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1.
Nervenarzt ; 91(1): 34-42, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31919550

RESUMO

BACKGROUND: Schizophrenia is a severe psychiatric disorder with variable therapeutic responses, the etiology and pathophysiology of which require further elucidation. OBJECTIVE: To review which pharmacological options are effective and safe and for which treatment goals in schizophrenia. MATERIAL AND METHODS: Narrative review of the pharmacological therapy of adults diagnosed with schizophrenia. RESULTS: Despite heterogeneous therapeutic responses, to date only dopamine antagonists or partial agonists are approved for the treatment of schizophrenia. The efficacy of antipsychotic agents differs only gradually, with the exception of clozapine for treatment-resistant schizophrenia, whereas undesired adverse effects are more variable. Those antipsychotic agents that show gradual efficacy advantages in meta-analyses of acute and maintenance treatment (clozapine, amisulpride, olanzapine, risperidone) are also those where at least one undesired adverse effect is most severely expressed. Antipsychotic adverse effects occur in subgroups of patients and are generally tolerable or treatable, whereas the "side effect" of untreated schizophrenia affects almost all patients, including relapses, psychosocial deterioration, secondary treatment resistance and increased mortality. Therefore, in patients with a confirmed diagnosis of schizophrenia, a lifelong continuous therapy is currently most likely indicated, ideally with antipsychotic agents for which adherence is directly measurable and improved. In the case of treatment resistant clozapine is the agent of choice, followed by electroconvulsive therapy, which also has the best evidence as augmentation treatment in cases of clozapine resistance. CONCLUSION: New therapeutic agents with improved efficacy and tolerability as well as effectiveness for negative symptoms and cognitive disturbance are needed.


Assuntos
Antipsicóticos , Esquizofrenia , Adulto , Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Humanos , Olanzapina/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico
2.
Postgrad Med ; 132(1): 80-90, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31813311

RESUMO

Objective: Based on a substantial literature, olanzapine appears to be one of the most efficacious antipsychotics marketed in the United States, with only clozapine clearly more advantageous. However, olanzapine is marred by an equally substantial literature demonstrating a metabolic burden of olanzapine, particularly for weight gain. With the publication of successful strategies to limit olanzapine induced weight gain, a reassessment of the clinical utility of olanzapine appears warranted. The purpose of this paper is to review recent evidence for olanzapine, highlighting use in both schizophrenia and other conditions, safety and supporting the use of olanzapine above 20 mg/day, focusing on studies published since our previous reviews in 2008 and 2009.Data Sources: The US National Library of Medicine's PubMed resource (https://www.ncbi.nlm.nih.gov/pubmed/) was searched using the text word 'olanzapine' for all English-language articles published between 2008 to July 2019, inclusive with a specific focus on double-blind randomized controlled trials and meta-analyses. In addition, we examined the review articles for other reports of interest that may have been missed by our initial search.Data Extraction: The studies were evaluated based on efficacy and safety data.Results: Use of olanzapine may be decreasing but remains common overall. Evidence continues to support both the relative efficacy advantage and weight gain/metabolic disadvantages of olanzapine in schizophrenia, and recent research supports olanzapine's use in treating anorexia nervosa and chemotherapy-induced nausea. The evidence for high dose olanzapine dosages >20 mg remains limited. Non-pharmacological options, such as dietary counseling and exercise, appear to be efficacious in addressing antipsychotic-induced weight gain. Topiramate, metformin and possibly the olanzapine-samidorphan combination also appear helpful.Conclusions: Olanzapine remains a useful antipsychotic, but requires with careful monitoring. Further research is needed to compare the different options available to mitigate olanzapine-induced weight gain and to evaluate potential synergism between pharmacological and non-pharmacological treatments.


