Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.842
Filtrar
1.
Environ Res ; 196: 110937, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33647295

RESUMO

BACKGROUND: Air pollution is associated with mental health in the general population, but its influence on maternal mental health during pregnancy has not been assessed. OBJECTIVE: We evaluated the relationship between unspecified mental disorders complicating pregnancy and depression with average air pollution exposure during 3-months preconception, first trimester and whole pregnancy. METHODS: Ambient air pollution was derived from a modified Community Multiscale Air Quality model and mental health diagnoses were based on electronic intrapartum medical records. Logistic regression models assessed the odds of unspecified mental disorder complicating pregnancy (n = 11,577) and depression (n = 9793) associated with an interquartile range increase in particulate matter (PM) less than 2.5 µm (PM2.5), PM10, carbon monoxide (CO), nitrogen dioxide (NO2), nitrogen oxide (NOx), sulfur dioxide (SO2), and ozone (O3). Pregnancies without mental health disorders were the reference group (n = 211,645). Models were adjusted for maternal characteristics and study site; analyses were repeated using cases with no additional mental health co-morbidity. RESULTS: Whole pregnancy exposure to PM10, PM2.5, NO2, and NOx was associated with a 29%-74% increased odds of unspecified mental disorders complicating pregnancy while CO was associated with 31% decreased odds. Results were similar for depression: whole pregnancy exposure to PM10, PM2.5, NO2, and NOx was associated with 11%-21% increased odds and CO and O3 were associated with 16%-20% decreased odds. SO2 results were inconsistent, with increased odds for unspecified mental disorders complicating pregnancy and decreased odds for depression. While most findings were similar or stronger among cases with no co-morbidity, PM2.5 and NOx were associated with reduced risk and SO2 with increased risk for depression only. DISCUSSION: Whole pregnancy exposure to PM10, PM2.5, NO2, and NOx were associated with unspecified mental disorder complicating pregnancy and depression, but some results varied for depression only. These risks merit further investigation.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Transtornos Mentais , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Feminino , Humanos , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/epidemiologia , Saúde Mental , Dióxido de Nitrogênio , Material Particulado/análise , Material Particulado/toxicidade , Gravidez
2.
Riv Psichiatr ; 56(1): 53-55, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33560276

RESUMO

Infection outbreak has been prevalent since previous decades. The impact of infection outbreak not merely limited to physical suffering but grounded for massive mental health issues. The fear of getting contagion and persistent exposure to diverse medication and vaccination contribute enormously to develop mental health issues among people. During previous infection treatment with diverse vaccination and antiviral agent, the common mental health issues found to be a mood disorder, delirium, schizophrenia, and psychotic symptoms. Cumbersomely, it is almost impossible to treat mental health issues during the pandemic with the help of only pharmacological availability. Hence psychological intervention is also important to ameliorate better consequences. The current study highlights the impact of CoViD-19 related diverse medication and vaccination on the mental health of the people.


Assuntos
Antivirais/efeitos adversos , Transtornos Mentais/induzido quimicamente , Saúde Mental , Pandemias , Monofosfato de Adenosina/efeitos adversos , Monofosfato de Adenosina/análogos & derivados , Alanina/efeitos adversos , Alanina/análogos & derivados , Amidas/efeitos adversos , /efeitos adversos , Combinação de Medicamentos , Medo , Humanos , Lopinavir/efeitos adversos , Transtornos Mentais/psicologia , Oseltamivir/efeitos adversos , Pirazinas/efeitos adversos , Ribavirina/efeitos adversos , Ritonavir/efeitos adversos
3.
An. psicol ; 36(3): 443-450, oct. 2020.
Artigo em Espanhol | IBECS | ID: ibc-195660

