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1.
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
3.
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
4.
Tidsskr Nor Laegeforen ; 139(14)2019 Oct 08.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31592608

RESUMO

BACKGROUND: Since 2016, all health regions have been instructed to provide drug-free psychiatric treatment options. The evidence base for such treatment has been called for. At Jæren District Psychiatric Centre we therefore identified the patients' wishes for drug-free treatment. MATERIAL AND METHOD: One hundred patients were sequentially asked upon admission whether they would want a drug-free treatment programme, given that it was available. The patients' age, sex, diagnosis and medical history were recorded, as well as their experience with the use of psychoactive drugs and counselling. RESULTS: Altogether 52 out of the 100 patients would want a drug-free treatment programme if this were available. The largest proportion was registered among patients who had been coercively sectioned (10 out of 13 patients) and among those who experienced least benefit from their drugs (17 out of 25). Even among those who reported to benefit well from their drugs, a considerable proportion wanted a drug-free option (24 out of 58). The majority of the patients had long illness trajectories and a high consumption of psychoactive drugs. INTERPRETATION: The observation that a large proportion of the patients would want a drug-free treatment programme if this were available can be seen as a reflection of frustration caused by persistent symptoms, adverse effects and a large burden of suffering despite the use of medication. An alternative interpretation is that the patients had an insufficient understanding of their need for preventive treatment or for their need for treatment at all.


Assuntos
Pacientes Internados/psicologia , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes/psicologia , Preferência do Paciente , Adolescente , Adulto , Idoso , Internação Compulsória de Doente Mental , Feminino , Humanos , Tratamento Psiquiátrico Involuntário , Masculino , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Psicotrópicos/administração & dosagem , Psicotrópicos/uso terapêutico , Adulto Jovem
6.
Clin Drug Investig ; 39(11): 1077-1092, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31399894

RESUMO

BACKGROUND AND OBJECTIVES: In Japan, polypharmacy reduction policy, which reduces the reimbursement of medical cost, was introduced to address unnecessary psychotropic polypharmacy. The rule was applied to the prescriptions of three or more anxiolytics or three or more hypnotics in the policy introduced in 2012. The prescriptions of four or more antidepressants or four or more antipsychotics were added to the rule in the policy revised in 2014. Furthermore, the prescriptions of three or more drugs of anxiolytics, hypnotics, antidepressants, or antipsychotics were subject to the reduction criteria of the policy revision in 2016. Benzodiazepine receptor agonists (BZs) are classified both into anxiolytics and hypnotics, and the reduction rule was not applied to the category of BZs before April 2018. This study aimed to examine the effect of the policy on the prescriptions of four drug categories as well as BZs from the point of view of the number of drugs and doses. METHODS: This was a retrospective observational study using a large-scale Japanese health insurance claims database. Patients who were prescribed at least one psychotropic drug (anxiolytic, hypnotic, antidepressant, or antipsychotic) during the study period (from April 2011 to March 2017) were selected. Segmented regression analysis was used to analyze the proportions of patients with three or more or four or more drugs as well as patients above clinically recommended doses, and the means of the average daily doses by drug category. RESULTS: A total of 312,167 patients were identified as a study population. The proportions of patients with three or more drugs in anxiolytics, hypnotics, antidepressants, and antipsychotics significantly decreased after the introduction or revisions of the policy, but not BZs. The proportions of patients with three or more drugs in March 2017 were 0.9%, 2.0%, 1.2%, 2.4%, and 8.9% in anxiolytics, hypnotics, antidepressants, antipsychotics, and BZs, respectively. The effect of the policy in reducing the proportions of patients above clinically recommended doses was identified in antipsychotics after the revision in 2016, but not identified in the sum of anxiolytics and hypnotics as well as BZs after the revision in 2014, and antidepressants after the revision in 2016. The proportions of monotherapy were increased from April 2011 to March 2017 only for antidepressants (76.9% → 80.8%) and antipsychotics (79.8% → 82.1%), and not changed or decreased for anxiolytics (85.2% → 85.7%), hypnotics (78.6% → 77.6%), sum of anxiolytics and hypnotics (68.1% → 65.7%), BZs (68.0% → 67.3%), and sum of psychotropic drugs (52.1% → 49.9%). CONCLUSIONS: The polypharmacy reduction policy reduced the proportions of patients with three or more drugs in four drug categories, but not BZs. Only limited effects were seen for reducing the proportions of patients above clinically recommended doses. The policy was revised in April 2018 again. Further investigation is needed to examine the effect of the revision in 2018.