Assuntos
Antipsicóticos/uso terapêutico , Olanzapina/uso terapêutico , Anorexia Nervosa/tratamento farmacológico , Antipsicóticos/administração & dosagem , Humanos , Náusea/tratamento farmacológico , Olanzapina/administração & dosagem , Esquizofrenia/tratamento farmacológico
4.
Medicine (Baltimore) ; 98(38): e17237, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567988

RESUMO

INTRODUCTION: With the second-generation antipsychotics (SGAs) widely applied to treat patients with schizophrenia, adverse effects, especially the metabolic syndrome (MetS), were paid more attention following by the efficacy of SGAs. Several studies have suggested that acupuncture could be an effective and safe intervention for MetS. Here, we present a study protocol to investigate the effect of electroacupuncture on MetS due to olanzapine and risperidone. METHODS: This study is a prospective, randomized, single-centered, patient-assessor-blinded, parallel-controlled clinical pilot trial. In all, 36 patients will be randomized to an experimental group or control group by a 1:1 ratio. All patients will receive lifestyle interventions. The experimental group will receive electroacupuncture treatment. The control group will receive sham electroacupuncture treatment. The primary outcomes are body mass index (BMI) and waist circumference (WC). The secondary outcome measures include blood pressure (BP), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), leptin, and adiponectin. We will assess at baseline, 8 weeks after intervention and at the end of 3 months' follow-up. DISCUSSION: The results of this trial are expected to provide data on the efficacy and safety of electroacupuncture on MetS due to olanzapine and risperidone, and potential biochemical mechanism.


Assuntos
Antipsicóticos/efeitos adversos , Eletroacupuntura , Síndrome Metabólica/terapia , Olanzapina/efeitos adversos , Risperidona/efeitos adversos , Antipsicóticos/uso terapêutico , Protocolos Clínicos , Eletroacupuntura/efeitos adversos , Eletroacupuntura/métodos , Humanos , Síndrome Metabólica/induzido quimicamente , Olanzapina/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico
5.
Actas esp. psiquiatr ; 47(5): 190-201, sept.-oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185171

RESUMO

El trastorno esquizoafectivo (TEA) es un trastorno psicótico que ha entrañado cierta controversia nosológica, junto a esta dificultad encontramos muy pocos estudios que aborden su tratamiento como una entidad diferente a la esquizofrenia. Estas dos dificultades dan como resultado la falta de evidencia específica sobre el tratamiento. Actualmente, el mismo, se basa principalmente en el empleo de antipsicóticos, aunque no existen guías específicas de manejo terapéutico. Esta revisión tiene el objetivo de conocer cuáles son los fármacos que actualmente cuentan con estudios de mayor calidad científica que avalen su empleo según variables clínicas de efectividad, seguridad, adherencia y tolerancia, así como su papel en los diferentes subtipos de TEA y situaciones clínicas. Para ello, se realizó una revisión exhaustiva de estudios experimentales y observacionales que incluyeran pacientes con diagnóstico de TEA. Se concluyó que son necesarios más ensayos clínicos realizados en pacientes con diagnóstico exclusivo de TEA. La paliperidona, el único fármaco con uso autorizado en el TEA es el fármaco que cuenta con mayor cantidad y calidad de estudios que avalen su uso. Risperidona, olanzapina, aripiprazol y ziprasidona también tienen ensayos clínicos aleatorizados que apoyan su eficacia y seguridad. En pacientes refractarios, hay estudios observacionales que señalan la utilidad de la clozapina. Así mismo, hay evidencia de estudios observacionales que señalan la utilidad de litio y carbamazepina durante la fase de mantenimiento. Es necesario establecer el papel del tratamiento combinado con regula-dores del humor y/o antidepresivos


