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1.
Artigo em Russo | MEDLINE | ID: mdl-31793547

RESUMO

Antipsychotics are used in the treatment of schizophrenia and other psychoses, as well as bipolar disorder, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and specific types of personality disorders. Due to better tolerability, as well as some advantages of the pharmacological profile, the second-generation antipsychotics are preferred in clinical practice. A special place among antipsychotics is taken by sulpiride, which shows the ability to improve the condition of patients with different types of mental disorders as well as with internal diseases.


Assuntos
Antipsicóticos , Transtorno Bipolar , Transtorno Obsessivo-Compulsivo , Transtornos Psicóticos , Esquizofrenia , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Humanos , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/tratamento farmacológico
2.
J Opioid Manag ; 15(5): 362-366, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849027

RESUMO

OBJECTIVE: To assess the efficacy of buprenorphine augmentation in treatment of psychotic symptoms in bipolar disorder type I. DESIGN: Bipolar type I patients with manic or depressive episodes and psychotic feature and with opioid dependency comorbidity were randomly included and allocated. Both groups of buprenorphine (4 or 6 mg/d) and placebo were also treated with enough dosages of sodium valproate and risperidone. Psychosis as primary outcome and depressive and manic symptoms as secondary outcome were assessed at baseline and after 1 and 2 weeks. Data were analyzed through t test and repeated measure ANOVA. RESULTS: Twenty-four patients remained in each group. Both groups displayed significant reduction in psychotic, depressive, and manic symptoms during the 2 weeks of study, although there was not any significant difference between them. CONCLUSIONS: Buprenorphine did not add any efficacy to usual treatment of psychotic episodes of bipolar, although did not aggravate psychiatric symptoms.


Assuntos
Antipsicóticos , Transtorno Bipolar , Buprenorfina , Transtornos Psicóticos , Analgésicos Opioides , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Buprenorfina/uso terapêutico , Método Duplo-Cego , Humanos , Transtornos Psicóticos/tratamento farmacológico , Resultado do Tratamento
3.
Actas esp. psiquiatr ; 47(5): 190-201, sept.-oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185171

RESUMO

El trastorno esquizoafectivo (TEA) es un trastorno psicótico que ha entrañado cierta controversia nosológica, junto a esta dificultad encontramos muy pocos estudios que aborden su tratamiento como una entidad diferente a la esquizofrenia. Estas dos dificultades dan como resultado la falta de evidencia específica sobre el tratamiento. Actualmente, el mismo, se basa principalmente en el empleo de antipsicóticos, aunque no existen guías específicas de manejo terapéutico. Esta revisión tiene el objetivo de conocer cuáles son los fármacos que actualmente cuentan con estudios de mayor calidad científica que avalen su empleo según variables clínicas de efectividad, seguridad, adherencia y tolerancia, así como su papel en los diferentes subtipos de TEA y situaciones clínicas. Para ello, se realizó una revisión exhaustiva de estudios experimentales y observacionales que incluyeran pacientes con diagnóstico de TEA. Se concluyó que son necesarios más ensayos clínicos realizados en pacientes con diagnóstico exclusivo de TEA. La paliperidona, el único fármaco con uso autorizado en el TEA es el fármaco que cuenta con mayor cantidad y calidad de estudios que avalen su uso. Risperidona, olanzapina, aripiprazol y ziprasidona también tienen ensayos clínicos aleatorizados que apoyan su eficacia y seguridad. En pacientes refractarios, hay estudios observacionales que señalan la utilidad de la clozapina. Así mismo, hay evidencia de estudios observacionales que señalan la utilidad de litio y carbamazepina durante la fase de mantenimiento. Es necesario establecer el papel del tratamiento combinado con regula-dores del humor y/o antidepresivos


Schizoaffective disorder (SAD) is a psychotic disorder which has presented a certain nosological controversy. Apart from these difficulties, very few studies focused in SAD as a distinct condition from schizophrenia have been found. This lack of specifical studies on SAD results in a lack of specific evidence about treatment. Currently, its treatment is based mainly on the use of antipsychotics, although there are no specific treatment guidelines for SAD. The objective of this review is to establish which are the most recommended treatments according to evidence avail-able, considering clinical variables such as efficacy, safety, adherence, and tolerance as well as the role of these factors in different subtypes of SAD. This exhaustive review exam-ines experimental and observational studies involving patients with a diagnosis of SAD. It was concluded that more clinical trials performed exclusively on patients affected by SAD are needed. Paliperidone, the only drug with authorized use in SAD, is the one that has the highest quality of studies to support its use. Risperidone, olanzapine, aripiprazole and ziprasidone also have randomized clinical trials supporting their efficacy and safety. In treatment-refractory patients, there are observational studies indicating the usefulness of clozapine. Like-wise, there is evidence from observational studies showing the usefulness of lithium and carbamazepine during the treatment maintenance phase. It is necessary to establish the role of combined treatment with mood stabilizers and/or antidepressants


