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2.
An Bras Dermatol ; 95(3): 271-277, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32317131

RESUMO

Finasteride is a 5α-reductase enzyme inhibitor that has been approved for the treatment of male androgenic alopecia since 1997. Over time, it has been considered a safe and well-tolerated drug with rare and reversible side effects. Recently there have been reports of adverse drug-related reactions that persisted for at least three months after discontinuation of this drug, and the term post-finasteride syndrome arose. It includes persistent sexual, neuropsychiatric, and physical symptoms. Studies to date cannot refute or confirm this syndrome as a nosological entity. If it actually exists, it seems to occur in susceptible people, even if exposed to small doses and for short periods, and symptoms may persist for long periods. Based on currently available data, the use of 5α-reductase inhibitors in patients with a history of depression, sexual dysfunction, or infertility should be carefully and individually assessed.


Assuntos
Inibidores de 5-alfa Redutase/efeitos adversos , Finasterida/efeitos adversos , Disfunções Sexuais Fisiológicas/induzido quimicamente , Doenças Cardiovasculares/induzido quimicamente , Humanos , Infertilidade/induzido quimicamente , Masculino , Transtornos Mentais/induzido quimicamente , Doenças Metabólicas/induzido quimicamente , Fatores de Risco , Espermatozoides/efeitos dos fármacos , Síndrome
3.
Biosci Trends ; 14(2): 139-143, 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32321905

RESUMO

In late March and early April 2020, the antimalarial drug, chloroquine, has been approved as an emergency treatment for the coronavirus disease 2019 (COVID-19) in the United States and in Europe. Although infrequent, neuropsychiatric symptoms have been reported in patients who received chloroquine for the treatment of malaria or autoimmune diseases. In this study, aiming to investigate these adverse events (AEs) using a large self-reporting database, we conducted a disproportionality analysis for the detection of neuropsychiatric AE signals associated with the use of chloroquine (or hydroxychloroquine), reported to FDA Adverse Event Reporting System (FAERS) database between the fourth quarter of 2012 and the fourth quarter of 2019. We included 2,389,474 AE cases, among which 520 cases developed neuropsychiatric AE following the use of chloroquine. Adjusted reporting odds ratio (ROR) for the development of each of the neuropsychiatric AEs following the use of chloroquine was calculated using a multilevel model: exposure to chloroquine was associated with a statistically significant high reporting of amnesia, delirium, hallucinations, depression, and loss of consciousness, (lower 95% confidence interval of the adjusted ROR > 1), although the degree of increase in their ROR was limited. There was no statistically significant high reporting of any other neuropsychiatric AE, including suicide, psychosis, confusion, and agitation. Current pharmacovigilance study results did not suggest any potential link between the use of chloroquine and an increased risk of suicide, psychosis, confusion, and agitation, which would be informative during the emergency use of chloroquine for the treatment of COVID-19.


Assuntos
Cloroquina/efeitos adversos , Transtornos Mentais/induzido quimicamente , Síndromes Neurotóxicas/etiologia , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Betacoronavirus/isolamento & purificação , Cloroquina/administração & dosagem , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Farmacovigilância , Estudos Retrospectivos , Estados Unidos , United States Food and Drug Administration
4.
Pediatr Blood Cancer ; 67(3): e27968, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31407461

RESUMO

Survivors of childhood acute lymphoblastic leukemia (ALL) treated with chemotherapy only are at risk for neurocognitive impairment. Regions of interest were identified a priori based on glucocorticoid receptor distribution, and sex-stratified multivariable linear regression models were used to test associations between brain MRI morphology and total number of intrathecal injections, and serum concentration of dexamethasone and methotrexate. Compared with controls, ALL survivors have persistently smaller volumes in the bilateral cerebellum (P < 0.005), hippocampal subregions (P < 0.03), temporal lobe regions (P < 0.03), frontal lobe regions (P < 0.04), and parietal lobe regions (precuneus; P < 0.002). Long-term problems with learning may be related to residual posttreatment brain differences.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Sobreviventes de Câncer/estatística & dados numéricos , Dexametasona/efeitos adversos , Transtornos Mentais/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Lactente , Masculino , Transtornos Mentais/induzido quimicamente , Neuroanatomia , Testes Neuropsicológicos , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
5.
Chemosphere ; 241: 125118, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31683416