Schizoaffective disorder (SAD) is a psychotic disorder which has presented a certain nosological controversy. Apart from these difficulties, very few studies focused in SAD as a distinct condition from schizophrenia have been found. This lack of specifical studies on SAD results in a lack of specific evidence about treatment. Currently, its treatment is based mainly on the use of antipsychotics, although there are no specific treatment guidelines for SAD. The objective of this review is to establish which are the most recommended treatments according to evidence avail-able, considering clinical variables such as efficacy, safety, adherence, and tolerance as well as the role of these factors in different subtypes of SAD. This exhaustive review exam-ines experimental and observational studies involving patients with a diagnosis of SAD. It was concluded that more clinical trials performed exclusively on patients affected by SAD are needed. Paliperidone, the only drug with authorized use in SAD, is the one that has the highest quality of studies to support its use. Risperidone, olanzapine, aripiprazole and ziprasidone also have randomized clinical trials supporting their efficacy and safety. In treatment-refractory patients, there are observational studies indicating the usefulness of clozapine. Like-wise, there is evidence from observational studies showing the usefulness of lithium and carbamazepine during the treatment maintenance phase. It is necessary to establish the role of combined treatment with mood stabilizers and/or antidepressants


Assuntos
Humanos , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Psicofarmacologia , Resultado do Tratamento , Medicina Baseada em Evidências , Transtornos Psicóticos/tratamento farmacológico , Risperidona/uso terapêutico , Olanzapina/uso terapêutico , Aripiprazol/uso terapêutico , Clozapina/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico
6.
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
7.
JAMA ; 322(7): 622-631, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429896

RESUMO

Importance: Psychotic depression is a severely disabling and potentially lethal disorder. Little is known about the efficacy and tolerability of continuing antipsychotic medication for patients with psychotic depression in remission. Objective: To determine the clinical effects of continuing antipsychotic medication once an episode of psychotic depression has responded to combination treatment with an antidepressant and antipsychotic agent. Design, Setting, and Participants: Thirty-six week randomized clinical trial conducted at 4 academic medical centers. Patients aged 18 years or older had an episode of psychotic depression acutely treated with sertraline plus olanzapine for up to 12 weeks and met criteria for remission of psychosis and remission or near-remission of depressive symptoms for 8 weeks before entering the clinical trial. The study was conducted from November 2011 to June 2017, and the final date of follow-up was June 13, 2017. Interventions: Participants were randomized either to continue olanzapine (n = 64) or switch from olanzapine to placebo (n = 62). All participants continued sertraline. Main Outcomes and Measures: The primary outcome was risk of relapse. Main secondary outcomes were change in weight, waist circumference, lipids, serum glucose, and hemoglobin A1c (HbA1c). Results: Among 126 participants who were randomized (mean [SD] age, 55.3 years [14.9 years]; 78 women [61.9%]), 114 (90.5%) completed the trial. At the time of randomization, the median dosage of sertraline was 150 mg/d (interquartile range [IQR], 150-200 mg/d) and the median dosage of olanzapine was 15 mg/d (IQR, 10-20 mg/d). Thirteen participants (20.3%) randomized to olanzapine and 34 (54.8%) to placebo experienced a relapse (hazard ratio, 0.25; 95% CI, 0.13 to 0.48; P < .001). The effect of olanzapine on the daily rate of anthropometric and metabolic measures significantly differed from placebo for weight (0.13 lb; 95% CI, 0.11 to 0.15), waist circumference (0.009 inches; 95% CI, 0.004 to 0.014), and total cholesterol (0.29 mg/dL; 95% CI, 0.13 to 0.45) but was not significantly different for low-density lipoprotein cholesterol (0.04 mg/dL; 95% CI, -0.01 to 0.10), high-density lipoprotein cholesterol (-0.01 mg/dL; 95% CI, -0.03 to 0.01), triglyceride (-0.153 mg/dL; 95% CI, -0.306 to 0.004), glucose (-0.02 mg/dL; 95% CI, -0.12 to 0.08), or HbA1c levels (-0.0002 mg/dL; 95% CI, -0.0021 to 0.0016). Conclusions and Relevance: Among patients with psychotic depression in remission, continuing sertraline plus olanzapine compared with sertraline plus placebo reduced the risk of relapse over 36 weeks. This benefit needs to be balanced against potential adverse effects of olanzapine, including weight gain. Trial Registration: ClinicalTrials.gov Identifier: NCT01427608.