Assuntos
Humanos , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Psicofarmacologia , Resultado do Tratamento , Medicina Baseada em Evidências , Transtornos Psicóticos/tratamento farmacológico , Risperidona/uso terapêutico , Olanzapina/uso terapêutico , Aripiprazol/uso terapêutico , Clozapina/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico
4.
Tijdschr Psychiatr ; 61(9): 649-653, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31560785

RESUMO

A 19-year-old female was seen at the emergency department following an auto-intoxication. An oculogyric crisis (ogc) was observed, in the absence of other extrapyramidal symptoms (eps). In a second anamnesis, patient indicated that she had taken risperidone 3 mg (an atypical antipsychotic). This particular case description of an isolated ogc shows that care providers should be attentive to the occurrence of ogc, even if the most frequent eps are absent. This case also emphasizes the importance of a complete history in order to efficiently and timely guide the care provider to the correct diagnosis.


Assuntos
Antipsicóticos/efeitos adversos , Distonia/induzido quimicamente , Transtornos da Motilidade Ocular/induzido quimicamente , Risperidona/efeitos adversos , Diagnóstico Diferencial , Distonia/diagnóstico , Feminino , Humanos , Transtornos da Motilidade Ocular/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Adulto Jovem
5.
Psychiatr Danub ; 31(Suppl 3): 608-612, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488799

RESUMO

Schizophrenic patients have traditionally suffered from high rates of cardiovascular disease and early mortality. NICE guidelines suggest that several physical health measures be monitored regularly in these patients, and particularly those on antipsychotic medication, which has a wide side-effect profile that may potentiate the risk of cardiovascular disease and other comorbidities. This general practice audit aimed to determine the rates of physical health monitoring in primary care in patients on antipsychotic medication for over a year for psychotic symptoms or schizophrenia. The search was conducted in three different general practices in March 2019, yielding 19, 8 and 30 patients respectively, with a total of 57 patients. This audit aims to record and analyse rates of monitoring of a range of physical health measures recommended by NICE guidelines over the past year. The results demonstrated that physical health monitoring was poor amongst all the practices audited, especially that of prolactin and waist circumference. We recommend that these rates of monitoring be improved, through implementing templates or the delivery of targeted education to general practitioners and nurses.


Assuntos
Antipsicóticos/efeitos adversos , Medicina Geral , Atenção Primária à Saúde , Transtornos Psicóticos/complicações , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológico , Antipsicóticos/administração & dosagem , Auditoria Clínica , Humanos , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/fisiopatologia
6.
Internist (Berl) ; 60(11): 1209-1214, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31501912

RESUMO

BACKGROUND: Clozapine is an alternative antipsychotic medication used to control symptoms of schizophrenia and to reduce risks of suicidal behavior in patients who did not adequately respond to standard medication. Due to severe side effects including cardiomyopathy and myocarditis its clinical use is limited. CASE REPORT: A 31-year-old man of east European descent presented to the emergency medical department with fatigue, shortness of breath and chest pain. Due to a schizoaffective disorder he was treated with clozapine and lithium. Echocardiography revealed severely impaired left ventricular systolic function. After exclusion of coronary artery disease by coronary angiography an endomyocardial biopsy was performed according to the guidelines. This confirmed the clinically suspected toxic cardiomyopathy. Therefore, antipsychotic treatment was immediately changed and state of the art heart failure medication was started resulting in a clear improvement of left ventricular function. CONCLUSION: In patients treated with clozapine or lithium and clinical signs of heart failure, toxic cardiomyopathy should be considered.


