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1.
Transl Psychiatry ; 10(1): 337, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33009366

RESUMO

Data are scarce regarding the comorbid mental disorders and their management among COVID-19 patients. This study described the clinical characteristics and management of COVID-19 patients treated in psychiatric inpatient settings due to comorbid first-onset mental disorders in Wuhan, China. This electronic medical records-based study included 25 COVID-19 patients with first-onset mental disorders and 55 patients with first-onset mental disorders without COVID-19 (control group). Data collected included ICD-10 diagnoses of mental disorders, psychiatric and respiratory symptoms, treatments, and outcomes. Adjustment disorder (n = 11, 44.0%) and acute and transient psychotic disorders, with associated acute stress (n = 6, 24.0%) were main clinical diagnoses in the COVID-19 group while serious mental illnesses (i.e., schizophrenia, 24.5%) and alcohol use disorders (10.9%) were overrepresented in the control group. On admission, the most common psychiatric symptom in COVID-19 patients was insomnia symptoms (n = 18, 72.0%), followed by aggressive behaviors (n = 16, 64.0%), delusion (n = 10, 40.0%), and severe anxiety (n = 9, 36.0%). In addition to respiratory treatments, 76.0% COVID-19 patients received antipsychotics, 40.0% sedative-hypnotics, and 24.0% mood stabilizers. At the end of inpatient treatment, 4 (16.0%) COVID-19 patients were transferred to other hospitals to continue respiratory treatment after their psychiatric symptoms were controlled while the remaining 21 (84.0%) all recovered. Compared to the control group, COVID-19 group had significantly shorter length of hospital stay (21.2 vs. 37.4 days, P < 0.001). Adjustment disorder and acute and transient psychotic disorders are the main clinical diagnoses of COVID-19 patients managed in psychiatric inpatient settings. The short-term prognosis of these patients is good after conventional psychotropic treatment.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Hospitalização/estatística & dados numéricos , Transtornos Mentais , Pandemias , Pneumonia Viral , Psicotrópicos , China/epidemiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/fisiopatologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Prognóstico , Escalas de Graduação Psiquiátrica , Psicotrópicos/classificação , Psicotrópicos/uso terapêutico , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
2.
Rev Prat ; 70(5): 496-501, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-33058633

RESUMO

When should we use antidepressant medications in children? Antidepressant medication may not be considered as a first-line treatment in children; psychotherapeutic treatments should always be preferentially used. At this age, the efficacy of SSRI is regarded as low to moderate for depression, but moderate to high for Obsessive Compulsive Disorder (OCD) and anxiety disorders. When an antidepressant medication is prescribed, a SSRI should always be used first. In particular, fluoxetine is the most studied SSRI and the only medication who received approval by the French regulatory authority. Sertraline and fluvoxamine which have been approved for OCD should preferentially be used for that purpose. During the first 4 weeks, clinicians should actively monitor the onset of side effects, especially mood swings and suicidal behavior. The onset or increase of suicidal thoughts during SSRI treatment would concern about 1 out of 100 young patients treated. This risk is maximal during the first four weeks following the introduction of the SSRI and should progressively decrease after one month. When used in children, antidepressant medication can only be used in association with psychotherapeutic treatments and psychosocial interventions targeting the maintaining factors perpetuating the cycle of affective symptoms.


Assuntos
Antidepressivos , Transtorno Obsessivo-Compulsivo , Antidepressivos/uso terapêutico , Transtornos de Ansiedade , Criança , Humanos , Transtornos do Humor , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Psicotrópicos
3.
Rev Prat ; 70(5): 514-519, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-33058637

RESUMO

Innovations in child psychotherapy. The psychotherapeutic approach represents the main focus of care in the field of child and adolescent mental health because of the limited place of psychopharmacology at this period of life. In recent years we have witnessed a diversification of theoretical models and the development of new focused approaches which explicitly raise the question of the formalization of therapeutic objectives and their sharing with the child/adolescent and his/her family. The aim of this article is to present some of the main innovations developed in recent years in the field of child and adolescent psychotherapy and in particular : parental guidance, mindfulness meditation, trauma-focused psychotherapies and psychotherapies delivered via the internet. Beyond the specificities of these models, all these approaches converge to underline the involvement of the entourage and the perception on the part of the child of being understood by the therapist as the two main mechanisms at the heart of change in psychotherapy and as levers capable of promoting the re-emergence of a capacity to learn in the interpersonal and social world.


