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1.
Curr Med Sci ; 39(2): 173-184, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31016507

RESUMO

The therapeutic potentials of probiotics in autism spectrum disorder (ASD) remains controversial, with the only existing systematic review on this topic published in 2015. Results from new trials have become available in recent years. We therefore conducted an updated systematic review, to assess the efficacy of probiotics in relieving behavioral symptoms of ASD and gastrointestinal comorbidities. Our review includes two randomized controlled trials, which showed improvement of ASD behaviors, and three open trials, all which exhibited a trend of improvement. Four of these trials concluded from subjective measures that gastrointestinal function indices showed a trend of improvement with probiotic therapy. Additional rigorous trials are needed to evaluate the effects of probiotic supplements in ASD.


Assuntos
Transtorno do Espectro Autista/tratamento farmacológico , Sintomas Comportamentais/tratamento farmacológico , Gastroenteropatias/tratamento farmacológico , Trato Gastrointestinal/efeitos dos fármacos , Probióticos/farmacologia , Ensaios Clínicos como Assunto , Humanos
2.
Semin Neurol ; 39(2): 167-178, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30925610

RESUMO

Treatment of dementias represents an important but relatively neglected part of neurological care of the elderly population. Individual therapeutic interventions may make only small changes to the quality of life of individuals afflicted with dementia, but when used in combination these interventions synergize and can make a significant difference. Additionally, given the societal scale of the problem of dementia care, the overall impact, in economic and sociological terms, of such therapies is of consequence. Presently there are no disease-modifying treatments for any of the neurodegenerative dementias. Instead, the clinician has several therapeutic tools to mitigate cognitive and behavioral consequences of dementias. There are also strategies to minimize harm to patients with dementia. In this article, we aim to review these tools and place them in the greater context of dementia care.


Assuntos
Sintomas Comportamentais/terapia , Disfunção Cognitiva/terapia , Remediação Cognitiva/métodos , Demência/terapia , Redução do Dano , Sintomas Comportamentais/tratamento farmacológico , Sintomas Comportamentais/etiologia , Disfunção Cognitiva/tratamento farmacológico , Demência/complicações , Demência/tratamento farmacológico , Humanos
3.
Eur Psychiatry ; 58: 1-9, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30738380

RESUMO

BACKGROUND: Negative symptoms in schizophrenia are heterogeneous and multidimensional; effective treatments are lacking. Cariprazine, a dopamine D3-preferring D3/D2 receptor partial agonist and serotonin 5-HT1A receptor partial agonist, was significantly more effective than risperidone in treating negative symptoms in a prospectively designed trial in patients with schizophrenia and persistent, predominant negative symptoms. METHODS: Using post hoc analyses, we evaluated change from baseline at week 26 in individual items of the Positive and Negative Syndrome Scale (PANSS) and PANSS-derived factor models using a mixed-effects model for repeated measures (MMRM) in the intent-to-treat (ITT) population (cariprazine = 227; risperidone = 227). RESULTS: Change from baseline was significantly different in favor of cariprazine versus risperidone on PANSS items N1-N5 (blunted affect, emotional withdrawal, poor rapport, passive/apathetic social withdrawal, difficulty in abstract thinking) (P < .05), but not on N6 (lack of spontaneity/flow of conversation) or N7 (stereotyped thinking). On all PANSS-derived negative symptom factor models evaluated (PANSS-Factor Score for Negative Symptoms, Liemburg factors, Khan factors, Pentagonal Structure Model Negative Symptom factor), statistically significant improvement was demonstrated for cariprazine versus risperidone (P < .01). Small and similar changes in positive/depressive/EPS symptoms suggested that negative symptom improvement was not pseudospecific. Change from baseline was significantly different for cariprazine versus risperidone on PANSS-based factors evaluating other relevant symptom domains (disorganized thoughts, prosocial function, cognition; P < .05). CONCLUSIONS: Since items representing different negative symptom dimensions may represent different fundamental pathophysiological mechanisms, significant improvement versus risperidone on most PANSS Negative Subscale items and across all PANSS-derived factors suggests broad-spectrum efficacy for cariprazine in treating negative symptoms of schizophrenia.


