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1.
Rev Med Suisse ; 16(707): 1751-1755, 2020 Sep 23.
Artigo em Francês | MEDLINE | ID: mdl-32969612

RESUMO

Acute treatment of agitation in psychiatry is one of the urgent situations for which management recommendations are needed. Various existing international recommendations have been evaluated and adapted to our clinical practice and to the drugs available in Switzerland in order to propose a uniform management strategy in our hospital. This strategy includes a treatment choice algorithm with different options depending on the clinical situation and the possible route of administration. Dose recommendations for the oral and intramuscular routes, certain pharmacokinetic parameters, as well as risks of interactions and important warnings are also included in this clinical recommendation.


Assuntos
Algoritmos , Tomada de Decisão Clínica , Psiquiatria/métodos , Tranquilizantes/administração & dosagem , Tranquilizantes/uso terapêutico , Teoria da Decisão , Vias de Administração de Medicamentos , Humanos , Suíça , Tranquilizantes/farmacocinética
3.
J Zoo Wildl Med ; 51(1): 88-95, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32212550

RESUMO

A prospective clinical trial was performed to evaluate the efficacy of haloperidol premedication prior to xylazine-ketamine anesthesia with a goal of reducing capture stress in adult male captive spotted deer (Axis axis). On the morning of the study, deer were fed a banana either containing haloperidol tablets (1 mg/kg) (haloperidol group, n = 10) or without haloperidol (placebo group, n = 10). Six hours postadministration, xylazine (3 mg/kg) and ketamine (2 mg/kg) was administered intramuscularly via a dart. Rectal temperature, heart rate, respiratory rate, and SpO2 (percent hemoglobin saturation) were recorded at 5-min intervals. Blood gas analysis was performed at time 0 (venous blood) and 10 and 20 min (arterial blood) postinduction. Serum cortisol was determined from venous blood (35 min postinduction), following which yohimbine was administered at a dose of 0.15 mg/kg intramuscular and 0.15 mg/kg intravenous. Statistical analysis of repeated measures data was performed with a two-way analysis of variance. Paired data were analyzed with a Wilcoxon rank-sum test (categorical data) or a paired t-test (continuous data). Significance was set at P ≤ 0.05, and results were expressed as mean ± SEM. There was no significant difference in induction time or recovery time between treatment groups. Rectal temperature and heart rate were significantly lower in the haloperidol group. Both groups demonstrated acidosis with venous pH being significantly lower in the placebo group when compared to the haloperidol group. Serum cortisol and arterial plasma lactate were lower in the haloperidol group indicative of reduced stress and physical exertion. Haloperidol premedication proved to be beneficial in reducing capture stress, when administered prior to xylazine-ketamine anesthesia, in spotted deer.


Assuntos
Cervos/fisiologia , Haloperidol/uso terapêutico , Pré-Medicação/veterinária , Estresse Fisiológico/efeitos dos fármacos , Tranquilizantes/uso terapêutico , Administração Oral , Anestésicos Dissociativos/administração & dosagem , Animais , Animais de Zoológico/fisiologia , Hipnóticos e Sedativos/administração & dosagem , Ketamina/administração & dosagem , Masculino , Pré-Medicação/métodos , Xilazina/administração & dosagem
4.
Eur Arch Psychiatry Clin Neurosci ; 270(1): 107-117, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31440829

RESUMO

Adjustment disorder is a temporary change in behaviour or emotion as a reaction to a stress factor. Therapy consists of psychotherapy, and pharmacotherapy can be advised. However, data on the real-life pharmacological treatment are sparse. Prescription data for 4.235 psychiatric inpatients diagnosed with adjustment disorder in the time period 2000-2016 were analysed. The data were obtained from the Drug Safety Programme in Psychiatry (AMSP). Data were collected on two reference days per year; prescription patterns and changes over time were analysed. Of all patients, 81.2% received some type of psychotropic drug. Mostly antidepressants (59.8%), antipsychotics (35.5%), and tranquilisers (22.6%) were prescribed. Prescription rates for antidepressants decreased slightly over the years, while rates for antipsychotics increased, especially for atypical antipsychotics. It is important to note that the diagnosis "adjustment disorder" is most likely a working diagnosis that is used for patients in immediate need of psychiatric aid. Overall, pharmacotherapy for inpatients with this diagnosis is mostly symptom-oriented and focuses on depressive moods, agitation and anxiety. Therapy regimes changed over time and show an increased use of atypical antipsychotics with sedative properties. However, for most of the medication, there are neither evidence-based studies nor guidelines, and drugs might be contraindicated in some cases.