Assuntos
Psicoterapia , Psicotrópicos , Adolescente , Criança , Feminino , Humanos , Masculino , Saúde Mental , Pais
5.
Cochrane Database Syst Rev ; 9: CD007667, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32880105

RESUMO

BACKGROUND: Antisocial personality disorder (AsPD) is associated with rule-breaking, criminality, substance use, unemployment, relationship difficulties, and premature death. Certain types of medication (drugs) may help people with AsPD. This review updates a previous Cochrane review, published in 2010. OBJECTIVES: To assess the benefits and adverse effects of pharmacological interventions for adults with AsPD. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also checked reference lists and contacted study authors to identify studies. SELECTION CRITERIA: Randomised controlled trials in which adults (age 18 years and over) with a diagnosis of AsPD or dissocial personality disorder were allocated to a pharmacological intervention or placebo control condition. DATA COLLECTION AND ANALYSIS: Four authors independently selected studies and extracted data. We assessed risk of bias and created 'Summary of findings tables' and assessed the certainty of the evidence using the GRADE framework. The primary outcomes were: aggression; reconviction; global state/global functioning; social functioning; and adverse events. MAIN RESULTS: We included 11 studies (three new to this update), involving 416 participants with AsPD. Most studies (10/11) were conducted in North America. Seven studies were conducted exclusively in an outpatient setting, one in an inpatient setting, and one in prison; two studies used multiple settings. The average age of participants ranged from 28.6 years to 45.1 years (overall mean age 39.6 years). Participants were predominantly (90%) male. Study duration ranged from 6 to 24 weeks, with no follow-up period. Data were available from only four studies involving 274 participants with AsPD. All the available data came from unreplicated, single reports, and did not allow independent statistical analysis to be conducted. Many review findings were limited to descriptive summaries based on analyses carried out and reported by the trial investigators. No study set out to recruit participants on the basis of having AsPD; many participants presented primarily with substance abuse problems. The studies reported on four primary outcomes and six secondary outcomes. Primary outcomes were aggression (six studies) global/state functioning (three studies), social functioning (one study), and adverse events (seven studies). Secondary outcomes were leaving the study early (eight studies), substance misuse (five studies), employment status (one study), impulsivity (one study), anger (three studies), and mental state (three studies). No study reported data on the primary outcome of reconviction or the secondary outcomes of quality of life, engagement with services, satisfaction with treatment, housing/accommodation status, economic outcomes or prison/service outcomes.   Eleven different drugs were compared with placebo, but data for AsPD participants were only available for five comparisons. Three classes of drug were represented: antiepileptic; antidepressant; and dopamine agonist (anti-Parkinsonian) drugs. We considered selection bias to be unclear in 8/11 studies, attrition bias to be high in 7/11 studies, and performance bias to be low in 7/11 studies. Using GRADE, we rated the certainty of evidence for each outcome in this review as very low, meaning that we have very little confidence in the effect estimates reported. Phenytoin (antiepileptic) versus placebo One study (60 participants) reported very low-certainty evidence that phenytoin (300 mg/day), compared to placebo, may reduce the mean frequency of aggressive acts per week (phenytoin mean = 0.33, no standard deviation (SD) reported; placebo mean = 0.51, no SD reported) in male prisoners with aggression (skewed data) at endpoint (six weeks). The same study (60 participants) reported no evidence of difference between phenytoin and placebo in the number of participants reporting the adverse event of nausea during week one (odds ratio (OR) 1.00, 95% confidence interval (CI) 0.06 to 16.76; very low-certainty evidence). The study authors also reported that no important side effects were detectable via blood cell counts or liver enzyme tests (very low-certainty evidence). The study did not measure reconviction, global/state functioning or social functioning. Desipramine (antidepressant) versus placebo One study (29 participants) reported no evidence of a difference between desipramine (250 to 300 mg/day) and placebo on mean social functioning scores (desipramine = 0.19; placebo = 0.21), assessed with the family-social domain of the Addiction Severity Index (scores range from zero to one, with higher values indicating worse social functioning), at endpoint (12 weeks) (very low-certainty evidence). Neither of the studies included in this comparison measured the other primary outcomes: aggression; reconviction; global/state functioning; or adverse events. Nortriptyline (antidepressant) versus placebo One study (20 participants) reported no evidence of a difference between nortriptyline (25 to 75 mg/day) and placebo on mean global state/functioning scores (nortriptyline = 0.3; placebo = 0.7), assessed with the Symptom Check List-90 (SCL-90) Global Severity Index (GSI; mean of subscale scores, ranging from zero to four, with higher scores indicating greater severity of symptoms), at endpoint (six months) in men with alcohol dependency (very low-certainty evidence). The study measured side effects but did not report data on adverse events for the AsPD subgroup. The study did not measure aggression, reconviction or social functioning. Bromocriptine (dopamine agonist) versus placebo One study (18 participants) reported no evidence of difference between bromocriptine (15 mg/day) and placebo on mean global state/functioning scores (bromocriptine = 0.4; placebo = 0.7), measured with the GSI of the SCL-90 at endpoint (six months) (very low-certainty evidence). The study did not provide data on adverse effects, but reported that 12 patients randomised to the bromocriptine group experienced severe side effects, five of whom dropped out of the study in the first two days due to nausea and severe flu-like symptoms (very low-certainty evidence). The study did not measure aggression, reconviction and social functioning. Amantadine (dopamine agonist) versus placebo The study in this comparison did not measure any of the primary outcomes. AUTHORS' CONCLUSIONS: The evidence summarised in this review is insufficient to draw any conclusion about the use of pharmacological interventions in the treatment of antisocial personality disorder. The evidence comes from single, unreplicated studies of mostly older medications. The studies also have methodological issues that severely limit the confidence we can draw from their results. Future studies should recruit participants on the basis of having AsPD, and use relevant outcome measures, including reconviction.