Assuntos
Transtornos Psicóticos Afetivos/tratamento farmacológico , Antipsicóticos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Olanzapina/uso terapêutico , Adolescente , Adulto , Idoso , Antidepressivos/uso terapêutico , Antipsicóticos/efeitos adversos , Transtorno Depressivo Maior/psicologia , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Olanzapina/efeitos adversos , Modelos de Riscos Proporcionais , Prevenção Secundária , Sertralina/uso terapêutico , Adulto Jovem
8.
Psiquiatr. biol. (Internet) ; 26(2): 45-51, mayo-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185028

RESUMO

La olanzapina es un antipsicótico comúnmente utilizado como tratamiento de enfermedades como la esquizofrenia y el trastorno bipolar. En ocasiones la manifestación de la enfermedad difiere entre sexos, pero poco se ha investigado sobre la influencia de esta diferencia biológica en la respuesta al tratamiento o en los efectos secundarios. En esta revisión sistemática analizamos estas diferencias de sexo en la efectividad y en los efectos adversos de la olanzapina. Aunque algunos estudios mostraron mayor efectividad en mujeres, este resultado es ambiguo al no encontrar diferencias en otros trabajos. Por otro lado, encontramos mayor tendencia de los hombres a la ganancia de peso y al parkinsonismo, mientras que más mujeres experimentaron mareos, mayor aumento del colesterol y del intervalo QT. Dado el amplio uso a nivel mundial de la olanzapina, es importante realizar futuros estudios analizando las diferencias observadas, ya que podrían ser cruciales para mejorar la calidad de vida de los pacientes


Olanzapine is an antipsychotic drug commonly used in the treatment of illnesses such as schizophrenia and bipolar disorder. Occasionally the manifestation of the illness differs between genders, but little has been investigated on the influence of this biological difference in the response to the treatment or the secondary effects. In this systematic review, an analysis is made of these gender differences on the effectiveness and adverse effects of olanzapine treatment. Although some studies showed a higher effectiveness in women, this was ambiguous due to not finding any differences in other works. On the other hand, there was a greater tendency for men to gain weight and suffer from Parkinson symptoms, while the women were more likely to suffer from dizzy spells, a greater increase in cholesterol, and in QT interval. Given the worldwide use of olanzapine, it is important that further studies should be performed to analyse these differences observed, since they could be crucial for improving the quality of life of the patients


Assuntos
Humanos , Olanzapina/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Transtornos Psicóticos/tratamento farmacológico , Distribuição por Sexo , Antipsicóticos/uso terapêutico , Olanzapina/efeitos adversos
9.
Psiquiatr. biol. (Internet) ; 26(2): 60-61, mayo-ago. 2019.
Artigo em Espanhol | IBECS | ID: ibc-185031

RESUMO

Introducción: Además de agranulocitosis, el tratamiento con clozapina se asocia con eosinofilia. Aunque es un efecto secundario poco conocido, tiene una incidencia similar a la primera y además es potencialmente grave, ya que puede afectar a órganos diana como el hígado. Presentación del caso: Varón con sintomatología psicótica que tras varias semanas de ingreso comienza tratamiento con clozapina por la falta de respuesta farmacológica. Coincidiendo con el inicio de la misma presenta eosinofilia junto con un aumento de las enzimas hepáticas que alcanzan niveles tóxicos, por lo que se procede a su retirada. Discusión: La eosinofilia inducida por la clozapina puede ser periférica y benigna o puede infiltrar órganos diana como el hígado, desencadenando una hepatitis potencialmente mortal. Conclusiones: A pesar de que la hepatitis secundaria al tratamiento con clozapina puede ser fulminante, los controles seriados de las enzimas hepáticas no se incluyen en el protocolo de seguimiento de dicho tratamiento


