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2.
Gesundheitswesen ; 82(1): 14-22, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31962367

RESUMO

AIM: The aims of this study were to create a scale for measuring the sedating and activating effects of drugs and to analyse if the total value of this scale correlates significantly with falls requiring medical treatment in dementia patients. Furthermore, prescription of drugs in nursing homes included in the PRISCUS-List, Anticholinergic Cognitive Burden List (ACB-List) and usage of psychotropic drugs were investigated. METHOD: This is a data analysis of a randomized controlled trial which tested the effects of a non-pharmacological multimodal activation therapy (MAKS®) in 139 patients with degenerative dementia in 5 nursing homes. At the beginning of the study, all prescribed drugs were rated on a five-tier scale by 2 pharmacologists based on the drugs' sedating or activating effects. The scale ranged from severely activating (+2) to severely sedating (- 2). The "central nervous system (CNS) depressant score" of each patient was calculated by summing up the scale value of all the medications they were taking. The correlation between CNS-depressant score and falls resulting in injuries within an observation period of 12 months was investigated by binary logistic regression analysis. RESULTS: Nearly 30% of the nursing home residents received drugs listed in the PRISCUS-list, 50% received drugs on the ACB-List, 55% took psychotropic drugs and 66% received at least 5 drugs. Sedating drugs were prescribed to 62% of patients. During the observation period, 36 out of 139 nursing home residents suffered falls and medical treatment was necessary. In multivariate analysis, the CNS-depressant score was associated significantly (p=0.045) with falls with resulting injuries. Increased sedation resulted in a higher number of fall incidents. CONCLUSIONS: The CNS-depressant score is a useful tool to describe the degree of sedation. Due to the significant association between sedation and falls resulting in injuries, the sedating medication of people suffering from dementia should be minimised as much as possible to reduce the risk of undesirable side effects.


Assuntos
Acidentes por Quedas , Demência , Hipnóticos e Sedativos , Psicotrópicos , Acidentes por Quedas/estatística & dados numéricos , Antagonistas Colinérgicos , Demência/tratamento farmacológico , Alemanha , Humanos , Hipnóticos e Sedativos/efeitos adversos , Casas de Saúde , Psicotrópicos/efeitos adversos
3.
Forensic Sci Int ; 307: 110107, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31951949

RESUMO

New psychoactive substances have emerged as a vast and diverse group of illicit drugs over the past decade, with synthetic cannabinoids comprising the largest of the categories. Commonly, a single synthetic cannabinoid is applied to plant material, creating a product that is designed to be smoked by the user. The clandestine preparation process can result in an unevenly distributed product, with varying concentration within and between plant materials. This investigation describes the novel co-detection of the synthetic cannabinoid AMB-FUBINACA, with the piperazine para-fluorophenylpiperazine (pFPP), in a number of plant material samples analysed in New Zealand in 2017. Of 157 samples of plant material containing AMB-FUBINACA, pFPP was detected in 55 of them. A range of pFPP concentrations was observed between the plant material samples, as well as intra-batch variation. The presence of both drugs may be designed to enhance, prolong or balance the psychoactive effects caused from smoking the plant material. However the intended purpose has not been verified. This is the first reported combination of a synthetic cannabinoid and a piperazine in plant material.


Assuntos
Canabinoides/análise , Indazóis/análise , Piperazinas/análise , Plantas/química , Psicotrópicos/análise , Valina/análogos & derivados , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Nova Zelândia , Valina/análise
4.
Medicine (Baltimore) ; 99(1): e18635, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895824

RESUMO

This cross sectional study examined patients' perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting. The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire. Diagnosis and treatment information were obtained at the clinical visits and from patient records.Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study. The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86-89) and a convergent validity toward the available variables. The MedSupport mean score was 3.8 (standard deviation.9, median 3.8). Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support. Patients diagnosed with behavioral and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.The MedSupport inventory was suitable for assessing the patients' perceived support from health care service regarding their medication. Awareness of differences in patients' perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.