RESUMO

El propósito de este estudio es presentar el perfil psicopatológico y las diferencias entre hombres y mujeres que inician tratamiento residencial para las adicciones. La muestra se compuso de 142 pacientes (116 hombres y 26 mujeres), que cumplimentaron el EuropASI y MMCMI-III. Se analizan variables socio-demográficas, patrón de consumo y otras características, así como patrones, trastornos de personalidad y síndromes clínicos. El grupo de hombres presenta alta prevalencia en el patrón de personalidad antisocial (31%). Las mujeres, en el depresivo (23,1%), dependiente (26,9%) y antisocial (26,9%), solo en el dependiente las diferencias son estadísticamente significativas. En los síndromes clínicos los hombres presentan prevalencia en dependencia de sustancias (86,2%), trastorno de ansiedad (60,3%) y dependencia de alcohol (45,7%), las mujeres en el trastorno de ansiedad (76,9%), dependencia de alcohol (69,2%), sustancias (53,8%) y distímico (46,2%). Aparecen diferencias significativas estadísticamente en el trastorno ansioso, distímico y dependencia de alcohol, donde las mujeres se muestran más afectadas. En el síndrome clínico trastorno de pensamiento los hombres puntúan más alto y las mujeres más altas en depresión, en ambos casos las diferencias son estadísticamente significativas. Se comentan las implicaciones que estos resultados tienen en la evaluación y mejora de los tratamientos


The aim of this study is to present the psychopathological profile and the differences between men and women who start an addition residential treatment. The sample included 142 patients (116 were men and 26 women). We analysed socio-demographic variables, consumption pattern as well as personality disorders and clinical syndromes using EuropASI and MCMI-III as evaluating instruments. Men group showed a high prevalence at antisocial personality disorder (31%). On the other hand, women did so at depressive (23,1%), dependent (26,9%) and antisocial (26,9%) patterns, finding statistically significant differences only at the dependent disorder. At clinical syndromes men showed a relevant prevalence when analysing substances dependence (86,2%), anxiety disorder (60,3%) and alcohol dependence (45,7%), and women group at anxiety disorder (76,9%), alcohol dependence (69,2%), substances (53,8%) and dysthymic (46,2%). We found statistically significant differences at anxiety disorder, dystymic and alcohol dependence where women appeared to be more affected. At thought clinical syndrome men raised higher scores, and women did so at depression, being both differences statistically significant. The results are discussed and their clinical implications analysed


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Saúde Mental , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Usuários de Drogas/psicologia , Transtornos Mentais/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias/complicações , Escalas de Graduação Psiquiátrica , Estatísticas não Paramétricas , Distribuição por Sexo , Fatores Socioeconômicos , Fatores Sexuais , Espanha/epidemiologia
5.
J Toxicol Sci ; 45(7): 391-399, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32612007

RESUMO

This study was aimed at examining propofol- (a known anesthetic) induced emotion-related behavioral disorders in mice, and exploring the possible molecular mechanisms. A total of 60 mice were divided into two groups: control and propofol group. Mice were injected with propofol (150 mg/kg, ip) at 8:00 a.m. (once a day, lasting for 30 days). During the 30 days, loss of righting reflex (LORR) and return of righting reflex (RORR) of mice were recorded every day. At the 1st (T1) and 30th (T2) day of drug discontinuance (T2), 15 mice of each group were selected to perform the open field test; then the mice underwent perfusion fixation, and the midbrain and corpus striatum were separated for immunofluorescence assay with anti-tyrosine hydroxylase (Th) and anti- dopamine transporter (DAT) antibodies. Results showed that after propofol injection, LORR and RORR increased and decreased, respectively. Long-term use of propofol resulted in decreased activities of mice (activity trajectory, line crossing, rearing time, scratching times and defecating frequency). Immunofluorescence assay showed long-term use of propofol induced decrease of Th and DAT. Collectively, our present work suggested long-term abuse of propofol induces neuropsychiatric function impairments, and the possible mechanisms are related to dopamine dyssynthesis via down-regulating tyrosine hydroxylase and dopamine transporter.


Assuntos
Anestésicos/toxicidade , Comportamento Animal/efeitos dos fármacos , Corpo Estriado/metabolismo , Corpo Estriado/patologia , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Neurônios Dopaminérgicos/patologia , Transtornos Mentais/induzido quimicamente , Propofol/toxicidade , Transtornos Relacionados ao Uso de Substâncias/metabolismo , Transtornos Relacionados ao Uso de Substâncias/patologia , Tirosina 3-Mono-Oxigenase/metabolismo , Área Tegmentar Ventral/metabolismo , Área Tegmentar Ventral/patologia , Anestésicos/efeitos adversos , Animais , Neurônios Dopaminérgicos/metabolismo , Emoções/efeitos dos fármacos , Masculino , Transtornos Mentais/metabolismo , Transtornos Mentais/fisiopatologia , Transtornos Mentais/psicologia , Camundongos Endogâmicos C57BL , Propofol/efeitos adversos , Reflexo de Endireitamento/efeitos dos fármacos
6.
Eur J Endocrinol ; 183(3): C11-C13, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32508315