Assuntos
Transtornos de Adaptação/tratamento farmacológico , Monitoramento de Medicamentos/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Transtornos Mentais , Padrões de Prática Médica/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Transtornos de Adaptação/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Áustria/epidemiologia , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Padrões de Prática Médica/tendências , Suíça/epidemiologia , Tranquilizantes/uso terapêutico , Adulto Jovem
5.
Drug Alcohol Depend ; 204: 107592, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586804

RESUMO

BACKGROUND: Recent data suggest increases in methamphetamine potency, affordability, and availability in the US. Other data indicate rising rates of methamphetamine use among patients seeking treatment for opioid use disorder. The extent to which similar increases in methamphetamine use have occurred for populations outside of a treatment context and for those reporting other substance use is unknown. PURPOSE: The current analysis used a nationally representative data source to evaluate recent trends in past month methamphetamine use based on opioid use history. METHODS: Data from the 2015-2017 National Survey on Drug Use and Health (NSDUH) were analyzed for yearly variations in past month methamphetamine use by opioid use history. Sensitivity analyses assessed if these trends were specific to methamphetamine use and to persons reporting opioid use. RESULTS: Significant increases in past month methamphetamine use were observed for persons reporting past month heroin use, past year heroin use disorder, and past year prescription opioid use disorder. Among individuals reporting past month heroin use, for example, methamphetamine use tripled from 9.0% in 2015 to 30.2% in 2017. These associations were specific to methamphetamine with little change in other substance use. Similar increases in methamphetamine use were not observed for populations reporting other illicit substance use with the exception of prescription tranquilizers. CONCLUSIONS: These results provide data corroborating evidence of emergent concerns related to methamphetamine use in the US. Such findings highlight the importance of considering global drivers of substance use to avoid cyclic waves of new and emerging substance use crises.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Analgésicos Opioides/efeitos adversos , Epidemias , Inquéritos Epidemiológicos/tendências , Metanfetamina/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/diagnóstico , Estudos Transversais , Epidemias/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Tranquilizantes/uso terapêutico , Estados Unidos/epidemiologia
6.
Pharmacoepidemiol Drug Saf ; 28(10): 1336-1343, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31407838

RESUMO

PURPOSE: The purpose of the present study was to assess the agreement between self-reported use of sleep medications and tranquilizers and dispensed hypnotics and anxiolytics. METHODS: Self-reported medication use was obtained from the population-based survey Health and Environment in Oslo (HELMILO) (2009-2010) (n = 13 019). Data on dispensed hypnotics and anxiolytics were obtained from the Norwegian Prescription Database (NorPD). As measures of validity, we calculated sensitivity and specificity using both self-reports and prescription records as the reference standard. Furthermore, we calculated Cohen's kappa. Current self-reported medication use was compared with prescription data in time windows of both 100 and 200 days preceding questionnaire completion. RESULTS: The highest sensitivity was observed for current sleep medication use in the 100-day time window (sensitivity = 0.76, 95% confidence interval [CI]: 0.74, 0.79) when using prescription records as the reference standard. Sensitivity was generally lower for tranquilizers compared with sleep medications. Cohen's kappa showed the highest agreement for the 200-day time window with substantial agreement for sleep medications (kappa = 0.64; 95% CI: 0.62, 0.67) and moderate agreement for tranquilizers (kappa = 0.45; 95% CI: 0.41, 0.48). CONCLUSIONS: The present study suggests moderate to substantial agreement between self-reported use of sleep medications and tranquilizers and dispensed drugs in a general adult population. The magnitude of agreement varied according to drug category and time window. Since self-reported and registry-based use of these drug classes does not match each other accurately, limitations of each data source should be considered when such medications are applied as the exposure or outcome in epidemiologic studies.