Assuntos
Bases de Dados Factuais/tendências , Prescrições de Medicamentos , Revisão da Utilização de Seguros/tendências , Polimedicação , Psicotrópicos/administração & dosagem , Adolescente , Adulto , Idoso , Antidepressivos/administração & dosagem , Antipsicóticos/administração & dosagem , Bases de Dados Factuais/normas , Prescrições de Medicamentos/normas , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Revisão da Utilização de Seguros/normas , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
7.
Medwave ; 19(6): e7670, 2019 Jul 30.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31442218

RESUMO

Background: The consumption of psychotropic drugs without a medical prescription is a growing public health problem worldwide. Misuse or indiscriminate use involves several risks. Objective: To determine sociodemographic factors and behaviors associated with the consumption of psychotropic drugs without prescription in Chile. Methods: This is a descriptive study based on the data of the XI National Study of Drugs in the General Population in Chile, carried out in the population between 12 and 64 years old (n = 19 512) during 2014. Prevalence was estimated, and a multivariate logistic regression model was adjusted. Also, a multiple correspondence analysis was performed. Results: The prevalence of psychotropic drug use was 2.3%. In the studied population, associated risk factors are female sex (odds ratio: 1.4; 95% confidence interval: 1.16 to 1.77); ages between 20-29 (odds ratio: 1.4; 95% confidence interval: 0.98 to 2.26) and 40-49 (odds ratio: 1.8; 95% confidence interval: 1.19 to 2.75); consumption of marijuana (odds ratio: 3.0; 95% confidence interval: 3.32 to 3.97), cocaine or crack (odds ratio: 3.7; 95% confidence interval: 2.45 to 5.70); tobacco (odds ratio: 1.4; 95% confidence interval: 1.17 to 1.78); alcohol (odds ratio: 1.3; 95% confidence interval: 1.11 to 1.73); and poor health perception (odds ratio: 1.8; 95% confidence interval: 1.51 to 2.28). Military personnel used more pain and cough medication; young women between 19 to 25 years old used stimulants; the population between 45 to 64 years had a bad perception of health associated with the use of tranquilizers; and men between 12 and 18 years used illicit drugs. Conclusions: The prevalence found in the different groups is consistent with data reported in Latin America, showing the relationship between the use of non-prescription psychotropic drugs with sociodemographic factors, risk behaviors, and the identification of consumption profiles.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Psicotrópicos/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Chile/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Assunção de Riscos , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
8.
Cien Saude Colet ; 24(8): 2993-3000, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389546

RESUMO

OBJECTIVE: To investigate the process of medicalization among the Xukuru indigenous people of Pesqueira (PE), Brazil following the 2003 conflict. METHOD: This is a descriptive, cross-sectional, quantitative study developed with the indigenous attended at the Xukuru de Cimbres basic center. The final sample consisted of 75 individuals who used psychotropic drugs. Data were analyzed by SPSS version 18.0, using the chi-square test. RESULTS AND DISCUSSION: We observed that 8% of the studied population use psychotropic drugs, and the most used is BZD (78.67%). Regarding age, 68% are young adults and 26.67% are elderly. The income of 81.33% of households is more than one minimum wage. As for marital status, 50.85% and 66.67%, respectively of the indigenous group using BZD and other psychotropic drugs are married. CONCLUSION: The study outlined the profile of the Xukuru de Cimbres indigenous people who used psychotropics and showed a fragmented mental health care focused on the disease and the use of medication. Results reveal a socioeconomically vulnerable adult population, a pattern of chronic use of psychotropic drugs and distancing from traditional indigenous healing, typical of the health medicalization process.