RESUMO

There can potentially be a number of clinical interactions that could adversely affect patient outcomes in a patient with a prolactinoma and psychiatric disease that might require antipsychotic and dopamine agonist treatment. Dopamine agonists stimulate the dopamine D2 receptor, resulting in a decrease in prolactin (PRL) levels and in prolactinoma size but action on dopamine receptors in the meso-limbic system may rarely cause psychosis and more commonly cause impulse control disorders. The psychiatric benefits of antipsychotic agents involve blocking the D2 and other dopamine receptors but this blockade often also causes hyperprolactinemia. In patients with macroprolactinomas and psychosis, observation, estrogen/progestin replacement, and surgery can be considered in addition to dopamine agonists. In those who require dopamine agonists for PRL and tumor size control, the introduction of antipsychotics may blunt this effect, so that higher doses of the dopamine agonists may be needed. Alternatively, antipsychotics that have less of a blocking effect at the D2 receptor, such as aripiprazole, can be tried, if appropriate. For patients already on antipsychotic drugs who are found to have a macroprolactinoma for which dopamine agonists are required, dopamine agonists can be initiated at low dose and the dose escalated slowly. However, such patients require careful monitoring of psychiatric status to avoid the rare complication of exacerbation of the underlying psychosis. Again, if appropriate, use of antipsychotics that have less of a blocking effect at the D2 receptor may allow lower doses of dopamine agonists to be used in this situation.


Assuntos
Antipsicóticos/efeitos adversos , Agonistas de Dopamina/efeitos adversos , Transtornos Mentais/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Antipsicóticos/administração & dosagem , Agonistas de Dopamina/administração & dosagem , Interações Medicamentosas , Humanos , Hiperprolactinemia/induzido quimicamente , Transtornos Mentais/induzido quimicamente , Prolactina/metabolismo , Prolactinoma/patologia , Receptores de Dopamina D2/efeitos dos fármacos
7.
Epilepsia ; 61(6): 1109-1119, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32511754

RESUMO

OBJECTIVE: To assess the effectiveness and tolerability of perampanel (PER) monotherapy in routine clinical practice for the treatment of focal onset and generalized tonic-clonic seizures (GTCS). METHODS: This multicenter, retrospective, observational study was conducted in patients aged ≥12 years treated with PER as primary monotherapy or converted to PER monotherapy by progressive reduction of background antiepileptic drugs. Outcomes included retention, responder, and seizure-free rate after 3, 6, and 12 months and tolerability throughout the follow-up. RESULTS: A total of 98 patients (mean age = 49.6 ± 21.7 years, 51% female) with focal seizures and/or GTCS were treated with PER monotherapy for a median exposure of 14 months (range = 1-57) with a median dose of 4 mg (range = 2-10). The retention rates at 3, 6, and 12 months and last follow-up were 93.8%, 89.3%, 80.9%, and 71.4%, respectively. The retention rates according to the type of monotherapy (primary vs conversion) did not differ (log-rank P value = .57). Among the 98 patients, 61.2% patients had seizures throughout the baseline period, with a median seizure frequency of 0.6 seizures per month (range = 0.3-26). Responder rates at 3, 6, and 12 months were 79.6%, 70.1%, and 52.8%, respectively, and seizure freedom rates at the same points were 62.7%, 56.1%, and 41.5%. Regarding the 33 patients who had GTCS in the baseline period, 87.8% were seizure-free at 3 months, 78.1% at 6 months, and 55.1% at 12 months. Over the entire follow-up, PER monotherapy was generally well tolerated, and only 16% of patients discontinued PER due to adverse events (AEs). Female patients were found to be at a higher risk of psychiatric AEs (female vs male odds ratio = 2.85, 95% confidence interval = 1-8.33, P = .046). SIGNIFICANCE: PER demonstrated good effectiveness and a good safety profile when used as primary therapy or conversion to monotherapy at relatively low doses, in a clinical setting with patients with focal seizures and GTCS.