RESUMO

Deltamethrin (DM) has become one of the most widely used insecticides in the world due to its low toxicity, high efficiency and low persistence in soil. However, it is still unknown whether DM exposure has any effects on the Hypothalamic-Pituitary-Thyroid (HPT) axis in adolescent mice. In this study, the open field test and circadian activity test showed that DM exposure increased activity. There was no significant difference between the groups in the light/dark box test and nest building test. Forced swimming test showed that after 6 and 12 mg kg-1 DM exposure 28 days, the immobility time was increased and the swimming time was reduced. After 6 mg kg-1 DM treatment, the thyroid stimulating hormone (TSH) content increased, and thyrotropin releasing hormone (TRH), triiodothyronine (T3) and thyroxine (T4) decreased. After exposure to 6 and 12 mg kg-1 DM, mRNA levels of HPT axis-related genes were destroyed. The histological examination showed that, the DM groups mice thyroid tissues appeared expanded thyroid follicles, scanty colloid and hyperplastic thyroid cells. Western blot results showed that the expression level of tyrosine hydroxylase (TH) protein decreased and the content of dopamine transporter (DAT) protein increased in DM treated mice striatum. Collectively, our results indicated that DM exposure could induce thyroid dysfunction and behavioral disorders in adolescent mice.


Assuntos
Transtornos Mentais/induzido quimicamente , Nitrilos/farmacologia , Piretrinas/farmacologia , Glândula Tireoide/fisiopatologia , Hormônios Tireóideos/metabolismo , Envelhecimento , Animais , Comportamento Animal/efeitos dos fármacos , Inseticidas/farmacologia , Masculino , Camundongos , Glândula Tireoide/metabolismo , Tireotropina/metabolismo , Hormônio Liberador de Tireotropina/metabolismo , Tiroxina/metabolismo , Tri-Iodotironina/metabolismo
6.
Ann Ist Super Sanita ; 55(4): 338-344, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850860

RESUMO

INTRODUCTION: Ketamine is an essential medicine used as an anesthetic in low and middle-income countries and in veterinary medicine. Recreational use is widespread throughout the world, especially owing to its lower price compared to other substances. In Western countries its use has been mainly linked to subpopulations of young people who use drugs recreationally. Ketamine misuse is associated with amnesia, dependence, dissociation, lower urinary tract dysfunction and poor impulse control. Regular ketamine use is associated with abdominal pains. AIMS: The aims of this study are to analyze characteristics and main symptoms of ketamine abusers attending emergency departments (EDs) in the metropolitan area of Bologna, Emilia-Romagna Region, northern Italy. METHODS: We identified 74 records of ketamine-related visits: 30% female; 22% non-natives; mean age 25.6 years. Forty-two percent reported ketamine use alone, 46% reported the use of other illegal substance (cocaine 19%, heroin 18%), 26% alcohol misuse. RESULTS: The most common reported symptoms were neurological (soporous state 18%, agitation 14%, confusion 7%, panic attacks 7%, mydriasis 7%, tremors 7%), gastro-intestinal (abdominal pain 15%, vomiting 11%), urological (6.8%) and cardiac (palpitations 5%, chest pain 5%). Complications secondary to falls and cuts (7%) were the most frequent trauma complications. We highlight a significant number of visits regarding suicide attempts (10%) and overdose (4%). CONCLUSIONS: The results highlight a particular population of problematic ketamine users identified using the hospital's ICT system. In particular, poly-drug users who consume ketamine in combination with heroin or cocaine presenting to the ED represent a specific target for targeted prevention projects on non-lethal overdoses and suicide attempts.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Ketamina/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Adulto , Alcoolismo/epidemiologia , Doenças Cardiovasculares/induzido quimicamente , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Comorbidade , Estudos Transversais , Overdose de Drogas/epidemiologia , Feminino , Gastroenteropatias/induzido quimicamente , Humanos , Itália/epidemiologia , Masculino , Transtornos Mentais/induzido quimicamente , Doenças do Sistema Nervoso/induzido quimicamente , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Avaliação de Sintomas , Adulto Jovem
7.
Georgian Med News ; (294): 141-145, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687967

