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1.
Adv Exp Med Biol ; 1305: 429-445, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834411

RESUMO

Major depressive disorder (MDD) is one of the leading causes of disability worldwide, and a considerable portion of depressed patients does not respond well to available treatment strategies. Algorithm-based treatment may contribute to improving the MDD outcomes and have the potential to homogenize the pharmacological treatment of MDD patients, facilitating outcome research and cost-effectiveness analysis. This chapter provides a critical review of the available literature on the use of treatment algorithms for the management of MDD. The main available algorithms, their effectiveness, and challenges and limitations associated with their development are discussed. Finally, we provide a discussion of the future direction of algorithm-based treatments for MDD.


Assuntos
Transtorno Depressivo Maior , Psicofarmacologia , Algoritmos , Análise Custo-Benefício , Transtorno Depressivo Maior/tratamento farmacológico , Humanos
2.
Adv Exp Med Biol ; 1305: 449-461, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834412

RESUMO

Major depressive disorder carries a significant burden and a high risk for suicide. The need for more effective, safer, and faster-acting drugs is, therefore, compelling. The present chapter briefly assesses the most promising agents, focusing on non-monoamine-targeting compounds, namely, the glutamate antagonist ketamine and its enantiomer esketamine. A critical overview of the evidence and the pitfalls associated with current antidepressant drug development is likewise provided in the following text.


Assuntos
Transtorno Depressivo Maior , Psicofarmacologia , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios , Humanos
3.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(11): 108-115, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33340305

RESUMO

However, despite successful use of lithium in the treatment of affective disorders for almost 40 years, the mechanisms of its therapeutic action are still poorly understood. This review presents and summarizes the current literature about the use of lithium in treatment of affective disorders, as well as its effects on cellular physiology, with a separate description of the effect of this ion on the functioning of nerve tissue and ion-molecular mechanisms.


Assuntos
Transtorno Bipolar , Psicofarmacologia , Transtorno Bipolar/tratamento farmacológico , Humanos , Lítio/farmacologia , Lítio/uso terapêutico , Transtornos do Humor/tratamento farmacológico
6.
Am J Geriatr Psychiatry ; 28(9): 999-1003, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32680760

RESUMO

OBJECTIVES: As the COVID-19 pandemic developed in March 2020 in greater Seattle, our clinical trial site faced several ethical and clinical dilemmas. We remained open to research patients including high-risk elderly patients and adapted to changing health recommendations. METHODS: Beginning March 14, 2020 we developed an in-person evaluation for potential risk of COVID-19. Included are the first 3 weeks of screening by our physicians for potential exposure to COVID-19, common symptoms, temperature, blood oxygen saturation, and heart rate. Individuals with higher risk (n = 23) were identified and managed. RESULTS: The 825 evaluations included 37 staff, 167 patients, and 152 visitors. No one needed isolation or transfer to acute care facility, staff attendance was 95%, all 33 geriatric patients continued in phase II trials, and others decreased by 5%. CONCLUSION: We share how we incorporated COVID-19 Center for Disease Control health recommendations to a clinical trial center and addition of pulse oximetry.


Assuntos
Ensaios Clínicos como Assunto/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pandemias , Assistência ao Paciente/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Psicofarmacologia/métodos , Adulto , Idoso , Betacoronavirus , Centers for Disease Control and Prevention, U.S. , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Estados Unidos , Washington , Adulto Jovem
7.
Psychiatry Res ; 287: 112900, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32179209

RESUMO

Autism spectrum disorder (ASD) is characterized by impaired social communication and restricted repetitive behaviors and interests. There are no FDA-approved medications for these core symptoms, and there are limited data regarding pharmacological management of ASD in adults. Here, the literature was reviewed in an effort to develop an algorithm for pharmacological management of core symptoms of ASD in adults. The literature search was conducted using PubMed. It was very difficult to distil a plausible algorithm from these data. Not included in this review are behavioral strategies, which are first-line. For instances when medication is being considered for management of core ASD symptoms in adults, the authors suggest starting with fluvoxamine as first-line, with possible consideration of a second SSRI trial if there is an inadequate or no response to fluvoxamine. The next step, if there is comorbid irritability, is to consider a second-generation antipsychotic. If there is no comorbid irritability, in the final step of the tentative algorithm, there are possible augmenting agents: propranolol, memantine, d-cycloserine, and oxytocin. Management of the symptoms of ASD requires a comprehensive treatment approach, and treatment planning must be individualized. Treatment of core ASD symptoms is not always desired. Further studies are needed to develop a stronger evidence base to support pharmacological management of core symptoms.


