction (RT-PCR) on CSF for the SARS-CoV-2 was negative. The patient received Olanzapine for treatment and his mood problems concurrently improved as indicated by scores of Young Manic Rating Scale (YMRS). LIMITATION: This is a single case report only, and the RT-PCR test for SARS-CoV-2 in CSF was not performed simultaneously when SARS-CoV-2 was positive in samples of sputum and stool. CONCLUSION: This first case of COVID-19 patient with manic-like symptoms highlights the importance of evaluation of mental health status and may contribute to our understanding of potential risk of CNS impairments by SARS-CoV-2 infection.


Assuntos
Transtorno Bipolar/etiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Anticorpos Antivirais/líquido cefalorraquidiano , Antipsicóticos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Transtorno Bipolar/líquido cefalorraquidiano , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Encéfalo/diagnóstico por imagem , Dor no Peito , China , Técnicas de Laboratório Clínico , Cobicistat/uso terapêutico , Infecções por Coronavirus/líquido cefalorraquidiano , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Darunavir/uso terapêutico , Dispneia , Febre , Glucocorticoides/uso terapêutico , Humanos , Indóis/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Olanzapina/uso terapêutico , Pandemias , Faringite , Pneumonia Viral/líquido cefalorraquidiano , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Reação em Cadeia da Polimerase Via Transcriptase Reversa
9.
Expert Opin Pharmacother ; 21(12): 1455-1466, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32633577

RESUMO

INTRODUCTION: Currently conceptualized as an obsessive compulsive and related disorder, trichotillomania, or hair-pulling disorder, is a common illness that causes significant distress or functional impairments in various life domains. Most individuals with trichotillomania also have other comorbid diagnoses. Treating trichotillomania with pharmacotherapy is complicated since there are currently no FDA-approved drugs for its treatment. AREAS COVERED: The databases PubMed, PsychINFO, CINAHL, Evidence-based Medicine Reviews, and Cochrane Database of Systematic Reviews were searched, yielding a total of 10 open trials and 10 controlled trials selected. This review aims to examine pharmacotherapeutic options for the treatment of trichotillomania in adults and makes recommendations for the assessment and management of the disorder. EXPERT OPINION: There is preliminary evidence that clomipramine, olanzapine, and N-acetylcysteine may be effective in cases of trichotillomania, however, given the paucity of controlled studies with large sample sizes, decisions regarding the use of drugs should be made on a case-by-case basis taking into account the severity of trichotillomania and the nature of psychiatric comorbidity.


Assuntos
Acetilcisteína/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Antipsicóticos/uso terapêutico , Clomipramina/uso terapêutico , Olanzapina/uso terapêutico , Tricotilomania/tratamento farmacológico , Adulto , Ensaios Clínicos como Assunto , Comorbidade , Feminino , Humanos , Resultado do Tratamento , Tricotilomania/epidemiologia , Tricotilomania/psicologia
11.
Nord J Psychiatry ; 74(8): 594-601, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32496921

RESUMO

Introduction: Cognitive impairment is a core feature of schizophrenia. The effects of atypical antipsychotics on the cognitive functions of patients with first-episode schizophrenia have not been comprehensively investigated so far. This study aims to compare neurocognitive effects of risperidone, olanzapine, and aripiprazole for first-episode schizophrenia.Methods: The study was a multicenter, randomized, open-label clinical trial. 546 patients were randomly divided into three medication groups, and followed up for 1 year. Cognitive performance was evaluated with a neuropsychological test battery. The Clinical trials.gov ID of the study is NCT01057849.Results: At 6 months, treatment resulted in significant improvements in all three groups in most cognitive domains except verbal learning and memory. At 12 months, three treatment groups had further improvements in three cognitive domains, but visual learning and memory performance dropped back to baseline.Conclusion: All three atypical antipsychotics tested in the study can potentially improve cognitive performance in first-episode schizophrenia, but no significant difference in the degree of improvement was found between drugs.