Assuntos
Sintomas Comportamentais/tratamento farmacológico , Piperazinas/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Sintomas Comportamentais/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Resultado do Tratamento
4.
Psychogeriatrics ; 19(4): 320-324, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30784147

RESUMO

AIM: To characterise the effects of antipsychotics on brain functions of patients with behavioural psychological symptoms of dementia (BPSD). METHODS: Studies were performed during 6 weeks of intervention with either a nonantipsychotic drug (group A, n = 38) or an antipsychotic drug (group B, n = 10). RESULTS: Neuropsychiatric Inventory scores were significantly decreased in both groups. Scores on the Mini-Mental State Examination did not change with intervention. By contrast, favourable natures of emotional functions, scored using the Delightful Emotional Index of 10 items, were significantly lower in the antipsychotic drug treatment group B relative to scores in the nonantipsychotic drug treatment group A. CONCLUSIONS: Antipsychotics reduce favourite emotions as well as BPSD, and this should be considered in prescribing medications for patients with dementia.


Assuntos
Antipsicóticos/farmacologia , Sintomas Comportamentais/tratamento farmacológico , Demência/tratamento farmacológico , Uso Off-Label , Psicotrópicos/farmacologia , Idoso , Idoso de 80 Anos ou mais , Ansiolíticos/farmacologia , Anticonvulsivantes/farmacologia , Antidepressivos/farmacologia , Sintomas Comportamentais/etiologia , Demência/complicações , Feminino , Seguimentos , Humanos , Masculino , Testes de Estado Mental e Demência , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença
5.
Curr Med Chem ; 26(20): 3764-3774, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29521195

RESUMO

BACKGROUND: Alzheimer's Disease (AD) accounts for approximately 50% of all cases of dementia and, in spite of the great effort for the development of disease-modifying drugs, a definitive treatment of cognitive impairment is not available yet. A perfect adherence to the current therapy of cognitive decline is needed for a better control of the disease and this is proven to reduce, though not completely abolish, the associated Behavioural and Psychological Symptoms of Dementia (BPSDs) from occurring. This cluster of symptoms, remarkably affecting patients' health-related quality of life (HRQL), is tightly associated with pain states. Antipsychotics are the only treatment for BPSDs. However, these drugs are more effective and safer in the short-term (6-12 weeks), they are able to manage aggression but not agitation and they cannot control pain. Aromatherapy with Melissa officinalis and Lavandula officinalis has been employed to handle BPSDs, but it has not provided strong evidence to offer relief from pain. OBJECTIVE: Bergamot Essential Oil (BEO) exerts antinociceptive activity through several pharmacological mechanisms: in particular, it is able to enhance autophagy, a process undergoing derangement in chronic pain. Thus, the sound pharmacological basis for clinical translation of aromatherapy with BEO in the treatment of BPSDs has been pointed out. CONCLUSION: The antinociceptive effects elicited by BEO in experimental pain models make it a possible candidate for the pharmacological management of pain-related BPSDs.


Assuntos
Analgésicos/uso terapêutico , Sintomas Comportamentais/tratamento farmacológico , Dor Crônica/complicações , Dor Crônica/tratamento farmacológico , Demência/complicações , Demência/tratamento farmacológico , Óleos Vegetais/uso terapêutico , Analgésicos/química , Animais , Sintomas Comportamentais/complicações , Humanos , Óleos Vegetais/química , Qualidade de Vida
6.
J Am Med Dir Assoc ; 19(11): 948-958.e12, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30241987