RESUMO

General anesthesia may cause damage of the central nervous system and cognitive dysfunction in the postoperative period. A new intranasal form of Noopept (N-Phenylacetyl-L-prolylglycine ethyl ester) was developed by our team at the Department of the medical technology (Zaporizhzhia State Medical University, Ukraine). The objectives of this investigation were the study of neuroprotective action of Noopept and to prove using in the clinic for correction of amnestic and behavioral disorders after ketamine anesthesia. We discovered that the intranasal administration of noopept after ketamine anesthesia significantly decreases anxiety and excitability, raises the animal's activity, shows an intensive antiamnesic effects and increases animal's training ability. Noopept significantly exceeds piracetam and cerebrocurin according to neuroprotective effects.


Assuntos
Amnésia/tratamento farmacológico , Ketamina/efeitos adversos , Transtornos Mentais/tratamento farmacológico , Fármacos Neuroprotetores/uso terapêutico , Amnésia/induzido quimicamente , Anestesia , Anestesia Geral , Animais , Dipeptídeos/uso terapêutico , Ketamina/administração & dosagem , Transtornos Mentais/induzido quimicamente , Resultado do Tratamento , Ucrânia
8.
Lancet ; 394(10209): 1652-1667, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668409

RESUMO

We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.


Assuntos
Anfetaminas/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/mortalidade , Cocaína/efeitos adversos , Adolescente , Adulto , Anfetaminas/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/mortalidade , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/prevenção & controle , Inibidores da Captação de Dopamina/efeitos adversos , Feminino , Infecções por HIV/induzido quimicamente , Infecções por HIV/mortalidade , Hepatite C/induzido quimicamente , Hepatite C/mortalidade , Humanos , Incidência , Masculino , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/mortalidade , Pessoa de Meia-Idade , Prevalência , Viroses/sangue , Viroses/induzido quimicamente , Viroses/mortalidade , Adulto Jovem
9.
Neurotoxicol Teratol ; 76: 106839, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644947

RESUMO

Recent developments in the field of insecticide exposure have led to a renewed interest in alternative antioxidant therapy. The present study was to investigate the neuroprotective role of syringic acid (SA, 25 mg/kg/day) on the neurotoxicity and oxidative damage induced by deltamethrin (DTM, 1.28 mg/kg/day during two months) in CA1/3 pyramidal neurons. Animals were divided into 4 groups (n = 16/group) (250-270 g) for control, DTM, SA and DTM + SA. DTM and SA were administered by oral gavage daily. Rats that were given sub-chronic DTM had revealed a significant increase in caspase-3 levels, impaired recognition memory, reduced antioxidant activity and enhanced free radicals in the hippocampus. The results showed that SA ameliorated neurobehavioral alterations, reduced reactive oxygen/nitrogen species, pyknosis in the CA1/3 and increased antioxidant enzyme activity. In conclusion, SA (25 mg/kg/day) had potential neuroprotective and therapeutic impacts against sub-chronic DTM exposure via its antioxidant and antiapoptotic efficacy. Therefore, it can be used as a neuroprotective natural plant-derived agent against DTM-induced neurotoxicity.


