Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.379
Filtrar
1.
Rev Prat ; 70(5): 502-506, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-33058634

RESUMO

Review of the prescription of antipsychotics in children. In France, as in the rest of the world, prescribing of antipsychotic drugs increases in children and adolescentsIndeed, antipsychotics are frequently prescribed in children and adolescents for both psychotic and non-psychotic disorders, with 36 to 93%o fprescriptionsbeingoff-label in this population. In addition, a high number of adverse events have been reported in the literature under antipsychotic treatment. The consequences of these adverse events are still poorly documented. In France, a 12-months national prospective study (ETAPE) observed a high incidence rate, severity and persistence of adverse events during first-time antipsychotic treatment in pediatric patients. Therefore, a careful and continuous clinical and biological monitoring all over the treatment period is required to adapt treatment decisions based on benefice-risk-analysis.


Assuntos
Antipsicóticos , Transtornos Mentais , Adolescente , Antipsicóticos/efeitos adversos , Criança , França/epidemiologia , Humanos , Transtornos Mentais/tratamento farmacológico , Prescrições , Estudos Prospectivos
2.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32958610

RESUMO

BACKGROUND: Gender-incongruent (GI) youth have high rates of mental health problems. Although gender-affirming medical care (GAMC) provides psychological benefit, some GI youth present to care at older ages. Whether a relationship exists between age of presentation to GAMC and mental health difficulties warrants study. METHODS: A cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY) (<15 years of age at presentation) or older presenting youth (OPY) (≥15 years of age). Self-reported rates of mental health problems and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health problems. Covariates included pubertal stage at presentation, social transition status, and assigned sex. RESULTS: Of 300 youth, there were 116 YPY and 184 OPY. After presentation, more OPY than YPY reported a diagnosis of depression (46% vs 30%), had self-harmed (40% vs 28%), had considered suicide (52% vs 40%), had attempted suicide (17% vs 9%), and required psychoactive medications (36% vs 23%), with all P < .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (odds ratio 5.49; 95% confidence interval [CI]: 1.14-26.32) and anxiety disorders (odds ratio 4.18 [95% CI: 1.22-14.49]), whereas older age remained associated only with psychoactive medication use (odd ratio 1.31 [95% CI: 1.05-1.63]). CONCLUSIONS: Late pubertal stage and older age are associated with worse mental health among GI youth presenting to GAMC, suggesting that this group may be particularly vulnerable and in need of appropriate care.


Assuntos
Fatores Etários , Disforia de Gênero/psicologia , Disforia de Gênero/terapia , Transtornos Mentais/epidemiologia , Transexualidade/psicologia , Transexualidade/terapia , Adolescente , Antipsicóticos/uso terapêutico , Transtornos de Ansiedade/epidemiologia , Criança , Estudos Transversais , Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Revelação , Humanos , Modelos Logísticos , Transtornos Mentais/tratamento farmacológico , Saúde Mental , Puberdade , Comportamento Autodestrutivo/epidemiologia , Fatores Sexuais , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos
3.
Yakugaku Zasshi ; 140(8): 1025-1033, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32741860

RESUMO

Additional fees for ward pharmacists' services have been valued for hospitals in Japan. However, the calculation period for services provided to inpatients in the psychiatric ward is limited to 8 weeks. This study aimed to reveal the need for the services of pharmacists in the hospital ward for inpatients hospitalized for >8 weeks in the psychiatric ward. Patients who were hospitalized in the psychiatric ward from September 2016 to February 2017 were analyzed retrospectively. The pharmacists suggested prescriptions for inpatients admitted for >8 weeks, similar to those admitted for <9 weeks, and this supported pharmacotherapy without exacerbating patient outcomes. Moreover, significant decreases in benzodiazepine doses were found between the prior and post prescription suggestions of the pharmacist for inpatients >8 weeks of admission. Healthcare expenditures were also reduced. These results suggest that the prescriptions suggested by pharmacists for inpatients admitted for >8 weeks in the psychiatric ward were useful. In conclusion, our findings show that ward pharmacists' services were necessary not only for the inpatients hospitalized for <9 weeks, but also for those hospitalized for >8 weeks.