Assuntos
Antipsicóticos/efeitos adversos , Cardiomiopatias/induzido quimicamente , Dor no Peito/etiologia , Clozapina/efeitos adversos , Dispneia/etiologia , Fadiga/etiologia , Transtornos Psicóticos/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Biópsia , Clozapina/uso terapêutico , Ecocardiografia , Coração/diagnóstico por imagem , Humanos , Masculino , Miocárdio/patologia , Resultado do Tratamento
7.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383672

RESUMO

Sexual side-effects are common among those using antipsychotic medication and may result in poor compliance and reduced quality of life. Retrograde ejaculation (RE) has been described occurring with a number of antipsychotic medications (thioridazine, risperidone, iloperidone and clozapine) but there are no guidelines regarding management of antipsychotic-associated RE. Imipramine has been suggested as a treatment for antipsychotic-associated RE in one small study of patients prescribed thioridazine and a case series of patients prescribed iloperidone. Quetiapine is a commonly used antipsychotic and is thought to be associated with less sexual side-effects relative to other antipsychotic medications. This case report describes a 25-year-old man with first episode psychosis who developed RE during treatment with quetiapine which improved with low-dose imipramine. This is the first description of RE occurring with quetiapine and successful treatment of quetiapine-associated RE with imipramine.


Assuntos
Antipsicóticos/efeitos adversos , Imipramina/administração & dosagem , Ejaculação Precoce/tratamento farmacológico , Transtornos Psicóticos/tratamento farmacológico , Fumarato de Quetiapina/efeitos adversos , Adulto , Ejaculação/efeitos dos fármacos , Humanos , Masculino , Ejaculação Precoce/induzido quimicamente , Resultado do Tratamento
8.
Ned Tijdschr Geneeskd ; 1632019 08 19.
Artigo em Holandês | MEDLINE | ID: mdl-31433145

RESUMO

Physical and emotional pain are signalling and protective functions. In this clinical lesson, we describe the case of a patient with a psychotic disorder who had an episode of seriously disturbed pain awareness and experience, which caused severe delays in care and resulted in severe permanent damage. Due to his psychosis and lack of pain, the patient refused medical treatment and his leg henceforth developed mummification necrosis. Once admitted to a medical psychiatric unit, he was declared incompetent by his doctor and curator and his leg could be amputated. His psychosis adapted to the new situation, which he could then accept. This clinical lesson underlines the importance of awareness on disturbed pain and pain experience when it concerns a patient with a psychotic disorder, and that adequate medical treatment should not be ignored due to incompetence of the patient.


Assuntos
Saúde Mental , Transtornos Psicóticos/psicologia , Humanos , Masculino , Transtornos Psicóticos/tratamento farmacológico
9.
Psiquiatr. biol. (Internet) ; 26(2): 45-51, mayo-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185028

RESUMO

La olanzapina es un antipsicótico comúnmente utilizado como tratamiento de enfermedades como la esquizofrenia y el trastorno bipolar. En ocasiones la manifestación de la enfermedad difiere entre sexos, pero poco se ha investigado sobre la influencia de esta diferencia biológica en la respuesta al tratamiento o en los efectos secundarios. En esta revisión sistemática analizamos estas diferencias de sexo en la efectividad y en los efectos adversos de la olanzapina. Aunque algunos estudios mostraron mayor efectividad en mujeres, este resultado es ambiguo al no encontrar diferencias en otros trabajos. Por otro lado, encontramos mayor tendencia de los hombres a la ganancia de peso y al parkinsonismo, mientras que más mujeres experimentaron mareos, mayor aumento del colesterol y del intervalo QT. Dado el amplio uso a nivel mundial de la olanzapina, es importante realizar futuros estudios analizando las diferencias observadas, ya que podrían ser cruciales para mejorar la calidad de vida de los pacientes


Olanzapine is an antipsychotic drug commonly used in the treatment of illnesses such as schizophrenia and bipolar disorder. Occasionally the manifestation of the illness differs between genders, but little has been investigated on the influence of this biological difference in the response to the treatment or the secondary effects. In this systematic review, an analysis is made of these gender differences on the effectiveness and adverse effects of olanzapine treatment. Although some studies showed a higher effectiveness in women, this was ambiguous due to not finding any differences in other works. On the other hand, there was a greater tendency for men to gain weight and suffer from Parkinson symptoms, while the women were more likely to suffer from dizzy spells, a greater increase in cholesterol, and in QT interval. Given the worldwide use of olanzapine, it is important that further studies should be performed to analyse these differences observed, since they could be crucial for improving the quality of life of the patients


Assuntos
Humanos , Olanzapina/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Transtornos Psicóticos/tratamento farmacológico , Distribuição por Sexo , Antipsicóticos/uso terapêutico , Olanzapina/efeitos adversos
10.
Psiquiatr. biol. (Internet) ; 26(2): 60-61, mayo-ago. 2019.
Artigo em Espanhol | IBECS | ID: ibc-185031