Assuntos
Ácido Gálico/análogos & derivados , Hipocampo/patologia , Inseticidas/toxicidade , Transtornos Mentais/prevenção & controle , Fármacos Neuroprotetores/uso terapêutico , Síndromes Neurotóxicas/prevenção & controle , Nitrilos/toxicidade , Piretrinas/toxicidade , Animais , Apoptose/efeitos dos fármacos , Região CA1 Hipocampal/metabolismo , Região CA1 Hipocampal/patologia , Região CA3 Hipocampal/metabolismo , Região CA3 Hipocampal/patologia , Ácido Gálico/uso terapêutico , Hipocampo/metabolismo , Aprendizagem/efeitos dos fármacos , Masculino , Memória/efeitos dos fármacos , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/metabolismo , Síndromes Neurotóxicas/psicologia , Estresse Oxidativo/efeitos dos fármacos , Células Piramidais , Ratos , Ratos Wistar
11.
Pediatr Hematol Oncol ; 36(7): 445-450, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31538841

RESUMO

Corticosteroids play an essential role in the treatment of pediatric malignancies, but have many untoward side effects including behavioral and mood disturbances which can be quite burdensome to families. Potassium chloride has been used anecdotally to decrease these neuropsychiatric effects but this experience has not been studied systematically. We therefore retrospectively reviewed our experience utilizing KCl supplementation to reduce corticosteroid-induced neuropsychiatric effects among children with acute lymphoblastic leukemia. Thirteen of 16 patients (81%) had a objective benefit with KCl at a median dose of 0.5 mEq/kg/day, with no reported adverse effects. Further prospective study is required to confirm these data.


Assuntos
Corticosteroides , Transtornos Mentais , Cloreto de Potássio/administração & dosagem , Leucemia-Linfoma Linfoblástico de Células Precursoras , Adolescente , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/prevenção & controle , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/psicologia , Estudos Prospectivos , Estudos Retrospectivos
12.
Bol. latinoam. Caribe plantas med. aromát ; 18(5): 459-479, sept. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1008268

RESUMO

Neuronal cell damage is often caused by prolonged misuse of Methylphenidate (MPH). Topiramate (TPM) carries neuroprotective properties but its assumed mechanism remains unclear. The present study evaluates in vivo role of various doses of TPM and its mechanism against MPH-induced motor activity and related behavior disorder. Thus, we used domoic acid (DOM), bicuculline (BIC), Ketamine (KET), Yohimibine (YOH) and Haloperidole (HAL) as AMPA/kainite, GABAA, NMDA, ɑ2 adrenergic and D2 of dopamine receptor antagonists respectively. Open Field Test (OFT), Elevated Plus Maze (EPM) and Forced Swim Test (FST) were used to study motor activity, anxiety and depression level. TPM (100 and 120 mg/kg) reduced MPH-induced rise and inhibited MPH-induced promotion in motor activity disturbance, anxiety and depression. Pretreatment of animals with KET, HAL, YOH and BIC inhibited TPM- improves anxiety and depression through the interacting with Dopaminergic, GABAA, NMDA and ɑ2-adrenergic receptors.


El daño a las células neuronales a menudo es causado por el uso prolongado de metilfenidato (MPH). El topiramato (TPM) tiene propiedades neuroprotectoras, pero su mecanismo de acción no es claro. El presente estudio evalúa el papel in vivo de varias dosis de TPM y su mecanismo contra la actividad motora inducida por MPH y el trastorno de comportamiento relacionado. Utilizamos ácido domoico (DOM), bicuculina (BIC), ketamina (KET), yohimbina (YOH) y haloperidol (HAL), así como antagonistas AMPA/kainato, GABAA, NMDA, ɑ2-adrenérgico y D2 dopaminérgicos, respectivamente. Se utilizaron las pruebas de campo abierto (OFT), elevación de laberinto (EPM) y natación forzada (FST) para estudiar la actividad motora, la ansiedad y el nivel de depresión. El TPM (100 y 120 mg/kg) redujo el aumento inducido por MPH e inhibió la promoción inducida por MPH en la alteración de la actividad motora, la ansiedad y la depresión. El tratamiento previo de animales con KET, HAL, YOH y BIC inhibió el TPM, mejora la ansiedad y la depresión a través de la interacción con los receptores dopaminérgicos, GABAA, NMDA y ɑ2-adrenérgico.