Assuntos
Pacientes Internados , Transtornos Mentais/tratamento farmacológico , Farmacêuticos , Serviço de Farmácia Hospitalar , Prescrições , Sugestão , Benzodiazepinas/administração & dosagem , Benzodiazepinas/economia , Custos de Cuidados de Saúde , Japão , Transtornos Mentais/economia , Prescrições/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo
4.
Psiquiatr. biol. (Internet) ; 27(2): 43-46, mayo-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193245

RESUMO

Se trata de un estudio donde se ha seleccionado una muestra de 84 pacientes en seguimiento en unidades de salud mental comunitaria con diagnóstico de trastorno mental y en tratamiento con palmitato de paliperidona (PPM). El objetivo ha sido investigar si, tras la administración de PPM, se experimentan reducciones en los ingresos hospitalarios, media de estancia y necesidad de atención urgente durante el periodo de un año. El método utilizado para analizar los diferentes grupos (muestra general, muestra con esquizofrenia, muestra con esquizofrenia o trastorno esquizoafectivo) ha sido de imagen en espejo. Se ha realizado un análisis bivariante comprobando la existencia de diferencias estadísticamente significativas (Prob > chi2) entre los resultados anteriores y posteriores al tratamiento con PPM, observándose una disminución de los ingresos hospitalarios, reduciendo los días de hospitalización y la asistencia a urgencias generales


This observational study included a sample of 84 patients selected for follow-up in community mental health units, with a diagnosis of mental disorder and on treatment with paliperidone palmitate (PPM). The objective was to determine whether there were any reductions in hospital admissions, days of hospital stay, and emergency care after administering PPM, during a one year follow-up. A mirror-image method was used to analyse the different groups (general sample, sample with schizophrenia, sample with schizophrenia, or schizoaffective disorder). A bivariate analysis was carried out, with statistically significant differences (Prob > chi2) being found between the results before and after the treatment with PPM, with a reduction in hospital admissions, days of hospital stay, and urgent care


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Palmitato de Paliperidona/administração & dosagem , Transtornos Mentais/tratamento farmacológico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Estudos Prospectivos , Seguimentos
5.
Psiquiatr. biol. (Internet) ; 27(2): 61-67, mayo-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193248

RESUMO

A lo largo de todas las etapas evolutivas, las personas con discapacidad intelectual pueden presentar trastornos psiquiátricos comórbidos, que a menudo son secundarios a sus déficits intelectivos y a las dificultades en sus capacidades adaptativas a los diferentes entornos que forman parte de sus vidas. Estas comorbilidades psiquiátricas cursan en ocasiones con alteraciones de conducta de difícil manejo, tanto con psicoterapia como con tratamientos farmacológicos. La medicación puede ser esencial para el control de alteraciones de conducta y otros síntomas asociados. Actualmente carecemos de guías clínicas específicas, de recomendaciones farmacológicas con la suficiente evidencia científica y de medicamentos con indicaciones expresas para abordar estos síntomas en pacientes con discapacidad intelectual. Este artículo de revisión tiene como objetivo resumir un conjunto de recomendaciones relacionadas con el uso de psicofármacos en este grupo poblacional


Throughout all evolutionary stages, people with intellectual disabilities (ID) may present with comorbid psychiatric disorders, which are often secondary to their intellectual deficits, and to the difficulties they face in their ability to adapt to the different environments that are part of their lives. These psychiatric comorbidities sometimes result in behavioral problems that are difficult to handle, both with psychotherapy and with pharmacological treatments. Medication can be essential for the control of behavioral disorders, and other associated symptoms. We currently lack specific clinical guidelines, pharmacological recommendations based on sufficient scientific evidence, and drugs with express indications for these symptoms in patients with ID. This review article aims to summarize a set of recommendations related to the use of psychiatric drugs in this population group