RESUMO

Introducción: Además de agranulocitosis, el tratamiento con clozapina se asocia con eosinofilia. Aunque es un efecto secundario poco conocido, tiene una incidencia similar a la primera y además es potencialmente grave, ya que puede afectar a órganos diana como el hígado. Presentación del caso: Varón con sintomatología psicótica que tras varias semanas de ingreso comienza tratamiento con clozapina por la falta de respuesta farmacológica. Coincidiendo con el inicio de la misma presenta eosinofilia junto con un aumento de las enzimas hepáticas que alcanzan niveles tóxicos, por lo que se procede a su retirada. Discusión: La eosinofilia inducida por la clozapina puede ser periférica y benigna o puede infiltrar órganos diana como el hígado, desencadenando una hepatitis potencialmente mortal. Conclusiones: A pesar de que la hepatitis secundaria al tratamiento con clozapina puede ser fulminante, los controles seriados de las enzimas hepáticas no se incluyen en el protocolo de seguimiento de dicho tratamiento


Introduction: In addition to agranulocytosis, treatment with clozapine is associated with eosinophilia. Although it is a little-known side effect, it has an incidence similar to the former, and is also potentially serious, since it can affect target organs, such as the liver. Presentation of the case: A male with psychotic symptoms, on whom, after several weeks in hospital, it was decided to start clozapine due to the lack of pharmacological response. Coinciding with starting the drug, he presented with eosinophilia, as well as increased liver enzymes that reached toxic levels. The drug was then withdrawn. Discussion: Eosinophilia induced by clozapine may be peripheral and benign, or it may infiltrate target organs such as the liver, triggering potentially life-threatening hepatitis. Conclusions: Although hepatitis secondary to treatment with clozapine may be fulminant, serial liver enzyme tests are not included in the follow-up protocol for this treatment


Assuntos
Humanos , Masculino , Eosinofilia/induzido quimicamente , Clozapina/efeitos adversos , Transtornos Psicóticos/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/complicações , Olanzapina/uso terapêutico , Substituição de Medicamentos/métodos , Testes de Função Hepática/estatística & dados numéricos , Ensaios Enzimáticos/métodos
11.
Psychiatr Pol ; 53(2): 223-244, 2019 Apr 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-31317955

RESUMO

OBJECTIVES: Antiepileptic drugs (AEDs), which are commonly used as a treatment for acute phases and prevention of relapses in bipolar disorder (BD) and schizoaffective disorder (SAD), have been often associated to adverse outcomes in pregnancy and major congenital malformations (MCM). We aimed to summarize available evidence assessing these outcomes when AEDs are used in pregnant women with BD and/or SAD. METHODS: We searched four databases from inception to 18 January, 2019. We included peer-reviewed observational studies on the use of AEDs in pregnant women with BD or SAD. We excluded studies not reporting data on BD or SAD, not specifying the AED or not assessing pregnancy outcomes or MCM. RESULTS: The pooled records amounted to 2,861. After duplicate removal and inclusion/exclusion criteria application, we included 9 observational studies assessing patients with BD and SAD. The AEDs evaluated were lamotrigine (LTG), valproate (VPA), carbamazepine (CBZ), oxcarbazepine (OXC), topiramate (TPR) and gabapentin (GBP). VPA and CBZ were the AED most commonly associated to MCM. LTG showed the best safety profile. Higher rates of complications during pregnancy were observed in treated and untreated women with BD compared to healthy controls. CONCLUSIONS: AEDs may produce adverse outcomes in pregnancy and MCM in children of pregnant women with BD or SAD, showing higher risks at higher doses. LTG could be considered in this type of patients, given the low rate of adverse events. VPA and CBZ use should be avoided during pregnancy.


Assuntos
Anormalidades Induzidas por Medicamentos/etiologia , Anticonvulsivantes/efeitos adversos , Complicações na Gravidez/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Transtornos Psicóticos/tratamento farmacológico , Adulto , Transtorno Bipolar/tratamento farmacológico , Carbamazepina/efeitos adversos , Feminino , Humanos , Lactente , Gravidez , Resultado da Gravidez
12.
Psychiatr Prax ; 46(5): 287-289, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31269521

RESUMO

Systemic infections are known to alter the metabolism of various drugs via inhibition of the cytochrome P450 family. Here, we report the cases of two patients with schizophrenic psychosis and highly elevated clozapine levels during pulmonary systemic infection, however without experiencing side effects. After antibiotic treatment and temporary reduction of clozapine dosage blood levels of clozapine normalized within a few days. These cases show that clozapine levels may be highly elevated without necessarily causing side effects and that intensified pharmacovigilance should be considered by the clinician in patients with systemic infections.