Assuntos
Animais , Masculino , Ratos , Comportamento Animal/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , /farmacologia , Transtornos Mentais/prevenção & controle , Metilfenidato/efeitos adversos , Ratos Wistar , Neurotransmissores/metabolismo , Transtornos Mentais/induzido quimicamente , Atividade Motora/efeitos dos fármacos
17.
Cad Saude Publica ; 35(6): e00097718, 2019 07 04.
Artigo em Português | MEDLINE | ID: mdl-31291423

RESUMO

The current study aimed to grasp the healthcare aspects present at the basis of the indiscriminate use of benzodiazepines. Based on a partnership between a Brazilian university and a Cuban university, the study aimed to understand the practices related to the use of these drugs in primary care and the meanings healthcare workers assign to them. The research was part of a multiple case study in the cities of São Paulo and Diadema (Brasil), and Santiago de Cuba (Cuba). The fieldwork data collection strategy was based on individual interviews and focus groups. Data were analyzed thematically and yielded five themes: (i) no man's land: lack of management of benzodiazepine use by primary care workers; (ii) inadequate indications: the benzodiazepine prescribed for unjustifiable situations; (iii) salvation and perdition: the medicine as attenuating the difficulty of acting in mental health by primary care professionals; (iv) limited empowerment to work in mental health; and (v) fragmented care: dissociation of the psychosocial care network. Limited grasp of mental health issues by primary care workers, fragmented care, work overload with what are considered other priorities, deficiencies in the availability of therapeutic resources, and limited investment in specific training contribute to the inadequate use of benzodiazepines. Independently of the health contexts, the challenges are similar for the health systems and can only be confronted if they become a priority for the organizations' management and the health workers as a whole.


Assuntos
Benzodiazepinas/administração & dosagem , Saúde Mental , Transtornos Relacionados ao Uso de Substâncias , Brasil , Cuba , Grupos Focais , Humanos , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/tratamento farmacológico , Serviços de Saúde Mental , Assistência Farmacêutica , Atenção Primária à Saúde , Pesquisa Qualitativa , Universidades
18.
Am J Health Syst Pharm ; 76(13): 953-963, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31361885

RESUMO

PURPOSE: This study presents a medication-associated altered mental status (AMS) risk model for real-time implementation in inpatient electronic health record (EHR) systems. METHODS: We utilized a retrospective cohort of patients admitted to 2 large hospitals between January 2012 and October 2013. The study population included admitted patients aged ≥18 years with exposure to an AMS risk-inducing medication within the first 5 hospitalization days. AMS events were identified by a measurable mental status change documented in the EHR in conjunction with the administration of an atypical antipsychotic or haloperidol. AMS risk factors and AMS risk-inducing medications were identified from the literature, drug information databases, and expert opinion. We used multivariate logistic regression with a full and backward eliminated set of risk factors to predict AMS. The final model was validated with 100 bootstrap samples. RESULTS: During 194,156 at-risk days for 66,875 admissions, 262 medication-associated AMS events occurred (an event rate of 0.13%). The strongest predictors included a history of AMS (odds ratio [OR], 9.55; 95% confidence interval [CI], 5.64-16.17), alcohol withdrawal (OR, 3.34; 95% CI, 2.18-5.13), history of delirium or psychosis (OR, 3.25; 95% CI, 2.39-4.40), presence in the intensive care unit (OR, 2.53; 95% CI, 1.89-3.39), and hypernatremia (OR, 2.40; 95% CI, 1.61-3.56). With a C statistic of 0.85, among patients scoring in the 90th percentile, our model captured 159 AMS events (60.7%). CONCLUSION: The risk model was demonstrated to have good predictive ability, with all risk factors operationalized from discrete EHR fields. The real-time identification of higher-risk patients would allow pharmacists to prioritize surveillance, thus allowing early management of precipitating factors.