Introduction: In addition to agranulocytosis, treatment with clozapine is associated with eosinophilia. Although it is a little-known side effect, it has an incidence similar to the former, and is also potentially serious, since it can affect target organs, such as the liver. Presentation of the case: A male with psychotic symptoms, on whom, after several weeks in hospital, it was decided to start clozapine due to the lack of pharmacological response. Coinciding with starting the drug, he presented with eosinophilia, as well as increased liver enzymes that reached toxic levels. The drug was then withdrawn. Discussion: Eosinophilia induced by clozapine may be peripheral and benign, or it may infiltrate target organs such as the liver, triggering potentially life-threatening hepatitis. Conclusions: Although hepatitis secondary to treatment with clozapine may be fulminant, serial liver enzyme tests are not included in the follow-up protocol for this treatment


Assuntos
Humanos , Masculino , Eosinofilia/induzido quimicamente , Clozapina/efeitos adversos , Transtornos Psicóticos/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/complicações , Olanzapina/uso terapêutico , Substituição de Medicamentos/métodos , Testes de Função Hepática/estatística & dados numéricos , Ensaios Enzimáticos/métodos
11.
Med. clín (Ed. impr.) ; 153(2): 70-77, jul. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183367

RESUMO

El estado de mal epiléptico (EE) es una emergencia neurológica que requiere tratamiento urgente con terapias antiepilépticas, y un rápido tratamiento de su causa. En los últimos años se ha actualizado su definición para adaptarla a todos los tipos de EE y estandarizar el tratamiento. La nueva definición se basa en 2 tiempos: un tiempo t1 tras el cual una crisis no cede espontáneamente, y un tiempo t2 tras el que aparece daño neuronal. En el tratamiento hay 3 líneas: la primera son las benzodiacepinas; la segunda línea de tratamiento, los fármacos antiepilépticos; y una tercera, los anestésicos intravenosos. La aplicación de las diferentes líneas de tratamiento plantea cuestiones aún sin responder, ya que el pronóstico depende también de la etiología y la edad; por este motivo se están desarrollando diferentes escalas pronósticas con el fin de ayudarnos a prever la evolución y, por tanto, adaptar la agresividad del tratamiento a cada paciente


Status epilepticus (SE) is a neurological emergency that requires urgent antiepileptic therapies, and a rapid treatment of its cause. In recent years, its definition has been updated to adapt it to all types of SE; this update helps to standardise the treatment. The new definition is based on two times: point t1, after which the event will not spontaneously cease, and period t2, after which neuronal damage may appear. There are three lines of treatment: first, benzodiazepines; second, antiepileptic drugs; and third, intravenous anaesthetics. The application of the different lines of treatment raises still unanswered questions, since the prognosis also depends on the aetiology, age and duration. For this reason, different prognostic scales are being developed to help us to assess its evolution and in turn, adapt the aggressiveness of the treatment to each patient


Assuntos
Humanos , Criança , Adulto , Epilepsia/etiologia , Epilepsia/terapia , Anticonvulsivantes/uso terapêutico , Olanzapina/uso terapêutico , Epilepsia/classificação
13.
J Clin Psychopharmacol ; 39(4): 305-311, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205195

RESUMO

BACKGROUND: Atypical antipsychotics are used for the treatment of acute mania, either as monotherapy or in combination with lithium or divalproex, which have a better tolerability profile as compared with typical antipsychotics. Asenapine, a newer atypical antipsychotic, has been found to be effective for the treatment of mania, with efficacy similar to olanzapine. The objective of the study was to compare the efficacy and safety of asenapine and olanzapine when used in combination with divalproex in patients with acute mania. METHODS: One hundred twenty patients aged 18 to 55 years, diagnosed with manic episode, were randomized to receive either flexible dose of sublingual asenapine (10-20 mg/d) or tablet olanzapine (10-20 mg/d), in combination with valproate 20 mg/kg per day for a period of 6 weeks. Efficacy was measured as change in Young Mania Rating Scale and Clinical Global Impression-Bipolar using intention-to-treat analysis with last observation carried forward, and safety was measured using Udvalg for Kliniske Undersøgelser scale and Modified Simpson-Angus Extrapyramidal Side Effects Scale. RESULTS: There was a significant reduction in Young Mania Rating Scale and Clinical Global Impression-Bipolar scores over time in both groups, with a significantly higher reduction in the olanzapine group as shown by the group × time interaction effect. Higher weight gain, increased sleep and appetite, and tremors were seen in the olanzapine-treated patients as compared with asenapine-treated patients; however, tongue hypesthesia was seen in the asenapine group only. CONCLUSIONS: This study found that asenapine was an effective and well-tolerated atypical antipsychotic alternative to olanzapine in combination with divalproex for the short-term management of acute mania.