Assuntos
Transtorno da Personalidade Antissocial/tratamento farmacológico , Psicotrópicos/uso terapêutico , Adulto , Agressão/efeitos dos fármacos , Transtornos Relacionados ao Uso de Álcool/tratamento farmacológico , Amantadina/uso terapêutico , Ansiedade/tratamento farmacológico , Bromocriptina/uso terapêutico , Desipramina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nortriptilina/uso terapêutico , Fenitoína/uso terapêutico , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Artigo em Inglês | MEDLINE | ID: mdl-32942345

RESUMO

Background: There is a paucity of studies on treatment of childhood-onset bipolar disorder and its associated comorbidities, which leads to a wide diversity of opinion on choice and sequencing of treatment options. Methods: From December 2018 to January 2019, a graphic depiction of medications and weekly ratings of symptoms of mania, depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional behavior that parents had rated on their 9-year-old child over a period of several years was sent to experts in child and adult bipolar disorder. These responding medical doctors (MDs, 8 child and 18 adult psychiatrists) rated a comprehensive list of medications that they would choose (and with what priority) to treat the child's now improved mood (mania and depression) but continued mild to moderate symptoms of anxiety, ADHD, and oppositional behavior. Results: In the whole group, the drugs most highly endorsed were lamotrigine: 69%, lithium: 62%, lurasidone: 62%, quetiapine: 54%, aripiprazole: 46%, and valproate: 42%. Among the antidepressants, 38% endorsed a selective serotonin reuptake inhibitor, 12% a serotonin-norepinephrine reuptake inhibitor, and 27% bupropion. Of the child MDs, 75% suggested increasing the 1-mg dose of risperidone, while few adult MDs suggested this. Conversely, 56% of the adult MDs suggested using valproate, while only 1 child MD did so. There was little consensus on how to manage ADHD symptoms unresponsive to methylphenidate 36 mg/d. How these treatment options were sequenced also varied widely. Conclusions: There was wide variation in suggestions on to how to treat persistent symptoms of anxiety, ADHD, and oppositional behavior in a child whose mania and depression had been brought under good control. We surmise that this great diversity in recommendations among experts in child and adult bipolar disorder stems at least partially from inadequate literature on treatment and that a new emphasis on funding and conducting studies on efficacy and effectiveness is needed.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/tratamento farmacológico , Transtorno Bipolar/tratamento farmacológico , Psicotrópicos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno Bipolar/terapia , Criança , Consenso , Feminino , Humanos , Prevenção Primária , Indução de Remissão
9.
Psychiatr Danub ; 32(2): 205-209, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32796785