Assuntos
Antipsicóticos , Esquizofrenia , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Humanos , Olanzapina/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico
12.
BMC Palliat Care ; 19(1): 56, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321488

RESUMO

BACKGROUND: Olanzapine is an atypical antipsychotic that has affinity for many central nervous system receptors. Its efficacy is supported by several studies in the prevention and treatment of chemotherapy-induced nausea and vomiting. No recommendations exist on the antiemetic use of olanzapine in the palliative care setting. The aim of this work is to complete the initial work of Fonte et al. published in 2015, to determine whether the literature supports the use of olanzapine as an antiemetic in palliative situations and, in practice, to propose a therapeutic schema adapted to the palliative setting. METHODS: Systematic review of the literature according to the PRISMA criteria. We searched the PubMed, Cochrane, RefDoc, EMBase databases and the gray literature databases. The bibliographic search was conducted between November 2016 and August 2017. RESULTS: Thirteen articles were included: 2 case studies, 3 case series, 3 retrospective studies, 2 prospective studies, 2 literature reviews. All studies concluded on the efficacy of olanzapine as an antiemetic in the palliative care setting. No serious adverse effects were reported. Based on the data from the literature review, we propose a therapeutic scheme adapted to the palliative care context. CONCLUSION: Action of olanzapine on many receptors and its tolerance profile make it an interesting antiemetic treatment in palliative medicine. But to date, studies are scarce and have a low statistical power. Further investigation is therefore needed to determine the benefit of this treatment in palliative care patients, compared to usual treatments.


Assuntos
Antieméticos/uso terapêutico , Olanzapina/normas , Medicina Paliativa/instrumentação , Antieméticos/normas , Antipsicóticos/normas , Antipsicóticos/uso terapêutico , Humanos , Náusea/tratamento farmacológico , Náusea/prevenção & controle , Olanzapina/uso terapêutico , Medicina Paliativa/métodos , Medicina Paliativa/tendências , Vômito/tratamento farmacológico , Vômito/prevenção & controle
14.
Psychiatr Danub ; 32(1): 84-91, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32303037

RESUMO

BACKGROUND: Symptomatic remission is an achievable goal in the treatment of schizophrenia. The type of antipsychotic medication and particular genetic variants of the dopaminergic system might be associated with remission. Potential pharmacogenetic markers of the treatment response to antipsychotic medication are missing. This study assessed the possible association between dopamine receptor type 2 (DRD2 rs1800497) and dopamine transporter (DAT1 rs28363170) gene variants with symptomatic remission in schizophrenia. SUBJECTS AND METHODS: Olanzapine (5-20 mg/d) monotherapy was administered for 6 months to 150 male Caucasian subjects with schizophrenia. Remission was evaluated according to "Remission in Schizophrenia Working Group" criteria. Genotyping was performed by PCR-RFLP. RESULTS: Symptomatic remission was found in 31% of patients. DRD2 rs1800497 and DAT1 rs28363170 gene variants were not significantly associated with symptomatic remission. The limitations are a relatively small sample size of patients with schizophrenia (N=150), especially of group with symptomatic remission (N=45). However, the study had moderate but adequate sample sizes for most of the comparisons. Only two dopaminergic polymorphisms were analyzed, and plasma concentration of olanzapine was not determined. CONCLUSION: These results revealed a lack of association between DRD2 rs1800497 and DAT1 rs28363170 genetic variants and symptomatic remission in male patients treated with olanzapine, suggesting that these genetic variants could not be used to predict symptomatic remission to olanzapine monotherapy. Negative results should be further confirmed or rejected in the larger samples, including haplotype analyses, to detect clinically useful and easy obtainable pharmacogenetic markers that might predict therapeutic response or remission in schizophrenia.


Assuntos
Antipsicóticos/uso terapêutico , Proteínas da Membrana Plasmática de Transporte de Dopamina/genética , Mutação , Olanzapina/administração & dosagem , Olanzapina/uso terapêutico , Receptores de Dopamina D2/genética , Esquizofrenia/tratamento farmacológico , Esquizofrenia/genética , Adulto , Antipsicóticos/administração & dosagem , Grupo com Ancestrais do Continente Europeu/genética , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
16.
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
17.
Anesthesiology ; 132(6): 1419-1428, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32229754