Assuntos
Farmacoepidemiologia/métodos , Sistema de Registros/estatística & dados numéricos , Autorrelato/estatística & dados numéricos , Medicamentos Indutores do Sono/uso terapêutico , Tranquilizantes/uso terapêutico , Adulto , Estudos Transversais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Noruega , Farmacoepidemiologia/estatística & dados numéricos , Medicamentos sob Prescrição/uso terapêutico , Sensibilidade e Especificidade
7.
Metab Brain Dis ; 34(6): 1679-1687, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31422510

RESUMO

First-episode psychosis (FEP) patients are more sensitive to neuroleptic side-effects such as hyperprolactinemia. We examined the prolactin levels of previously minimally treated patients with first episode schizophrenia over their first year of treatment with flupenthixol decanoate and the relationship between prolactin levels, gender and clinical features of schizophrenia. Prolactin levels were assessed at three monthly intervals in 126 patients with first-episode schizophrenia in a single-site study conducted over 12 months during treatment with flupenthixol decanoate according to a fixed protocol. The mean prolactin level for the total sample was 11.91 ng/ml (standard deviation [SD]15.52) at baseline. Women had higher levels of prolactin than men at month 3, 6 and 12, reaching statistical significance at month 12 (p = 0.02). At 12 months more women than men had hyperprolactinemia (defined as more than 20 ng/ml for males, and as more than 25 ng/ml for females (p = 0.007). Using a mixed effect model, there was a significant association between prolactin change scores over 12 months and gender (p = 0.025) as well as Positive and Negative Syndrome Scale (PANSS) total scores (p = 0.001). In addition female gender (p = 0.04) and age (p = 0.02) correlated with the risk of hyperprolactinemia as categorical variable. In this study treatment with flupenthixol decanoate was associated with relatively low levels of hyperprolactinemia, likely owing to flupenthixol's relatively atypical mode of action, as well as to the low doses used in our study. We found an inverse correlation between total PANSS scores and prolactin levels, which could support the suggested theory of prolactin having antipsychotic properties. Our study confirms the importance of gender on the prolactin raising effects of antipsychotic treatment.


Assuntos
Flupentixol/análogos & derivados , Hiperprolactinemia/induzido quimicamente , Propafenona/sangue , Esquizofrenia/tratamento farmacológico , Tranquilizantes/uso terapêutico , Adolescente , Adulto , Fatores Etários , Feminino , Flupentixol/efeitos adversos , Flupentixol/uso terapêutico , Humanos , Masculino , Esquizofrenia/sangue , Fatores Sexuais , Tranquilizantes/efeitos adversos , Resultado do Tratamento , Adulto Jovem
8.
Aust N Z J Psychiatry ; 53(5): 458-469, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30727750

RESUMO

OBJECTIVE: The treatment of bipolar disorder is challenging because of its clinical complexity and availability of multiple treatment options, none of which are ideal mood stabilizers. This survey studies prescription practices of psychiatrists in India and their adherence to guidelines. METHOD: In total, 500 psychiatrists randomly selected from the Indian Psychiatric Society membership directory were administered a face-to-face 22-item questionnaire pertaining to the management of bipolar disorder. RESULTS: For acute mania, most practitioners preferred a combination of a mood stabilizer and an atypical antipsychotic to monotherapy. For acute depression, there was a preference for a combination of an antidepressant and a mood stabilizer over other alternatives. Electroconvulsive therapy was preferred in the treatment of severe episodes and to hasten the process of recovery. Approximately, 50% of psychiatrists prescribe maintenance treatment after the first bipolar episode, but maintenance therapy was rarely offered lifelong. While the majority (85%) of psychiatrists acknowledged referring to various clinical guidelines, their ultimate choice of treatment was also significantly determined by personal experience and reference to textbooks. LIMITATIONS: The study did not study actual prescriptions. Hence, the responses to queries in the survey are indirect measures from which we have tried to understand the actual practices, and of course, these are susceptible to self-report and social-desirability biases. This was a cross-sectional study; therefore, temporal changes in responses could not be considered. CONCLUSION: Overall, Indian psychiatrists seemed to broadly adhere to recommendations of clinical practice guidelines, but with some notable exceptions. The preference for antidepressants in treating depression is contrary to general restraint recommended by most guidelines. Therefore, the efficacy of antidepressants in treating bipolar depression in the context of Indian psychiatrists' practice needs to be studied systematically. Not initiating maintenance treatment early in the course of illness may have serious implications on the long-term outcome of bipolar disorder.