Assuntos
Anticonvulsivantes/uso terapêutico , Piridonas/uso terapêutico , Sistema de Registros , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/efeitos adversos , Feminino , Humanos , Masculino , Transtornos Mentais/induzido quimicamente , Pessoa de Meia-Idade , Piridonas/efeitos adversos , Estudos Retrospectivos , Convulsões/epidemiologia , Resultado do Tratamento , Adulto Jovem
8.
Am J Nurs ; 120(7): 18, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590581
9.
Psychosomatics ; 61(5): 411-427, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32425246

RESUMO

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


Assuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Transtornos Mentais/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Psicotrópicos/uso terapêutico , Monofosfato de Adenosina/efeitos adversos , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Corticosteroides/efeitos adversos , Alanina/efeitos adversos , Alanina/análogos & derivados , Alanina/uso terapêutico , Amidas/efeitos adversos , Amidas/uso terapêutico , Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/efeitos adversos , Ácido Ascórbico/efeitos adversos , Ácido Ascórbico/uso terapêutico , Azitromicina/efeitos adversos , Azitromicina/uso terapêutico , Betacoronavirus , Cloroquina/efeitos adversos , Cloroquina/uso terapêutico , Colchicina/efeitos adversos , Colchicina/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/terapia , Combinação de Medicamentos , Interações Medicamentosas , Humanos , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Imunização Passiva , Interferons/efeitos adversos , Interferons/uso terapêutico , Lopinavir/efeitos adversos , Lopinavir/uso terapêutico , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/complicações , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo , Psicotrópicos/efeitos adversos , Psicotrópicos/metabolismo , Pirazinas/efeitos adversos , Pirazinas/uso terapêutico , Ritonavir/efeitos adversos , Ritonavir/uso terapêutico , Vitaminas/efeitos adversos , Vitaminas/uso terapêutico
10.
Encephale ; 46(3S): S14-S34, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32376004

RESUMO

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


Assuntos
Betacoronavirus , Infecções por Coronavirus , Transtornos Mentais/tratamento farmacológico , Pandemias , Pneumonia Viral , Psicotrópicos/uso terapêutico , Fatores Etários , Antivirais/efeitos adversos , Antivirais/uso terapêutico , Biotransformação , Doenças Cardiovasculares/induzido quimicamente , Comorbidade , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Citocromo P-450 CYP1A2/metabolismo , Interações Medicamentosas , Febre/induzido quimicamente , França/epidemiologia , Gastroenteropatias/induzido quimicamente , Humanos , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/epidemiologia , Preparações Farmacêuticas/provisão & distribução , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Psicotrópicos/administração & dosagem , Psicotrópicos/efeitos adversos , Psicotrópicos/farmacocinética , Transtornos Respiratórios/induzido quimicamente , Medição de Risco , Abandono do Hábito de Fumar , Avaliação de Sintomas
12.
J Opioid Manag ; 16(3): 223-226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32421844

RESUMO

BACKGROUND: In 2018, nearly 4,000 Canadian lives were claimed by the opioid epidemic. To date, only a few studies have reviewed shifts in emergency department (ED) utilization for opioid-related psychiatric presentations. AIMS: To describe the characteristics of patients seeking ED care for opioid-related psychiatric presentations and to identify demographic and clinical characteristics that were associated with psychiatric inpatient admission for such presentations. METHODS: Retrospective cohort study with multivariate logistic regression. FINDINGS: Over a 4-year period, 555 opioid-related presentations were recorded (50 percent female, mean age 40.0 years). Time trend analysis showed a nonsignificant increase in the number of visits by fiscal year. The most common reason for ED presentation relevant to opioids was opioid withdrawal (49 percent). Nearly 20 percent of all visits required psychiatric admission; predictors of psychiatric admission were arrival by ambulance (adjusted odds ratio (AOR) = 2.03), older age (AOR = 1.05), longer length of ED stay (AOR = 1.10), and more severe triage score (AOR = 0.4). Sex and referring service were not associated with disposition in the ED. Admissions were more likely for opioid intoxication and withdrawal. CONCLUSION: EDs are serving increasing numbers of patients in psychiatric crisis related to opioid-use. A decision support tool could be developed and validated in the future to provide reliable, clinically relevant information to providers and case managers relevant to opioid-related ED presentations.