Assuntos
Transtornos Mentais/tratamento farmacológico , Serviços de Saúde Mental , Psicotrópicos/uso terapêutico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
5.
Forensic Sci Int ; 307: 110136, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31896021

RESUMO

In forensic toxicology studies, drug concentrations must be estimated by the analytical data of formalin-fixed tissues if fresh or frozen tissue specimens are not available. We wished to investigate the stability and time-course of metabolism/degradation of drugs in formalin-fixed tissues using porcine liver homogenates (PLHs) instead of human tissue. Ten psychotropic drugs (amitriptyline, brotizolam, diazepam, diphenhydramine, estazolam, etizolam, levomepromazine, paroxetine, quetiapine and triazolam) were added to PLHs. After the PLHs had been fixed with neutral buffered formalin at room temperature, the concentrations of the drugs in the PLHs were determined by liquid chromatography-tandem mass spectrometry after 3 days, 1 week, 2 weeks, 4 weeks, 2 months, 4 months and 6 months. After 6 months, the residual ratio of amitriptyline, diphenhydramine and quetiapine was 80 %-95 %; that of diazepam, paroxetine and triazolam was 10 %-45 %; and that of brotizolam, etizolam and levomepromazine was 1 %-5 %. Estazolam was not detected from the first day of formalin fixation. These data suggest that the concentrations of drugs in PLHs measured after formalin fixation decreased to varying degrees compared with their initial concentrations. These time-dependent changes in drug concentration were due to degradation during preservation in formalin solution and metabolism by hepatic microsomal enzymes.


Assuntos
Estabilidade de Medicamentos , Toxicologia Forense/métodos , Fígado/química , Psicotrópicos/análise , Psicotrópicos/química , Animais , Cromatografia Líquida , Fixadores , Formaldeído , Preservação de Órgãos , Manejo de Espécimes , Suínos , Espectrometria de Massas em Tandem
6.
Toxicol Lett ; 320: 113-123, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31634548

RESUMO

3,4-Dimethylmethcathinone (3,4-DMMC) is a new psychoactive substance whose recreational use and trade have recently increased. Given the absence of information on the toxicokinetics of 3,4-DMMC, the present work aimed at validating a GC-MS methodology for the drug quantification in biological matrices, and further characterizing its biodistribution in Wistar rats. The method was validated based on the evaluation of the drug stability, limit of detection and quantification, linearity, selectivity, precision, accuracy and recovery. To characterize biodistribution, Wistar rats were administered with 20 or 40 mg/Kg of 3,4-DMMC i.p.. After 1 h or 24 h, rats were anaesthetized, euthanized and blood, brain, liver, heart, kidneys, lungs, spleen, urine (only at 24 h), and a portion of gut, muscle and adipose tissue were collected for analysis. After 1 h, 3,4-DMMC was present in all analysed matrices, and the presence of two metabolites was further detected in all of them. The drug accumulation was higher in kidneys, lungs, spleen and brain. After 24 h, 3,4-DMMC was only present in urine, along with five metabolites. All metabolites were tentatively identified. Through elucidation of the most appropriate analytical matrices and the metabolites that may have the largest detection windows, these data are expected to assist in future clinical and forensic investigations.


Assuntos
Cromatografia Gasosa-Espectrometria de Massas , Propiofenonas/farmacocinética , Psicotrópicos/farmacocinética , Animais , Biotransformação , Estabilidade de Medicamentos , Feminino , Injeções Intraperitoneais , Limite de Detecção , Propiofenonas/administração & dosagem , Psicotrópicos/administração & dosagem , Ratos Wistar , Reprodutibilidade dos Testes , Distribuição Tecidual
7.
Forensic Sci Int ; 306: 110043, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31743834

RESUMO

3',4'-methylenedioxy-2,2-dibromobutyrophenone has been identified and fully characterized in a sample obtained from an anonymous consumer acquired as ketamine through the Internet market. The substance has been deeply characterized by using standard and high performance analytical techniques such as: attenuated total reflectance-infrared spectroscopy, gas chromatography-mass spectrometry, high-resolution mass spectrometry, elemental analysis, and nuclear magnetic resonance, including 1H, 13C, distortionless enhancement by polarization transfer, two dimensional homonuclear 1H-1H correlation spectroscopy, and 1H-13C heteronuclear single-quantum correlation spectra. 3',4'-methylenedioxy-2,2-dibromobutyrophenone is a precursor or intermediate in the synthesis of several synthetic cathinone derivatives, such as pentylone and methylenedioxy pyrovalerone. It is expected that 3',4'-methylenedioxy-2,2-dibromobutyrophenone does not act as psychoactive substance through disruption nor dysregulation of central and peripheral nervous systems, due to the absence of the characteristic amine group of cathinone derivatives. Although it cannot be considered a trend in new psychoactive substances consumption, the presence in the market and the unknown toxicity of this substance makes it a relevant fact.


