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2.
Lakartidningen ; 1172020 09 15.
Artigo em Sueco | MEDLINE | ID: mdl-32940904

RESUMO

Neuroleptic malignant syndrome and serotonin syndrome are two conditions that can occur with psychotropic medications. Although both states are associated with psychiatric care they can also occur in somatic settings. The clinical pictures are complex with many different symptoms of varying severity.  Both diagnoses are therefore easy to miss. Opinions remain divided on how to treat both states pharmacologically. The aim of this article is to increase the understanding and awareness of these potentially life-threatening conditions, which arise from treatment with dopaminergic or serotonergic substances.


Assuntos
Síndrome Maligna Neuroléptica , Psicotrópicos , Síndrome da Serotonina , Humanos , Psicotrópicos/efeitos adversos
3.
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
4.
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
5.
Encephale ; 46(3S): S93-S98, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32507556

RESUMO

Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 epidemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe, thus caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety reduction. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Pandemias , Transtorno de Pânico/psicologia , Pneumonia Viral/psicologia , Ansiedade/etiologia , Ansiedade/psicologia , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Catastrofização , Comorbidade , Infecções por Coronavirus/epidemiologia , Dispneia/etiologia , Dispneia/psicologia , Feminino , Humanos , Hipopotassemia/etiologia , Masculino , Transtorno de Pânico/tratamento farmacológico , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/fisiopatologia , Pneumonia Viral/epidemiologia , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Sistema Renina-Angiotensina/fisiologia , Respiração/efeitos dos fármacos , Estresse Psicológico/etiologia , Estresse Psicológico/fisiopatologia , Terminologia como Assunto , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/etiologia
6.
7.
Nervenarzt ; 91(7): 604-610, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32488413

RESUMO

In view of the current coronavirus disease 2019 (COVID-19) pandemic, patient care, including that of psychiatric patients, is facing unprecedented challenges. Treatment strategies for mental illness include psychotherapy and psychopharmacological interventions. The latter are associated with a multitude of adverse drug reactions (ADR); however, they may currently represent the preferred treatment due to restrictions regarding patient care (i.e. social distancing). Direct contact to patients may have to be reduced in favor of telephone calls or video conferences, so that new techniques in diagnosing and treating patients have to be established to guarantee patient safety. Patients should be extensively informed about relevant ADRs and physicians should actively ask patients about the timely recognition of ADRs. The use of psychotropic drugs may lead to an increased risk of developing ADRs, which are considered to be particularly unfavorable if they occur simultaneously with an acute infection or may even lead to an increased risk of infection. These include respiratory depression, agranulocytosis, intoxication by inhibition of metabolizing enzymes and venous thromboembolism, each of which may be associated with potentially fatal consequences; however, physicians should simultaneously ensure adequate efficacy of treatment, since the ongoing crisis may lead to a worsening of preexisting mental illnesses and to a surge in first onset of psychiatric disorders.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Psicoterapia , Psicotrópicos , Betacoronavirus , Infecções por Coronavirus/psicologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Pandemias/estatística & dados numéricos , Pneumonia Viral/psicologia , Psicoterapia/métodos , Psicoterapia/organização & administração , Psicotrópicos/administração & dosagem , Psicotrópicos/efeitos adversos
8.
Fortschr Neurol Psychiatr ; 88(10): 669-673, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32544955

RESUMO

Ayahuasca is a psychoactive drug which has been used by indigenous cultures in the amazonas basin for hundreds of years for medical and religious purpose. Backpackers who came in contact with ayahuasca exported its use in the western world and increased its popularity. By presenting a case report of a patient seeking medical help due to psychotic symptoms after having attended an ayahuasca ritual we give an short overview of pharmacology, legal status, use and side effects of the substance.