Assuntos
Algoritmos , Antipsicóticos/uso terapêutico , Transtorno do Espectro Autista/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Avaliação de Sintomas/métodos , Adulto , Transtorno do Espectro Autista/psicologia , Regras de Decisão Clínica , Comorbidade , Feminino , Fluvoxamina/uso terapêutico , Humanos , Humor Irritável/efeitos dos fármacos , Masculino , Psicofarmacologia
8.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 23(1): 39-44, ene.-feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187798

RESUMO

Introducción: La práctica clínica exige un conocimiento sistémico y un actuar interprofesional, de ahí que los profesionales de la salud deban estar formados en el ejercicio del pensamiento complejo. Objetivo: Presentar un diseño formativo interprofesional cuyo propósito es contribuir al desarrollo del pensamiento complejo en el desempeño clínico de los estudiantes de ciencias de la salud. Sujetos y métodos: Se incluyeron estudiantes de medicina, enfermería y psicología, quienes cumplieron con dos sesiones teóricas a fin de estudiar, a través de un caso escrito, la neurobiología y la farmacología de los medicamentos antidepresivos, además del tratamiento combinado con la psicoterapia; un seminario interdisciplinario, en el cual definieron sus roles profesionales, un tratamiento integral y una colaboración interprofesional; y una estación de simulación con una paciente estandarizada para evaluar, mediante lista de cotejo, su desempeño en cuatro categorías de aplicación del pensamiento complejo: valoración diagnóstica, instauración terapéutica, comunicación con la paciente y comunicación interprofesional, con 47 tareas en total. Resultados: Se encontró que las calificaciones medias en las categorías de pensamiento complejo estuvieron entre 8,1 ± 1,8 y 9,3 ± 0,9. Los estudiantes que cumplieron con las distintas tareas fueron el 80-94%. No hubo diferencias estadísticas entre los grupos. Conclusión: La implementación de un diseño formativo interprofesional se convierte en una estrategia de aprendizaje y evaluación que contribuye al desarrollo del pensamiento complejo en el desempeño clínico de estudiantes de ciencias de la salud


Introduction: Clinical practice requires systemic knowledge and an interprofessional act, hence, health professionals must be trained in the exercise of complex thinking. Aim: An interprofessional formative design is presented, whose purpose is to contribute to the development of complex thinking in the clinical performance of health science students. Subjects and methods: Medical, nursing and psychology students were included, who completed two theoretical sessions to study the neurobiology and pharmacology of antidepressant medications through a written case, and the psychotherapy; an interdisciplinary seminar, in which, they defined their professional roles, an integral treatment and an interprofessional collaboration; and a simulation station with a standardized patient to evaluate, by checklist, in four categories of application of complex thinking: diagnostic assessment, therapeutic indication, communication with the patient, and interprofessional, with 47 tasks in total. Results: It was found that the mean average in the categories of complex thinking were between 8.1 ± 1.8 and 9.3 ± 0.9, also, that the percentages of students who completed the different tasks were from 80% to 94%. There were no statistical differences between the groups. Conclusions: The implementation of an interprofessional formative design becomes a learning and evaluation strategy that contributes to the development of complex thinking in the clinical performance of health science students


Assuntos
Humanos , Educação Interprofissional/métodos , Estudantes de Ciências da Saúde , Ocupações em Saúde/educação , Currículo , Estudos Transversais , Psicofarmacologia/educação
10.
Pharmacol Rev ; 72(1): 80-151, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31826934