RESUMO

BACKGROUND: The aim of this study was to evaluate the association of bruxism and treatment regimens among remitted bipolar patients. SUBJECTS AND METHODS: The total case group included 222 adult patients with BD. Diagnosis of bruxism was based upon the on 'self-reports' plus the outcome from the clinical examinations. RESULTS: The sample consisted of 112 (50.5%) bipolar patients with bruxism and 110 (49.5%) without bruxism. Remitted bipolar patients who were on mood stabilizer plus atypical antipsychotic treatment had lower bruxism rates than patients on other than bipolar patients on mood stabilizer treatment regimen (p=0.04) and bipolar patients on polypharmacy (p=0.01). CONCLUSION: Our findings have supported the existence of psychotropic drug-bruxism relation and atypical antipsychotic related therapeutic effect among bipolar patients.


Assuntos
Antipsicóticos , Transtorno Bipolar , Bruxismo , Adulto , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Humanos , Psicotrópicos
10.
Psiquiatr. biol. (Internet) ; 27(2): 61-67, mayo-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193248

RESUMO

A lo largo de todas las etapas evolutivas, las personas con discapacidad intelectual pueden presentar trastornos psiquiátricos comórbidos, que a menudo son secundarios a sus déficits intelectivos y a las dificultades en sus capacidades adaptativas a los diferentes entornos que forman parte de sus vidas. Estas comorbilidades psiquiátricas cursan en ocasiones con alteraciones de conducta de difícil manejo, tanto con psicoterapia como con tratamientos farmacológicos. La medicación puede ser esencial para el control de alteraciones de conducta y otros síntomas asociados. Actualmente carecemos de guías clínicas específicas, de recomendaciones farmacológicas con la suficiente evidencia científica y de medicamentos con indicaciones expresas para abordar estos síntomas en pacientes con discapacidad intelectual. Este artículo de revisión tiene como objetivo resumir un conjunto de recomendaciones relacionadas con el uso de psicofármacos en este grupo poblacional


Throughout all evolutionary stages, people with intellectual disabilities (ID) may present with comorbid psychiatric disorders, which are often secondary to their intellectual deficits, and to the difficulties they face in their ability to adapt to the different environments that are part of their lives. These psychiatric comorbidities sometimes result in behavioral problems that are difficult to handle, both with psychotherapy and with pharmacological treatments. Medication can be essential for the control of behavioral disorders, and other associated symptoms. We currently lack specific clinical guidelines, pharmacological recommendations based on sufficient scientific evidence, and drugs with express indications for these symptoms in patients with ID. This review article aims to summarize a set of recommendations related to the use of psychiatric drugs in this population group


Assuntos
Humanos , Transtornos Mentais/complicações , Transtornos Mentais/tratamento farmacológico , Deficiência Intelectual/complicações , Transtorno da Conduta/complicações , Psicotrópicos/administração & dosagem , Comorbidade
11.
Med Care ; 58(9): 763-769, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32732784