Assuntos
Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Olanzapina/uso terapêutico , Ácido Valproico/uso terapêutico , Adolescente , Adulto , Antropometria , Benzodiazepinas/efeitos adversos , Combinação de Medicamentos , Feminino , Compostos Heterocíclicos de 4 ou mais Anéis/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Olanzapina/efeitos adversos , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Ganho de Peso
14.
Medicina (Kaunas) ; 55(5)2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31108997

RESUMO

Background and Objectives: The use of the dopamine-partial agonist subclass (also termed dopamine stabilizers) of atypical antipsychotics for the treatment of negative schizophrenia symptoms and some mood disorders has increased recently. Similar to other second-generation antipsychotics (SGAs), aripiprazole (ARI) and cariprazine (CAR) also influence food intake, but the peripheral effects of these drugs on adipose-tissue homeostasis, including adipokine secretion as well as lipo- and adipogenesis, are not fully elucidated. In this study, we explored the adipocyte-related mechanisms induced by second-generation antipsychotics (SGAs), leading to changes in peripheral signals involved in energy homeostasis. Materials and Methods: CAR, a new SGA, was compared with ARI and olanzapine (OLA), using cell cultures to study adipogenesis, and the expression levels of peroxisome proliferator-activated receptor-γ (PPAR-γ) was measured in adipocytes derived from mouse fibroblasts, by western blotting on days 7, 14, and 21 postinduction. The triglyceride (TG) content of the cells was also evaluated on day 15 using Oil Red O staining, and the adiponectin (AN) content in the cell culture supernatants was quantified on days 7 and 15 by enzyme-linked immunosorbent assay. Cells were treated with two concentrations of ARI (0.5 and 20 µg/mL), OLA (1 and 20 µg/mL), and CAR (0.1 and 2 µg/mL). Results: Both concentrations of ARI and OLA, as well as the lower concentration of CAR, significantly increased the TG contents. The AN levels in the supernatants were significantly increased by the higher concentration of ARI on days 7 and 15 (p < 0.05). Although PPAR-γ levels were not significantly affected by ARI and OLA, the lower concentration of CAR induced a significant time-dependent decrease in PPAR-γ expression (p < 0.05). Conclusions: The in vitro adipogenesis considered from TG accumulation, AN secretion, and PPAR-γ expression was differently influenced by ARI, CAR, and OLA. Understanding the adipocyte-related mechanisms of antipsychotics could contribute to understanding their weight-influencing effect.


Assuntos
Aripiprazol/uso terapêutico , Fibroblastos/efeitos dos fármacos , Olanzapina/uso terapêutico , Piperazinas/uso terapêutico , Adiponectina/análise , Adiponectina/sangue , Animais , Aripiprazol/administração & dosagem , Aripiprazol/farmacologia , Diferenciação Celular/efeitos dos fármacos , Modelos Animais de Doenças , Fibroblastos/patologia , Camundongos , Transtornos do Humor/tratamento farmacológico , Olanzapina/administração & dosagem , Olanzapina/farmacologia , PPAR gama/análise , PPAR gama/sangue , Piperazinas/administração & dosagem , Piperazinas/farmacologia , Triglicerídeos/análise , Triglicerídeos/sangue
15.
J Coll Physicians Surg Pak ; 29(6): S56-S58, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31142424