RESUMO

This review evaluates current knowledge about obsessive-compulsive disorder (OCD), with the goal of providing a roadmap for future directions in research on the psychopharmacology of the disorder. It first addresses issues in the description and diagnosis of OCD, including the structure, measurement, and appropriate description of the disorder and issues of differential diagnosis. Current pharmacotherapies for OCD are then reviewed, including monotherapy with serotonin reuptake inhibitors and augmentation with antipsychotic medication and with psychologic treatment. Neuromodulatory therapies for OCD are also described, including psychosurgery, deep brain stimulation, and noninvasive brain stimulation. Psychotherapies for OCD are then reviewed, focusing on behavior therapy, including exposure and response prevention and cognitive therapy, and the efficacy of these interventions is discussed, touching on issues such as the timing of sessions, the adjunctive role of pharmacotherapy, and the underlying mechanisms. Next, current research on the neurobiology of OCD is examined, including work probing the role of various neurotransmitters and other endogenous processes and etiology as clues to the neurobiological fault that may underlie OCD. A new perspective on preclinical research is advanced, using the Research Domain Criteria to propose an adaptationist viewpoint that regards OCD as the dysfunction of a normal motivational system. A systems-design approach introduces the security motivation system (SMS) theory of OCD as a framework for research. Finally, a new perspective on psychopharmacological research for OCD is advanced, exploring three approaches: boosting infrastructure facilities of the brain, facilitating psychotherapeutic relearning, and targeting specific pathways of the SMS network to fix deficient SMS shut-down processes. SIGNIFICANCE STATEMENT: A significant proportion of patients with obsessive-compulsive disorder (OCD) do not achieve remission with current treatments, indicating the need for innovations in psychopharmacology for the disorder. OCD may be conceptualized as the dysfunction of a normal, special motivation system that evolved to manage the prospect of potential danger. This perspective, together with a wide-ranging review of the literature, suggests novel directions for psychopharmacological research, including boosting support systems of the brain, facilitating relearning that occurs in psychotherapy, and targeting specific pathways in the brain that provide deficient stopping processes in OCD.


Assuntos
Antipsicóticos/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/psicologia , Inibidores de Captação de Serotonina/uso terapêutico , Animais , Antipsicóticos/farmacologia , Estimulação Encefálica Profunda , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/terapia , Psicofarmacologia , Psicoterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores de Captação de Serotonina/farmacologia
12.
Saúde Soc ; 29(1): e190936, 2020. tab
Artigo em Português | LILACS | ID: biblio-1101910

RESUMO

Resumo O consumo de medicamentos para aprimorar processos mentais, como memória, concentração e estado de alerta, tem se expandido. As chamadas smart drugs e fármacos nootrópicos são utilizados na expectativa de obter melhor desempenho em tarefas profissionais e acadêmicas. Este artigo analisa a difusão do uso de medicamentos para aprimoramento cognitivo, a partir de um blog brasileiro chamado Cérebro Turbinado, com ênfase na discussão da categoria "nootrópicos". A metodologia adotada foi a pesquisa socioantropológica documental, baseada em materiais de divulgação científica que integram o conteúdo do blog, criado em 2015 por um estudante de medicina de uma universidade pública. O blog apresenta os nootrópicos como opções mais acessíveis, seguras e igualmente eficazes em comparação com os medicamentos psicotrópicos utilizados como smart drugs. Editor e leitores produzem um saber coletivo para otimizar o desempenho cerebral. As experiências pessoais evidenciam a maneira como os indivíduos interpretam seus estados corporais e os relacionam com os medicamentos. Na esteira dos processos de farmacologização da sociedade, a produção de modos de subjetividade baseadas em uma concepção individualista dos processos de saúde/doença/incapacidade, apoiada na compreensão neuromolecular do cérebro, fundamenta-se no compartilhamento de práticas e conhecimentos sobre tais substâncias.


Abstract The use of drugs to improve mental processes, such as memory, concentration and alertness, has been increasing. Nicknamed "smart drugs", nootropic drugs are used with the expectation that better performance can be achieved in professional and academic tasks. This analyzes the spread of cognitive enhancement drugs according to a Brazilian blog called Cérebro Turbinado focusing on the discussion of the nootropic drugs category. This is a documentary socio-anthropological research grounded on the scientific outreach materials that integrate the blog content, created in 2015 by a medical student from a public university. The blog presents nootropics as the most affordable, safe and equally effective options for psychotropic drugs used as smart drugs. Editor and readers turn to the production of collective knowledge to optimize brain performance. The narratives of personal experiences highlight the way individuals interpret their body states and relate them to medication. In the wake of society's medicalization processes, the production of subjectivity modes based on an individualistic conception of health/disease/disability processes, supported by neuromolecular understanding of the brain, is grounded on the sharing of practices and knowledge about such substances.