Assuntos
Índios Sul-Americanos/estatística & dados numéricos , Medicalização , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/administração & dosagem , Adolescente , Adulto , Benzodiazepinas/administração & dosagem , Brasil , Estudos Transversais , Feminino , Humanos , Renda , Masculino , Medicina Tradicional/métodos , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Adulto Jovem
9.
Pan Afr Med J ; 32: 204, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312316

RESUMO

Background: Suicidal behaviors are increasing in Tunisia at younger and younger ages. This study aims to describe the sociodemographic and clinical profile of suicide attempts in children and adolescents. Methods: We conducted a cross-sectional and descriptive study, including 50 suicidal individuals, recruited in the Child Psychiatry Department at the Razi Hospital in Manouba and in two Departments in Tunisia (Intensive Care and Reanimation Department and Department of Pediatrics) between July 2012 and June 2013. We identified the socio-demographic and clinical factors, the histories of abuse, subjects' education, the characteristics of the attempted suicides (TS), suicidal ideation assessed by the Suicidal Intent Scale and psychopathological disorders diagnosed using the Mini-International Neuropsychiatric Interview. Results: The sex-ratio was 0.56, the average age was 12.4 years ranging from 7 to 16 years. School failure or dropout were found in 86% of suicidal individuals. In 38% of cases suicidal behavior was recurrent; the subjects had a history of self-mutilation to the same extent. A context of abuse was reported in 46% of cases. Drug ingestion was the most common means of suicide, psychotropic drugs were the most common substances used. There was a significant gender difference in the use of the means of suicide: the boys mainly used physical means (P=0.04) while the girls poisoning (P=0.001). Suicidal intent was high in 44% of cases. A major depressive episode and adjustment disorder were the most common disorders found (58% and 24% of cases respectively). Conclusion: Depressive disorders and abuse are risk factors of TS in children and adolescents, these factors should be considered when implementing suicide prevention strategies for this population.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Transtornos de Adaptação/epidemiologia , Adolescente , Criança , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Psicotrópicos/administração & dosagem , Recidiva , Fatores de Risco , Comportamento Autodestrutivo/epidemiologia , Fatores Sexuais , Tentativa de Suicídio/psicologia , Tunísia/epidemiologia
10.
Drugs Aging ; 36(8): 769-780, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31209735

RESUMO

BACKGROUND AND OBJECTIVE: Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards person-centred care) achieved significant reductions in psychotropic drug use. The initiative outline was transcribed into a general intervention template, and consequently implemented in five nursing homes (in mixed locations and with a mixed character) in preparation for a future broader roll-out in Belgium. The impact of the intervention on the use of psychotropic drugs in these five nursing homes is reported in this paper. METHODS: The general intervention template was fitted into the individual nursing home setting. Education for the nursing home personnel on psychotropic drugs and non-pharmacological alternatives, as well as details for a transition to person-centred care was provided. Psychotropic drug use was recorded using a dynamic cohort study design with cross-sectional observations (November 2016-November 2017). RESULTS: At baseline, participants' (n = 677) mean age was 85.6 years (range 54-109 years), with 72.6% female. Mean medication intake was 8.5 (range 1-22), predominantly central nervous system drugs (Anatomic Therapeutic Chemical classification N, 88.8%). Long-term (> 3 months) psychotropic drug use (62.0%) and concomitant psychotropic drug use (31.5% taking two or more medications) were high. After 12 months, the prevalence of long-term psychotropic drug use decreased significantly (from 62.0 to 52.9%, p < 0.001), likewise the combined use of psychotropic drugs (from 31.5 to 24.0%, p = 0.001). The decrease in the prevalence of antidepressant and hypnosedative use was significant (respectively, from 32.2 to 23.4%, p < 0.001, and from 35.3 to 28.7%, p = 0.006) in contrast to antipsychotic use (from 17.1 to 15.9%, p = 0.522). CONCLUSIONS: The stand-alone adaptation of the previously reported initiative using a general template was possible. This intervention resulted in a significant decrease in psychotropic drug use (predominantly hypnosedatives and antidepressants) among nursing home residents after 12 months.