RESUMO

BACKGROUND: Increases in prescription drug cost-sharing may decrease adherence to treatment among persons with schizophrenia and lead to discontinuation of use and an increased risk of hospitalization. OBJECTIVE: The objective of this study was to investigate the impact of new deductible and increased drug copayments implemented on antipsychotic and other drug purchases and on rates of hospitalizations and primary care contacts among persons with schizophrenia in Finland. RESEARCH DESIGN: Interrupted time series analysis. SUBJECTS: All persons with schizophrenia in Finland who were alive at the beginning of 2015 (N=41,017). MEASURES: We measured the rates of antipsychotic, other psychotropic and cardiometabolic drug purchasers, hospitalizations, and primary care contacts during 2015 and 2016 with data collected from several nationwide health care registers. RESULTS: During 2016, the proportion of antipsychotic purchasers decreased by -0.26 percentage points per month [95% confidence interval (CI): -0.47 to -0.05] compared with 2015. The trend of other psychotropic purchasers decreased to -0.13 percentage points per month in 2016 (95% CI: -0.22 to -0.04) compared with 2015 and cardiometabolic drug purchases to -0.17 percentage points per month (95% CI: -0.29 to -0.05) compared with 2015. The decreasing trend of psychiatric hospitalizations in 2015 halted in 2016. There were no other significant differences in health care utilization. CONCLUSIONS: In our nationwide time-series analysis, we observed decreases in the slopes of antipsychotic and other drug purchases of persons with schizophrenia after prescription drug cost-sharing increase implementation on January 1, 2016. Policymakers need to be aware of the unintended consequences of increasing cost-sharing among people with severe mental disorders.


Assuntos
Antipsicóticos/administração & dosagem , Antipsicóticos/economia , Custo Compartilhado de Seguro/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Adulto , Idoso , Antipsicóticos/uso terapêutico , Feminino , Finlândia , Hospitalização/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Psicotrópicos/administração & dosagem , Psicotrópicos/economia
12.
Niger Postgrad Med J ; 27(3): 230-236, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687124

RESUMO

Background: Psychoactive substance use is frequently encountered in hospitals' emergency departments (EDs). It accounts for major health-care problems frequently leading to accident and ED admissions, yet it is frequently unidentified. The aim of this study was to determine the prevalence and pattern of psychoactive substance use among patients presenting in the Accident and EDs and to compare the case detection rate of psychoactive substance use between self-report questionnaire and biochemical markers (e.g., urine toxicology). Methods: To achieve this, 200 consenting participants attending the accident and emergency unit of a tertiary hospital were consecutively enlisted into the study within 2 weeks. They were screened for psychoactive substance use with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the urine drug test (UDT). Results: The lifetime prevalence of psychoactive substance use was 45.5%, while the past 3 months (recent use) prevalence was 27.0%. The pattern of psychoactive substance use revealed that alcohol was the predominant psychoactive substance use with a lifetime prevalence of 13.0% and recent use of 12.0%. The UDT significantly detected more patients who used psychoactive substance compared to self-report (P < 0.001). Conclusion: The prevalence of drug use recorded among attendees of the accident and emergency unit was high in this study. The UDT significantly detected more patients who used psychoactive substances compared to self-report (P < 0.001). Several patients with major health problems as a result of psychoactive substance use were identified with the aid of these screening tools.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Intoxicação Alcoólica/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicamentos sem Prescrição/efeitos adversos , Psicotrópicos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Consumo de Bebidas Alcoólicas/epidemiologia , Intoxicação Alcoólica/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Medicamentos sem Prescrição/uso terapêutico , Prevalência , Transtornos Relacionados ao Uso de Substâncias/psicologia , Centros de Atenção Terciária , Adulto Jovem
13.
J Clin Psychiatry ; 81(4)2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32659874