Assuntos
Clozapina , Pneumonia/metabolismo , Antipsicóticos/farmacocinética , Clozapina/farmacocinética , Alemanha , Humanos , Transtornos Psicóticos/tratamento farmacológico
13.
Nord J Psychiatry ; 73(6): 349-356, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271338

RESUMO

Background: Treatment satisfaction predicts treatment adherence and long-term outcome for patients with psychosis. It is therefore important to understand the underpinnings of patient satisfaction in psychosis treatment for optimal treatment delivery. Aims: To examine the associations between satisfaction and level and change in positive symptoms, insight, depression and side effects of antipsychotics in previously medicated and antipsychotic-naïve patients. Method: Data derive from a randomised trial, with 226 respondents at baseline and 104 at follow-up. The measures were the positive subscale and insight item from the Positive and Negative Syndrome Scale, Calgary Depression Scale, the UKU Consumer Satisfaction Rating Scale, and the UKU side effects scale. Structural equation modelling was used to test the model. The full information maximum likelihood estimator used all available data. Results: In the sample of 226 patients, 67.3% were male and 44.2% were antipsychotic-naïve. The mean age was 34.1 years. For previously medicated patients, satisfaction was predicted by level of insight (b = -2.21, ß = -0.42) and reduction in positive symptoms (b = -0.56, ß = -0.39). For antipsychotic-naïve patients, satisfaction was predicted by level and change of insight (b = -2.21, ß = -0.46), change in depression (b = -0.37, ß = -0.26) and side effects (b = -0.15, ß = -0.30). All predictors were significant at the 0.05 level. Conclusion: Reducing positive symptoms and side effects are important to enhance patient satisfaction. However, improving insight and reducing depression are more important in antipsychotic-naïve patients.


Assuntos
Antipsicóticos/uso terapêutico , Satisfação do Paciente , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Doença Aguda/psicologia , Doença Aguda/terapia , Adulto , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Psychiatr Danub ; 31(2): 162-171, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31291220

RESUMO

In this project, we recruited a sample of 150 patients with first episode of psychosis with schizophrenia features (FEP) and 100 healthy controls. We assessed the differences between these two groups, as well as the changes between the acute phase of illness and subsequent remission among patients over 18-month longitudinal follow-up. The assessments were divided into four work packages (WP): WP1- psychopathological status, neurocognitive functioning and emotional recognition; WP2- stress response measured by saliva cortisol during a stress paradigm; cerebral blood perfusion in the resting state (with single photon emission computed tomography (SPECT) and during activation paradigm (with Transcranial Ultrasonography Doppler (TCD); WP3-post mortem analysis in histologically prepared human cortical tissue of post mortem samples of subjects with schizophrenia in the region that synaptic alteration was suggested by WP1 and WP2; WP4- pharmacogenetic analysis (single gene polymorphisms and genome wide association study (GWAS). We expect that the analysis of these data will identify a set of markers that differentiate healthy controls from patients with FEP, and serve as an additional diagnostic tool in the first episode of psychosis, and prediction tool which can be then used to help tailoring individualized treatment options. In this paper, we describe the project protocol including aims and methods and provide a brief description of planned post mortem studies and pharmacogenetic analysis.


Assuntos
Biomarcadores/análise , Transtornos Psicóticos/genética , Feminino , Seguimentos , Estudo de Associação Genômica Ampla , Humanos , Hidrocortisona/análise , Masculino , Farmacogenética , Estudos Prospectivos , Transtornos Psicóticos/complicações , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Saliva/química , Esquizofrenia/complicações
15.
BMC Res Notes ; 12(1): 376, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262359