Assuntos
Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Tranquilizantes/uso terapêutico , Estudos Transversais , Quimioterapia Combinada , Fidelidade a Diretrizes , Humanos , Índia , Guias de Prática Clínica como Assunto
9.
J Feline Med Surg ; 21(2): 178-185, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29595359

RESUMO

CASE SERIES SUMMARY: This was a retrospective study on the clinical features and response to treatment in seven cats with feline hyperaesthesia syndrome (FHS) and tail mutilation. FHS is a poorly understood disorder characterised by skin rippling over the dorsal lumbar area, episodes of jumping and running, excessive vocalisation, and tail chasing and self-trauma. The majority of the cats were young, with a median age of 1 year at the onset of clinical signs, male (n = 6) and with access to the outdoors (n = 5). Multiple daily episodes of tail chasing and self-trauma were reported in five cats, with tail mutilation in four cats. Vocalisation during the episodes (n = 5) and rippling of lumbar skin (n = 5) were also reported. Haematology, serum biochemistry, Toxoplasma gondii and feline immunodeficiency virus/feline leukaemia virus serology, MRI scans of brain, spinal cord and cauda equina, cerebrospinal fluid analysis and electrodiagnostic tests did not reveal any clinically significant abnormalities. A definitive final diagnosis was not reached in any of the cats, but hypersensitivity dermatitis was suspected in two cases. A variety of medications was used alone or in combination, including gabapentin (n = 6), meloxicam (n = 4), antibiotics (n = 4), phenobarbital (n = 2), prednisolone (n = 2) and topiramate (n = 2); ciclosporin, clomipramine, fluoxetine, amitriptyline and tramadol were used in one cat each. Clinical improvement was achieved in six cases; in five cats complete remission of clinical signs was achieved with gabapentin alone (n = 2), a combination of gabapentin/ciclosporin/amitriptyline (n = 1), gabapentin/prednisolone/phenobarbital (n = 1) or gabapentin/topiramate/meloxicam (n = 1). RELEVANCE AND NOVEL INFORMATION: This is the first retrospective study on a series of cats with FHS. The diagnostic work-up did not reveal any significant abnormalities of the central or peripheral nervous system; dermatological and behavioural problems could not be ruled out. We propose an integrated multidisciplinary diagnostic pathway to be used for the management of clinical cases and for future prospective studies.


Assuntos
Doenças do Gato , Hiperestesia , Animais , Comportamento Animal , Doenças do Gato/diagnóstico , Doenças do Gato/etiologia , Doenças do Gato/terapia , Gatos , Dermatite , Hiperestesia/diagnóstico , Hiperestesia/etiologia , Hiperestesia/terapia , Hiperestesia/veterinária , Estudos Retrospectivos , Tranquilizantes/uso terapêutico
11.
J Clin Psychopharmacol ; 38(6): 598-603, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30273199

RESUMO

PURPOSE: Little is known regarding the trend of polypharmacy in Asia. We used data from 5 Asian countries to examine the patterns of antidepressant (AD) prescription and trends of psychotropic polypharmacy over time. METHODS: We used the cross-sectional, pharmacoepidemiological data from 2004 and 2013 REAP-AD (Research on Asian Psychotropic Prescription Patterns for Antidepressants) to examine the patterns of AD prescriptions in clinical settings in China, Japan, Korea, Singapore, and Taiwan. We compared the trend in polypharmacy (ie, concomitant use of ≥2 classes of psychotropic) among individuals receiving AD prescriptions in 2004 and 2013 using multivariable logistic regression models in different diagnostic categories. RESULTS: The proportion of patients with psychotropic polypharmacy decreased from 2004 to 2013 in all 3 diagnostic categories, including mood disorders (adjusted odds ratio [aOR], 0.44 [0.35-0.56]; P < 0.001), anxiety disorders (aOR, 0.58 [0.36-0.94]; P = 0.028), and psychotic disorders (aOR, 0.18 [0.05-0.60]; P = 0.006). Among individuals with AD prescriptions, concomitant use of anxiolytics (including sedative-hypnotics) decreased in patients with mood disorders (aOR, 0.34 [0.27-0.42]; P < 0.001) and anxiety disorders (aOR, 0.43 [0.27-0.67]; P < 0.001). In contrast, concomitant use of antipsychotics in patients with mood disorders increased (aOR, 1.43 [1.15-1.77]; P = 0.001), and concomitant use of mood stabilizers in patients with psychotic disorders also increased (aOR, 3.49 [1.50-8.14]; P = 0.004). CONCLUSIONS: This is the first study examining trends in psychotropic polypharmacy in East Asia. We found a generally decreasing trend of psychotropic polypharmacy in contrast to the increasing trend reported from Western countries. These findings could offer significant implications for health system reform or policy making.