Assuntos
Banisteriopsis/efeitos adversos , Banisteriopsis/química , Estilo de Vida , Psicotrópicos/efeitos adversos , Psicotrópicos/farmacologia , Religião , Alucinógenos/efeitos adversos , Alucinógenos/química , Alucinógenos/farmacologia , Humanos , Psicotrópicos/química
9.
BMC Psychiatry ; 20(1): 294, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32527250

RESUMO

BACKGROUND: Involuntary treatment for individuals who lack sufficient capacity to make informed decisions regarding treatment has been associated with increased rates of injectable antipsychotics, antipsychotic polytherapy, and/or high doses. However, little is known about non-antipsychotic psychotropic prescription, or psychotropic medication burden as a more encompassing approach for people treated involuntarily. The aim of this study was to examine the relationship between Mental Health Act (MHA) status and psychotropic polypharmacy and/or high-dose medication prescribing practices in an Australian inpatient mental health unit. METHODS: A retrospective cohort study of 800 adults discharged from a large metropolitan Queensland mental health unit was undertaken. Data was collected for 200 individuals, discharged on at least one psychotropic medicine, at four time periods; Cohort 1 (on or before 31st January 2014), Cohort 2 (2015), Cohort 3 (2016) and Cohort 4 (2017). The number of prescribed medicines and total daily doses were recorded and reviewed for alignment with current clinical guidelines. Participant demographics and clinical characteristics were compared by individual MHA status using chi-square test for categorical variables and analysis of variance for continuous variables. Associations between MHA status and prescribing practices (psychotropic polypharmacy and/or high-dose prescribing) were assessed using bivariate and multivariate binomial logistic regression models. Age, gender, birth country, year of admission, admissions in previous 12 months, primary diagnosis, ECT/clozapine treatment, and other psychotropic medications were adjusted as covariates. RESULTS: Regression analysis found that compared to their voluntary counterparts, individuals treated involuntarily were 2.7 times more likely to be prescribed an antipsychotic at discharge, 8.8 times more likely to be prescribed more than one antipsychotic at discharge and 1.65 times more likely to be prescribed high-dose antipsychotic treatment at discharge. The adjusted model also found that they were half as likely to be prescribed an antidepressant at discharge. CONCLUSION: Implicit review of justifications for increased psychotropic medication burden (antipsychotic polypharmacy and high-doses) in those treated involuntarily is required to ensure clinical outcomes and overall quality of life are improved in this vulnerable group. Clearly documented medication histories, reconciliation at discharge and directions for medication management after discharge are necessary to ensure quality use of medicines.


Assuntos
Antipsicóticos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Tratamento Involuntário/métodos , Transtornos Mentais/tratamento farmacológico , Saúde Mental , Psicotrópicos/uso terapêutico , Adulto , Antipsicóticos/efeitos adversos , Austrália , Quimioterapia Combinada , Humanos , Masculino , Polimedicação , Padrões de Prática Médica , Medicamentos sob Prescrição/uso terapêutico , Psicotrópicos/efeitos adversos , Qualidade de Vida , Queensland , Estudos Retrospectivos
10.
Encephale ; 46(3S): S116-S118, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32360037
11.
Encephale ; 46(3S): S14-S34, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32376004