Assuntos
Alcaloides/química , Butirofenonas/química , Medicamentos Falsificados , Drogas Desenhadas/química , Psicotrópicos/química , Cromatografia Líquida , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Internet , Ketamina , Espectroscopia de Ressonância Magnética , Espectroscopia de Infravermelho com Transformada de Fourier
8.
J Forensic Sci ; 65(1): 160-165, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31343744

RESUMO

The characteristics of mental disorders, as well as deficiencies in their treatment, must be properly defined. This was a prospective, longitudinal, observational study, in which all men referred to a penitentiary psychiatric consultation of three penitentiary centers in Spain were invited to participate. Those who consented to participation (1328) were interviewed at the baseline timepoint and at intervals for up to 3 years. The presence of mental disorders was high: 68.2% had a cluster B personality disorder, 14% had an affective and/or anxiety disorders, 13% had schizophrenia, and over 80% had a dual disorder. Polypharmacy was the norm. Moreover, the health care received in prison did not match that provided in the community in terms of quantity and quality. These results should help to facilitate the design of mental healthcare provision for prisoners, focusing on both the most frequent patient profiles and equality of care.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Prisioneiros/psicologia , Prisões , Adulto , Coinfecção , Feminino , Infecções por HIV/epidemiologia , Hepatite C Crônica/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Polimedicação , Estudos Prospectivos , Psicotrópicos/uso terapêutico , Espanha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
9.
Talanta ; 206: 120212, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31514841

RESUMO

Graphene oxide-Fe3O4 (GO-Fe3O4) nanocomposite was synthesized by a facile chemical co-precipitation method. The GO-Fe3O4 was used as magnetic sorbent to extract the eight psychoactive drugs from urine samples. The analytes are morphine (MOR), 6-monoacetylmorphine (6-MAM), amphetamine (AMP), methamphetamine (MAMP), codeine, cocaine, dolantin and benzoylecgonine (BZE), which were determined by ultrahigh performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). This method has high selectivity for the target analytes. The limit of detection (LOD) and limit of quantification (LOQ) were 0.02-0.2 µg L-1 and 0.05-0.5 µg L-1, respectively. The Mandel's fitting test revealed good linearity within all linear ranges. The linear ranges were calculated as 0.05-1000 µg L-1 for AMP, MAMP, cocaine and dolantin; 0.1-1000 µg L-1 for 6-MAM and codein; and 0.5-1000 µg L-1 for MOR and BZE. The recoveries ranged in 80.4-105.5%. The intra-day and inter-day RSDs are in the range of 2.7-13.1% and 3.9-13.7%, respectively. Magnetic solid phase extraction (MSPE) with GO-Fe3O4 provides a convenient, rapid and green sample pretreatment method for extracting the target psychoactive drugs from urine. This methodology can be used for simultaneous or individual detection of eight major psychoactive drugs with high sensitivity. This method has high potential in clinical and forensic areas for psychoactive drugs analysis.


Assuntos
Grafite/química , Nanopartículas de Magnetita/química , Nanocompostos/química , Psicotrópicos/urina , Cromatografia Líquida de Alta Pressão/métodos , Óxido Ferroso-Férrico/síntese química , Grafite/síntese química , Limite de Detecção , Extração em Fase Sólida/métodos , Espectrometria de Massas em Tandem/métodos
10.
Forensic Sci Int ; 306: 110002, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31864775

RESUMO

Designer drugs or new psychoactive substances (NPS) are a heterogeneous group of substances obtained through the modification of chemical structure of some natural products or drugs. NPS illegally commercialized in blotter papers mimicking the most common form of LSD consumption, with a great variability of colours and symbols, have largely increased worldwide, including in Brazil, becoming an important emerging public health issue. In this study, we have evaluated the presence and profile of NPS in blotters seized in the State of Santa Catarina, Brazil, over the period of 2011 to 2017. The state government criminal forensics staff has performed gas chromatography-mass spectrometer (GC-MS) analyses in order to determine the chemical composition of the blotters. During the evaluated period, there was a considerable increase in the seizing of blotters events, from 87 in 2011, to 301 in 2016 and reaching 277 in 2017. There was also an increase in the number of blotters seized per event. Interestingly, while in 2011, 100% of blotters contained LSD, this number decreased to 0,1% in 2014, and achieved 17,6% in 2017, when up to 25 different substances were detected in blotters seized. Drugs such as DOx, NBOMe, fentanyl, mescaline derivatives, triptamines, cathinones, and synthetic cannabinoids were detected and became the major substances found in blotters. In some cases, more than one substance was found in the same blotter, characterizing a new mixture scenario. The presence of several new psychoactive substances in blotters is a reality in forensic toxicology. In Brazil, it might be related to the fact that most of these substances were not considered illegal by Brazilian legislation by the time they emerged.