RESUMO

OBJECTIVES: Caution is advised when prescribing antipsychotics to people with dementia. This study explored the determinants of appropriate, evidence-based antipsychotic prescribing behaviors for nursing home residents with dementia, with a view to informing future quality improvement efforts and behavior change interventions. DESIGN: Semistructured qualitative interviews based on the Theoretical Domains Framework (TDF). SETTING AND PARTICIPANTS: A purposive sample of 27 participants from 4 nursing homes, involved in the care of nursing home residents with dementia (8 nurses, 5 general practitioners, 5 healthcare assistants, 3 family members, 2 pharmacists, 2 consultant geriatricians, and 2 consultant psychiatrists of old age) in a Southern region of Ireland. MEASURES: Using framework analysis, the predominant TDF domains and determinants influencing these behaviors were identified, and explanatory themes developed. RESULTS: Nine predominant TDF domains were identified as influencing appropriate antipsychotic prescribing behaviors. Participants' effort to achieve "a fine balance" between the risks and benefits of antipsychotics was identified as the cross-cutting theme that underpinned many of the behavioral determinants. On one hand, neither healthcare workers nor family members wanted to see residents over-sedated and without a quality of life. Conversely, the reality of needing to protect staff, family members, and residents from potentially dangerous behavioral symptoms, in a resource-poor environment, was emphasized. The implementation of best-practice guidelines was illustrated through 3 explanatory themes ("human suffering"; "the interface between resident and nursing home"; and "power and knowledge: complex stakeholder dynamics"), which conceptualize how different nursing homes strike this "fine balance." CONCLUSIONS: Implementing evidence-based antipsychotic prescribing practices for nursing home residents with dementia remains a significant challenge. Greater policy and institutional support is required to help stakeholders strike that "fine balance" and ultimately make better prescribing decisions. This study has generated a deeper understanding of this complex issue and will inform the development of an evidence-based intervention.


Assuntos
Antipsicóticos/uso terapêutico , Atitude do Pessoal de Saúde , Demência/tratamento farmacológico , Demência/psicologia , Família/psicologia , Casas de Saúde , Adulto , Idoso , Sintomas Comportamentais/tratamento farmacológico , Sintomas Comportamentais/etiologia , Competência Clínica , Arquitetura de Instituições de Saúde , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/provisão & distribução , Defesa do Paciente , Guias de Prática Clínica como Assunto , Qualidade de Vida
7.
Harv Rev Psychiatry ; 26(5): 264-273, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30188338

RESUMO

OBJECTIVES: Despite evidence for many potential risks, use of benzodiazepines (BZDs) among older adults is common. The authors evaluated the available evidence for BZD effectiveness and tolerability for use in older adults in three psychiatric conditions for which BZDs are commonly prescribed: insomnia, anxiety disorders, and behavioral and psychological symptoms of dementia. DESIGN: Electronic databases, including PubMed/MEDLINE, were searched to identify articles that (1) included patients ≥50 years of age, (2) focused on patients diagnosed with insomnia, anxiety disorders, or behavioral and psychological symptoms of dementia, and (3) were either a randomized, placebo-controlled trial or a randomized trial comparing a BZD with either another psychotropic medication or psychotherapy. RESULTS: Thirty-one studies met the inclusion criteria. Of the three clinical indications evaluated, treatment of insomnia had the greatest available evidence for use of BZDs among older adults, with 21 of 25 trials demonstrating improved sleep outcomes with use of BZDs. Only one trial was found to meet eligibility criteria for BZD use in anxiety disorders, demonstrating benefit over placebo. Five studies for use in behavioral disturbances in dementia were included, of which only one demonstrated improvement over placebo. CONCLUSION: This systematic review suggests that BZD prescribing to older adults is significantly in excess of what the available evidence suggests is appropriate. Future trials should focus on efforts to reduce both acute and chronic BZD use among older adults while improving access to effective non-pharmacologic treatment alternatives.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Sintomas Comportamentais/tratamento farmacológico , Benzodiazepinas/uso terapêutico , Demência/tratamento farmacológico , Prescrições de Medicamentos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Sintomas Comportamentais/etiologia , Demência/complicações , Humanos , Pessoa de Meia-Idade
8.
J Am Med Dir Assoc ; 19(11): 1009-1014, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30100234