RESUMO

Erotomania is a delusional phenomenon in which patient believes that some celebrity is in love with her. It is associated with various psychiatric illnesses. We herein present a report of a young woman with erotomanic delusion diagnosed with recurrent depression, current episode being severe with psychotic features. A 22-year woman, previously treated for a depressive episode three years ago, was brought by the mother for evaluation. The woman presented with symptoms of depression for the past six months along with the delusion that famous singer SY is in love with her for the past two months. This has resulted in a gross decline in social and academic functioning. Psychometrics revealed Beck's depression inventory (BDI) score of 36 and brief psychiatric rating scale (BPRS) score of 41. A diagnosis of recurrent depression with current severe episode with psychotic features, was made at our psychiatric facility. This case report highlights that psychotic depression can present with a rare mood incongruent delusion of erotomanic content and accurate diagnosis and management require adequate knowledge about this phenomenon.


Assuntos
Transtorno Bipolar/complicações , Delusões/diagnóstico , Depressão/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos Psicóticos/complicações , Delusões/etiologia , Delusões/psicologia , Depressão/tratamento farmacológico , Depressão/psicologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Emoções , Feminino , Fluoxetina/administração & dosagem , Fluoxetina/uso terapêutico , Humanos , Amor , Olanzapina/administração & dosagem , Olanzapina/uso terapêutico , Transtornos Psicóticos/psicologia , Adulto Jovem
16.
Psychiatry Res ; 276: 1-5, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30981095

RESUMO

Obsessive-compulsive symptoms (OCS) occur in a substantial portion of schizophrenia patients and have significant impacts on clinical course. This study was intended to investigate the relationships of OCS with pharmacological parameters of olanzapine, psychopathology, and quality of life. Totally 151 schizophrenia patients were recruited, and rated using Yale-Brown Obsessive-Compulsive scale (YBOCS), Positive and Negative Syndrome Scale (PANSS), Montgomery-Åsberg Depression Rating Scale (MADRS), and World Health Organization Questionnaire on Quality of Life: Short Form (WHOQOL-BREF). The concentrations of olanzapine and N-desmethylolanzapine were determined by HPLC. Twenty-five patients (16.6%) revealed the presence of OCS. OCS group had significantly higher olanzapine dose, more numbers of past hospitalizations, higher PANSS total, positive, negative, and general psychopathology scores, and higher MADRS score than those in non-OCS group. The WHOQOL-BREF physical subscale score in schizophrenia patients with OCS was significantly lower. Olanzapine dose, PANSS score, and MADRS score were significantly correlated with YBOCS score. Our findings highlight that OCS is highly prevalent in schizophrenia patients under olanzapine treatment, especially those at high doses. Schizophrenia patients with OCS had higher severity of psychotic and depressive symptoms and poorer quality of life. Clinicians should monitor OCS in patients with schizophrenia receiving olanzapine treatment.


Assuntos
Antipsicóticos/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Olanzapina/uso terapêutico , Qualidade de Vida , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Adulto , Comorbidade , Estudos Transversais , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Escalas de Graduação Psiquiátrica , Psicopatologia , Qualidade de Vida/psicologia , Esquizofrenia/diagnóstico , Inquéritos e Questionários
17.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936353

RESUMO

A dopamine excess is thought to be involved in positive psychotic symptoms in schizophrenia. All current antipsychotics show a degree of dopamine receptor antagonism. Little is known about the differential effectiveness of different antipsychotics in treating specific sets of symptoms. We report the case of a 35-year-old man with schizophrenia who presented with prominent hallucinatory symptoms (Positive and Negative Syndrome Scale [PANSS] P1=5, P3=5, P6=5) resistant to high doses of a dopamine, serotonin receptor antagonist, olanzapine. Switching from olanzapine to zuclopenthixol, a dopamine D2 receptor antagonist, led to a complete shift of his symptomatology: his hallucinations abated, however, he presented as very highly paranoid (PANSS P1=6, P3=2, P6=7). On a combination of both antipsychotics, his symptoms subsided (PANSS P1=3, P3=2, P6=2). We discuss the potential for differential effectiveness of different antipsychotic medications in treating hallucinations and paranoia. We argue that future studies could address this question by stratifying patients based on symptoms.