RESUMO

OBJECTIVE: A recent randomized controlled trial of repetitive transcranial magnetic stimulation (TMS) for major depressive disorder (MDD) in veterans raised the question of whether comorbid posttraumatic stress disorder (PTSD) negatively impacted the outcome of TMS in veterans. To address this, a quality database was analyzed to compare outcomes of MDD treated with TMS in veterans with and without comorbid PTSD. METHODS: The clinical outcomes of all consecutive veterans with MDD treated with TMS at the James A. Haley Veterans' Hospital as outpatients from October 2013 through September 2018 were included. Patients were initially evaluated by an experienced psychiatrist, and the diagnosis of MDD was made by clinical evaluation per DSM-IV-TR/DSM-5 criteria. At the start of treatment, after every 5 treatments, and at the end of treatment, patients were assessed with self-report and clinician-rated scales of depression. All data were abstracted from an existing quality database. RESULTS: Among the 118 patients treated with TMS for depression, 55 (47%) had comorbid PTSD and 63 (53%) had no comorbid PTSD. Response and remission rates by score on the Montgomery-Asberg Depression Rating Scale were similar between patients with PTSD (52.5% and 40.9%, respectively) and without PTSD (53.8% and 35.6%, respectively). No seizures or persistent adverse effects were observed or reported in either group. CONCLUSIONS: Comorbid PTSD did not impact the outcome of TMS for depression in this sample of veterans. Future studies should include formal ratings of PTSD to determine if the severity of PTSD affects the outcome.


Assuntos
Transtorno Depressivo Maior/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Estimulação Magnética Transcraniana , Veteranos/psicologia , Adulto , Idoso , Terapia Combinada/métodos , Bases de Dados Factuais , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicotrópicos/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Estimulação Magnética Transcraniana/efeitos adversos , Resultado do Tratamento , Adulto Jovem
14.
J Clin Psychiatry ; 81(4)2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32659875

RESUMO

BACKGROUND: Electroconvulsive therapy (ECT) is an important therapy for treatment-resistant depression and is especially effective for elderly individuals with depression. This is the first US nationally representative description of ECT in the elderly. METHODS: Using 2014-2015 Medicare claims data, we compared elderly individuals with major depressive disorder (using ICD-9 and ICD-10 codes) who received ECT with those who did not on demographic and clinical measures. We characterized treatment patterns by setting and the proportion of individuals receiving index and continuation/maintenance courses, subtherapeutic courses of ECT, and post-ECT follow-up care. RESULTS: Of all Medicare beneficiaries aged 65 years and older diagnosed with depression in 2014-2015, 7,817 (0.41%) received 1 or more ECT sessions. Compared to the general population of elderly Medicare beneficiaries with depression, recipients of ECT were slightly younger and more likely to be male, non-Hispanic, and white and live in a zip code with a higher median income. Among those who received any ECT, 33.7% received < 5 total treatments. Of those who received an index ECT treatment, 33.7% received a continuation/maintenance course of ECT, while 60.9% received some form of post-ECT follow-up treatment (additional ECT or new psychotropic medication). Receipt of psychotherapy was the strongest predictor of those who received ≥ 5 ECT treatments (adjusted odds ratio = 1.43; 95% CI, 1.22 to 1.67). CONCLUSIONS: Despite substantial evidence of efficacy, ECT use remains rare among elderly patients with depression. Findings suggest a potential need for efforts to increase the proportion of patients receiving adequate courses of ECT and evidence-based post-ECT follow-up care.


Assuntos
Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/normas , Medicare/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Bases de Dados Factuais , Feminino , Humanos , Masculino , Psicotrópicos/uso terapêutico , Fatores Sexuais , Resultado do Tratamento , Estados Unidos
15.
J Clin Psychiatry ; 81(4)2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32726521

RESUMO

OBJECTIVE: To review the efficacy of antidepressants and other therapeutic agents for the treatment of cognitive impairment in adults with major depressive disorder (MDD). DATA SOURCES: We conducted a database search of MEDLINE, PsycINFO, and Embase through Ovid on May 7, 2019. The year of publication was not restricted. The search terms "Major Depressive Disorder," "depress*," "cognit*," and "therapeutics" were used. STUDY SELECTION: The studies included in this review were clinical trials of antidepressants and other therapeutic agents in MDD populations. Participants were aged between 18 and 65 years and had a DSM-III, -IV, or -5 diagnosis of MDD. In total, 2,045 research papers were screened, 53 full-text articles were assessed, and 26 articles were eligible to be included in this systematic review. DATA EXTRACTION: The data and quality of research papers were assessed and screened by 2 independent reviewers. Discrepancies were resolved through a third reviewer. RESULTS: Overall, studies demonstrated that tricyclic antidepressants do not have procognitive effects, while vortioxetine and bupropion have demonstrated procognitive effects in MDD populations relative to selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Several non-antidepressant agents, such as modafinil, amphetamines, and erythropoietin, have also demonstrated significant positive effects on cognition in depression. CONCLUSIONS: Present-day antidepressants and other agents have demonstrated procognitive effects in MDD, but the findings between various agents are mixed. Further research looking at objective measures of cognitive performance would be helpful to obtain more definitive results regarding the efficacy of therapeutics for cognitive impairment in MDD.