RESUMO

OBJECTIVE: Drugs for managing mental disorders can cause adverse drug reactions (ADRs) that have negative impacts on patients yet, in Malawi, epidemiological data on the drug-related problems are limited. This study assessed the prevalence and severity of ADRs in out-patients at Zomba Mental Hospital. RESULTS: Twenty-six of forty patients (65.0%) were taking haloperidol and 14 (35.0%) chlorpromazine. The commonest diagnosis was schizophrenia (n = 23, 57.5%) followed by epileptic psychosis (n = 4, 10.0%) and general psychosis (n = 4, 10.0%) with one of psychotic depression and one psychosis secondary to general medical condition. Comorbidities were also found with epilepsy being the commonest (n = 4, 10.0%). All patients reported at least one ADR of varying severity (mild, moderate and severe). Polydipsia was the most prevalent (24, 60.0%) followed by weight gain (20, 50.0%), spasm (15, 37.5%) and xerostomia (15, 37.5%). Some ADRs were gender specific and these included impotence (6/27, 29.6%) for males and menstrual changes (3/14, 21.4%) for females. Severe ADRs were more common in the older aged group (> 35 years 8.3% vs 7.1%), in males (11.1% vs 0.0%) and on chlorpromazine (14.3% vs 3.8%). Patients taking chlorpromazine and haloperidol are at risk of experiencing a wide range of ADRs with varying degrees of severity.


Assuntos
Antipsicóticos/efeitos adversos , Clorpromazina/efeitos adversos , Disfunção Erétil/diagnóstico , Haloperidol/efeitos adversos , Distúrbios Menstruais/diagnóstico , Polidipsia/diagnóstico , Espasmo/diagnóstico , Xerostomia/diagnóstico , Adolescente , Adulto , Antipsicóticos/administração & dosagem , Clorpromazina/administração & dosagem , Estudos Transversais , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Feminino , Haloperidol/administração & dosagem , Hospitais Psiquiátricos , Humanos , Malaui , Masculino , Distúrbios Menstruais/etiologia , Distúrbios Menstruais/fisiopatologia , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Polidipsia/etiologia , Polidipsia/fisiopatologia , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/tratamento farmacológico , Esquizofrenia/fisiopatologia , Convulsões/tratamento farmacológico , Convulsões/fisiopatologia , Espasmo/etiologia , Espasmo/fisiopatologia , Ganho de Peso/efeitos dos fármacos , Xerostomia/etiologia , Xerostomia/fisiopatologia
16.
Psychiatr Danub ; 31(Suppl 2): 148-152, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158115

RESUMO

BACKGROUND: Hyperprolactinemia is associated with side effect of antipsychotics in people suffering from psychotic disorders. However, increased prolactin levels (mlU/L) were found in patients suffering from the first psychotic episode who were not receiving antipsychotic therapy. The assumption of this study is that the abnormality in the level of prolactin is associated with the effect and influence of the disease, not the therapy that is carried out. SUBJECTS AND METHODS: Study involved 54 female patients hospitalized in Psychiatric hospital "Sveti Ivan", whose average age was 33.9 years. All patients had been diagnosed with a psychotic disorder (according to MKB-10, F20-F29). 18 patients had their first psychotic episode, while 36 patients had relapses of psychotic disorder. The methods used were: PANSS scale and measurement of prolactin concentration (Immunoanalyzer ACCESS 2, CLIA method). Arithmetic mean, standard deviations, correlation coefficient, Mann Whitney U test and the chi-squared test were used. RESULTS: 75.5% of patients had prolactin values above the reference values (min 121, max 4192 ml/L). In a sample of patients with first psychotic episode, 77.8% had elevated prolactin levels, while among re-hospitalized patients, elevated levels had 74.2%. Statistically significant results were obtained: patients with higher pronounced symptoms had higher prolactin values, especially particles on PANSS: P1 (delusions), N4 (Apathy), G15 (preoccupation) and G16 (active avoidance). CONCLUSION: Elevated prolactin in patients has been demonstrated regardless of antipsychotic therapy, therefore the question of etiology of hyperprolactinemia in psychotic disorders is questionable. The association of hyperprolactinemia with the severity of the clinical picture has also been demonstrated, higher prolactin values indicating a stronger clinical picture, which calls into question the protective role of prolactin in psychotic disorders.


Assuntos
Antipsicóticos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hiperprolactinemia , Transtornos Psicóticos , Adulto , Antipsicóticos/efeitos adversos , Feminino , Humanos , Hiperprolactinemia/induzido quimicamente , Prolactina , Transtornos Psicóticos/tratamento farmacológico
17.
Psychiatr Danub ; 31(Suppl 2): 153-161, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158116