RESUMO

BACKGROUND: Antipsychotic drugs are often used to treat behavioral and psychological symptoms (BPSD) in adults aged 65 years and older with dementia, although there is uncertainty about the effectiveness of long-term use for this indication and there are concerns that they may cause harm. OBJECTIVES: To evaluate whether discontinuation of long-term antipsychotic drugs for BPSD is successful in adults aged 65 years and older with dementia. This article is based on a Cochrane review updated in 2018. DESIGN: A Cochrane systematic review and meta-analysis. SETTING AND PARTICIPANTS: Eight databases were searched in January 2018 to identify 10 randomized controlled trials with 632 older adults. MEASURES: We used standard methodological procedures according to the Cochrane Handbook for Systematic Reviews of Interventions. We assessed the number of patients completing the study. We considered sustained withdrawal of antipsychotics until the end of the study period as successful outcome. RESULTS: Based on assessment of 7 studies (n = 446), discontinuation may make little or no difference to whether or not participants complete the study (low-quality evidence). In 2 trials, including participants with psychosis, agitation, or aggression who had responded to antipsychotic treatment, discontinuation of antipsychotics was associated with a higher risk of leaving the study prematurely because of symptomatic relapse or a shorter time to symptomatic relapse. We found low-quality evidence from 7 trials (n = 519) that discontinuation may make little or no difference to overall BPSD, measured using various scales. There was some evidence from subgroup analyses in 2 trials that discontinuation may be associated with a worsening of BPSD in participants with more severe BPSD at baseline. CONCLUSIONS: Our meta-analysis revealed that there is low-quality evidence that long-term antipsychotic drugs for BPSD may be successfully discontinued in most adults aged 65 and older.


Assuntos
Antipsicóticos/uso terapêutico , Demência/tratamento farmacológico , Desprescrições , Idoso , Sintomas Comportamentais/tratamento farmacológico , Demência/psicologia , Humanos
9.
J Womens Health (Larchmt) ; 27(11): 1368-1377, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30085899

RESUMO

BACKGROUND: Alzheimer's disease (AD) is characterized by progressive cognitive decline, often associated with Behavioral and Psychological Symptoms of Dementia (BPSD). Acetylcholinesterase inhibitors (ChEi) may attenuate cognitive decline and mitigate BPSD. The EVOLUTION group found that the switch from oral ChEi to transdermal rivastigmine patch formulation resulted in improvement/stabilization in the frequency of clinically relevant BPSD, but gender-specific subgroup analyses were not reported. METHODS: Participants underwent Neuropsychiatric Inventory to assess the frequency and severity of neuropsychiatric symptoms at baseline and 3 and 6 months after the switch from oral ChEi to transdermal rivastigmine patch. A descriptive post hoc analysis was conducted to assess whether there were gender-based differences in BPSD profile during the 6 months after the switch. RESULTS: The entire sample consisted of 475 patients, 274 women and 201 men. Women were on average slightly older and with poorer cognitive performance (60.6% of the women had moderate-AD, defined as Mini-Mental State Examination [MMSE] score of 10-17, vs. 43.8% of men). In mild-AD patients (MMSE score 18-26), the frequency of BPSD did not change significantly over time and an association was found between gender and depression (odds ratio; OR [95% confidence interval; CI] female vs. male = 3.32 [1.44-7.67]), anxiety (2.42 [1.23-4.79]), apathy (2.25 [1.07-4.70]), nighttime behavior disturbances (3.97 [1.66-9.49]), and appetite/eating abnormalities (2.39 [1.10-5.18]). Moderate-AD female patients had euphoria more frequently than male patients (OR [95% CI] female vs. male = 3.67 [1.25-10.74]). The frequency of delusions, anxiety, and irritability decreased during the first 3 months after the switch, independently of gender. CONCLUSION: Mild-AD women tended to suffer more frequently from BPSD than men; in the 3 months after treatment switch, moderate-AD patients showed a decrease in delusions, anxiety, and irritability, with no significant differences between genders. Ad hoc studies to investigate this potential gender effect in AD could be well worthwhile.


Assuntos
Doença de Alzheimer , Sintomas Comportamentais , Rivastigmina , Administração Oral , Idoso , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/psicologia , Sintomas Comportamentais/tratamento farmacológico , Sintomas Comportamentais/etiologia , Sintomas Comportamentais/psicologia , Inibidores da Colinesterase/administração & dosagem , Inibidores da Colinesterase/efeitos adversos , Cognição/efeitos dos fármacos , Substituição de Medicamentos/métodos , Substituição de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia , Masculino , Competência Mental , Testes de Estado Mental e Demência , Técnicas Psicológicas , Rivastigmina/administração & dosagem , Rivastigmina/efeitos adversos , Fatores Sexuais , Adesivo Transdérmico , Resultado do Tratamento
10.
Geriatr Psychol Neuropsychiatr Vieil ; 16(3): 279-285, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30078768