Assuntos
Analgésicos Opioides , Serviços Médicos de Emergência , Transtornos Mentais , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Canadá/epidemiologia , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Humanos , Incidência , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
J Clin Psychiatry ; 81(3)2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32412703

RESUMO

OBJECTIVE: Reviews on child outcomes following in utero antidepressant exposure have focused on short-term outcomes. However, several recent individual studies reported on adverse physical, neurodevelopmental, and psychiatric outcomes beyond infancy and early childhood. The objective of this systematic review was to establish the long-term effects of prenatal antidepressant exposure on physical, neurodevelopmental, and psychiatric outcomes in individuals aged 4 years and older. DATA SOURCES: Embase, MEDLINE Ovid, Web of Science, Cochrane Central, and Google Scholar were systematically searched for all relevant articles, written in English and published prior to November 8, 2018, using terms describing antidepressants, pregnancy, and developmental outcomes. STUDY SELECTION: All original research articles on long-term outcomes of prenatal antidepressant exposure were eligible for inclusion. After screening and removal of duplicates, a total of 34 studies were identified. DATA EXTRACTION: Included articles were qualitatively analyzed to determine inconsistency, indirectness, imprecision, and study bias. RESULTS: The identified studies demonstrated statistically significant associations between prenatal antidepressant exposure and a range of physical, neurodevelopmental, and psychiatric outcomes. Yet, the risk of confounding by indication was high. When controlling for confounders, 5 studies investigating physical outcomes (asthma, cancer, body mass index [BMI], epilepsy) found no association except conflicting outcomes for BMI. Eighteen studies examining neurodevelopmental outcomes (cognition, behavior, IQ, motor development, speech, language, and scholastic outcomes) found no consistent associations with antidepressant exposure after taking confounders into account. Eleven studies investigated psychiatric outcomes. After adjusting for confounders, prenatal antidepressant exposure was associated with affective disorders but not with childhood psychiatric outcomes (eg, autism spectrum disorders, attention-deficit/hyperactivity disorder). CONCLUSIONS: Reported associations between in utero exposure to antidepressants and physical, neurodevelopmental, and psychiatric outcomes, in large part, seem to be driven by the underlying maternal disorder. When limiting confounding by indication, prenatal exposure to antidepressants was significantly associated only with offspring BMI and affective disorders.


Assuntos
Antidepressivos/efeitos adversos , Desenvolvimento Infantil/efeitos dos fármacos , Transtornos Mentais/induzido quimicamente , Transtornos do Neurodesenvolvimento/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Criança , Pré-Escolar , Feminino , Humanos , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/psicologia
14.
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
15.
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
16.
Sci Rep ; 10(1): 4075, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32139811

RESUMO

Ayahuasca is a hallucinogenic decoction used as a traditional medicine in several Amazonian regions. The ritualistic use of ayahuasca has spread throughout many countries, making it necessary to study its risks and benefits. Two sub-studies were designed for this investigation. In sub-study 1, a psychiatric interview and a battery of questionnaires were administered to subjects (n = 40) before their first ayahuasca use. Two follow-ups were conducted at 1 and 6 months. In sub-study 2, the same interview and battery of questionnaires were administered to long-term ayahuasca users (n = 23) and their scores were compared with those of the ayahuasca-naïve group. In the first assessment, nearly half (45%) of the naïve users were found to meet the diagnostic criteria for a psychiatric disorder. After the ayahuasca use, more than 80% of those subjects showed clinical improvements that persisted at 6 months. The questionnaires showed significant reductions in depression and psychopathology. Regarding sub-study 2, long-term users showed lower depression scores, and higher scores for self-transcendence and quality of life, as compared to their peers in sub-study 1. Further controlled and observational naturalistic studies assessing the eventual risks and potential benefits of ayahuasca are warranted.