Assuntos
Uso de Medicamentos/tendências , Casas de Saúde/tendências , Psicotrópicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/administração & dosagem , Antidepressivos/uso terapêutico , Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Bélgica , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Psicotrópicos/administração & dosagem
11.
J Med Case Rep ; 13(1): 183, 2019 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-31202268

RESUMO

BACKGROUND: Prolactinomas are tumors of the pituitary gland that usually respond very well to treatment with cabergoline. Resistance to cabergoline is very rare, but when it occurs, it is a difficult problem to resolve if the tumor is inoperable. CASE PRESENTATION: A 62-year-old white man was treated for a giant macroprolactinoma detected during investigation of a subacute subdural hematoma of the left frontal lobe. The patient was treated with cabergoline for 17 years with a dose ranging from 1.0 mg to 3.5 mg per week. We were not able to normalize his prolactin level, which initially was 14,992 ng/ml and ultimately 1754 ng/ml. The tumor significantly shrank during the follow-up period but persisted. The patient had cardiac valvulopathies that did not worsen. He had an ischemic stroke and developed a psychotic condition that was successfully treated by lowering the cabergoline and administering quetiapine and mirtazapine together. This regimen led to a small increase in the patient's prolactin that returned to previous levels and remained as such until the last medical evaluation. The tumor continued to shrink and had a cystic degeneration in the last evaluation. CONCLUSIONS: Combined use of cabergoline with quetiapine and mirtazapine to treat a psychotic crisis may have contributed to shrinking the tumor in our patient because these antipsychotics have action mediated by growth factors that interfere with growth of pituitary tumors.


Assuntos
Cabergolina , Mirtazapina/administração & dosagem , Neoplasias Hipofisárias , Prolactina/sangue , Prolactinoma , Transtornos Psicóticos , Fumarato de Quetiapina/administração & dosagem , Acidente Vascular Cerebral/complicações , Cabergolina/administração & dosagem , Cabergolina/efeitos adversos , Agonistas de Dopamina/administração & dosagem , Agonistas de Dopamina/efeitos adversos , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/patologia , Prolactinoma/sangue , Prolactinoma/complicações , Prolactinoma/tratamento farmacológico , Prolactinoma/patologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/etiologia , Psicotrópicos/administração & dosagem , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento , Carga Tumoral
12.
Nord J Psychiatry ; 73(6): 323-330, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31240984

RESUMO

Background: Although cannabis use has been linked with schizophrenia in a dose-response pattern, to our knowledge, the relationship between cannabis and schizophrenia has rarely been reported in Asian population. Aim: We compared the clinical characteristics and psychotropic prescription patterns between cannabis users and non-users among Asian patients with schizophrenia. Moreover, we aimed to identify the independent correlates of cannabis use in these subjects. Methods: We performed the analysis of the data from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP), a collaborative consortium survey used to collate the prescription patterns for antipsychotic and other psychotropic medications in patients with schizophrenia in Asia. We included 132 schizophrenia patients in the group of lifetime cannabis use and 1756 in the group that had never used cannabis. A binary logistic model was fitted to detect the clinical correlates of lifetime cannabis use. Results: Adjusting for the effects of age, sex, geographical region, income group, duration of untreated psychosis, and Charlson comordity index level, a binary logistic regression model revealed that lifetime cannabis use was independently associated with aggressive behavior [adjusted odds ratio (aOR) = 1.582, 95% confidence interval (CI) = 1.006-2.490, p = .047] and with long-acting injectable antipsychotic treatment (aOR = 1.796, 95% CI = 1.444-2.820, p = .001). Conclusion: Our findings indicate a close link between lifetime cannabis use and aggressive behavior. The use of long-acting, injectable antipsychotics preferentially treats the aggressive behavior cannabis users among patients with schizophrenia in Asia, especially, the South or Southeast Asia.