Assuntos
Drogas Desenhadas/análise , Papel , Psicotrópicos/análise , Brasil/epidemiologia , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Dietilamida do Ácido Lisérgico/análise , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
11.
Forensic Sci Int ; 307: 110101, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31865266

RESUMO

Flualprazolam is a novel designer benzodiazepine, structurally related to alprazolam, flubromazolam and triazolam. In the last couple of years, it has been frequently detected in seizures and in forensic cases in Sweden and Finland. However, there is a lack of published blood concentrations for the drug, which presents difficulties when assessing its relevance for the cause of death. A quantitative method for the determination of flualprazolam in post-mortem blood was developed and validated, and subsequently used to analyse samples from 33 deaths previously screened as testing positive for flualprazolam in Sweden and Finland. Most of the cases in the study were accidental deaths (61 %) or suicides (18 %). The median (range) flualprazolam concentration was 18.0 (3.0-68) ng/g. The majority of the deceased were male (82 %) and the median age was 30 years. The median age in the Swedish cases was significantly higher (35 years) than in the Finnish cases (23 years) (p< 0.05). Poly-drug use and particularly the concomitant use of flualprazolam and opioids were very common in the study population. Most of the cases that were positive for flualprazolam were fatal poisonings by a drug (N=23), and in 13 cases, flualprazolam was implicated in the cause of death. Combining the resources of two countries in which all post-mortem toxicology is centralised provided a more comprehensive insight into the toxicology of flualprazolam. Research on novel psychoactive substances, such as flualprazolam, is required in order to be able to provide scientific evidence on the risks of these new substances for drug administration and potential users.


Assuntos
Benzodiazepinas/sangue , Drogas Desenhadas/análise , Psicotrópicos/sangue , Triazolam/sangue , Acidentes/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Benzodiazepinas/envenenamento , Drogas Desenhadas/química , Drogas Desenhadas/envenenamento , Feminino , Finlândia/epidemiologia , Toxicologia Forense , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Masculino , Pessoa de Meia-Idade , Estrutura Molecular , Psicotrópicos/química , Psicotrópicos/envenenamento , Distribuição por Sexo , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Suicídio/estatística & dados numéricos , Suécia/epidemiologia , Triazolam/envenenamento , Adulto Jovem
12.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(10): 127-133, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31793554

RESUMO

The prescription of psychotropic drugs requires a thorough assessment not only of the effectiveness of pharmacotherapy, but also of its safety. It is an essential component of the rational treatment of patients with mental disorders. Most of adverse drug reactions are predictable and, accordingly, preventable. The solution to problem of adverse drug reactions prevention is feasible thanks to the interdisciplinary approach, in which the skills and methods of clinical pharmacology can be used in psychiatry. This literature review covers the current possibilities for monitoring the safety of psychopharmacotherapy.


Assuntos
Transtornos Mentais , Psicotrópicos , Humanos , Transtornos Mentais/tratamento farmacológico , Psiquiatria/tendências , Psicotrópicos/uso terapêutico
13.
Lancet ; 394(10209): 1668-1684, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668410

RESUMO

The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.


Assuntos
Monitoramento de Medicamentos/métodos , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Psicotrópicos/efeitos adversos , Saúde Pública/legislação & jurisprudência , Adolescente , Adulto , Comércio/legislação & jurisprudência , Coleta de Dados , Controle de Medicamentos e Entorpecentes/métodos , Feminino , Humanos , /legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Motivação , Psicotrópicos/classificação , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
14.
Forensic Sci Int ; 305: 109999, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31671355