Assuntos
Antidepressivos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Transtornos do Humor/tratamento farmacológico , Polimedicação , Padrões de Prática Médica/estatística & dados numéricos , Transtornos Psicóticos/tratamento farmacológico , Tranquilizantes/uso terapêutico , Adulto , China , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , República da Coreia , Singapura , Taiwan
12.
Int J Mol Sci ; 19(7)2018 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-30041458

RESUMO

In this paper, the authors review the history of the pharmacological treatment of bipolar disorder, from the first nonspecific sedative agents introduced in the 19th and early 20th century, such as solanaceae alkaloids, bromides and barbiturates, to John Cade's experiments with lithium and the beginning of the so-called "Psychopharmacological Revolution" in the 1950s. We also describe the clinical studies and development processes, enabling the therapeutic introduction of pharmacological agents currently available for the treatment of bipolar disorder in its different phases and manifestations. Those drugs include lithium salts, valproic acid, carbamazepine, new antiepileptic drugs, basically lamotrigine and atypical antipsychotic agents (olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole, asenapine, cariprazine and lurasidone). Finally, the socio-sanitary implications derived from the clinical introduction of these drugs are also discussed.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Psicofarmacologia/história , Tranquilizantes/uso terapêutico , Animais , Transtorno Bipolar/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Lítio/história , Lítio/uso terapêutico , Tranquilizantes/história
13.
Drug Alcohol Depend ; 189: 172-177, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29960204

RESUMO

BACKGROUND: Prescription drug misuse (PDM) rates are highest in adolescents and young adults. Little research in these high-risk groups has examined PDM differences by educational status or attainment. This investigation attempted to further our understanding of adolescent and young adult prescription drug use and misuse through examining PDM type (i.e., nonmedical misuse, medical misuse and mixed misuse) and substance use disorder (SUD) symptoms from PDM by educational status/attainment. METHODS: Data were from the 2015 National Survey on Drug Use and Health, with 13,585 adolescent and 14,553 young adult respondents. Participants were categorized by educational status separately in adolescents and young adults. Outcomes were rates of past-year prescription drug use, PDM, PDM type, and SUD symptoms, with analyses performed separately by age group and for opioids, stimulants and sedatives/tranquilizers. Analyses used logistic regression and controlled for age, race/ethnicity and sex. RESULTS: In adolescents and across medication classes, the highest rates of any use, PDM, medical misuse, nonmedical misuse and presence of two or more SUD symptoms were seen in those with poor school adjustment or not in school. In young adults, opioid-PDM and related outcomes were more prevalent in those not in school, especially high school dropouts. For stimulants, rates were highest in full-time college students and college graduates. CONCLUSIONS: These results further suggest the importance of assessing educational status in adolescent and educational attainment in young adult PDM investigations. Adolescents poorly engaged in school or not in school appear especially in need of interventions to limit PDM and associated SUD symptoms.


Assuntos
Escolaridade , Uso Indevido de Medicamentos sob Prescrição/psicologia , Uso Indevido de Medicamentos sob Prescrição/tendências , Estudantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Estimulantes do Sistema Nervoso Central/efeitos adversos , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Estudos Transversais , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Medicamentos sob Prescrição/efeitos adversos , Medicamentos sob Prescrição/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Tranquilizantes/efeitos adversos , Tranquilizantes/uso terapêutico , Estados Unidos/epidemiologia , United States Substance Abuse and Mental Health Services Administration/tendências , Universidades/tendências , Adulto Jovem
14.
J Affect Disord ; 238: 327-335, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29902737

RESUMO

OBJECTIVE: Physical inactivity is a major public health problem associated with an increased risk of several psychiatric and physical conditions. This study investigated the association between leisure time physical activity (PA) and incident use of prescription tranquilizers in a regionally representative and prospective cohort. METHODS: A total of 4043 men and women (mean age: 61.3 years; 57% women) from the Tromsø Study were followed for six years. Leisure time PA was captured at baseline. Psychiatric morbidity was measured by use of prescription tranquilizers, captured at both baseline and follow-up. Leisure time PA at baseline was used as a predictor of subsequent (incident) use of prescription tranquilizers. We used multinomial regression models and Poisson regression models to estimate relative risk-ratios (RRRs), and relative risks (RRs), respectively, and their corresponding 95% confidence intervals (CIs). RESULTS: In the fully-adjusted model, accounting for socio-demographic factors, parental history of psychopathology, years of education, smoking, respondent's psychopathology at baseline, and occupational PA, a lower leisure time PA conferred a 41% increased risk of incident use of prescription tranquilizers at follow-up (RR = 1.41, 95% CI: 1.09, 1.83; p = 0.010). CONCLUSIONS: These findings suggest that physical inactivity increases the risk of psychiatric morbidity (albeit, measured via use of prescription tranquilizers). Future regionally representative and longitudinal research is required to confirm/refute our findings and explore underlying mechanisms.