RESUMO

To identify factors that influence use of potentially inappropriate psychotropic drugs among elderly residents living in nursing homes (NH). Cross-sectional, multicentre study among 65+ years NH residents, based on queries performed on the PATHOS database and on prescription information from residents' medical data. Medications were coded using the Anatomical Therapeutical Chemical classification. Psychotropic agents were classed using Delay and Deniker's classification, and the Beers Criteria (Beers list 2015 update) were used to identify potentially inappropriate psychotropic drugs (PIPs). Logistic regression was performed to identify factors related to use of potentially inappropriate psychotropic drugs, and factors related to PIPs. The average number of drugs per subject (n=2,343) was 7.8±3.5. In total, 1,709 (71.6%) subjects were taking psychotropic drugs (1.8±0.9 psychotropic drugs per user). Psychotropic agents represented 17.4% of the 18,143 drugs used by the whole study population. The frequency of PIPs was 44.1%. By multivariable analysis, the use of psychotropic drug was significantly associated with behavioural disorders (OR 3.21, 95%CI [2.46-4.18]); depression (OR 8.79, 95%CI [6.64-11.6]); anxiety (OR 3.43, 95%CI [2.45-4.8]); psychosis (OR 2.05, 95%CI [1.28-3.30]), use of >4 drugs (OR 4.85, 95%CI [3.60-6.53]); and dehydration (OR 0.49, 95%CI [0.32-0.75]). PIPs was significantly associated to behavioural disorders (odds ratio (OR) 1.56, 95% confidence interval (CI) [1.89-1.29]); depression (OR 2.90, 95%CI [3.60-2.3]); anxiety (OR 1.68, 95%CI [2.32-1.22]); dementia (OR 2.43, 95%CI [2.96-1.99]); use of >4 drugs (OR 3.41, 95%CI [4.90-2.37]); dehydration (OR 0.53, 95%CI [0.76-0.37]), arthritis/arthrosis of the hip (OR 1.48, 95%CI [2.04-1.07]) and arthritis/arthrosis of the shoulder (OR 2.06, 95%CI [3.43-1.23]). Regular review of prescriptions and emphasis on non-drug therapy of behavioural disorders in elderly subjects can help to reduce the rate of prescription of psychotropic drugs and PIPs in NH residents.


Assuntos
Prescrição Inadequada/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Psicotrópicos , Idoso , Idoso de 80 Anos ou mais , Sintomas Comportamentais/tratamento farmacológico , Estudos Transversais , Uso de Medicamentos , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Masculino
11.
Exp Clin Psychopharmacol ; 26(5): 497-502, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29963872

RESUMO

Disulfiram (Antabuse), an acetaldehyde dehydrogenase and dopamine-beta hydroxylase inhibitor, has shown promise in preclinical and clinical studies as a pharmacotherapy for cocaine addiction. However, the extent to which disulfiram may alter the abuse-related behavioral effects of related psychostimulants, such as methamphetamine, is unknown. Here, the therapeutic potential of disulfiram was evaluated by examining its impact on the reinforcing and discriminative stimulus effects of d-methamphetamine in adult rhesus monkeys (N = 4 per group). In subjects trained to respond for injections of methamphetamine or food delivery, i.v. methamphetamine (.001-.032 mg/kg) maintained dose-related and stable levels of self-administration in all subjects. Pretreatment with disulfiram (5.6 mg/kg) produced a significant downward shift in the d-methamphetamine dose-response function; surprisingly, lower and higher pretreatment doses (3.0 mg/kg; 10 mg/kg) were ineffective. Also, disulfiram (3-10 mg/kg) did not significantly alter food-maintained responding or, in subjects trained to discriminate the effects of cocaine from vehicle, the ability of d-methamphetamine (.032-.32 mg/kg) to substitute for cocaine. Taken together, the present data reveal dose-dependent effects of disulfiram in modifying some of the abuse-related effects of d-methamphetamine and provides support for future investigations examining the capacity of disulfiram as a treatment for d-methamphetamine abuse. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas , Sintomas Comportamentais , Dissulfiram/farmacologia , Metanfetamina/farmacologia , Inibidores de Acetaldeído Desidrogenases/farmacologia , Transtornos Relacionados ao Uso de Anfetaminas/tratamento farmacológico , Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Animais , Sintomas Comportamentais/induzido quimicamente , Sintomas Comportamentais/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/farmacologia , Cocaína , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Feminino , Macaca mulatta , Masculino , Resultado do Tratamento
12.
Australas Psychiatry ; 26(4): 358-365, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29671334