RESUMO

In the US, the use of synthetic opioids (e.g. fentanyl and derivatives) has become an increasing health issue with thousands of overdose deaths being observed since 2013. With the high mortality rate associated with these substances, postmortem analyses and interpretation of synthetic opioids has become extremely important. However, due to the novelty of these compounds, the available data are limited and provides challenges to toxicologists. The objectives of this study were (1) to develop and validate analytical methods for the determination of synthetic opioids in vitreous humor and brain, and (2) to investigate the postmortem distribution of new synthetic opioids in blood, vitreous humor, and brain tissue. Vitreous humor (0.5mL) and brain tissue (5g) homogenized in water (diluted 1:3, w/w) were extracted by mixed mode cation exchange-reversed phase solid phase extraction. Extracts were analyzed by liquid chromatography tandem mass spectrometry (LC-MSMS). The chromatographic separation was performed by reversed-phase with 0.1% formic acid in water and in acetonitrile as mobile phases in gradient mode, with a total run time of 21min. Data were acquired with ESI+ in dynamic multiple reaction mode (dMRM), monitoring 2 transitions per compound. The methods were succesfully validated following SWGTOX guidelines, with limits of quantification of 0.1ng/mL in vitreous humor and 0.1ng/g in brain. Fifty-eight authentic case samples from the New York City Office of the Chief Medical Examiner (NYC-OCME) were analyzed to assess the distribution and detectability of synthetic opioids in these postmortem samples. Of the fifteen synthetic opioids included in the method, six synthetic opioids and metabolites (4-ANPP, acetylfentanyl, fentanyl, furanylfentanyl, norfentanyl, U-47700) were detected in the authentic cases. Concentrations for most analytes were within the 0.1 to 100ng/mL or ng/g calibration range across all three matrices, with only concentrations from acetylfentanyl and U-47700 exceeding 100ng/mL or ng/g. The highest concentrations were observed in brain (except norfentanyl), followed by blood and vitreous humor. Most analytes were detected in all three matrices in a given case. This was followed by detection of an analyte in combinations of brain and another matrix or brain only. Through the case analyses, vitreous humor and brain demonstrated to be viable alternatives to blood when performing postmortem analyses of synthetic opioids. Brain exhibited a higher detectability for most analytes when compared to blood and vitreous humor.


Assuntos
Analgésicos Opioides/análise , Química Encefálica , Medicamentos Sintéticos/análise , Corpo Vítreo/química , Analgésicos Opioides/farmacocinética , Cromatografia Líquida , Toxicologia Forense , Humanos , Psicotrópicos/análise , Psicotrópicos/farmacocinética , Extração em Fase Sólida , Medicamentos Sintéticos/farmacocinética , Espectrometria de Massas em Tandem
15.
Clin Ter ; 170(6): e425-e426, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31696904

RESUMO

The practice of drug of abuse adulteration is changing. Currently, the risk of new adulteration practices involves New Psychoactive Substances (NPS), which can also be used as adulterants. In particular, the phenomenon of adulteration concerns fentanyl and its analogs, substances that can be toxic even if taken in very small quantities. The adulteration that involves NPS is creating a serious threat to the health of drug users, not only because of the pharmacological action but because of the increased toxicity of these new cutting agents.


Assuntos
Contaminação de Medicamentos , Psicotrópicos/efeitos adversos , Usuários de Drogas , Fentanila/efeitos adversos , Humanos
16.
Adv Exp Med Biol ; 1192: 225-249, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705497

RESUMO

Brain disorders and mental diseases, in particular, are common and considered as a top global health challenge for the twenty-first century. Interestingly, women suffer more frequently from mental disorders than men. Moreover, women may respond to psychotropic drugs differently than men, and, through their lifespan, they endure sex-orientated social stressors. In this chapter, we present how women may differ in the development and manifestation of mental health issues and how they differ from men in pharmacokinetics and pharmacodynamics. We discuss issues in clinical trials regarding women participation, issues in the use of psychotropic medications in pregnancy, and challenges that psychiatry faces as a result of the wider use of contraceptives, of childbearing at older age, and of menopause. Such issues, among others, demand further women-oriented psychiatric research that can improve the care for women during the course of their lives. Indeed, despite all these known sex differences, psychiatry for both men and women patients uses the same approach. Thereby, a modified paradigm for women's psychiatry, which takes into account all these differences, emerges as a necessity, and psychiatric research should take more vigorously into account sex differences.


Assuntos
Menopausa/psicologia , Transtornos Mentais , Psiquiatria , Saúde Reprodutiva , Serviços de Saúde da Mulher , Idoso , Feminino , Saúde Global , Humanos , Masculino , Serviços de Saúde Mental , Gravidez , Psicotrópicos/uso terapêutico , Saúde da Mulher
17.
Adv Exp Med Biol ; 1192: 313-329, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705502

RESUMO

With vigorous researches related to novel treatment in psychiatric field, paradigm shift is emerging with its design and assessment. Comprehension of the psychiatric phenomenon expanded beyond disease model, with dimensional approach. Assessment of patients' clinical state includes subjective reports related to problematic symptoms, functional change, and quality of life. They also include objective findings collected from mobile e-wearable monitoring system and advanced neuroimaging modalities. Novel treatment protocols are not just limited to pharmacology itself or psychotherapy itself, but the approach is integrated with stratification; pharmacological treatment enhanced by cognitive behavioral management and psychotherapeutic intervention has been emerged and studied for its impact. Numerous studies were conducted to understand placebo response and to differentiate this phenomenon with novel treatments. Trials to draw good adherence to research protocol with good compliance to treatment in real are strengthened by integrated approach, so-called psychopharmacology. With these paradigm shifts observed from recent researches, it is promising for great advance in quality of life and our mental health.