Assuntos
Exercício Físico/psicologia , Comportamento Sedentário , Tranquilizantes/uso terapêutico , Adulto , Estudos de Coortes , Feminino , Humanos , Atividades de Lazer/psicologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Análise de Regressão , Fumar/epidemiologia
16.
Cochrane Database Syst Rev ; 4: CD009412, 2018 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-29634083

RESUMO

BACKGROUND: Aggressive, agitated or violent behaviour due to psychosis constitutes an emergency psychiatric treatment where fast-acting interventions are required. Risperidone is a widely accessible antipsychotic that can be used to manage psychosis-induced aggression or agitation. OBJECTIVES: To examine whether oral risperidone alone is an effective treatment for psychosis-induced aggression or agitation. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (up to April 2017); this register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings. There are no language, date, document type, or publication status limitations for inclusion of records into the register. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing rapid use of risperidone and other drugs, combinations of drugs or placebo for people exhibiting aggression or agitation (or both) thought to be due to psychosis. DATA COLLECTION AND ANALYSIS: We independently inspected all citations from searches, identified relevant abstracts, and independently extracted data from all included studies. For binary data we calculated risk ratio (RR) and for continuous data we calculated mean difference (MD), all with 95% confidence intervals (CI) and used a fixed-effect model. We assessed risk of bias for the included studies and used the GRADE approach to produce a 'Summary of findings' tables. MAIN RESULTS: The review now contains data from nine trials (total n = 582) reporting on five comparisons. Due to risk of bias, small size of trials, indirectness of outcome measures and a paucity of investigated and reported 'pragmatic' outcomes, evidence was graded as very-low quality. None of the included studies provided useable data on our primary outcome 'tranquillisation or asleep' by 30 minutes, repeated need for tranquillisation or any economic outcomes. Data were available for our other main outcomes of agitation or aggression, needing restraint, and incidence of adverse effects.Risperidone versus haloperidol (up to 24 hours follow-up)For the outcome, specific behaviour - agitation, no clear difference was found between risperidone and haloperidol in terms of efficacy, measured as at least 50% reduction in the Positive and Negative Syndrome Scale - Psychotic Agitation Sub-score (PANSS-PAS) (RR 1.04, 95% CI 0.86 to 1.26; participants = 124; studies = 1; very low-quality evidence) and no effect was observed for need to use restraints (RR 2.00, 95% CI 0.43 to 9.21; participants = 28; studies = 1; very low-quality evidence). Incidence of adverse effects was similar between treatment groups (RR 0.94, 95% CI 0.54 to 1.66; participants = 124; studies = 1; very low-quality evidence).Risperidone versus olanzapineOne small trial (n = 29) reported useable data for the comparison risperidone versus olanzapine. No effect was observed for agitation measured as PANSS-PAS endpoint score at two hours (MD 2.50, 95% CI -2.46 to 7.46; very low-quality evidence); need to use restraints at four days (RR 1.43, 95% CI 0.39 to 5.28; very-low quality evidence); specific movement disorders measured as Behavioural Activity Rating Scale (BARS) endpoint score at four days (MD 0.20, 95% CI -0.43 to 0.83; very low-quality evidence).Risperidone versus quetiapineOne trial reported (n = 40) useable data for the comparison risperidone versus quetiapine. Aggression was measured using the Modified Overt Aggression Scale (MOAS) endpoint score at two weeks. A clear difference, favouring quetiapine was observed (MD 1.80, 95% CI 0.20 to 3.40; very-low quality evidence). No evidence of a difference between treatment groups could be observed for incidence of akathisia after 24 hours (RR 1.67, 95% CI 0.46 to 6.06; very low-quality evidence). Two participants allocated to risperidone and one allocated to quetiapine experienced myocardial ischaemia during the trial.Risperidone versus risperidone + oxcarbazepineOne trial (n = 68) measured agitation using the Positive and Negative Syndrome Scale - Excited Component.(PANSS-EC) endpoint score and found a clear difference, favouring the combination treatment at one week (MD 2.70, 95% CI 0.42 to 4.98; very low-quality evidence), but no effect was observed for global state using Clinical Global Impression - Improvement (CGI-I) endpoint score at one week (MD -0.20, 95% CI -0.61 to 0.21; very-low quality evidence). Incidence of extrapyramidal symptoms after 24 hours was similar between treatment groups (RR 1.59, 95% CI 0.49 to 5.14; very-low quality evidence).Risperidone versus risperidone + valproic acidTwo trials compared risperidone with a combination of risperidone plus valproic acid. No clear differences between the treatment groups were observed for aggression (MOAS endpoint score at three days: MD 1.07, 95% CI -0.20 to 2.34; participants = 54; studies = 1; very low-quality evidence) or incidence of akathisia after 24 hours: RR 0.75, 95% CI 0.28 to 2.03; participants = 122; studies = 2; very low-quality evidence). AUTHORS' CONCLUSIONS: Overall, results for the main outcomes show no real effect for risperidone. The only data available for use in this review are from nine under-sampled trials and the evidence available is of very low quality. This casts uncertainty on the role of risperidone in rapid tranquillisation for people with psychosis-induced aggression. High-quality pragmatic RCTs are feasible and are needed before clear recommendations can be drawn on the use of risperidone for psychosis-induced aggression or agitation.