Assuntos
Humanos , Masculino , Feminino , Psicofarmacologia , Automedicação , Nootrópicos , Melhoramento Biomédico , Medicalização/tendências
15.
Dement. neuropsychol ; 13(4): 422-426, Oct.-Dec. 2019.
Artigo em Inglês | LILACS | ID: biblio-1056009

RESUMO

ABSTRACT Despite recent advances in cognitive rehabilitation of patients with cognitive disorders, there are many major obstacles to the optimized global use of this therapeutic resource. Objective: The authors outline the concept of 'therapeutic synergism', i.e. the concurrent use of pharmacological and cognitive rehabilitation therapies to maximize functional benefits, addressing the optimization of therapeutic approaches for cognitive disorders. Methods: Three psychopharmacological and rehabilitation interrelationship paradigms are presented in three different clinical settings. Results: Paradigm 1: Behavioral and cognitive symptoms that hinder a cognitive rehabilitation program, but can be improved with psychopharmacology. Paradigm 2: Cognitive symptoms that hinder cognitive rehabilitation, but can be improved with anticholinesterases. Paradigm 3: Behavioral symptoms that hamper the use of cognitive rehabilitation, but can be improved by psychotropic drugs. Conclusion: Judicious use of psychotropic drugs in cognitive disorders can benefit, directly or indirectly, cognitive functions, thereby favoring other treatment modalities for cognitive impairment, such as neuropsychological rehabilitation.


RESUMO Apesar dos recentes avanços na reabilitação cognitiva de pacientes com distúrbios cognitivos, existem muitos e graves obstáculos ao uso otimizado globalmente desse recurso terapêutico. Objetivo: Os autores destacam o conceito de 'sinergismo terapêutico', ou seja, o uso simultâneo de terapias de reabilitação farmacológica e cognitiva, maximizando os benefícios funcionais, a fim de abordar a otimização da abordagem terapêutica dos distúrbios cognitivos. Métodos: Três paradigmas de inter-relacionamento psicofarmacológico e de reabilitação são apresentados em três contextos clínicos diferentes. Resultados: Paradigma 1: sintomas comportamentais e cognitivos que dificultam um programa de reabilitação cognitiva, mas podem ser melhorados com a psicofarmacologia. Paradigma 2: sintomas cognitivos que dificultam a reabilitação cognitiva, mas podem ser melhorados com anticolinesterásicos. Paradigma 3: sintomas comportamentais que dificultam o uso da reabilitação cognitiva melhorada por drogas psicotrópicas. Conclusão: O uso criterioso das drogas psicotrópicas nos distúrbios cognitivos pode beneficiar, direta ou indiretamente, as funções cognitivas, favorecendo, portanto, outras modalidades de tratamento para o comprometimento cognitivo, como a reabilitação neuropsicológica.


Assuntos
Humanos , Psicofarmacologia , Terapêutica , Sinergismo Farmacológico , Reabilitação Neurológica
17.
Handb Clin Neurol ; 165: 179-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31727211

RESUMO

Huntington disease (HD) is a hereditary neurodegenerative disorder caused by an expanded cytosine-adenine-guanine triplet repeat in the huntingtin gene. The current diagnosis is based on the presence of typical motor signs in combination with a positive gene test. The motor onset of the disease is usually between 30 and 50 years of age, and the disease then progresses over around 20 more years. Nonmotor symptoms and signs such as cognitive decline, metabolic dysfunction, sleep disturbances, as well as psychiatric symptoms are common and can occur many years before motor onset. Psychiatric symptoms include irritability, apathy, depression, anxiety, and OCD. Although there exist no disease-modifying treatment, available pharmacologic drugs often offer significant symptom relief and improve quality of life. Today, there are only two drugs that are approved by the US Food and Drug Association for the treatment of HD. These are the dopamine-depleting drugs tetrabenazine and deutetrabenazine that both target motor symptoms. The current status of best clinical practice for HD is based on expert opinions as well as evidence and/or experience of treating similar symptoms in other conditions. In this chapter, we provide an overview of the complex clinical manifestations of HD and the commonly used psychopharmacologic treatments.


Assuntos
Inibidores da Captação Adrenérgica/uso terapêutico , Doença de Huntington/tratamento farmacológico , Doença de Huntington/metabolismo , Tetrabenazina/análogos & derivados , Tetrabenazina/uso terapêutico , Inibidores da Captação Adrenérgica/farmacologia , Humanos , Doença de Huntington/diagnóstico , Psicofarmacologia , Tetrabenazina/farmacologia , Proteínas Vesiculares de Transporte de Monoamina/antagonistas & inibidores , Proteínas Vesiculares de Transporte de Monoamina/metabolismo
18.
Handb Clin Neurol ; 165: 191-205, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31727212