Assuntos
Humanos , Transtornos Mentais/complicações , Transtornos Mentais/tratamento farmacológico , Deficiência Intelectual/complicações , Transtorno da Conduta/complicações , Psicotrópicos/administração & dosagem , Comorbidade
6.
PLoS Med ; 17(8): e1003262, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32813696

RESUMO

BACKGROUND: Complex traumatic events associated with armed conflict, forcible displacement, childhood sexual abuse, and domestic violence are increasingly prevalent. People exposed to complex traumatic events are at risk of not only posttraumatic stress disorder (PTSD) but also other mental health comorbidities. Whereas evidence-based psychological and pharmacological treatments are effective for single-event PTSD, it is not known if people who have experienced complex traumatic events can benefit and tolerate these commonly available treatments. Furthermore, it is not known which components of psychological interventions are most effective for managing PTSD in this population. We performed a systematic review and component network meta-analysis to assess the effectiveness of psychological and pharmacological interventions for managing mental health problems in people exposed to complex traumatic events. METHODS AND FINDINGS: We searched CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, International Pharmaceutical Abstracts, MEDLINE, Published International Literature on Traumatic Stress, PsycINFO, and Science Citation Index for randomised controlled trials (RCTs) and non-RCTs of psychological and pharmacological treatments for PTSD symptoms in people exposed to complex traumatic events, published up to 25 October 2019. We adopted a nondiagnostic approach and included studies of adults who have experienced complex trauma. Complex-trauma subgroups included veterans; childhood sexual abuse; war-affected; refugees; and domestic violence. The primary outcome was reduction in PTSD symptoms. Secondary outcomes were depressive and anxiety symptoms, quality of life, sleep quality, and positive and negative affect. We included 116 studies, of which 50 were conducted in hospital settings, 24 were delivered in community settings, seven were delivered in military clinics for veterans or active military personnel, five were conducted in refugee camps, four used remote delivery via web-based or telephone platforms, four were conducted in specialist trauma clinics, two were delivered in home settings, and two were delivered in primary care clinics; clinical setting was not reported in 17 studies. Ninety-four RCTs, for a total of 6,158 participants, were included in meta-analyses across the primary and secondary outcomes; 18 RCTs for a total of 933 participants were included in the component network meta-analysis. The mean age of participants in the included RCTs was 42.6 ± 9.3 years, and 42% were male. Nine non-RCTs were included. The mean age of participants in the non-RCTs was 40.6 ± 9.4 years, and 47% were male. The average length of follow-up across all included studies at posttreatment for the primary outcome was 11.5 weeks. The pairwise meta-analysis showed that psychological interventions reduce PTSD symptoms more than inactive control (k = 46; n = 3,389; standardised mean difference [SMD] = -0.82, 95% confidence interval [CI] -1.02 to -0.63) and active control (k-9; n = 662; SMD = -0.35, 95% CI -0.56 to -0.14) at posttreatment and also compared with inactive control at 6-month follow-up (k = 10; n = 738; SMD = -0.45, 95% CI -0.82 to -0.08). Psychological interventions reduced depressive symptoms (k = 31; n = 2,075; SMD = -0.87, 95% CI -1.11 to -0.63; I2 = 82.7%, p = 0.000) and anxiety (k = 15; n = 1,395; SMD = -1.03, 95% CI -1.44 to -0.61; p = 0.000) at posttreatment compared with inactive control. Sleep quality was significantly improved at posttreatment by psychological interventions compared with inactive control (k = 3; n = 111; SMD = -1.00, 95% CI -1.49 to -0.51; p = 0.245). There were no significant differences between psychological interventions and inactive control group at posttreatment for quality of life (k = 6; n = 401; SMD = 0.33, 95% CI -0.01 to 0.66; p = 0.021). Antipsychotic medicine (k = 5; n = 364; SMD = -0.45; -0.85 to -0.05; p = 0.085) and prazosin (k = 3; n = 110; SMD = -0.52; -1.03 to -0.02; p = 0.182) were effective in reducing PTSD symptoms. Phase-based psychological interventions that included skills-based strategies along with trauma-focused strategies were the most promising interventions for emotional dysregulation and interpersonal problems. Compared with pharmacological interventions, we observed that psychological interventions were associated with greater reductions in PTSD and depression symptoms and improved sleep quality. Sensitivity analysis showed that psychological interventions were acceptable with lower dropout, even in studies rated at low risk of attrition bias. Trauma-focused psychological interventions were superior to non-trauma-focused interventions across trauma subgroups for PTSD symptoms, but effects among veterans and war-affected populations were significantly reduced. The network meta-analysis showed that multicomponent interventions that included cognitive restructuring and imaginal exposure were the most effective for reducing PTSD symptoms (k = 17; n = 1,077; mean difference = -37.95, 95% CI -60.84 to -15.16). Our use of a non-diagnostic inclusion strategy may have overlooked certain complex-trauma populations with severe and enduring mental health comorbidities. Additionally, the relative contribution of skills-based intervention components was not feasibly evaluated in the network meta-analysis. CONCLUSIONS: In this systematic review and meta-analysis, we observed that trauma-focused psychological interventions are effective for managing mental health problems and comorbidities in people exposed to complex trauma. Multicomponent interventions, which can include phase-based approaches, were the most effective treatment package for managing PTSD in complex trauma. Establishing optimal ways to deliver multicomponent psychological interventions for people exposed to complex traumatic events is a research and clinical priority.