Assuntos
Agressão , Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Cannabis/efeitos adversos , Fumar Maconha/efeitos adversos , Esquizofrenia/tratamento farmacológico , Adulto , Ásia/epidemiologia , Grupo com Ancestrais do Continente Asiático/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Fumar Maconha/epidemiologia , Fumar Maconha/psicologia , Razão de Chances , Psicotrópicos/administração & dosagem , Psicotrópicos/uso terapêutico , Esquizofrenia/epidemiologia , Inquéritos e Questionários
13.
PLoS One ; 14(5): e0216317, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048918

RESUMO

BACKGROUND: Intentional drug overdose is the most common method of self-harm. As psychiatric disorders are very common in self-harm patients, the medication used to treat these disorders can become the means for the self-harm act. The present study aimed at investigating an association between the use of prescribed medication (analgesics and antipyretics, anti-epileptics, antipsychotics, antidepressants and psychostimulants) as a method of self-harm and prescription rates of this medication in Flanders. We investigated the possible effect of gender, alcohol use during the self-harm act and a history of self-harm. METHODS: Data from the multicenter study of self-harm in Flanders between 2008 and 2013 were used. The significance of differences in percentages was calculated by GEE and the strength by odds ratios (OR). RESULTS: There was an increase in the odds of using antidepressants (0.8%) and antipsychotics (2%) among females when the rate of prescription increases. Analgesics and antipyretics (39.3/1,000) and antidepressants (124.9/1,000) were the most commonly prescribed drugs among females. Antidepressants (63.9/1,000) and antipsychotics (26.5/1,000) were the most commonly prescribed drugs among males. Antidepressants and analgesics and antipyretics were the most frequently used medications for self-harm. Analgesics and antipyretics during the self-harm act were more common among first-timers, while repeaters more commonly overdosed using antipsychotics and antidepressants. CONCLUSION: These findings suggest that the availability of medication via prescriptions plays an important role in the choice of the medication ingested during the self-harm act. Precautions are necessary when prescribing medication, including restrictions on the number of prescriptions and the return of unused medication to pharmacies after cessation of treatment. These issues should be a focus of attention in the education and training of physicians and pharmacists.


Assuntos
Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Medicamentos sob Prescrição/efeitos adversos , Psicotrópicos/efeitos adversos , Tentativa de Suicídio , Adulto , Bélgica/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Medicamentos sob Prescrição/administração & dosagem , Psicotrópicos/administração & dosagem , Fatores Sexuais
14.
Brain Behav ; 9(5): e01275, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30941915

RESUMO

BACKGROUND: Repetitive Transcranial Magnetic Stimulation (rTMS) is commonly administered to Major Depressive Disorder (MDD) patients taking psychotropic medications, yet the effects on treatment outcomes remain unknown. We explored how concomitant medication use relates to clinical response to a standard course of rTMS. METHODS: Medications were tabulated for 181 MDD patients who underwent a six-week rTMS treatment course. All patients received 10 Hz rTMS administered to left dorsolateral prefrontal cortex (DLPFC), with 1 Hz administered to right DLPFC in patients with inadequate response to and/or intolerance of left-sided stimulation. Primary outcomes were change in Inventory of Depressive Symptomatology Self Report (IDS-SR30) total score after 2, 4, and 6 weeks. RESULTS: Use of benzodiazepines was associated with less improvement at week 2, whereas use of psychostimulants was associated with greater improvement at week 2 and across 6 weeks. These effects were significant controlling for baseline variables including age, overall symptom severity, and severity of anxiety symptoms. Response rates at week 6 were lower in benzodiazepine users versus non-users (16.4% vs. 35.5%, p = 0.008), and higher in psychostimulant users versus non-users (39.2% vs. 22.0%, p = 0.02). CONCLUSIONS: Concomitant medication use may impact rTMS treatment outcome. While the differences reported here could be considered clinically significant, results were not corrected for multiple comparisons and findings should be replicated before clinicians incorporate the evidence into clinical practice. Prospective, hypothesis-based treatment studies will aid in determining causal relationships between medication treatments and outcome.