RESUMO

Wilson disease (WD) is a hereditary metabolic disorder (HMD) caused by a mutation in the copper-transporting gene ATP7B affecting the liver and central nervous system. About 30% of patients with WD may initially present with psychiatric symptoms, and management can be difficult. More generally, HMDs are a rare but important cause of psychiatric disorders in adolescents and adults. Main signs of HMDs may remain isolated for years before the appearance of hepatic or neurologic signs. The incidence of HMDs has been estimated at approximately 40 cases per 100,000 live births. Some of them are treatable and new diagnostic methods and therapies have become available. HMDs that present purely with psychiatric symptoms are very difficult to diagnose due to low awareness of these rare diseases among psychiatrists and neurologists. However, it is important to identify HMDs in order to provide disease-specific treatment and possible prevention of irreversible physical and neurologic complications. Genetic counseling can also be provided. Psychotropic medications should be prescribed carefully in that indication. This chapter focuses on three HMD categories: chronic, treatable HMDs (e.g., WD); acute, treatable HMDs; and chronic HMDs that are difficult to treat. In this review we focus on the psychopharmacology of WD and other chronic and difficult-to-treat HMDs. We provide some keys to take into account the main side effects associated with common psychotropic medications.


Assuntos
Degeneração Hepatolenticular/metabolismo , Degeneração Hepatolenticular/terapia , Doenças Metabólicas/metabolismo , Doenças Metabólicas/terapia , Psicotrópicos/uso terapêutico , Aconselhamento Genético/métodos , Degeneração Hepatolenticular/diagnóstico , Humanos , Doenças Metabólicas/diagnóstico , Psicofarmacologia
19.
Handb Clin Neurol ; 165: 207-227, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31727213

RESUMO

Epilepsy affects 1% of the world's population and is defined as two or more unprovoked seizures. Psychiatric conditions (depression, psychosis, anxiety, and attention deficit hyperactivity disorder (ADHD)) may coexist and are linked to negative seizure outcomes and poorer quality of life. There is an increasing body of evidence to suggest a bidirectional relationship between epilepsy and psychiatric disorders, which may imply shared pathophysiologic mechanisms. Extensive research has examined neurobiologic and neuroanatomic substrates for this association revealing some interesting similarities. Psychiatric disorders in people with epilepsy often go underdiagnosed and undertreated, due to fears of exacerbating psychiatric symptoms or provoking seizures, which may cause delays in optimal management. This chapter covers psychiatric conditions in epilepsy largely focusing on depressive disorders and psychotic disorders. Anxiety and ADHD in association with epilepsy are also discussed. Epidemiology, pathophysiologic mechanisms, and pharmacotherapies used to treat epilepsy and psychiatric disorders are also covered.


Assuntos
Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Epilepsia/tratamento farmacológico , Epilepsia/psicologia , Ansiedade/tratamento farmacológico , Ansiedade/epidemiologia , Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Depressão/tratamento farmacológico , Depressão/epidemiologia , Depressão/psicologia , Epilepsia/epidemiologia , Humanos , Psicofarmacologia
20.
Handb Clin Neurol ; 165: 229-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31727214

RESUMO

Poststroke depression (PSD) is a frequent complication and source of suffering among stroke survivors. Assessment of mood, suicidal ideation, and other neuropsychiatric disturbances that can co-occur or share similar features with depression are important aspects of clinical stroke care. Pharmacotherapy is the first-line treatment of PSD, with selective serotonin reuptake inhibitors (SSRIs) being agents of first choice. The evidence for SSRIs, newer generation antidepressants, and tricyclic antidepressants for PSD will be reviewed with consideration of their side effect profiles and use for other neuropsychiatric comorbidities. Additional therapeutic options, such as cognitive enhancing medications, brain stimulation, and psychotherapy can also be considered. Given the prevalence of PSD, preventive pharmacologic strategies may be effective alternatives. Ultimately, the choice of treatment will be determined by the type and severity of medical and psychiatric comorbidities as well as the preferences of the patient.


Assuntos
Transtornos Cerebrovasculares/tratamento farmacológico , Transtornos Cerebrovasculares/psicologia , Depressão/tratamento farmacológico , Depressão/psicologia , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/psicologia , Transtornos Cerebrovasculares/complicações , Depressão/etiologia , Diagnóstico Diferencial , Humanos , Psicofarmacologia , Inibidores de Captação de Serotonina/uso terapêutico , Acidente Vascular Cerebral/complicações
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