Assuntos
Antidepressivos/uso terapêutico , Disfunção Cognitiva/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Psicotrópicos/uso terapêutico , Disfunção Cognitiva/complicações , Transtorno Depressivo Maior/complicações , Humanos
16.
BMC Med ; 18(1): 215, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32664944

RESUMO

BACKGROUND: The novel coronavirus pandemic calls for a rapid adaptation of conventional medical practices to meet the evolving needs of such vulnerable patients. People with coronavirus disease (COVID-19) may frequently require treatment with psychotropic medications, but are at the same time at higher risk for safety issues because of the complex underlying medical condition and the potential interaction with medical treatments. METHODS: In order to produce evidence-based practical recommendations on the optimal management of psychotropic medications in people with COVID-19, an international, multi-disciplinary working group was established. The methodology of the WHO Rapid Advice Guidelines in the context of a public health emergency and the principles of the AGREE statement were followed. Available evidence informing on the risk of respiratory, cardiovascular, infective, hemostatic, and consciousness alterations related to the use of psychotropic medications, and drug-drug interactions between psychotropic and medical treatments used in people with COVID-19, was reviewed and discussed by the working group. RESULTS: All classes of psychotropic medications showed potentially relevant safety risks for people with COVID-19. A set of practical recommendations was drawn in order to inform frontline clinicians on the assessment of the anticipated risk of psychotropic-related unfavorable events, and the possible actions to take in order to effectively manage this risk, such as when it is appropriate to avoid, withdraw, switch, or adjust the dose of the medication. CONCLUSIONS: The present evidence-based recommendations will improve the quality of psychiatric care in people with COVID-19, allowing an appropriate management of the medical condition without worsening the psychiatric condition and vice versa.


Assuntos
Infecções por Coronavirus/complicações , Interações Medicamentosas , Transtornos Mentais/tratamento farmacológico , Pneumonia Viral/complicações , Psicotrópicos/efeitos adversos , Betacoronavirus , Medicina Baseada em Evidências , Humanos , Transtornos Mentais/epidemiologia , Pandemias , Psicotrópicos/uso terapêutico , Saúde Pública , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Revisões Sistemáticas como Assunto
17.
Fundam Clin Pharmacol ; 34(5): 530-547, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32603486

RESUMO

Patients with COVID-19 are sometimes already being treated for one or more other chronic conditions, especially if they are elderly. Introducing a treatment against COVID-19, either on an outpatient basis or during hospitalization for more severe cases, raises the question of potential drug-drug interactions. Here, we analyzed the potential or proven risk of the co-administration of drugs used for the most common chronic diseases and those currently offered as treatment or undergoing therapeutic trials for COVID-19. Practical recommendations are offered, where possible.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Medicamentos sob Prescrição/farmacologia , Analgésicos/farmacologia , Antiasmáticos/farmacologia , Antibacterianos/farmacologia , Anti-Inflamatórios/farmacologia , Anticoagulantes/farmacologia , Antineoplásicos/farmacologia , Antituberculosos/farmacologia , Antivirais/farmacologia , Betacoronavirus , Fármacos Cardiovasculares/farmacologia , Interações Medicamentosas , Humanos , Hidroxicloroquina/farmacologia , Hipoglicemiantes/farmacologia , Hipolipemiantes/farmacologia , Interferon beta-1b/farmacologia , Pandemias , Medicamentos sob Prescrição/farmacocinética , Psicotrópicos/farmacologia , Receptores de Interleucina/antagonistas & inibidores , Medição de Risco , Hormônios Tireóideos/farmacologia
18.
J Anal Toxicol ; 44(7): 697-707, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-32685960