Assuntos
Terapia Combinada/métodos , Transtorno Depressivo Maior , Córtex Pré-Frontal , Psicotrópicos , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Psicotrópicos/administração & dosagem , Psicotrópicos/classificação , Estudos Retrospectivos , Autorrelato , Resultado do Tratamento
16.
Drug Alcohol Depend ; 199: 106-115, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31029878

RESUMO

BACKGROUND: With increasing access to legal cannabis across the globe, it is imperative to more closely study its behavioral and physiological effects. Furthermore, with the proliferation of cannabis use, modes of consumption are changing, with edible formulations becoming increasingly popular. Nevertheless, there are relatively few animal models of self-administration of the primary psychoactive component of cannabis, Δ9-tetrahydrocannabinol (THC), and almost all incorporate routes of administration other than those used by humans. The aim of the current study was to develop a model of edible THC self-administration and assess its impact on CB1 receptor-mediated behaviors in female and male mice. METHODS: Mice were given limited access to a palatable dough which occasionally contained THC in doses ranging from 1 to 10 mg/kg. Following dough consumption, mice were assessed for home cage locomotor activity, body temperature, or analgesia. Locomotor activity was also assessed in conjunction with the CB1 receptor antagonist SR141716A. RESULTS: Dough was well-consumed, but consumption decreased at the highest THC concentrations. Edible THC produced dose-dependent decreases in locomotor activity and body temperature in both sexes, and these effects were more pronounced in male mice. Hypolocomotion induced by edible THC was attenuated by SR141716A, indicating mediation by CB1 receptor activation. CONCLUSIONS: In contrast to other cannabinoid self-administration models, edible THC is relatively low in stress and uses a route of administration analogous to one used by humans. Potential applications include chronic THC self-administration, determining THC reward/reinforcement, and investigating consequences of oral THC use.


Assuntos
Temperatura Corporal/efeitos dos fármacos , Dronabinol/administração & dosagem , Atividade Motora/efeitos dos fármacos , Psicotrópicos/administração & dosagem , Recompensa , Animais , Temperatura Corporal/fisiologia , Canabinoides/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Atividade Motora/fisiologia , Receptor CB1 de Canabinoide/agonistas , Receptor CB1 de Canabinoide/antagonistas & inibidores , Receptor CB1 de Canabinoide/fisiologia , Autoadministração
18.
Psychother Psychosom ; 88(2): 96-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30923288

RESUMO

BACKGROUND AND OBJECTIVE: Methods and justifications for discontinuing psychotropic drugs in randomized controlled trials (RCTs), and RCTs' acknowledgement of possible withdrawal symptoms following discontinuation, have not been examined systematically, which this review aims to do. Study Eligibility, Data Extraction, and Synthesis: Publications in MEDLINE, EMBASE, and PsycINFO (2000-2017) randomly assigning participants diagnosed with mental disorders to discontinue antipsychotic, antidepressant, anticonvulsant, antimanic, mood-stabilizing, benzodiazepine, or stimulant drugs. Authors independently extracted data, devised a typology of trials, and assessed trials' recognition of with-drawal symptoms. RESULTS: Eighty RCTs (70% with industry participation) discontinued drugs from 5,757 participants to investigate relapse prevention (44%), successful dis-continuation (26%), architecture of withdrawal (14%), and practicality of discontinuation (10%). RCTs of stimulants, antidepressants, and antipsychotics mostly aimed to reach conclusions about relapse prevention by testing abrupt or rapid discontinuations; RCTs of benzodiazepines mostly aimed to reduce drug use by testing longer-lasting, supportive discontinuations. In 67% of RCTs, no justification was given for the specific discontinuation strategy, which lasted under 2 weeks in 60% of RCTs. Possible withdrawal confounding of trial outcomes was addressed in 14% of eligible RCTs. LIMITATIONS: Only the published literature was searched. CONCLUSIONS AND IMPLICATIONS: RCTs use drug discontinuation to study several key issues in psychopharmacology but infrequently justify how they implement it or acknowledge that possible withdrawal symptoms may threaten internal validity. Reappraising the use of drug discontinuation and the recognition of withdrawal symptoms in RCTs is required.