RESUMO

BACKGROUND: Postdischarge nausea and vomiting after ambulatory surgery is a common problem that is not adequately addressed in current practice. This prospective, randomized, double-blind, parallel-group, placebo-controlled study was designed to test the hypothesis that oral olanzapine is superior to placebo at preventing postdischarge nausea and vomiting. METHODS: In a single-center, double-blind, randomized, placebo-controlled trial, the authors compared a single preoperative dose of olanzapine 10 mg to placebo, in adult female patients 50 years old or less, undergoing ambulatory gynecologic or plastic surgery with general anesthesia. All patients received standard antiemetic prophylaxis with dexamethasone and ondansetron. The primary composite outcome was nausea and/or vomiting in the 24 h after discharge. Secondary outcomes included severe nausea, vomiting, and side effects. RESULTS: A total of 140 patients were randomized and evaluable. The primary outcome occurred in 26 of 69 patients (38%) in the placebo group and in 10 of 71 patients (14%) in the olanzapine group (relative risk, 0.37; 95% CI, 0.20 to 0.72; P = 0.003). Severe nausea occurred in 14 patients (20%) in the placebo group and 4 patients (6%) in the olanzapine group (relative risk, 0.28; 95% CI, 0.10 to 0.80). Vomiting occurred in eight patients (12%) in the placebo group and two patients (3%) in the olanzapine group (relative risk, 0.24; 95% CI, 0.05 to 1.10). The median score for sedation (scale 0 to 10, with 10 being highest) in the 24 h after discharge was 4 (interquartile range, 2 to 7) in the placebo group and 6 (interquartile range, 3 to 8) in the olanzapine group (P = 0.023). CONCLUSIONS: When combined with ondansetron and dexamethasone, the addition of olanzapine relative to placebo decreased the risk of nausea and/or vomiting in the 24 hafter discharge from ambulatory surgery by about 60% with a slight increase in reported sedation.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Antieméticos/uso terapêutico , Olanzapina/uso terapêutico , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Adulto , Método Duplo-Cego , Feminino , Humanos , Alta do Paciente , Náusea e Vômito Pós-Operatórios/prevenção & controle , Estudos Prospectivos , Resultado do Tratamento
18.
Psiquiatr. biol. (Internet) ; 27(1): 3-8, ene.-abr. 2020. ilus, tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-193254

RESUMO

INTRODUCCIÓN: Actualmente disponemos de un amplio abanico de antipsicóticos para el tratamiento de las psicosis, pero a excepción de la clozapina en pacientes resistentes, las guías clínicas no aclaran qué antipsicótico ha de prescribirse en primer lugar. Teniendo en cuenta la eficacia contrastada de olanzapina y su perfil de efectos secundarios, existe un interés en investigar su patrón de prescripción en nuestro país y sus factores asociados. MATERIAL Y MÉTODOS: Se administró una encuesta autoaplicada de 62 ítems, de carácter anónimo y voluntario, a 118 psiquiatras del territorio nacional. RESULTADOS: El perfil más frecuente entre los participantes fue el de un psiquiatra de entre 30-50 años que trabajaba en un centro de salud mental (76%). Respecto a los patrones generales de prescripción, la eficacia fue lo más valorado a la hora de elegir un antipsicótico. El uso de una combinación de antipsicóticos fue reportado por el 95% de los encuestados y la formulación preferida fue la oral. Olanzapina fue seleccionada como el antipsicótico con mayor adherencia y eficacia. El motivo del uso más señalado fueron los primeros episodios psicóticos en un 32%, siendo la dosis más utilizada la de 10 mg/día. Se prefiere olanzapina especialmente en cuadros con elevada agitación y síntomas psicóticos acusados. El aumento de peso y el síndrome metabólico son los efectos adversos que más motivan al facultativo a descartar olanzapina como tratamiento. CONCLUSIONES: Este estudio constató la relevancia de la eficacia a la hora de elegir un tratamiento antipsicótico. La muestra encuestada percibe la olanzapina como un fármaco efectivo, de uso habitual y especialmente útil para determinados perfiles clínicos


INTRODUCTION: Although there is a wide range of antipsychotic drugs currently available for the treatment of psychiatric disorders, apart from clozapine in resistant patients, the clinical guidelines are not clear on which antipsychotic drug should be prescribed in the first place. Taking into account the known efficacy of olanzapine and its side-effects profile, it would be of interest to study its prescription pattern as well as its associated factors in this country. MATERIAL AND METHODS: A self-administered, 62-item questionnaire was anonymously and voluntarily completed by 118 psychiatrists from all over the country. RESULTS: The most common profile of the participants was a psychiatrist of 30-50 years that worked in a mental health centre (76%). As regards the general prescribing patterns, efficacy was the most valued when choosing an antipsychotic drug. The use of a combination of antipsychotic drugs was reported by 95% of those that completed the questionnaire, and the preferred administration route was oral. Olanzapine was chosen as the antipsychotic drug with greater adherence and efficacy. The most stated reason for use was for the first psychotic episodes in 32%, with 10 mg/day being the dose most used. Olanzapine was preferred particularly in clinical pictures with increased agitation and marked psychotic symptoms. An increase in weight and metabolic syndrome are the side-effects that most motivate the psychiatrist to rule out olanzapine as a treatment. CONCLUSIONS: This study shows the importance of efficacy when choosing antipsychotic treatment. The surveyed sample perceived olanzapine as an effective drug, in routine use, and especially useful for certain clinical profiles