RESUMO

The 2019-20 coronavirus pandemic (SARS-CoV-2; severe acute respiratory syndrome coronavirus 2) has dramatic consequences on populations in terms of morbidity and mortality and in social terms, the general confinement of almost half of the world's population being a situation unprecedented in history, which is difficult today to measure the impact at the individual and collective levels. More specifically, it affects people with various risk factors, which are more frequent in patients suffering from psychiatric disorders. Psychiatrists need to know: (i) how to identify, the risks associated with the prescription of psychotropic drugs and which can prove to be counterproductive in their association with COVID-19 (coronavirus disease 2019), (ii) how to assess in terms of benefit/risk ratio, the implication of any hasty and brutal modification on psychotropic drugs that can induce confusion for a differential diagnosis with the evolution of COVID-19. We carried out a review of the literature aimed at assessing the specific benefit/risk ratio of psychotropic treatments in patients suffering from COVID-19. Clinically, symptoms suggestive of COVID-19 (fever, cough, dyspnea, digestive signs) can be caused by various psychotropic drugs and require vigilance to avoid false negatives and false positives. In infected patients, psychotropic drugs should be used with caution, especially in the elderly, considering the pulmonary risk. Lithium and Clozapine, which are the reference drugs in bipolar disorder and resistant schizophrenia, warrant specific attention. For these two treatments the possibility of a reduction in the dosage - in case of minimal infectious signs and in a situation, which does not allow rapid control - should ideally be considered taking into account the clinical response (even biological; plasma concentrations) observed in the face of previous dose reductions. Tobacco is well identified for its effects as an inducer of CYP1A2 enzyme. In a COVID+ patient, the consequences of an abrupt cessation of smoking, particularly related with the appearance of respiratory symptoms (cough, dyspnea), must therefore be anticipated for patients receiving psychotropics metabolized by CYP1A2. Plasma concentrations of these drugs are expected to decrease and can be related to an increase risk of relapse. The symptomatic treatments used in COVID-19 have frequent interactions with the most used psychotropics. If there is no curative treatment for infection to SARS-CoV-2, the interactions of the various molecules currently tested with several classes of psychotropic drugs (antidepressants, antipsychotics) are important to consider because of the risk of changes in cardiac conduction. Specific knowledge on COVID-19 remains poor today, but we must recommend rigor in this context in the use of psychotropic drugs, to avoid adding, in patients suffering from psychiatric disorders, potentially vulnerable in the epidemic context, an iatrogenic risk or loss of efficiency.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Transtornos Mentais/tratamento farmacológico , Pandemias , Pneumonia Viral , Psicotrópicos/uso terapêutico , Fatores Etários , Antivirais/efeitos adversos , Antivirais/uso terapêutico , Biotransformação , Doenças Cardiovasculares/induzido quimicamente , Comorbidade , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Citocromo P-450 CYP1A2/metabolismo , Interações Medicamentosas , Febre/induzido quimicamente , França/epidemiologia , Gastroenteropatias/induzido quimicamente , Humanos , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/epidemiologia , Preparações Farmacêuticas/provisão & distribução , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Psicotrópicos/administração & dosagem , Psicotrópicos/efeitos adversos , Psicotrópicos/farmacocinética , Transtornos Respiratórios/induzido quimicamente , Medição de Risco , Abandono do Hábito de Fumar , Avaliação de Sintomas
12.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32430443

RESUMO

OBJECTIVE: To determine if adverse family factors are associated with a higher likelihood of psychotropic polypharmacy among US youth with a mental health condition. METHODS: The 2009-2015 Medical Expenditure Panel Survey data were used to identify family characteristics of 5136 youth aged ≤18 years with an emotional or behavioral health condition. Family adversity was based on family size, number of parents in the household, parental education and income, and parent-reported physical and/or cognitive or mental health disability. Cluster analysis identified family adversity subgroups. Polypharmacy was defined as 3 or more psychotropic classes (eg, stimulants, antipsychotics, antidepressants, mood stabilizers, and sedatives) in at least 1 interview round in a calendar year. Weighted logistic regression evaluated associations between family adversity and psychotropic polypharmacy among youth. RESULTS: Nearly half (47.8%) of youth lived with parents who had a disability. Parents in the least socioeconomically disadvantaged cluster mainly had a mental illness, and 94% of parents in the most socioeconomically disadvantaged cluster had a parent-reported physical and/or cognitive disability and mental illness. Among youth, mood disorder (24.2%; 95% confidence interval [CI]: 12.6%-16.0%), antidepressant use (16.0%; 95% CI: 10.6%-21.5%), and antipsychotic use (7.5%; 95% CI: 5.4%-9.6%) were higher in the most socioeconomically disadvantaged cluster relative to the other clusters. Approximately 3% of youth received psychotropic polypharmacy. The odds of psychotropic polypharmacy were 2.7 (95% CI: 1.1-6.4) times greater among youth in the most relative to the least socioeconomically disadvantaged cluster. CONCLUSIONS: Higher use of psychotropic polypharmacy among youth with parents who have multiple disabilities raises concerns about oversight and monitoring of complex psychotropic treatment.


Assuntos
Experiências Adversas da Infância/economia , Experiências Adversas da Infância/tendências , Filho de Pais Incapacitados/psicologia , Polimedicação , Psicotrópicos/efeitos adversos , Fatores Socioeconômicos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Estados Unidos/epidemiologia
13.
Psychosomatics ; 61(5): 411-427, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32425246