RESUMO

OBJECTIVES: This clinical update review focuses on the management of cognition and the neuropsychiatric features of Alzheimer's disease (AD) and highlights current issues regarding pharmacological and non-pharmacological treatment, putative therapeutics and recent relevant research findings in this area. CONCLUSIONS: AD is a neurodegenerative progressive condition characterised by cognitive impairment and functional decline. Most people with AD will demonstrate neuropsychiatric features, better known as behavioural and psychological symptoms of dementia (BPSD). Early recognition and treatment of BPSD are essential, as these cause considerable distress and carer burden. While there are many disease-modifying therapies for the cognitive symptoms still in the research stage, only symptomatic treatments are currently available for these and the BPSD.


Assuntos
Doença de Alzheimer/terapia , Antipsicóticos/uso terapêutico , Sintomas Comportamentais/terapia , Inibidores da Colinesterase/uso terapêutico , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Reabilitação Psiquiátrica/métodos , Doença de Alzheimer/complicações , Doença de Alzheimer/tratamento farmacológico , Sintomas Comportamentais/tratamento farmacológico , Sintomas Comportamentais/etiologia , Humanos
13.
Australas Psychiatry ; 26(4): 376-380, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29687724

RESUMO

OBJECTIVES: This clinical update review focuses on the management of the neuropsychiatric manifestations of Huntington's disease (HD). The review highlights current issues regarding pharmacological and non-pharmacological treatment, putative therapeutics and recent relevant research findings in this area. CONCLUSIONS: Neuropsychiatric symptoms may precede the classic motor clinical symptoms of HD (prodromal HD) by decades and cause significant functional impairment. Early recognition and comprehensive non-pharmacological, usually in combination with pharmacological, treatment is essential.


Assuntos
Sintomas Comportamentais/terapia , Transtorno Bipolar/terapia , Doença de Huntington/terapia , Transtornos do Humor/terapia , Reabilitação Psiquiátrica/métodos , Psicoterapia/métodos , Transtornos Psicóticos/terapia , Sintomas Comportamentais/tratamento farmacológico , Sintomas Comportamentais/etiologia , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/etiologia , Humanos , Doença de Huntington/complicações , Doença de Huntington/tratamento farmacológico , Transtornos do Humor/tratamento farmacológico , Transtornos do Humor/etiologia , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/etiologia
14.
Cleve Clin J Med ; 85(3): 209-214, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29522388

RESUMO

Alzheimer disease is the most common type of dementia. Two classes of cognition-enhancing drugs are approved to treat the symptoms, and both have provided modest benefit in clinical trials. Psychotropic drugs are sometimes used off-label to treat behavioral symptoms of Alzheimer disease. All these medications should be continuously evaluated for clinical efficacy and, when appropriate, discontinued if the primary benefit--preservation of cognitive and functional status and a reduction in behaviors associated with dementia--is no longer being achieved.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Psicotrópicos/uso terapêutico , Doença de Alzheimer/complicações , Sintomas Comportamentais/tratamento farmacológico , Sintomas Comportamentais/psicologia , Transtornos Cognitivos/tratamento farmacológico , Transtornos Cognitivos/psicologia , Humanos , Resultado do Tratamento , Suspensão de Tratamento
15.
Lancet Neurol ; 17(5): 445-455, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29398641

RESUMO

Improvements in the function, quality of life, and longevity of patients with Duchenne muscular dystrophy (DMD) have been achieved through a multidisciplinary approach to management across a range of health-care specialties. In part 3 of this update of the DMD care considerations, we focus on primary care, emergency management, psychosocial care, and transitions of care across the lifespan. Many primary care and emergency medicine clinicians are inexperienced at managing the complications of DMD. We provide a guide to the acute and chronic medical conditions that these first-line providers are likely to encounter. With prolonged survival, individuals with DMD face a unique set of challenges related to psychosocial issues and transitions of care. We discuss assessments and interventions that are designed to improve mental health and independence, functionality, and quality of life in critical domains of living, including health care, education, employment, interpersonal relationships, and intimacy.