Assuntos
Antipsicóticos/uso terapêutico , Clopentixol/uso terapêutico , Antagonistas de Dopamina/uso terapêutico , Alucinações/tratamento farmacológico , Olanzapina/uso terapêutico , Transtornos Paranoides/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/efeitos adversos , Quimioterapia Combinada , Humanos , Masculino , Transtornos Paranoides/induzido quimicamente , Receptores Dopaminérgicos/efeitos dos fármacos , Esquizofrenia/complicações , Resultado do Tratamento
19.
Am J Psychiatry ; 176(6): 457-467, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30845818

RESUMO

OBJECTIVE: Preclinical evidence and data from a proof-of-concept study in healthy volunteers suggest that samidorphan, an opioid antagonist, mitigates weight gain associated with olanzapine. This study prospectively compared combination therapy of olanzapine plus either samidorphan or placebo for the treatment of schizophrenia. METHODS: This was an international, multicenter, randomized phase 2 study of olanzapine plus samidorphan in patients with schizophrenia. The study had a 1-week open-label olanzapine lead-in period followed by a 12-week double-blind treatment phase in which patients were randomly assigned in a 1:1:1:1 ratio to receive olanzapine plus placebo (N=75) or olanzapine plus 5 mg (N=80), 10 mg (N=86), or 20 mg (N=68) of samidorphan. The primary aims were to confirm that the antipsychotic efficacy of olanzapine plus samidorphan was comparable to olanzapine plus placebo, to assess the effect of combining olanzapine with samidorphan on olanzapine-induced weight gain, and to assess the overall safety and tolerability of olanzapine plus samidorphan. RESULTS: Antipsychotic efficacy, as assessed by total score on the Positive and Negative Syndrome Scale (PANSS), was equivalent across all treatment groups. Treatment with olanzapine plus samidorphan resulted in a statistically significant lower weight gain (37% lower weight gain compared with olanzapine plus placebo). The least square mean percent change from baseline in body weight was 4.1% (2.9 kg) for the olanzapine plus placebo group and 2.6% (1.9 kg) for the olanzapine plus samidorphan group (2.8% [2.1 kg] for the 5 mg group, 2.1% [1.5 kg] for the 10 mg group, and 2.9% [2.2 kg] for the 20 mg group). Adverse events reported at a frequency ≥5% in any of the olanzapine plus samidorphan groups and occurring at a rate ≥2 times greater than in the olanzapine plus placebo group were somnolence, sedation, dizziness, and constipation. Other safety measures were comparable between the olanzapine plus samidorphan groups and the olanzapine plus placebo group. CONCLUSIONS: The antipsychotic efficacy of olanzapine plus samidorphan was equivalent to that of olanzapine plus placebo, and olanzapine plus samidorphan was associated with clinically meaningful and statistically significant mitigation of weight gain compared with olanzapine plus placebo. Olanzapine plus samidorphan was generally well tolerated, with a safety profile similar to olanzapine plus placebo.


Assuntos
Antipsicóticos/uso terapêutico , Naltrexona/análogos & derivados , Antagonistas de Entorpecentes/uso terapêutico , Olanzapina/uso terapêutico , Esquizofrenia/tratamento farmacológico , Ganho de Peso , Adulto , Constipação Intestinal/induzido quimicamente , Tontura/induzido quimicamente , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Análise dos Mínimos Quadrados , Masculino , Pessoa de Meia-Idade , Naltrexona/uso terapêutico , Sonolência
20.
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
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