Assuntos
Saúde Mental , Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/psicologia , Antipsicóticos/uso terapêutico , Terapia Cognitivo-Comportamental/métodos , Comorbidade , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Transtornos de Estresse Pós-Traumáticos/epidemiologia
7.
BMC Med ; 18(1): 215, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32664944

RESUMO

BACKGROUND: The novel coronavirus pandemic calls for a rapid adaptation of conventional medical practices to meet the evolving needs of such vulnerable patients. People with coronavirus disease (COVID-19) may frequently require treatment with psychotropic medications, but are at the same time at higher risk for safety issues because of the complex underlying medical condition and the potential interaction with medical treatments. METHODS: In order to produce evidence-based practical recommendations on the optimal management of psychotropic medications in people with COVID-19, an international, multi-disciplinary working group was established. The methodology of the WHO Rapid Advice Guidelines in the context of a public health emergency and the principles of the AGREE statement were followed. Available evidence informing on the risk of respiratory, cardiovascular, infective, hemostatic, and consciousness alterations related to the use of psychotropic medications, and drug-drug interactions between psychotropic and medical treatments used in people with COVID-19, was reviewed and discussed by the working group. RESULTS: All classes of psychotropic medications showed potentially relevant safety risks for people with COVID-19. A set of practical recommendations was drawn in order to inform frontline clinicians on the assessment of the anticipated risk of psychotropic-related unfavorable events, and the possible actions to take in order to effectively manage this risk, such as when it is appropriate to avoid, withdraw, switch, or adjust the dose of the medication. CONCLUSIONS: The present evidence-based recommendations will improve the quality of psychiatric care in people with COVID-19, allowing an appropriate management of the medical condition without worsening the psychiatric condition and vice versa.