Assuntos
Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/terapia , Continuidade da Assistência ao Paciente , Serviços Médicos de Emergência/métodos , Serviços de Saúde Mental , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/terapia , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/métodos , Qualidade de Vida , Sintomas Comportamentais/tratamento farmacológico , Continuidade da Assistência ao Paciente/normas , Serviços Médicos de Emergência/normas , Humanos , Serviços de Saúde Mental/normas , Guias de Prática Clínica como Assunto/normas , Atenção Primária à Saúde/normas
16.
Psychiatr Clin North Am ; 41(1): 127-139, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29412841

RESUMO

Behavioral and psychological symptoms of dementia (BPSD) are universally experienced by people with dementia throughout the course of the illness and cause a significant negative impact on quality of life for patients and caregivers. Nonpharmacologic treatments have been recommended as first-line treatment of BPSD by multiple professional organizations and should target patients with dementia factors, caregiver factors, and environmental factors. Psychotropic medications are often prescribed off-label without significant evidence to support their use. The Describe, Investigate, Create, Evaluate approach can provide a structured method to investigate and treat BPSD with flexibility to use in multiple treatment settings.


Assuntos
Sintomas Comportamentais/terapia , Demência/terapia , Psicoterapia/métodos , Psicotrópicos/uso terapêutico , Idoso , Sintomas Comportamentais/tratamento farmacológico , Sintomas Comportamentais/etiologia , Demência/complicações , Demência/tratamento farmacológico , Humanos
17.
J Intellect Disabil Res ; 62(2): 140-149, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29349928

RESUMO

BACKGROUND: Problem behaviours (PBs) are a common cause for clinician contact in people with disorders of intellectual development and may be a common cause for the prescription of psychotropic medication. We aimed to use a large, multinational sample to define the prevalence of PBs, the associations with psychotropic medication use, and to assess for any potential 'diagnostic overshadowing' by the label of PBs in a population of people with disorders of intellectual development. METHOD: A multinational, multi-setting, cross-sectional service evaluation and baseline audit was completed. Data were collected from UK hospitals, UK community settings, Sri Lanka and Hong Kong. A semi-structured questionnaire was completed by treating clinicians, capturing demographic details, prevalence rates of intellectual disability and psychotropic medication use, alongside psychiatric co-morbidity. RESULTS: A sample size of 358 was obtained, with 65% of included participants treated in an inpatient setting. Psychotropic use was prevalent (90%) in our sample, particularly antipsychotics (74%). The prevalence of PB was high (83%). There was no statistically significant association between psychotropic prescription and recorded psychiatric co-morbidity, suggesting prevalent 'off-label' use for PBs, or poor recording of psychiatric co-morbidity. There was some evidence of possible diagnostic overshadowing due to the PB classification. A higher dose of psychotropic medication was associated with aggression toward others (P = 0.03). CONCLUSIONS: We found evidence of prevalent potential 'off-label' use for psychotropic medication, which may be due to PBs. We also found evidence of potential diagnostic-overshadowing, where symptoms of psychiatric co-morbidity may have been attributed to PBs. Our findings provide renewed importance, across borders and health systems, for clinicians to consider a holistic approach to treating PBs, and attempting to best understand the precipitants and predisposing factors before psychotropic prescribing.


Assuntos
Sintomas Comportamentais , Deficiência Intelectual , Uso Off-Label , Psicotrópicos/uso terapêutico , Adulto , Antipsicóticos/uso terapêutico , Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/tratamento farmacológico , Sintomas Comportamentais/epidemiologia , Sintomas Comportamentais/etiologia , Comorbidade , Estudos Transversais , Feminino , Hong Kong/epidemiologia , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/tratamento farmacológico , Deficiência Intelectual/epidemiologia , Masculino , Pessoa de Meia-Idade , Uso Off-Label/estatística & dados numéricos , Prevalência , Comportamento Problema , Sri Lanka/epidemiologia , Reino Unido/epidemiologia
18.
Clin Neuropharmacol ; 41(1): 43-44, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29300206