RESUMO

Background: With the rapid, global spread of severe acute respiratory syndrome coronavirus 2, hospitals have become inundated with patients suffering from coronavirus disease 2019. Consultation-liaison psychiatrists are actively involved in managing these patients and should familiarize themselves with how the virus and its proposed treatments can affect psychotropic management. The only Food and Drug Administration-approved drug to treat COVID-19 is remdesivir, and other off-label medications used include chloroquine and hydroxychloroquine, tocilizumab, lopinavir/ritonavir, favipiravir, convalescent plasma therapy, azithromycin, vitamin C, corticosteroids, interferon, and colchicine. Objective: To provide an overview of the major safety considerations relevant to clinicians who prescribe psychotropics to patients with COVID-19, both related to the illness and its proposed treatments. Methods: In this targeted review, we performed structured literature searches in PubMed to identify articles describing the impacts of COVID-19 on different organ systems, the neuropsychiatric adverse effects of treatments, and any potential drug interactions with psychotropics. The articles most relevant to this one were included. Results: COVID-19 impacts multiple organ systems, including gastrointestinal, renal, cardiovascular, pulmonary, immunological, and hematological systems. This may lead to pharmacokinetic changes that impact psychotropic medications and increase sensitivity to psychotropic-related adverse effects. In addition, several proposed treatments for COVID-19 have neuropsychiatric effects and potential interactions with commonly used psychotropics. Conclusions: Clinicians should be aware of the need to adjust existing psychotropics or avoid using certain medications in some patients with COVID-19. They should also be familiar with neuropsychiatric effects of medications being used to treat this disease. Further research is needed to identify strategies to manage psychiatric issues in this population.


Assuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Transtornos Mentais/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Psicotrópicos/uso terapêutico , Monofosfato de Adenosina/efeitos adversos , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Corticosteroides/efeitos adversos , Alanina/efeitos adversos , Alanina/análogos & derivados , Alanina/uso terapêutico , Amidas/efeitos adversos , Amidas/uso terapêutico , Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/efeitos adversos , Ácido Ascórbico/efeitos adversos , Ácido Ascórbico/uso terapêutico , Azitromicina/efeitos adversos , Azitromicina/uso terapêutico , Betacoronavirus , Cloroquina/efeitos adversos , Cloroquina/uso terapêutico , Colchicina/efeitos adversos , Colchicina/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/terapia , Combinação de Medicamentos , Interações Medicamentosas , Humanos , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Imunização Passiva , Interferons/efeitos adversos , Interferons/uso terapêutico , Lopinavir/efeitos adversos , Lopinavir/uso terapêutico , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/complicações , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo , Psicotrópicos/efeitos adversos , Psicotrópicos/metabolismo , Pirazinas/efeitos adversos , Pirazinas/uso terapêutico , Ritonavir/efeitos adversos , Ritonavir/uso terapêutico , Vitaminas/efeitos adversos , Vitaminas/uso terapêutico
15.
Life Sci ; 253: 117704, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32339542

RESUMO

Adverse effects of drugs on male reproductive system can be categorized as pre-testicular, testicular, and post-testicular. Pre-testicular adverse effects disrupt the hypothalamic-pituitary-gonadal (HPG) axis, generally by interfering with endocrine function. It is known that the HPG axis has roles in the maintenance of spermatogenesis and sexual function. The hypothalamus secretes gonadotropin-releasing hormone (GnRH) which enters the hypophyseal portal system to stimulate the anterior pituitary. The anterior pituitary secretes gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) which are vital for spermatogenesis, into the blood. The FSH stimulates the Sertoli cells for the production of regulatory molecules and nutrients needed for the maintenance of spermatogenesis, while the LH stimulates the Leydig cells to produce and secrete testosterone. Many neurotransmitters influence the hypothalamic-pituitary regulation, consequently the HPG axis, and can consequently affect spermatogenesis and sexual function. Psychotropic drugs including antipsychotics, antidepressants, and mood stabilizers that all commonly modulate dopamine, serotonin, and GABA, can affect male spermatogenesis and sexual function by impairment of the hypothalamic-pituitary regulation, act like endocrine-disrupting chemicals. Otherwise, studies have shown the relationship between decreased sperm quality and psychotropic drugs treatment. Therefore, it is important to investigate the adverse reproductive effects of psychotropic drugs which are frequently used during reproductive ages in males and to determine the role of the hypothalamic-pituitary regulation axis on possible pathologies.