Assuntos
Agressão/efeitos dos fármacos , Antipsicóticos/uso terapêutico , Agitação Psicomotora/tratamento farmacológico , Transtornos Psicóticos/complicações , Risperidona/uso terapêutico , Administração Oral , Agressão/psicologia , Antipsicóticos/efeitos adversos , Carbamazepina/análogos & derivados , Carbamazepina/uso terapêutico , Humanos , Oxcarbazepina , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Fumarato de Quetiapina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Risperidona/efeitos adversos , Tranquilizantes/uso terapêutico , Ácido Valproico/uso terapêutico
17.
J Addict Med ; 12(4): 295-299, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29664895

RESUMO

OBJECTIVES: Previous studies have found a negative population-level correlation between medical marijuana availability in US states, and trends in medical and nonmedical prescription drug use. These studies have been interpreted as evidence that use of medical marijuana reduces medical and nonmedical prescription drug use. This study evaluates whether medical marijuana use is a risk or protective factor for medical and nonmedical prescription drug use. METHODS: Simulations based upon logistic regression analyses of data from the 2015 National Survey on Drug Use and Health were used to compute associations between medical marijuana use, and medical and nonmedical prescription drug use. Adjusted risk ratios (RRs) were computed with controls added for age, sex, race, health status, family income, and living in a state with legalized medical marijuana. RESULTS: Medical marijuana users were significantly more likely (RR 1.62, 95% confidence interval [CI] 1.50-1.74) to report medical use of prescription drugs in the past 12 months. Individuals who used medical marijuana were also significantly more likely to report nonmedical use in the past 12 months of any prescription drug (RR 2.12, 95% CI 1.67-2.62), with elevated risks for pain relievers (RR 1.95, 95% CI 1.41-2.62), stimulants (RR 1.86, 95% CI 1.09-3.02), and tranquilizers (RR 2.18, 95% CI 1.45-3.16). CONCLUSIONS: Our findings disconfirm the hypothesis that a population-level negative correlation between medical marijuana use and prescription drug harms occurs because medical marijuana users are less likely to use prescription drugs, either medically or nonmedically. Medical marijuana users should be a target population in efforts to combat nonmedical prescription drug use.


Assuntos
Analgésicos/uso terapêutico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Maconha Medicinal/uso terapêutico , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Medicamentos sob Prescrição/uso terapêutico , Tranquilizantes/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
18.
Addict Behav ; 81: 39-45, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29425791

RESUMO

BACKGROUND: Prescription drug misuse and its consequences (e.g., overdose) are a major public health concern. While national focus has been on opioids, misuse of sedatives/tranquilizers also occurs. Here we describe the use, correlates, and sources of prescription drugs in a community-based cohort of people who inject drugs (PWID). METHODS: We included participants of the AIDS Linked to the IntraVenous Experience (ALIVE) study in follow-up in 2014. We defined prescription drug use as use of opioids or sedatives/tranquilizers considering both medical "prescribed by a doctor" and non-medical sources "obtained from the street/friend/relative." Correlates were evaluated separately for opioids and sedatives/tranquilizers using logistic regression and included socioeconomic factors, health conditions, substance use, and health care access. RESULTS: 823 predominantly African-American (90.6%) and male (66.3%) ALIVE participants with a median age of 55 were included. Prevalence of prescription opioid and sedative/tranquilizer use was 25.3% and 16.3% respectively. While the majority (70%) obtained prescription drugs exclusively through medical sources, the 30% who reported any non-medical source were also more likely to use other substances by injection and non-injection routes. PWID reporting prescription drug use (from medical and non-medical sources) were significantly more likely to report other substance use, mental health disorder, and recent contact with health care providers or detoxification facilities. CONCLUSIONS: Prescription drug use was highly prevalent among PWID. While it is difficult to distinguish medically indicated from non-medical use, high levels of prescription drug use in conjunction with other drugs and alcohol heightens the risk for drug overdose and other adverse consequences.