RESUMO

Behavioral problems are seen in most patients with dementia and are often poorly characterized in the literature. We present a 70-year-old man with advanced Alzheimer disease and problematic disinhibited behaviors, including intrusiveness and Witzelsucht (disinhibited humor). These symptoms responded robustly to carbamazepine. Carbamazepine may be a useful adjunct in managing problematic behaviors in dementia, especially when those problems can be framed as behavioral disinhibition.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Sintomas Comportamentais/tratamento farmacológico , Carbamazepina/uso terapêutico , Hipercinese/tratamento farmacológico , Hipercinese/etiologia , Idoso , Sintomas Comportamentais/etiologia , Demência/complicações , Humanos , Masculino
19.
Int Psychogeriatr ; 30(3): 385-394, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28988552

RESUMO

ABSTRACTBackground:We aimed to assess whether there were any changes in the use of psychotropic drugs in Norwegian nursing homes between 2004 and 2011. Also, we investigated whether the predictors of use of specific psychotropic drug groups have changed. METHODS: We conducted a secondary analysis of two cohort studies of two Norwegian nursing home samples (2004/05 and 2010/11). Multivariate models were applied. RESULTS: We found a significant decrease in the prescription of antipsychotic drugs between 2004 and 2011 (0.63 OR, 95%CI = 0.49-0.82, p < 0.001) even after adjusting for relevant demographic and clinical variables. There are only minor changes for the other psychotropic drugs. We found that (1) the use of specific psychotropic drug groups as well as the number of psychotropic drugs used was associated with more affective symptoms and (2) the use of specific psychotropic drug groups as well as the number of psychotropic drugs used was associated with lower scores on the Physical Self-Maintenance scale. CONCLUSION: This is the first study to show a robust decrease in antipsychotic drug use in nursing home patients with dementia unrelated to possible changes in case mix. The change might be explained by treatment recommendations against its use except in the most severe conditions of aggression or psychosis. Our findings indicate that it takes several years to implement scientific knowledge in clinical practice in nursing homes.


Assuntos
Antipsicóticos/uso terapêutico , Sintomas Comportamentais/tratamento farmacológico , Transtornos Cognitivos/tratamento farmacológico , Demência/tratamento farmacológico , Uso de Medicamentos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Transtornos Psicóticos/tratamento farmacológico , Psicotrópicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Sintomas Comportamentais/psicologia , Transtornos Cognitivos/psicologia , Estudos de Coortes , Demência/psicologia , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Noruega/epidemiologia , Transtornos Psicóticos/epidemiologia , Psicotrópicos/administração & dosagem
20.
J Clin Neurosci ; 47: 154-156, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29113860

RESUMO

Neuropsychiatric symptoms have been well documented after subthalamic nucleus deep brain stimulation (STN-DBS), but those following a subthalamic lesion have been rarely reported. Herein, we present a 43-year-old woman with sudden-onset dramatic psychiatric and behavioral symptoms with hemiballism. Brain magnetic resonance imaging (MRI) with fluid attenuated inversion recovery (FLAIR) sequence during the acute phase demonstrated extensive hyperintensity in the left STN and adjacent regions. Contrast-enhanced MRI showed no abnormal areas of enhancement. Magnetic resonance venography (MRV) was normal. Routine blood and cerebrospinal fluid (CSF) tests were not remarkable. Autoimmune antibodies showed no significant results. A gradual recovery of both psychiatric and behavioral symptoms and hemiballism was observed with steroid and symptomatic treatment. Our case is unique in dramatic neuropsychiatric symptoms following a subthalamic lesion. We would like to point out that severe neuropsychiatric symptoms can occur in the patients with subthalamic lesions, and can be a troubling feature in their management.


Assuntos
Sintomas Comportamentais/etiologia , Edema Encefálico/complicações , Discinesias/etiologia , Núcleo Subtalâmico/patologia , Adulto , Agressão , Sintomas Comportamentais/tratamento farmacológico , Edema Encefálico/diagnóstico por imagem , Discinesias/tratamento farmacológico , Feminino , Humanos , Núcleo Subtalâmico/diagnóstico por imagem
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