Assuntos
Banisteriopsis/química , Alucinógenos/efeitos adversos , Transtornos Mentais/induzido quimicamente , Saúde Mental , Personalidade/efeitos dos fármacos , Qualidade de Vida , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Entrevista Psicológica , Estudos Longitudinais , Masculino , Transtornos Mentais/patologia , Pessoa de Meia-Idade , Psicopatologia , Inquéritos e Questionários , Adulto Jovem
17.
Arch Dis Child ; 105(8): 749-755, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32060030

RESUMO

OBJECTIVE: Due to lack of information on drug use in children, many drugs are used off-label in paediatrics. Increased knowledge of adverse drug reactions (ADRs) would enable a better risk-benefit analysis. Our aim was to characterise drugs causing psychiatric ADRs in children by conducting a descriptive study based on pharmacovigilance reports. DESIGN: Reports submitted to the Netherlands Pharmacovigilance Centre Lareb from 2003 to 2016 were used to investigate drugs causing psychiatric ADRs in the Dutch paediatric population. These data were corrected for drug utilisation in order to correct the number of reports for the number of users of a drug. MAIN OUTCOME MEASURES: ORs were calculated as a measure of disproportionality for drug-ADR associations for three different age groups. Significant drug-ADR associations were checked if it was labelled in the product information. RESULTS: Lareb received 918 reports of psychiatric ADRs, which constitute 15% of the reports of ADRs in children. Drugs used for the treatment of ADHD (methylphenidate and atomoxetine) and drugs used for the treatment of asthma (montelukast and fluticasone) were the most frequently reported. However, psychiatric ADRs were also reported for less often prescribed medications such as oxybutynin and isotretinoin. CONCLUSIONS: Real-world data on psychiatric ADRs in the Dutch paediatric population show a consistent pattern with what is known from drug labels and the literature. Reports of psychiatric ADRs should be taken seriously because of the impact on medication adherence and the well-being of the child and its family.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Transtornos Mentais/induzido quimicamente , Adolescente , Sistemas de Notificação de Reações Adversas a Medicamentos , Criança , Pré-Escolar , Bases de Dados Factuais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Lactente , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Países Baixos/epidemiologia , Razão de Chances , Farmacovigilância
18.
Epilepsy Behav ; 104(Pt A): 106856, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31954268

RESUMO

OBJECTIVE: This study aimed to explore the quality of life (QoL) of adult patients with epilepsy (PwE) in Australia and its relationship with comorbidities and adverse events (AEs) from antiepileptic drugs (AEDs). METHODS: Cross-sectional surveys were completed by PwE, or carer proxies, recruited via the online pharmacy application MedAdvisor and Australian PwE Facebook groups from May to August 2018. Data were collected on demographics, epilepsy severity and management, AEs, comorbidities, and QoL (using the Patient-Weighted Quality of Life in Epilepsy Inventory [QOLIE-10-P] total score). Two linear regression models were constructed to explore associations between AEs or comorbidities and QOLIE-10-P score, with possible confounders determined using stepwise selection. RESULTS: Nine hundred and seventy-eight of 1267 responses were eligible (mean age of respondents: 44.5 years, 64% female, 52% employed). Recent AED use was reported by 97%; 47% were on AED monotherapy, 35% had ≤2 lifetime AEDs, and 55% were seizure-free for >1 year. After stepwise selection, control variables included in both models were time since diagnosis, employment status, seizure frequency, number of currently prescribed AEDs, and number of general practitioner (GP) visits per year. In the model for comorbidities, "psychiatric disorders" was associated with the largest QOLIE-10-P score decrease (-23.14, p < 0.001). In the model for AEs, which additionally controlled for depression and anxiety disorder, self-reported "memory problems" was associated with the largest decrease in QOLIE-10-P score (-14.27, p < 0.001). CONCLUSIONS: In this survey of Australian PwE, many of whom had relatively well-controlled epilepsy, psychiatric and self-reported memory problems were common and associated with the greatest detrimental impact on QoL. Further research is needed to better understand the underlying causes of impaired QoL and thereby improve its management.


Assuntos
Anticonvulsivantes/efeitos adversos , Epilepsia/epidemiologia , Epilepsia/psicologia , Qualidade de Vida/psicologia , Inquéritos e Questionários , Adulto , Anticonvulsivantes/uso terapêutico , Austrália/epidemiologia , Cuidadores/psicologia , Comorbidade , Estudos Transversais , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , Transtornos da Memória/induzido quimicamente , Transtornos Mentais/induzido quimicamente , Pessoa de Meia-Idade , Autorrelato
19.
Int J Occup Med Environ Health ; 33(2): 125-136, 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-31942874