Assuntos
Analgésicos Opioides/uso terapêutico , Depressão/epidemiologia , Hipnóticos e Sedativos/uso terapêutico , Dor/epidemiologia , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Tranquilizantes/uso terapêutico , Baltimore/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Estudos de Coortes , Feminino , Acesso aos Serviços de Saúde , Dependência de Heroína/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Prevalência , Estudos Prospectivos , Fatores Socioeconômicos
19.
Cancer ; 124(10): 2246-2252, 2018 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-29469951

RESUMO

BACKGROUND: The Richmond Agitation-Sedation Scale (RASS) is commonly used to assess psychomotor activity; however, to the authors' knowledge, its minimal clinically important difference (MCID) has not been determined to date. The objective of the current study was to identify the MCID for RASS using 2 anchor-based approaches. METHODS: The current study was a secondary analysis of a randomized controlled trial to compare the effect of lorazepam versus placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium. The primary outcome was change in RASS (10-point numeric rating scale ranging from -5 [unarousable] to +4 [combative]) from baseline to 8 hours after treatment administration. The sensitivity-specificity and within-patient change methods were used to identify the MCID, with the anchor being patient comfort after the study intervention as perceived by caregivers and nurses. RESULTS: A total of 90 patients were randomized and 58 (64%) received the study medication for restlessness/agitation (mean baseline RASS, 1.6). A total of 23 caregivers (61%) and 23 nurses (55%) perceived that the patient was more comfortable after treatment. Using the sensitivity-specificity method, the optimal RASS reduction was ≥4 points according to both caregivers (sensitivity of 61% and specificity of 80%; area under the curve, 0.71) and nurses (sensitivity of 73% and specificity of 84%; area under the curve, 0.78). The RASS cutoff value based on the within-patient change method was similar (-4.2 for caregivers and -4.0 for nurses). CONCLUSIONS: For patients with persistent restlessness/agitation, a reduction of ≥4 points in RASS was considered to be the MCID for both nurses and caregivers. These preliminary findings may have implications for sample size calculation and the interpretation of treatment effect in future delirium trials. Cancer 2018;124:2246-52. © 2018 American Cancer Society.


Assuntos
Delírio/diagnóstico , Diferença Mínima Clinicamente Importante , Neoplasias/complicações , Agitação Psicomotora/diagnóstico , Tranquilizantes/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Delírio/tratamento farmacológico , Delírio/psicologia , Quimioterapia Combinada/métodos , Feminino , Haloperidol/uso terapêutico , Humanos , Lorazepam/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Cuidados Paliativos/métodos , Estudos Prospectivos , Psicometria/métodos , Agitação Psicomotora/tratamento farmacológico , Agitação Psicomotora/psicologia
20.
Int J Ment Health Nurs ; 27(5): 1449-1458, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29431294

RESUMO

Rapid tranquillization is a pharmacological intervention sometimes employed in mental health care for the management of acute behavioural disturbance. It is a form of restrictive practice, which, along with seclusion and restraint, is a conventional and controversial intervention in the therapeutic management of risk in mental health settings. This study surveyed mental health nurses practice in rapid tranquillization. A self-report questionnaire was utilized which addressed aspects such as definitions of rapid tranquillization, presence of rapid tranquillization policy, types of incidents where it is used and postintervention monitoring. The results demonstrate that rapid tranquillization is an intervention used in the management of acute behavioural disturbance in various mental health settings in Ireland. Respondents showed a basic understanding of rapid tranquillization as an intervention; however, some areas reported not having a specific rapid tranquillization policy. There was some evidence of a variation in postrapid tranquillization monitoring of psychiatric/mental health and physical health. Service user debriefing following rapid tranquillization was reported to be common; however, the content of this was not elaborated on. In the light of variations in practice, specific training and the development of rapid tranquillization policies are recommended.


Assuntos
Sedação Consciente/enfermagem , Enfermagem Psiquiátrica/métodos , Tranquilizantes/uso terapêutico , Sedação Consciente/métodos , Humanos , Irlanda , Auditoria Médica , Inquéritos e Questionários
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