Assuntos
Infecções por Coronavirus/complicações , Interações Medicamentosas , Transtornos Mentais/tratamento farmacológico , Pneumonia Viral/complicações , Psicotrópicos/efeitos adversos , Betacoronavirus , Medicina Baseada em Evidências , Humanos , Transtornos Mentais/epidemiologia , Pandemias , Psicotrópicos/uso terapêutico , Saúde Pública , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Revisões Sistemáticas como Assunto
8.
Zhongguo Zhong Yao Za Zhi ; 45(11): 2473-2480, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-32627477

RESUMO

Depression is a kind of mental disease with main symptoms of low mood and lack of pleasure, which seriously endangers human health. An appropriate depressive animal model is of great significance for the study of depression and new antidepressant drugs, while the suitable selection and matching of experimental animals, modeling methods and evaluation indexes are critical to eva-luate the scientificity and effectiveness of the depressive animal model. The study advance of depressive animal models in the aspects of experimental animal selection, modeling principle and method, characteristics, evaluation indexes and their application in traditional Chinese medicine are summarized through the systematic review of relevant literatures in PubMed, CNKI and other databases. The depressive animal modeling methods utilized in recent studies include stress, glucocorticoid induction, reserpine induction, lipopolysaccharide induction, surgical modeling, gene knockout, joint application modeling methods. Stress method is better to simulate the depressive symptoms of clinical patients, whereas there are some deficiencies, such as long modeling time and large cost. The depressive animal models induced by glucocorticoid, reserpine and lipopolysaccharide have the advantages of short modeling time and good controllability, but with a poor reliability. The pathogenesis of surgical modeling is highly matched with that of clinical depressive patients, whereas it has the defect of long postoperative recovery period. Gene knockout models can be used to study the precise role of specific genes in depression. However, its applicability may be restricted in studies on depression. The joint application modeling method can improve its reliability and accuracy, and attracts more and more attention. This paper provides a reference for the selection of animal models in future studies of pathological mechanism of depression, and screening and evaluation of antidepressant drugs.


Assuntos
Medicina Tradicional Chinesa , Transtornos Mentais/tratamento farmacológico , Animais , Antidepressivos/uso terapêutico , Depressão , Modelos Animais de Doenças , Humanos , Reprodutibilidade dos Testes
9.
Arch Biochem Biophys ; 690: 108505, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32679195

RESUMO

Obesity has major adverse consequences on human health contributing to the development of, among others, insulin resistance and type 2 diabetes, cardiovascular disease, non-alcoholic fatty liver disease, altered behavior and cognition, and cancer. Changes in dietary habits and lifestyle could contribute to mitigate the development and/or progression of these pathologies. This review will discuss current evidence on the beneficial actions of the flavan-3-ol (-)-epicatechin (EC) on obesity-associated comorbidities. These benefits can be in part explained through EC's capacity to mitigate several common events underlying the development of these pathologies, including: i) high circulating levels of glucose, lipids and endotoxins; ii) chronic systemic inflammation; iii) tissue endoplasmic reticulum and oxidative stress; iv) insulin resistance; v) mitochondria dysfunction and vi) dysbiosis. The currently known underlying mechanisms and cellular targets of EC's beneficial effects are discussed. While, there is limited evidence from human studies supplementing with pure EC, other studies involving cocoa supplementation in humans, pure EC in rodents and in vitro studies, support a potential beneficial action of EC on obesity-associated comorbidities. This evidence also stresses the need of further research in the field, which would contribute to the development of human dietary strategies to mitigate the adverse consequences of obesity.


Assuntos
Catequina/farmacologia , Obesidade/tratamento farmacológico , Animais , Glicemia/efeitos dos fármacos , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/tratamento farmacológico , Comorbidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Disbiose/metabolismo , Dislipidemias/metabolismo , Retículo Endoplasmático/metabolismo , Endotoxinas/metabolismo , Flavonoides/farmacologia , Humanos , Inflamação/metabolismo , Resistência à Insulina , Metabolismo dos Lipídeos , Transtornos Mentais/complicações , Transtornos Mentais/tratamento farmacológico , Mitocôndrias/metabolismo , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Estresse Oxidativo
10.
PLoS One ; 15(7): e0236393, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706806