Assuntos
Psicofarmacologia , Psicoterapia , Protocolos Clínicos , Humanos , Psicotrópicos , Qualidade de Vida , Pesquisa
18.
Clin Ter ; 170(5): e337-e338, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31612189

RESUMO

In this letter, which is meant as a response to the letter titled "Sex enhancers: challenges, threats and the need for targeted measures", the Authors discuss the evolution of Chemsex phenomenon towards at least two directions: firstly, the use of psychoactive and non-psychoactive substances usually implicated in Chemsex, such as GHB/GBL, ketamine, mephedrone and other synthetic cathinones and erectile dysfunction medications, is currently accompanied by the use of illicit opioids, which have recently been indicated as a new serious health threat for consumers. In addition, as reported by the last European Drug report, the simultaneous use of illicit benzodiazepines with non-medical opioids misuse has also been observed. Secondly, strictly linked to the rising use of non-medical opioids is the risk of transition towards heroine followed by the adoption of risky injection practices frequently accompanied by high-risk sexual behaviors. In this sense, the current definition of the phenomenon as "the voluntary intake of certain psychoactive and non- psychoactive drugs in the context of sex parties and sexual intercourses with the intention of facilitating and/or enhancing the sexual encounter mostly among men who have sex with other men (MSM)" has been expanded to "heterosexual chemsex".


Assuntos
/efeitos adversos , Psicotrópicos/efeitos adversos , Comportamento Sexual/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos , Adulto , Humanos , Masculino , Metanfetamina/efeitos adversos , Pessoa de Meia-Idade , Psicotrópicos/administração & dosagem , Saúde Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias , Inquéritos e Questionários
19.
Nervenarzt ; 90(11): 1125-1134, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31659372

RESUMO

Psychotherapy has been proven to be effective; however, this statement applies in particular to the "average patient" in randomized controlled trials. As a considerable proportion of patients do not show any benefits despite the constant development of new therapy methods and the mechanisms of action are still too little understood, innovative psychotherapy research has to address both problems. In addition, the idea of personalization that originated in somatic medicine or - from our point of view more appropriately - individualization or person-centering should be taken up. After providing an overview of further developments in psychotherapy beyond disorder-specific methods, this article presents an evidence- and process-based individualized and modular psychotherapy as a visionary goal of psychotherapeutic research: Beyond syndromes and disorders, as many biopsychosocial characteristics as possible and the processes and mechanisms underlying the mental problems should be analyzed and bundled in an individual comprehensive functional analysis. Based on this functional analysis, evidence-based techniques and modules should be selected. The individual response during the course of therapy should be continuously documented, so that feedback helps to determine the further therapeutic procedure. In order to pursue this vision, studies are needed that are oriented towards the individual patient, investigate the central mechanisms of action and generate large translational datasets. These should be analyzed by ideographic analyses and reduce the gap between research and practice, thus contributing to the paradigm of a practice research network, which is now consistently moving to the centre of research.


Assuntos
Psicoterapia , Psicotrópicos , Medicina Baseada em Evidências , Humanos , Psicoterapia/normas , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Resultado do Tratamento
20.
Sud Med Ekspert ; 62(5): 4-8, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626186

RESUMO

The purpose of the work is to study the prevalence of overdose deaths from narcotic drugs and psychotropic substances in Russia, as determined by forensic autopsies, for the period 2003 to 2018. For the study, medical statistics were processed, the percentages for each indication were calculated, and the changes in the percentages for different types of overdose deaths were noted. It was established in forensic autopsies for the period under study, that the percentage of narcotic overdose deaths ranged from 4.2% to 16.6% of the total number of poisonings, while the percentage of overdose deaths from psychotropic substances ranged from 0.7% to 1.3%.


Assuntos
Overdose de Drogas/mortalidade , Entorpecentes/envenenamento , Psicotrópicos/envenenamento , Humanos , Prevalência , Federação Russa/epidemiologia
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