Assuntos
Transtornos da Consciência/epidemiologia , Transtornos Mentais/epidemiologia , Adulto , Idoso , Comorbidade , Transtornos da Consciência/induzido quimicamente , Transtornos da Consciência/prevenção & controle , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Florida , Hospitalização , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/prevenção & controle , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco
19.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352378

RESUMO

A 45-year-old man, a regular cocaine user, presented with confusion and unusual behaviour to the emergency room. On examination he was unable to perform simple tasks or follow commands. He was treated for possible central nervous system infection. MRI of the brain showed multiple bilateral T2 hyperintense periventricular and deep white matter foci, best appreciated on FLAIR with contrast enhancement. He continued deteriorating, eventually becoming catatonic with extensor posturing and increased tone, requiring intensive therapy unit management. Repeat MRIs were also noted to show worsening changes. He was treated for a presumed inflammatory leucoencephalopathy with intravenous methylprednisolone, immunoglobulins, as well as plasmapheresis. After 2 weeks, the patient started to show clinical improvement with eventual transfer to a rehabilitation hospital. A year after his first presentation, the patient scored 30 out of 30 on the MMSE and his neurological examination was normal.


Assuntos
Cocaína/efeitos adversos , Confusão/induzido quimicamente , Leucoencefalopatias/fisiopatologia , Transtornos Mentais/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias/fisiopatologia , Substância Branca/patologia , Confusão/fisiopatologia , Eletroencefalografia , Humanos , Imunoglobulinas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Leucoencefalopatias/induzido quimicamente , Leucoencefalopatias/terapia , Imagem por Ressonância Magnética , Masculino , Transtornos Mentais/fisiopatologia , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Plasmaferese , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Transtornos Relacionados ao Uso de Substâncias/terapia , Resultado do Tratamento
20.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31285395

RESUMO

BACKGROUND AND OBJECTIVES: Adolescents represent the largest age group that presents to emergency departments (ED) for synthetic cannabinoid (SC) toxicity; however, the neurotoxic effects of acute SC exposures in this group are understudied. Our aim was to characterize the neuropsychiatric presentation of adolescents with SC-related exposure in the ED compared with those with traditional cannabis exposure. METHODS: A multicenter registry of clinical information prospectively collected by medical toxicologists (Toxicology Investigators Consortium Case Registry) was reviewed for adolescents presenting to the ED after SC or cannabis exposure from 2010 through 2018. Associations were measured between drug exposures and neuropsychiatric symptoms and/or signs. Exposures were classified into 4 groups: SC-only exposure, SC-polydrug exposures, cannabis-only exposure, and cannabis-polydrug exposures. RESULTS: Adolescents presenting to the ED with SC-only exposure (n = 107) had higher odds of coma and/or central nervous system depression (odds ratio [OR] 3.42; 95% confidence interval [CI] 1.51-7.75) and seizures (OR 3.89; 95% CI 1.39-10.94) than those with cannabis-only exposure (n = 86). SC-only drug exposure was associated with lower odds of agitation than cannabis-only exposure (OR 0.18; 95% CI 0.10-0.34). In contrast, the group with SC-polydrug exposures (n = 38) had higher odds of agitation (OR 3.11; 95% CI 1.56-7.44) and seizures (OR 4.8; 95% CI 1.80-12.74) than the cannabis-polydrug exposures group (n = 117). CONCLUSIONS: In this multisite cohort of US adolescents assessed in the ED, SC exposure was associated with higher odds of neuropsychiatric morbidity than cannabis exposure providing a distinct neurospychiatric profile of acute SC toxicity in adolescents.


Assuntos
Canabinoides/toxicidade , Serviço Hospitalar de Emergência/tendências , Abuso de Maconha/psicologia , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/psicologia , Adolescente , Feminino , Humanos , Masculino , Abuso de Maconha/diagnóstico , Abuso de Maconha/terapia , Transtornos Mentais/terapia , Sistema de Registros , Adulto Jovem
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