RESUMO

BACKGROUND: Burden of disease caused by depression and its association with socioeconomic status is well documented. However, research on over-indebtedness is scarce although millions of European citizens in all socioeconomic positions are over-indebted. Prior studies suggested that over-indebtedness is associated with poor physical and mental health. AIMS: Investigate the association between over-indebtedness and antidepressant use in Germany. METHOD: A cross-sectional survey among debt advice agencies' clients was conducted in North Rhine-Westphalia, Germany, in 2017 (OID). Data were merged with the first wave of the German Health Interview and Examination Survey for Adults (DEGS1). Descriptive statistics and logistic regression analysis were used to examine antidepressant use in the previous 7 days (OID: n = 699; DEGS1: n = 7115). RESULTS: Prevalence of antidepressant use was higher in the over-indebted (12.3%) than the general population (5.0%). The over-indebted were significantly more likely to use antidepressants than the general population even after controlling for other socioeconomic, demographic and health factors (adjusted odds ratio 1.83; 95% confidence interval 1.35-2.48). CONCLUSIONS: Stakeholders in health care, debt counselling, research and social policy should consider the link between over-indebtedness and mental illness to advance the understanding of health inequalities and to help those who have mental health and debt problems.


Assuntos
Antidepressivos/uso terapêutico , Transtornos Mentais , Saúde Mental , Classe Social , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Alemanha/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
11.
Am J Cardiol ; 128: 1-6, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650900

RESUMO

In this nation-wide cohort study we report the first long-term results of the association between having a atrial septal defects (ASD) on psychiatric disorders and use of psychotropic agents. Through population-based registries we included Danish individuals born before 1994 who received an ASD diagnosis between 1959and 2013. We used Cox proportional hazards regression and Fine and Grey competing risk regression to estimate the risk of receiving a psychiatric diagnosis and use of psychotropic medicine compared with a gender and age matched background population cohort. In 2,277 patients with a median follow-up from ASD diagnosis of 23.4 years (range 0.2 to 59.3 years) we found ASD patients to have a higher risk of psychiatric disorders (adjusted hazard ratio [HR]: 3.9; 95% confidence interval [CI] 3.4 to 4.5) compared with the comparison cohort and a cumulative incidence of using psychotropic agents 30 years after the ASD diagnosis of 47.4% (95% CI: 40.3 to 55.1) in the ASD patients and 25.5%, (95% CI: 23.5 to 27.8) in the comparison cohort. Diagnosis of the ASD before the age of 15 years (adjusted HR: 3.4; 95% confidence interval: 2.0 to 4.0) and surgical correction of the defect (HR: 1.5 (95% CI: 1.2 to 1.8), p <0.0001) had a higher risk than those with an ASD diagnosis after the age of 15 years and those with transcatheter closure of the defect. In conclusion, ASD patients had increased long-term risk of psychiatric disorder and use of psychotropic agents compared with a gender and age matched general population controls.


Assuntos
Comunicação Interatrial/epidemiologia , Transtornos Mentais/epidemiologia , Psicotrópicos/uso terapêutico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Criança , Pré-Escolar , Dinamarca/epidemiologia , Feminino , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/cirurgia , Humanos , Incidência , Lactente , Masculino , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Risco , Adulto Jovem
12.
Cien Saude Colet ; 25(suppl 1): 2457-2460, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-595544

RESUMO

Mental disorders (MD) are commonly comorbid with cardiovascular, metabolic, and some infectious diseases. Since the current SARS-CoV-2 epidemic is affecting the most multimorbid individuals, we might expect that the epidemic will be particularly problematic for people with MD. Understanding the burden of an outbreak on mental health is fundamental to effective action towards containing the spread of the disease, as psychopathology might reduce endurance during the lockdown. This can potentially reduce adhesion to ongoing treatment resulting in avoidable recurrence of a disorder. Additionally, there is the stress caused by the eminent risk of infection or economic uncertainty, especially in low-middle income settings. This is an overview on the expected influence of the COVID-19 on mental health from a research group that has not long ago been involved in the Zika epidemic. It aims to discuss the effects of the pandemic on a Low and Middle-Income country (LMIC), Brazil.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Países em Desenvolvimento , Saúde Mental , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Brasil , Cuidadores , Demência/enfermagem , Família , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Multimorbidade , Sensação , Isolamento Social
14.
Eur J Endocrinol ; 183(2): 221-231, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32583656