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Olanzapina/uso terapêutico , Antipsicóticos/uso terapêutico , Padrões de Prática Médica , Psiquiatria/estatística & dados numéricos , Transtornos Psicóticos/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde
19.
Am J Trop Med Hyg ; 102(5): 1030-1032, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32067632

RESUMO

The post-malaria neurological syndrome (PMNS) is an unusual and relatively underreported complication of malaria, which usually occurs after the resolution of acute febrile illness and the patient is free from parasitemia. The clinical spectrum of the PMNS varies from acute-onset cerebellar ataxia to significant encephalopathy with focal deficits resembling acute disseminated encephalomyelitis. Uncommon presentations of PMNS include Guillain-Barre syndrome, postural tremor, or even isolated neuropsychiatric features. Although in a significant proportion of PMNS cases clinical resolution occurs with conservative treatment only, corticosteroids have been used in an attempt to hasten recoveries. Here, we present a case of a 12-year-old girl with acute onset, isolated neuropsychiatric features, following Plasmodium falciparum malaria. Neuroimaging, clinical examination, and cerebrospinal fluid studies were within normal limits. The child recovered completely after treatment with methylprednisolone pulse therapy. This case report illustrates the need for creating awareness about this uncommon complication of malaria. In view of the uncommon complication, early diagnosis and prompt treatment might help in the early resolution of symptoms.


Assuntos
Encefalopatias/parasitologia , Malária Falciparum/complicações , Encefalopatias/diagnóstico por imagem , Encefalopatias/etiologia , Encefalopatias/terapia , Criança , Feminino , Humanos , Metilprednisolona/uso terapêutico , Neuroimagem , Olanzapina/uso terapêutico , Plasmodium falciparum
20.
PLoS One ; 15(2): e0228648, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017792

RESUMO

BACKGROUND: Antipsychotic medication, stress, gender, and age are factors that influence prolactin levels in patients with psychosis. The aim of the study was to investigate the level of prolactin response to antipsychotic treatment in acute patients, taking into account the total duration of psychosis. METHODS AND FINDINGS: The study was conducted on 170 acute patients with schizophrenia spectrum disorders and bipolar disorder. Subjects were divided into three subgroups according to the duration of the psychosis (less than 5 years, between 5 and 10 years and more than 10 years of disorder duration). The initial prolactin response under antipsychotic treatment was measured, while the severity of the psychiatric symptoms was assessed with the BPRS (Brief Psychiatric Rating Scale). Hyperprolactinemia was found in 120 (70.6%) patients, amongst which 80 (66.7%) were females and 40 (33.3%) were males. The average increase in prolactinemia was 2.46 times the maximum value in women, and 1.59 times in men. Gender (ß = 0.27, p<0.0001), type of antipsychotic medication according to potency of inducing hyperprolactinemia (ß = -0.23, p<0.003), and the duration of psychosis over 10 years (ß = -0.15, p = 0.04) significantly predicted prolactin levels, when age, diagnosis, antipsychotic category (conventional/atypical/combinations of antipsychotics), and BPRS total scores were controlled for. CONCLUSIONS AND RELEVANCE: Prolactin levels in patients treated with antipsychotic medication appeared to depend on patients' gender, on the type of antipsychotic medication according to potency of inducing hyperprolactinemia, and on the duration of the psychosis. An increase in prolactin levels was associated with female gender, while the use of prolactin sparing antipsychotics and a duration of psychosis over 10 years were associated with lower prolactin levels.


Assuntos
Antipsicóticos/farmacologia , Hiperprolactinemia/etiologia , Prolactina/efeitos dos fármacos , Transtornos Psicóticos/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Benzodiazepinas/efeitos adversos , Benzodiazepinas/uso terapêutico , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Hiperprolactinemia/diagnóstico , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Olanzapina/efeitos adversos , Olanzapina/uso terapêutico , Prolactina/sangue , Transtornos Psicóticos/complicações , Risperidona/efeitos adversos , Risperidona/uso terapêutico , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológico , Fatores Sexuais , Fatores de Tempo
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