Assuntos
Transtornos Mentais/complicações , Psicotrópicos/administração & dosagem , Psicotrópicos/efeitos adversos , Síndrome de Abstinência a Substâncias/complicações , Humanos , Transtornos Mentais/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Psychopharmacology (Berl) ; 236(9): 2635-2640, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30919005

RESUMO

RATIONALE: Δ-9-Tetrahydrocannabinol (Δ-9-THC) produces psychotomimetic effects in humans. However, the role of dopamine signaling in producing such effects is unclear. We hypothesized that dopaminergic antagonism would reduce the psychotomimetic effect of Δ-9-THC. OBJECTIVE: The objective of this study was to evaluate whether pre-treatment with haloperidol would alter the psychotomimetic and perceptual-altering effects of Δ-9-THC, measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and the Clinician-Administered Dissociative Symptom Scale (CADSS) in humans. METHODS: In a two-test-day double-blind study, 28 healthy individuals were administered with active (0.057 mg/kg) or placebo oral haloperidol, followed 90 and 215 min later by intravenous administration of active (0.0286 mg/kg) Δ-9-THC and placebo, respectively. This secondary analysis was conducted because of the observation in other studies and in our data that a significant proportion of individuals may not have an adequate response to THC (floor effect), thus limiting the ability to test an interaction. Therefore, this analysis was performed including only responders to THC (n = 10), defined as individuals who had an increase of at least one point on the PANSS positive scale, consistent with prior human laboratory studies. RESULTS: In the 10 responders, Δ-9-THC-induced increases in PANSS positive scores were significantly lower in the haloperidol condition (1.1 + 0.35) compared with the placebo condition (2.9 + 0.92). CONCLUSION: This responder analysis showed that haloperidol did reduce the psychotomimetic effect of Δ-9-THC, supporting the hypothesis that dopaminergic signaling may participate in the psychosis-like effects of cannabinoids.


Assuntos
Antipsicóticos/administração & dosagem , Antagonistas de Dopamina/administração & dosagem , Dronabinol/administração & dosagem , Haloperidol/administração & dosagem , Psicotrópicos/administração & dosagem , Administração Intravenosa , Administração Oral , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Percepção/efeitos dos fármacos , Percepção/fisiologia , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Adulto Jovem
20.
Issues Ment Health Nurs ; 40(6): 511-517, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30917088

RESUMO

Pro re nata (PRN) medication is medication administered by nurses as required commonly in response to a patient's symptoms or behaviour including insomnia, agitation or anxiety. There is a paucity of research around the process of PRN administration in mental health settings in Ireland and international evidence suggests inconsistencies in practices. This study aimed to explore the process of PRN medication administration by mental health nurses. Using a qualitative descriptive design, semi-structured interviews were undertaken with 19 mental health nurses in three acute inpatient units in one mental health service in Ireland. Most participants reported undertaking an assessment of the patient before administering PRN medication; however, many also reported having observed incidents of poor practice. There was evidence of some interdisciplinary sensitivities around instructions regarding the use of PRN medications between doctors who prescribed them and nurses who dispensed them. A need for service improvements were also identified including the use of alternative strategies to PRN use such as de-escalation techniques and education around psychopharmacology. PRN medication is commonly used in mental health settings; however, this study suggests that there is potential for improvement in relation to how it is prescribed and administered. Overuse of PRN medication has been associated with increased morbidity. Mental health nurses are required to carefully consider whether PRN medication is warranted in the first instance and how its use might impact on patients.


Assuntos
Esquema de Medicação , Transtornos Mentais/tratamento farmacológico , Enfermagem Psiquiátrica , Psicotrópicos/administração & dosagem , Atitude do Pessoal de Saúde , Feminino , Humanos , Irlanda , Masculino , Serviços de Saúde Mental , Papel do Profissional de Enfermagem , Pesquisa Qualitativa
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