RESUMO

OBJECTIVES: This study analyzed the prevalence of new psychoactive substance (NPS) use in the analyzed group and compared demographic features and psychoactive substance profiles between the 2 subgroups (NPS users, non-NPS users). The secondary measure was used to determine the prevalence of psychiatric comorbidities in study group and to compare demographic features and psychoactive substance profiles between 2 subgroups (the F11-19 only diagnosed group and the F11-19 group with psychiatric comorbidities according to ICD-10). MATERIAL AND METHODS: A 12-month retrospective cross-sectional analysis of medical records compiled for adult psychiatric patients who had been admitted to the Regional Psychiatric Hospital in Olsztyn, Poland, in October 1, 2016 - September 30, 2017 was conducted. After analyzing the available medical records, 157 cases were included and analyzed. Data for the study were collected in a specially designed monitoring card from discharge reports, including data from psychiatric examinations, especially anamnesis. RESULTS: The most commonly declared psychoactive substances were amphetamine (AMF) - 54% and cannabinoids - 46%. The prevalence of NPS use in the study group was 34%. Inpatients taking NPS, as compared with non-NPS users, were younger and more often admitted to hospital through the Emergency Department. It was also found that NPS users more often took AMF or cannabinoids, and less frequently benzodiazepines (BDZ) or opioids. However, the taking of AMF, cannabinoids and BDZ was also age-dependent. CONCLUSIONS: The prevalence of psychiatric comorbidities in the study group was 9%. Inpatients with psychiatric comorbidities were older and took BDZ significantly more often than AMF. In addition, NPS use affects different groups, including a specific group as the analyzed sample, which shows a similar NPS use profile as different groups described in the literature. Int J Occup Med Environ Health. 2020;33(2):125-36.


Assuntos
Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Transtornos Mentais/induzido quimicamente , Psicotrópicos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Comorbidade , Estudos Transversais , Usuários de Drogas/psicologia , Usuários de Drogas/estatística & dados numéricos , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Transtornos Mentais/epidemiologia , Polônia/epidemiologia , Prevalência , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
20.
Epilepsy Behav ; 103(Pt A): 106861, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31917143

RESUMO

OBJECTIVE: Among people with epilepsy, levetiracetam (LEV) can cause neuropsychiatric adverse events (NPAEs) that impact negatively on quality of life. It has been suggested that pyridoxine can ameliorate LEV-related NPAEs. We conducted a systematic review of studies on the use of pyridoxine supplementation to relieve NPAEs associated with LEV therapy. METHODS: The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE, Scholar, Cochrane-CENTRAL (2000-2019), and EThOS platform were searched for studies on the use of pyridoxine in patients with LEV-related NPAEs. Proportions of patients reported to benefit from pyridoxine supplementation were tabulated, and a random-effect model meta-analysis was conducted. RESULTS: Eleven retrospective studies/case reports and one randomized prospective study, mostly including pediatric populations, were identified. Retrospective studies, which were rated as low quality due to failure to control for bias, reported an overall improvement of NPAEs after pyridoxine supplementation in 72.5% (108/149) of patients. The proportion of patients showing improvement in a pooled analysis of the four largest retrospective studies (n = 134) was 72.1% (95% confidence interval (CI) 47.1-88.3), although there was high heterogeneity across studies (I2 = 82%, pheterogeneity < 0.01). In the only prospective trial, patients randomized to pyridoxine supplementation were more likely to show relief from NPAEs than patients not receiving supplementation (p < 0.01), but outcomes might have been affected by assessment bias. CONCLUSION: This systematic review suggests that pyridoxine might be of benefit in relieving LEV-related NPAEs. However, the quality of the evidence is poor, and better-designed prospective studies that include quantitative as well as qualitative data are needed to define the role of pyridoxine in the management of LEV-related NPAEs.


Assuntos
Anticonvulsivantes/efeitos adversos , Levetiracetam/efeitos adversos , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/tratamento farmacológico , Piridoxina/administração & dosagem , Complexo Vitamínico B/administração & dosagem , Testes Diagnósticos de Rotina , Suplementos Nutricionais , Quimioterapia Combinada , Epilepsia/tratamento farmacológico , Epilepsia/psicologia , Humanos , Transtornos Mentais/psicologia , Estudos Prospectivos , Qualidade de Vida/psicologia , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...