RESUMO

BACKGROUND: Many adolescents affected by psychiatric disorders require pharmacological treatment. Knowing which medication is being used is of utmost importance. Our main objective was to gain insight into prescribing patterns at the Department of child and adolescent psychiatry, Clinical Hospital Centre Rijeka. In addition, we looked for potential differences between adolescents regarding their pharmacotherapy status. SUBJECTS AND METHODS: The data from medical charts of 227 adolescents (55% females), age 12-18 years (16.4±1.18) were analysed. All of them were treated as outpatients during one year period (2014/15). Medical charts were obtained from the computerized archive system of Clinical Hospital Centre. Prescribed drug patterns were taken into account if patients have been taking medication for at least one month. RESULTS: Most of the patients, 162 (71.4%), were treated with psychiatric medication. In the pharmacologically treated group, adolescents were older (t=-4.678; p<0.001), predominately male (χ2=5.175, p=0.023) and hospitalized (χ2=20.612, p<0.0001). Accordingly, male (OR=2.09, P<0.05) and hospitalized (OR=15.32, P<0.001) adolescents were more disposed to be medicated. Psychotic disorder was the most commonly diagnosed disorder (51 patients). There were 454 different prescribing patterns, mostly prescribed antipsychotics, 36.6% of all prescriptions; followed by 31.5% anxiolytics' and 23.7% antidepressants' prescriptions. However, number of patients receiving antipsychotics, anxiolytics and antidepressants was quite similar (103: 110: 99). The highest number of patients was treated with sertraline (58), followed by those treated with risperidone (48). Majority of the patients (104/227) were treated with polytherapy. CONCLUSION: Prescribing psychiatric pharmacotherapy for adolescents is a common clinical practice. Adolescents that were prescribed pharmacotherapy were significantly older; hospitalized and male adolescents were more prone to be medicated. Antipsychotics were most frequently prescribed drugs. The prescribing patterns are generally consistent with international trends and guidelines; however caution regarding high proportion of polytherapy is necessary.


Assuntos
Antipsicóticos , Padrões de Prática Médica , Transtornos Psicóticos , Adolescente , Psiquiatria do Adolescente , Antidepressivos , Antipsicóticos/uso terapêutico , Criança , Prescrições de Medicamentos , Feminino , Humanos , Masculino , Transtornos Psicóticos/tratamento farmacológico , Risperidona
18.
Expert Rev Clin Pharmacol ; 12(7): 681-691, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31159608

RESUMO

Introduction: Parkinson's disease psychosis (PDP) may affect up to 60% of patients with Parkinson's disease over the course of their disease, and is associated with poor prognosis, including increased risks of mortality and nursing home placement. PDP treatments have been limited to off-label use of atypical antipsychotics, most of which pose risks of worsened motor symptoms and other potential adverse events (AEs) due to their dopamine receptor blockade and additional off-target receptor affinities. Pimavanserin is a highly selective 5-HT2A inverse agonist and poses no known risks for worsening of parkinsonism or other off-target receptor AEs. Pimavanserin is the first and only medication approved for PDP treatment. Areas covered: This review covers estimated prevalence, clinical characteristics, diagnostic criteria, and risk factors for PDP; the hypothetical progression of PDP; management of PDP including use of antipsychotics; pharmacology and clinical trial data on pimavanserin; and expert opinion on PDP treatment. The NLM/PubMed database was searched for papers using the search terms of "PDP" AND "treatment" AND "pimavanserin" for the last 10 years. Expert opinion: The recent insights into PDP pathophysiology and approval of the only medication specifically to treat PDP are key advances that should improve the recognition, diagnosis, and management of PDP.


Assuntos
Doença de Parkinson/tratamento farmacológico , Piperidinas/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Ureia/análogos & derivados , Antiparkinsonianos/farmacologia , Antiparkinsonianos/uso terapêutico , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Progressão da Doença , Humanos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Piperidinas/farmacologia , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/fisiopatologia , Fatores de Risco , Agonistas do Receptor 5-HT2 de Serotonina/farmacologia , Agonistas do Receptor 5-HT2 de Serotonina/uso terapêutico , Ureia/farmacologia , Ureia/uso terapêutico
19.
Trials ; 20(1): 331, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174586

RESUMO

BACKGROUND: Evidence is conflicting about a causal role of inflammation in psychosis and, specifically, regarding antibodies binding to neuronal membrane targets, especially N-methyl-D-aspartate receptors. NMDAR, LGI1 and GABA-A antibodies were found more prevalent in people with psychosis than in healthy controls. We aim to test whether these antibodies are pathogenic and may cause isolated psychosis. The SINAPPS2 phase IIa double-blinded randomised controlled trial will test the efficacy and safety of immunoglobulin and rituximab treatment versus placebo for patients with acute psychosis symptoms as added to psychiatric standard of care. METHODS: We will screen approximately 2500 adult patients with acute psychosis to identify 160 with antibody-positive psychosis without co-existing neurological disease and recruit about 80 eligible participants to the trial in the period from September 2017 to September 2021 across the UK. Eligible patients will be randomised 1:1 either to intravenous immunoglobulin (IVIG) followed by rituximab or to placebo infusions of 1% albumin followed by 0.9% sodium chloride, respectively. To detect a time-to-symptomatic-recovery hazard ratio of 0.322 with a power of 80%, 56 participants are needed to complete the trial, allowing for up to 12 participants to drop out of each group. Eligible patients will be randomised and assessed at baseline within 4 weeks of their eligibility confirmation. The treatment will start with IVIG or 1% albumin placebo infusions over 2-4 consecutive days no later than 7 days from baseline. It will continue 4-5 weeks later with a rituximab or sodium chloride placebo infusion and will end 2-3 weeks after this with another rituximab or placebo infusion. The primary outcome is the time to symptomatic recovery defined as symptomatic remission sustained for at least 6 months on the following Positive and Negative Syndrome Scale items: P1, P2, P3, N1, N4, N6, G5 and G9. Participants will be followed for 12 months from the first day of treatment or, where sustained remission begins after the first 6 months, for an additional minimum of 6 months to assess later response. DISCUSSION: The SINAPPS2 trial aims to test whether immunotherapy is efficacious and safe in psychosis associated with anti-neuronal membrane antibodies. TRIAL REGISTRATION: ISRCTN, 11177045. Registered on 2 May 2017. EudraCT, 2016-000118-31. Registered on 22 November 2016. ClinicalTrials.gov, NCT03194815. Registered on 21 June 2017.


Assuntos
Antipsicóticos/administração & dosagem , Imunoglobulinas Intravenosas/administração & dosagem , Transtornos Psicóticos/tratamento farmacológico , Rituximab/administração & dosagem , Adolescente , Adulto , Idoso , Antipsicóticos/efeitos adversos , Ensaios Clínicos Fase II como Assunto , Método Duplo-Cego , Feminino , Humanos , Imunoglobulinas Intravenosas/efeitos adversos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/imunologia , Transtornos Psicóticos/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Rituximab/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Reino Unido , Adulto Jovem
20.
J Med Case Rep ; 13(1): 175, 2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31174605

RESUMO

BACKGROUND: Inflammatory bowel disease and schizophrenia spectrum disorders are complex and multifactorial conditions characterized by great variability of age at onset, clinical presentation, and longitudinal course. Several lines of evidence suggested different connections among immunological dysregulation, gastrointestinal inflammation, and psychosis, but to date many controversial issues still exist in this field. CASE PRESENTATION: We present the case of a 14-year-old Caucasian boy with refractory ulcerative colitis, admitted to the Child Neuropsychiatry Unit of the Polyclinic Hospital of Bari in the course of his first-episode psychosis. He showed an acute onset of psychotic symptomatology during treatment with thalidomide, an immunomodulatory drug used in the experimental therapy of refractory inflammatory bowel disease. Thalidomide was discontinued and orally administered mesalazine was restarted. In addition, treatment with antipsychotics and mood stabilizers was introduced with gradual improvement of psychotic symptoms. According to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, a diagnosis of partial remission of a first episode of schizoaffective disorder was formulated after a 6-month follow-up. Throughout this period, both psychopharmacological and mesalazine-based gastrointestinal treatments were maintained with partial remission of psychiatric and gastrointestinal symptoms. CONCLUSIONS: We propose that refractory ulcerative colitis and psychosis might represent different manifestations of a common pathological pathway. However, it is also conceivable that thalidomide may have played a role in promoting the manifestation of psychotic symptoms in an individual with a specific vulnerability to schizoaffective disorders. Further investigations are needed to improve our knowledge regarding the complexity of brain-gut interactions, thus improving the management of co-existing inflammatory bowel and schizophrenia spectrum disorders.


Assuntos
Antipsicóticos/administração & dosagem , Colite Ulcerativa , Mesalamina/administração & dosagem , Transtornos Psicóticos , Talidomida , Adolescente , Assistência ao Convalescente , Idade de Início , Anti-Inflamatórios não Esteroides/administração & dosagem , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Substituição de Medicamentos/métodos , Cuidado Periódico , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/efeitos adversos , Masculino , Neuroimunomodulação , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/imunologia , Indução de Remissão/métodos , Talidomida/administração & dosagem , Talidomida/efeitos adversos
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