RESUMO

Context: In patients treated with antipsychotics, the rare occurrence of a macroprolactinoma represents a therapeutic challenge. Objective: Our aim was to evaluate the efficacy and psychiatric safety of dopamine agonists (DAs) prescribed for large macroprolactinomas in patients with psychosis treated with antipsychotics. Design: This was a multicenter (France and Belgium) retrospective study. Patients: Eighteen patients treated with antipsychotics were included. Results: Under DA, median PRL levels decreased from 1247 (117-81 132) to 42 (4-573) ng/mL (P = 0.008), from 3850 (449-38 000) to 141 (60-6000) ng/mL (P = 0.037) and from 1664 (94-9400) to 1215 (48-5640) ng/mL (P = 0.56) when given alone (n = 8), before surgery (n = 7), or after surgery (n = 6), respectively. The prolactinoma median largest diameter decreased by 28% (0-57) in patients under DAs alone (P = 0.02) but did not change when given after surgery. Optic chiasm decompression was achieved in 82% of patients. Five patients (28%) were admitted for psychotic relapse while receiving DAs (but three of them had stopped antipsychotic treatment at that time). A more severe underlying psychosis, rather than the DA treatment itself, may explain such psychiatric admissions. Conclusions: Even if the DA efficacy on PRL levels and tumor volume in patients with macroprolactinoma under antipsychotic drugs is less impressive than that typically observed, it may be considered satisfactory for half of our patients, particularly in cases of optic chiasm compression. Psychotic exacerbation was unusual in these patients, occurring mostly in those with the most severe psychotic forms. DAs may therefore be used as antitumor treatment for macroprolactinoma in patients with visual involvement, severe headaches or invasion into the skull base who receive antipsychotics.


Assuntos
Antipsicóticos/uso terapêutico , Agonistas de Dopamina/efeitos adversos , Agonistas de Dopamina/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Adulto , Bélgica , Interações Medicamentosas , Feminino , França , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/psicologia , Prolactina/sangue , Prolactinoma/patologia , Prolactinoma/psicologia , Transtornos Psicóticos/complicações , Transtornos Psicóticos/tratamento farmacológico , Recidiva , Estudos Retrospectivos
15.
Cien Saude Colet ; 25(suppl 1): 2457-2460, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32520289

RESUMO

Mental disorders (MD) are commonly comorbid with cardiovascular, metabolic, and some infectious diseases. Since the current SARS-CoV-2 epidemic is affecting the most multimorbid individuals, we might expect that the epidemic will be particularly problematic for people with MD. Understanding the burden of an outbreak on mental health is fundamental to effective action towards containing the spread of the disease, as psychopathology might reduce endurance during the lockdown. This can potentially reduce adhesion to ongoing treatment resulting in avoidable recurrence of a disorder. Additionally, there is the stress caused by the eminent risk of infection or economic uncertainty, especially in low-middle income settings. This is an overview on the expected influence of the COVID-19 on mental health from a research group that has not long ago been involved in the Zika epidemic. It aims to discuss the effects of the pandemic on a Low and Middle-Income country (LMIC), Brazil.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Países em Desenvolvimento , Saúde Mental , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Brasil , Cuidadores , Demência/enfermagem , Família , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Multimorbidade , Sensação , Isolamento Social
16.
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
18.
Neurotox Res ; 38(1): 1-7, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-244976