Assuntos
Disruptores Endócrinos/efeitos adversos , Psicotrópicos/efeitos adversos , Reprodução/efeitos dos fármacos , Animais , Disruptores Endócrinos/farmacologia , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo , Hipotálamo/efeitos dos fármacos , Masculino , Hipófise/efeitos dos fármacos , Psicotrópicos/farmacologia , Espermatogênese/efeitos dos fármacos , Espermatozoides/efeitos dos fármacos
16.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(4): 615-620, 2020 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-32344492

RESUMO

Both narcotic and psychotropic drugs are more often used to alleviate related multiple physical or mental health problems, but these drugs are very easily addicted to. With the aging of population, abuse of narcotic drugs and psychotropic drugs among the elderly are called for more attention. In this paper, harms caused by the abuse of anesthetic and psychotropic drugs, current situation and causes related to the abuse of anesthetic and psychotropic drugs as well as risk factors and preventive measures regarding the abuse of anesthetic and psychotropic drugs, among the elderly, are reviewed.


Assuntos
Entorpecentes/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Psicotrópicos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Psicotrópicos/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
17.
Rev Med Liege ; 75(4): 265-270, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32267117

RESUMO

The goal of the article was to provide some clinical recommendations for a secure use of lithium. We described the mechanism of action of lithium, that acts as a mood stabilizer but also has anti-suicidal and neuroprotective effects. We also described the toxics effects of lithium and the toxicological tools that help to prevent and to treat those effects. We concluded that lithium remains a first choice for the treatment of bipolar disorders.


Assuntos
Transtorno Bipolar , Lítio/efeitos adversos , Psicotrópicos , Transtorno Bipolar/tratamento farmacológico , Humanos , Psicotrópicos/efeitos adversos , Medição de Risco
18.
Ir Med J ; 113(1): 10, 2020 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-32298564

RESUMO

Aims We ascertained the level of psychotropic medication use among drivers from a sample population and examined whether psychiatrists and mental health service users are sufficiently informed about the effects of medications on driving ability and about drug-driving legislation and guidelines in Ireland. Methods This cross-sectional survey included a convenience sample of 50 service users aged 18 and over who presented to the acute psychiatric unit in Portlaoise, Laois-Offaly Mental Health Services (LOMHS) for urgent psychiatric assessment, along with a survey of 37 doctors working with LOMHS. Results Almost half of surveyed service users (46%) reported that they currently drive, with the majority of these (78%) driving most days. Sixty-one percent (61%) of drivers reported taking psychotropic medication, with 64% of these taking more than one medication. Of 17 doctors who returned questionnaires, 8 (47%) reported that driving and medication use is a common concern in their practice, while only 1 (6%) had received training in relation to assessing medical fitness to drive. Overall, 94% (16) of clinicians and 54% of service users (rising to 71% for service users who drive and take medication) expressed a need for more information about this topic. Conclusion In this sample, the majority of mental health service users who drive do so while taking prescribed medications and they are unclear on the implications. Furthermore, there are significant deficits in training for psychiatrists in the area of assessing medical fitness to drive. Therefore, considering the potential serious risks involved, there is a clear need for more information and training about this topic for both clinicians and service users alike.


Assuntos
Condução de Veículo , Psicotrópicos , Adolescente , Adulto , Idoso , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Psiquiatria , Psicotrópicos/efeitos adversos , Risco , Inquéritos e Questionários , Adulto Jovem
19.
J Clin Psychiatry ; 81(3)2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32237298

RESUMO

BACKGROUND: Psychiatric patients are known to be at high risk of developing cardiovascular diseases (CVDs), leading to an increased mortality rate. OBJECTIVE: To assess the CVD risk (presence of metabolic syndrome [MetS] and calculated 10-year CVD risk) in a Swiss psychiatric cohort taking weight gain-inducing psychotropic drugs, compare the findings to a Swiss population-based cohort, and evaluate the prevalence of participants treated for metabolic disruptions in both cohorts. METHODS: Data for 1,216 psychiatric patients (of whom 634 were aged 35-75 years) were obtained between 2007 and 2017 from a study with metabolic parameters monitored during psychotropic treatment and between 2003 and 2006 for 6,733 participants from the population-based CoLaus|PsyCoLaus study. RESULTS: MetS as defined by the International Diabetes Federation (IDF) was identified in 33% of the psychiatric participants and 24.7% of the population-based subjects. Specifically, prevalence per the IDF definition was more than 3 times higher in the psychiatric cohort among women aged 35 to 49 years (25.6% vs 8.0%; P < 10-4). The psychiatric and population-based cohorts, respectively, had comparable predicted CVD risk (10-year risk of CVD event > 20%: 0% vs 0.1% in women and 0.3% vs 1.8% [P = .01] in men; 10-year risk of CVD death > 5%: 8.5% vs 8.4% [P = .58] in women and 13.4% vs 16.6% [P = .42] in men). No difference was observed among the proportion of participants with MetS treated for metabolic disturbances in the two cohorts, with the exception of women aged 35-49 years, for whom those in the psychiatric cohort were half as likely to receive treatment compared to participants in CoLaus|PsyCoLaus (17.8% vs 38.8% per the IDF definition; P = .0004). CONCLUSIONS: These findings emphasize the concern that psychiatric patients present an altered metabolic profile and that they do not receive adequate treatment for metabolic disruptions. Presence of metabolic disturbances should be routinely assessed, and adequate follow-up is needed to intervene early after illness onset.


Assuntos
Doenças Cardiovasculares/etiologia , Transtornos Mentais/complicações , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Fatores de Risco , Suíça/epidemiologia
20.
Rev. Hosp. Ital. B. Aires (2004) ; 40(1): 34-38, mar. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1102292

RESUMO

Las mujeres han sido tratadas por décadas con testosterona intentando aliviar una gran variedad de síntomas con riesgos y beneficios inciertos. En la mayoría de los países, la testosterona se prescribe "off-label", de modo que las mujeres están utilizando compuestos y dosis ideadas para tratamientos en hombres. En este sentido, varias sociedades médicas de distintos continentes adoptaron recientemente por consenso una toma de posición sobre los beneficios y potenciales riesgos de la terapia con testosterona en la mujer, explorar las áreas de incertidumbre e identificar prácticas de prescripción con potencial de causar daño. Las recomendaciones con respecto a los beneficios y riesgos de la terapia con testosterona se basan en los resultados de ensayos clínicos controlados con placebo de al menos 12 semanas de duración. A continuación se comentan las recomendaciones. (AU)


There are currently no clear established indications for testosterone replacement therapy for women. Nonetheless, clinicians have been treating women with testosterone to alleviate a variety of symptoms for decades with uncertainty regarding its benefits and risks. In most countries, testosterone therapy is prescribed off-label, which means that women are using testosterone formulations or compounds approved for men with a modified dose for women. Due to these issues, there was a need for a global Consensus Position Statement on testosterone therapy for women based on the available evidence from placebo randomized controlled trials (RCTs). This Position Statement was developed to inform health care professionals about the benefits and potential risks of testosterone therapy intended for women. The aim of the Consensus was to provide clear guidance as to which women might benefit from testosterone therapy; to identify symptoms, signs, and certain conditions for which the evidence does not support the prescription of testosterone; to explore areas of uncertainty, and to identify any prescribing practices that have the potential to cause harm. (AU)


Assuntos
Humanos , Feminino , Idoso , Testosterona/uso terapêutico , Pós-Menopausa/efeitos dos fármacos , Depressores do Apetite/efeitos adversos , Fenitoína/efeitos adversos , Placebos/administração & dosagem , Psicotrópicos/efeitos adversos , Tamoxifeno/efeitos adversos , Testosterona/administração & dosagem , Testosterona/análise , Testosterona/efeitos adversos , Testosterona/farmacologia , Fármacos Cardiovasculares/efeitos adversos , Indometacina/efeitos adversos , Hormônio Liberador de Gonadotropina/efeitos adversos , Pós-Menopausa/fisiologia , Ensaios Clínicos Controlados como Assunto , Antagonistas Colinérgicos/efeitos adversos , Anticoncepcionais Orais/efeitos adversos , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/terapia , Danazol/efeitos adversos , Consenso , Inibidores da Aromatase/efeitos adversos , Uso Off-Label , Inibidores do Fator Xa/efeitos adversos , Anfetaminas/efeitos adversos , Antagonistas dos Receptores Histamínicos/efeitos adversos , Antagonistas de Androgênios/efeitos adversos , Androgênios/fisiologia , Cetoconazol/efeitos adversos , Entorpecentes/efeitos adversos
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