RESUMO

New psychoactive substances (NPS) are a major public health problem, primarily due to the increased number of acute poisoning cases. Detection of these substances is a challenge. The aim of this research was to develop and validate a sensitive screening method for 104 drugs of abuse, including synthetic cannabinoids, synthetic cathinones, fentanyl analogues, phenethylamines and other abused psychoactive compounds (i.e., THC, MDMA, LSD and their metabolites) in oral fluid by liquid chromatography-tandem mass spectrometry (LC-MS-MS). The Quantisal™ oral fluid device was used to collect oral fluid samples. The oral fluid-elution buffer mixture (500-µL sample) was extracted with t-butyl methyl ether, and chromatographic separation was performed on a Raptor™ biphenyl column (100 × 2.1 mm ID, 2.7 µm), with a total run time of 13.5 min. Limits of detection were established at three concentrations (0.05, 0.1 or 1 ng/mL) for most analytes, except for acetyl norfentanyl and mescaline (5 ng/mL). Matrix effects were generally <20% and overall extraction recoveries >60%. The highest matrix effect was observed within the synthetic cannabinoid group (PB22, -55.5%). Lower recoveries were observed for 2C-T (47.2%) and JWH-175 (58.7%). Recoveries from the Quantisal™ device were also evaluated for all analytes (56.7-127%), with lower recoveries noted for 25I-NBOMe, valerylfentanyl and mCPP (56.7, 63.0 and 69.9%, respectively). Drug stability in oral fluid was evaluated at 15, 60 and 90 days and at 25, 4 and -20°C. As expected, greater stability was observed when samples were stored at -20°C, but even when frozen, some NPS (e.g., synthetic cannabinoids) showed more than 20% degradation. The method was successfully applied to the analysis of seven authentic oral fluid samples positive for 17 different analytes. The method achieved good sensitivity and simultaneous detection of a wide range of NPS.


Assuntos
Drogas Ilícitas/análise , Psicotrópicos/análise , Detecção do Abuso de Substâncias/métodos , Canabinoides , Cromatografia Líquida , Limite de Detecção , Piperazinas , Espectrometria de Massas em Tandem
20.
Am J Cardiol ; 128: 1-6, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650900

RESUMO

In this nation-wide cohort study we report the first long-term results of the association between having a atrial septal defects (ASD) on psychiatric disorders and use of psychotropic agents. Through population-based registries we included Danish individuals born before 1994 who received an ASD diagnosis between 1959and 2013. We used Cox proportional hazards regression and Fine and Grey competing risk regression to estimate the risk of receiving a psychiatric diagnosis and use of psychotropic medicine compared with a gender and age matched background population cohort. In 2,277 patients with a median follow-up from ASD diagnosis of 23.4 years (range 0.2 to 59.3 years) we found ASD patients to have a higher risk of psychiatric disorders (adjusted hazard ratio [HR]: 3.9; 95% confidence interval [CI] 3.4 to 4.5) compared with the comparison cohort and a cumulative incidence of using psychotropic agents 30 years after the ASD diagnosis of 47.4% (95% CI: 40.3 to 55.1) in the ASD patients and 25.5%, (95% CI: 23.5 to 27.8) in the comparison cohort. Diagnosis of the ASD before the age of 15 years (adjusted HR: 3.4; 95% confidence interval: 2.0 to 4.0) and surgical correction of the defect (HR: 1.5 (95% CI: 1.2 to 1.8), p <0.0001) had a higher risk than those with an ASD diagnosis after the age of 15 years and those with transcatheter closure of the defect. In conclusion, ASD patients had increased long-term risk of psychiatric disorder and use of psychotropic agents compared with a gender and age matched general population controls.


Assuntos
Comunicação Interatrial/epidemiologia , Transtornos Mentais/epidemiologia , Psicotrópicos/uso terapêutico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Criança , Pré-Escolar , Dinamarca/epidemiologia , Feminino , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/cirurgia , Humanos , Incidência , Lactente , Masculino , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Risco , Adulto Jovem
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