RESUMO

As a severe and highly contagious infectious disease, coronavirus disease 2019 (COVID-19) has caused a global pandemic. Several case reports have demonstrated that the respiratory system is the main target in patients with COVID-19, but the disease is not limited to the respiratory system. Case analysis indicated that the nervous system can be invaded by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and that 36.4% of COVID-19 patients had neurological symptoms. Importantly, the involvement of the CNS may be associated with poor prognosis and disease worsening. Here, we discussed the symptoms and evidence of nervous system involvement (directly and indirectly) caused by SARS-CoV-2 infection and possible mechanisms. CNS symptoms could be a potential indicator of poor prognosis; therefore, the prevention and treatment of CNS symptoms are also crucial for the recovery of COVID-19 patients.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/etiologia , Pneumonia Viral/complicações , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/etiologia , Terapia Combinada , Transtornos da Consciência/epidemiologia , Transtornos da Consciência/etiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/virologia , Tontura/epidemiologia , Tontura/etiologia , Encefalite Viral/epidemiologia , Encefalite Viral/etiologia , Células Endoteliais/metabolismo , Células Endoteliais/virologia , Fadiga/epidemiologia , Fadiga/etiologia , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/epidemiologia , Hipertensão Intracraniana/etiologia , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Transtornos Mentais/terapia , Transtornos do Humor/tratamento farmacológico , Transtornos do Humor/epidemiologia , Transtornos do Humor/etiologia , Transtornos do Humor/terapia , Doenças do Sistema Nervoso/epidemiologia , Neurônios/metabolismo , Neurônios/virologia , Nervo Olfatório/virologia , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/psicologia , Pneumonia Viral/virologia , Prevalência , Prognóstico , Psicoterapia , Psicotrópicos/uso terapêutico , Receptores Virais/metabolismo , Estudos Retrospectivos , Transtornos das Sensações/epidemiologia , Transtornos das Sensações/etiologia , Glicoproteína da Espícula de Coronavírus/metabolismo
19.
N Z Med J ; 133(1515): 54-69, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32438377

RESUMO

AIMS: To explore patterns of medicinal cannabis use prior to implementation of the new Medicinal Cannabis Scheme (MCS) in New Zealand. METHODS: An anonymous online convenience survey of 3,634 last-year medicinal users of cannabis promoted via Facebook™ from May to August 2019. RESULTS: Fifty percent of the sample were female, 18% were Maori and the median age was 38 years. The medical conditions for which cannabis was most often used were pain (81%), sleep (66%) and mental health conditions (64%). Respondents perceived cannabis to be an effective therapy and reported reducing use of other pharmaceutical medicines. Fifty-two percent reported side effects from cannabis use, including increased appetite (29%), drowsiness (12%), eye irritation (11%), dependency (10%), memory impairment (10%) and lack of energy (9%). Smoking was the dominant route of administration. Nearly half (47%) had discussed their use of cannabis with a medical professional in the previous year, while 14% had requested a prescription and 5% accessed a prescribed cannabis-based product (mostly oral CBD). CONCLUSION: Respondents self-medicated with cannabis to treat a wide range of health complaints. Only half discussed medicinal cannabis use with their medical professional, and a minority requested a prescription and used a prescribed cannabis-based product.


Assuntos
Cannabis , Maconha Medicinal/uso terapêutico , Fitoterapia/estatística & dados numéricos , Extratos Vegetais/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cannabis/efeitos adversos , Feminino , Política de Saúde , Humanos , Masculino , Fumar Maconha/efeitos adversos , Fumar Maconha/legislação & jurisprudência , Maconha Medicinal/efeitos adversos , Maconha Medicinal/economia , Maconha Medicinal/provisão & distribução , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Nova Zelândia , Dor/tratamento farmacológico , Extratos Vegetais/efeitos adversos , Extratos Vegetais/economia , Extratos Vegetais/provisão & distribução , Transtornos do Sono-Vigília/tratamento farmacológico , Inquéritos e Questionários , Adulto Jovem
20.
Encephale ; 46(3S): S116-S118, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32360037
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA