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2.
J Clin Psychiatry ; 83(5)2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36070576

RESUMO

Objective: Switching of antipsychotic medications, which are used for many psychiatric conditions, is common. However, reasons and clinical documentation of such switches have scarcely been studied.Methods: A systematic, retrospective review of prescription records and prescriber notes was conducted to characterize reasons for and types of antipsychotic switches at one hospital during inpatient or outpatient care, starting August 1, 2017, until 270 antipsychotic switches with type and reasons were collected, as required by power analysis.Results: After removing 7 cases in which quetiapine was switched to a non-antipsychotic agent, 263 antipsychotic switches involving 195 unique subjects (median age = 31 [interquartile range, 24-47] years; schizophrenia = 36.9%, bipolar disorder = 27.7%, schizoaffective disorder = 18.5%) were analyzed. Frequent reasons for antipsychotic switch were intolerability (45.7%) and inefficacy/clinical worsening (17.6%). Reasons did not differ by race (P = .2644), age (P = .0621), or insurance type (P = .2970), but differed heterogeneously regarding different reasons by sex (P = .004). The most common reported switches were from second-generation oral antipsychotics (SGA-OAPs) to other SGA-OAPs (N = 155, 58.9%), mostly due to tolerability or inefficacy; second-generation long-acting injectable antipsychotics (SGA-LAIs) to SGA-OAPs (11%), mostly due to intolerability, patient preference, or insurance coverage problems; and SGA-OAPs to SGA-LAIs (10.7%) due to nonadherence. Reasons for antipsychotic switch were properly documented in 208 (79.1%) of the prescriber notes.Conclusions: In this retrospective chart review, switching varied by sex regarding reasons and occurred almost in half of the cases due to intolerability. Different reasons predominated in switches from SGA-OAP to SGA-OAP, SGA-LAI to SGA-OAP, and SGA-OAP to SGA-LAI. One in 5 switches were not properly documented, requiring attention.


Assuntos
Antipsicóticos , Administração Oral , Adulto , Antipsicóticos/uso terapêutico , Preparações de Ação Retardada , Humanos , Prescrições , Estudos Retrospectivos
3.
Comput Math Methods Med ; 2022: 2436322, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36072776

RESUMO

Background: Endocrine disorders such as amenorrhea, lactation, and irregular menstruation caused by antipsychotics are common in female patients. How to reduce or eliminate these adverse reactions is a matter of concern. Objective: To evaluate the therapeutic effect of progesterone in combination with vitamin B6 in the treatment of antipsychotic-induced amenorrhea. Methods: In our hospital, from May 2019 to May 2021, 120 patients with amenorrhea caused by antipsychotics who underwent surgery were selected for this prospective study. The random residue grouping method divided them into a progesterone group (60 cases) and a vitamin B6 group (60 cases). Among them, the progesterone group was treated only with progesterone, while the vitamin B6 group was given progesterone in combination with vitamin B6. The differences in endocrine index, prolactin, uterine size, and endometrial thickness, effectiveness, and safety analysis of the progesterone and vitamin B6 groups of patients were observed and compared. Results: Before treatment, there was no change in the comparison of endocrine indexes between the progesterone and vitamin B6 groups (P > 0.05). After 1 month of treatment, there were significant differences in estradiol, prolactin, and follicle-stimulating hormone between the progesterone and vitamin B6 groups of patients (P < 0.05). After 1 month of treatment, there were significant differences in prolactin, uterine size, and endometrial thickness, and the vitamin B6 group was significantly lower than the progesterone group (P < 0.05). The clinical efficiency of 95.00% in the vitamin B6 group was significantly higher than 83.33% in the progesterone group (P < 0.05). There were no adverse reactions in the progesterone and vitamin B6 groups. Conclusion: The effectiveness of progesterone combined with vitamin B6 in treating amenorrhea caused by antipsychotics is significantly better than simple progesterone, which can effectively improve the endocrine condition of patients and provide a reference for the clinical treatment of amenorrhea caused by antipsychotics.


Assuntos
Antipsicóticos , Progesterona , Amenorreia/induzido quimicamente , Antipsicóticos/efeitos adversos , Feminino , Humanos , Prolactina , Estudos Prospectivos , Piridoxina , Vitamina B 6/uso terapêutico
4.
J Psychiatr Pract ; 28(5): 421-425, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36074112

RESUMO

Corticosteroid-based drugs are widely used in the general population to treat several acute and chronic inflammatory conditions. However, the therapeutic efficacy of these drugs is often accompanied by severe psychiatric adverse effects through a yet unknown mechanism. To further complicate this situation, therapeutic strategies to counteract psychotic symptoms associated with these agents have yet to be devised. We report a case of a young white male Jehovah's Witness admitted to the psychiatry ward of the Maggiore della Carità Hospital, Novara, Italy. At admission, the patient presented with psychomotor agitation, auditory hallucinations, and thought disturbances, resulting in the working diagnosis of a manic episode with psychotic features. During the 16 days of his hospital admission, the patient was treated with antipsychotic medications (aripiprazole and haloperidol) and with benzodiazepines (lorazepam), and he achieved a complete remission of all psychotic symptoms. While his psychiatric history was negative, his medical records revealed a recent discharge from the infectious disease ward with a diagnosis of infectious mononucleosis treated with intravenous betamethasone. Thus, at discharge, a diagnosis of steroid-induced psychosis was made. In conclusion, our findings are suggestive of a potential role played by corticosteroids in the development of psychotic symptoms, for which routine screening protocols and therapeutic guidelines are still lacking.


Assuntos
Antipsicóticos , Transtornos Psicóticos , Doença Aguda , Antipsicóticos/uso terapêutico , Aripiprazol , Delusões/induzido quimicamente , Delusões/tratamento farmacológico , Haloperidol , Humanos , Masculino , Transtornos Psicóticos/diagnóstico
5.
J Psychiatr Pract ; 28(5): 431-435, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36074114

RESUMO

Psychiatric illness is associated with both chronic pain syndromes and opioid use disorder, further complicating how we care for patients with psychiatric issues. We report a unique case of a de novo and persistent psychotic disorder after complicated opioid withdrawal in a patient without any psychiatric history. The patient developed persistent auditory hallucinations after discontinuation of chronic opioid therapy that responded only to atypical antipsychotic (olanzapine) treatment. This case illustrates the neuropsychiatric effects of chronic opioid exposure, as well as layered clinical management dimensions related to opioid detoxification and psychosis treatment. Long-term opioid therapy may have lasting neuropsychiatric effects, including playing a role in the development and/or expression of psychotic disorders. Here we review the limited literature on the effects of opioids on psychosis. This complex case also demonstrates a clinical approach for effectively co-managing psychiatric symptoms in the context of chronic pain and chronic opioid therapy.


Assuntos
Antipsicóticos , Dor Crônica , Transtornos Psicóticos , Analgésicos Opioides , Antipsicóticos/efeitos adversos , Dor Crônica/tratamento farmacológico , Dor Crônica/psicologia , Humanos , Olanzapina/uso terapêutico , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/etiologia
6.
Int J Mol Sci ; 23(17)2022 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-36076984

RESUMO

Insulin-like growth factor 2 (IGF-2) and IGF binding protein 7 (IGFBP-7) have been related to schizophrenia (SZ) due to their implication in neurodevelopment. The purpose of this study was to assess whether the alterations in IGF-2 and IGFBP-7 in SZ patients are intrinsically related to the psychiatric disorder itself or are a secondary phenomenon due to antipsychotic treatment. In order to test this hypothesis, we measured plasma IGF-2 and IGFBP-7 in drug-naïve first episode (FE) and multiple episodes or chronic (ME) SZ Caucasian patients who have been following treatment for years. A total of 55 SZ patients (FE = 15, ME = 40) and 45 healthy controls were recruited. The Positive and Negative Syndrome Scale (PANSS) and the Self-Assessment Anhedonia Scale (SAAS) were employed to check schizophrenic symptomatology and anhedonia, respectively. Plasma IGF-2 and IGFBP-7 levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA). The FE SZ patients had much lower IGF-2, but not IGFBP-7, than controls. Moreover, both IGF-2 and IGFBP-7 significantly increased after atypical antipsychotic treatment (aripiprazole, olanzapine, or risperidone) in these patients. On the other hand, chronic patients showed higher levels of both proteins when compared to controls. Our study suggests that circulatory IGF-2 and IGFBP-7 increase after antipsychotic treatment, regardless of long-term conditions and being lower in drug-naïve FE patients.


Assuntos
Antipsicóticos , Esquizofrenia , Anedonia , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Humanos , Proteína 2 de Ligação a Fator de Crescimento Semelhante à Insulina , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/metabolismo , Proteínas de Ligação a Fator de Crescimento Semelhante a Insulina , Fator de Crescimento Insulin-Like I/metabolismo , Fator de Crescimento Insulin-Like II/metabolismo , Esquizofrenia/metabolismo
7.
Biol Pharm Bull ; 45(9): 1232-1237, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36047190

RESUMO

Clozapine is an atypical antipsychotic with several advantages over conventional antipsychotics, in addition to its well-known efficacy in treatment-resistant schizophrenia. However, the high risk of agranulocytosis associated with clozapine therapy limits its clinical application. Clozapine bioactivation to an unstable protein-reactive metabolite, identified as a nitrenium intermediate, has been implicated in cytotoxicity toward neutrophils. Clozapine affects myeloid precursor cells rather than neutrophils; however, the impact of its reactive metabolite on myeloid precursor cells undergoing granulocytic differentiation remains unclear. Herein, we used hydrogen peroxide (H2O2) to generate the reactive metabolite and compared reactive metabolite-induced cytotoxicity between HL-60 cells undergoing granulocytic differentiation and differentiated HL-60 cells. In addition, we examined the role of oxidative stress in this type of cytotoxicity. The reactive metabolite of clozapine induced rapid cytotoxicity in HL-60 cells undergoing granulocytic differentiation, but not in differentiated HL-60 cells, with the metabolite exhibiting more potent cytotoxicity than clozapine. No cytotoxicity was observed following incubation with olanzapine, a structural analog of clozapine, even after exposure of the drug to H2O2. The reactive metabolite of clozapine decreased the levels of reduced glutathione, while addition of reduced glutathione attenuated the reactive metabolite-induced cytotoxicity. These findings indicate that glutathione metabolism plays a role in the hematopoietic toxicity induced by the reactive metabolite of clozapine. Oxidative stress may potentially increase susceptibility to the hematopoietic toxicity induced by the reactive metabolite of clozapine.


Assuntos
Agranulocitose , Antipsicóticos , Clozapina , Agranulocitose/induzido quimicamente , Agranulocitose/metabolismo , Antipsicóticos/toxicidade , Clozapina/toxicidade , Glutationa/metabolismo , Células HL-60 , Humanos , Peróxido de Hidrogênio/farmacologia
8.
PLoS One ; 17(9): e0274865, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36137164

RESUMO

PURPOSE: To assess the effect of continuous ketamine administration in patients admitted to medical and cardiac intensive care units (ICUs) and received mechanical ventilation support. METHODS: We conducted a retrospective cohort study between March 2012 and June 2020 at an academy-affiliated tertiary hospital. Adult patients who received mechanical ventilation support for over 24 h and continuous ketamine infusion for at least 8 h were included. The primary outcome was immediate hemodynamic safety after continuous ketamine infusion. The secondary outcomes included immediate delirium, pain, and use of sedation. RESULTS: Of all 12,534 medical and cardiac ICU patients, 564 were eligible for the analysis. Ketamine was used for 33.3 (19.0-67.5) h and the median continuous infusion dose was 0.11 (0.06-0.23) mcg/kg/h. Of all patients, 469 (83.2%) received continuous ketamine infusion concomitant with analgosedation. Blood pressure and vasopressor inotropic scores did not change after continuous ketamine infusion. Heart rate decreased significantly from 106.9 (91.4-120.9) at 8 h before ketamine initiation to 99.8% (83.9-114.4) at 24 h after ketamine initiation. In addition, the respiratory rate decreased from 21.7 (18.6-25.4) at 8 h before ketamine initiation to 20.1 (17.0-23.0) at 24 h after ketamine initiation. Overall opioid usage was significantly reduced: 3.0 (0.0-6.0) mcg/kg/h as fentanyl equivalent dose at 8 h before ketamine initiation to 1.0 (0.0-4.1) mcg/kg/h as fentanyl equivalent dose at 24 h post-ketamine initiation. However, the use of sedatives and antipsychotic medications did not decrease. In addition, ketamine did not increase the incidence of delirium within 24 h after ketamine infusion. CONCLUSION: Ketamine may be a safe and feasible analgesic for medical and cardiac ICU patients who received mechanical ventilation support as an opioid-sparing agent without adverse hemodynamic effects.


Assuntos
Antipsicóticos , Delírio , Ketamina , Adulto , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Antipsicóticos/uso terapêutico , Delírio/tratamento farmacológico , Estudos de Viabilidade , Fentanila , Humanos , Hipnóticos e Sedativos/uso terapêutico , Unidades de Terapia Intensiva , Respiração Artificial , Estudos Retrospectivos
9.
Res Gerontol Nurs ; 15(5): 217-228, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36113012

RESUMO

The current descriptive qualitative study explored the perceived impact of the coronavirus disease 2019 pandemic on sleep disturbances and nighttime agitation; the reported use of antipsychotics and other sedating medications; and the overall well-being of older adults with Alzheimer's disease and related dementias (ADRD) and their caregivers. One investigator conducted in-depth, phone interviews with caregivers of nursing home residents with ADRD (four family caregivers [FCs], three nurse practitioners [NPs]) and seven FCs of older adults with ADRD who lived with them at home. Caregivers described multiple sleep disturbances. Nighttime agitation symptoms were perceived to continue or worsen, and sedating medications and nonpharmacological interventions were required. Adverse impacts on reported well-being were significant, and impacts were grouped into emotional, social, and physical themes. Caregivers said, "Please don't forget us," and requested telehealth support for those at home and technology and human resources for nursing homes to reduce adverse impacts. [Research in Gerontological Nursing, 15(5), 217-228.].


Assuntos
Doença de Alzheimer , Antipsicóticos , COVID-19 , Transtornos do Sono-Vigília , Idoso , Cuidadores/psicologia , Humanos , Pandemias
10.
J Child Adolesc Psychopharmacol ; 32(7): 374-389, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36074098

RESUMO

Objective: Antipsychotic-related prolactin changes may expose children and adolescents to severe adverse reactions (ARs) related to pubertal development and growth. We therefore aimed to assess the effects of antipsychotics on prolactin levels and associated somatic ARs in children and adolescents. Methods: We systematically searched PubMed and CENTRAL for placebo-controlled randomized trials of antipsychotics in children and adolescents aged ≤18 years, reporting prolactin levels and related ARs. We conducted a random-effect meta-analysis and assessed risk of bias version 2 (ROB2). Results: Thirty-two randomized controlled trials with an average trial duration of 6 weeks, covering 4643 participants with an average age of 13 years and a male majority of 65.3%. Risk of bias across domains was low or unclear. The following antipsychotic compounds: aripiprazole (n = 810), asenapine (n = 506), lurasidone (n = 314), olanzapine (n = 179), paliperidone (n = 149), quetiapine (n = 381), risperidone (n = 609), and ziprasidone (n = 16) were compared with placebo (n = 1658). Compared with placebo, statistically significant higher prolactin increase occurred with risperidone (mean difference [MD] = 28.24 ng/mL), paliperidone (20.98 ng/mL), and olanzapine (11.34 ng/mL). Aripiprazole significantly decreased prolactin (MD = -4.91 ng/mL), whereas quetiapine, lurasidone, and asenapine were not associated with significantly different prolactin levels than placebo. Our results on ziprasidone are based on a single study, making it insufficient to draw strong conclusions. On average, 20.8% of patients treated with antipsychotic developed levels of prolactin that were too high (hyperprolactinemia), whereas only 1.03% of patients reported prolactin-related ARs. Data were highly limited for long-term effects. Conclusions: In children and adolescents, risperidone, paliperidone, and olanzapine are associated with significant prolactin increase, whereas aripiprazole is associated with significant decrease. Despite the significant changes in prolactin level, few ARs were reported. Study protocol on PROSPERO: CRD42018116451.


Assuntos
Antipsicóticos , Hiperprolactinemia , Esquizofrenia , Adolescente , Antipsicóticos/efeitos adversos , Aripiprazol/efeitos adversos , Criança , Dibenzocicloeptenos/efeitos adversos , Humanos , Hiperprolactinemia/induzido quimicamente , Hiperprolactinemia/tratamento farmacológico , Cloridrato de Lurasidona/efeitos adversos , Masculino , Olanzapina/efeitos adversos , Palmitato de Paliperidona/efeitos adversos , Piperazinas/efeitos adversos , Prolactina/efeitos adversos , Fumarato de Quetiapina/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Risperidona/efeitos adversos , Esquizofrenia/tratamento farmacológico , Tiazóis/efeitos adversos
11.
Tijdschr Psychiatr ; 64(8): 500-503, 2022.
Artigo em Holandês | MEDLINE | ID: mdl-36117480

RESUMO

Background   Women with a schizophrenia-spectrum disorder (SSD) have a better clinical profile than men at the start of their illness but lose this advantage within the first few years of living with SSD. There are benefits to be gained across different areas in the care currently offered to women with psychosis. Aim   To describe point of improvement in the care for women with SSD. Method   Review or relevant literature. Results   An important point for improvement is the early detection of female-specific signs of a first episode of psychosis, to shorten the duration of untreated psychosis, with prompt access to early intervention services. Special attention should be paid to sexual health, and to any history of childhood trauma. Antipsychotics clearly require dosing and prescription tailored to the female body, considering hormonal life phases such as menopause. Switching to prolactin-sparing medications can benefit both mental and somatic health. Finally, hormone replacement therapy should be considered for postmenopausal women. Conclusion   By providing female-specific care, women with SSD can live up to their full potential.


Assuntos
Antipsicóticos , Transtornos Psicóticos , Esquizofrenia , Antipsicóticos/uso terapêutico , Feminino , Humanos , Masculino , Prolactina , Transtornos Psicóticos/diagnóstico , Melhoria de Qualidade , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico
12.
J Integr Neurosci ; 21(5): 141, 2022 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-36137961

RESUMO

Chronic migraine belongs to the "chronic long-duration headaches", and it is associated to high burden and significant economic impact. Treatment for both episodic (EM) and chronic migraine (CM) is based on the management of acute attacks and their prevention. For moderate/severe attacks, pharmacological therapies are triptans, dihydroergotamine nasal sprays or injections or neuroleptics, non-steroidal anti-inflammatory drugs, and corticosteroids. Chronic migraine belongs to the "chronic long-duration headaches", and it is associated to high burden and significant economic impact. Treatment for both episodic (EM) and chronic migraine (CM) is based on the management of acute attacks and their prevention. For moderate/severe attacks, pharmacological therapies are triptans, dihydroergotamine nasal sprays or injections or neuroleptics, non-steroidal anti-inflammatory drugs, and corticosteroids. The pathophysiology of CM is characterized by an abnormal activation of the trigemino-vascular system in the meninges causing a neurogenic inflammation, which explains the use of anti-inflammatory during attacks. It seems that the objective of the preventive therapy with the botulin toxin OnaBoNT-A consists in interrupting the release of CGRP and other neuropeptides as well as the activation of C-fiber nociceptor and of the nearby A-delta fibers. The protocol for migraine treatment with OnaBoNT-A injections consists of 31-39 pericranial injection sites involving seven muscle groups bilaterally in specific areas of the head and neck, with a total dose of between 155 and 195 units, every three months. The severe adverse events reported with high doses of botulin toxin for spasticity, have not been reported for CM treated with OnabotA at the labeled dose. The established improvement with onabotulinumtoxinA treatment in CM patients had a positive impact not only in reduction monthly headache days but also in improving quality of life, with reduction in both healthcare resource utilisation (HRU) and work impairment. Aim of this review was to give an overview on the use of BoNT-A in patients with CM, giving practical advices on the clinical indications.


Assuntos
Antipsicóticos , Toxinas Botulínicas Tipo A , Transtornos de Enxaqueca , Toxinas Botulínicas Tipo A/uso terapêutico , Peptídeo Relacionado com Gene de Calcitonina/uso terapêutico , Di-Hidroergotamina/uso terapêutico , Cefaleia/tratamento farmacológico , Humanos , Sprays Nasais , Qualidade de Vida , Resultado do Tratamento , Triptaminas/uso terapêutico
13.
Turk Psikiyatri Derg ; 33(3): 167-179, 2022.
Artigo em Inglês, Turco | MEDLINE | ID: mdl-36148567

RESUMO

OBJECTIVE: Regarding the patients using long acting injectable (LAI) antipsychotic treatment; we aimed to investigate the effect of attitude towards drugs, antipsychotic type and side effects on quality of life, caregiver burden and continuation of treatment. METHOD: Our study sample consisted of 110 patients in the age range of 18-65 using LAI antipsychotics for at least 12 weeks with the diagnosis of schizophrenia according to DSM-5 criteria. Sociodemographic and Clinical Data Form, Drug Attitude Inventory 10 (DAI-10), Positive and Negative Syndrome Scale (PANSS), UKU Side Effect Rating Scale, Quality of Life for Schizophrenia Scale were used for evaluation of patients. Sociodemographic Data Form, Zarit Caregiver Burden Scale (ZCBS) were used for the caregivers. RESULTS: It is observed that the patients with positive attitude against the treatment had longer antipsychotic treatment duration (13.7+9.1 years) compared to patients with negative attitude (7.7 + 6.6 years) (p<0.001). PANSS total scores of patients who were considering about treatment discontinuation (44.0+14.3) were higher than the other patients (38.6+9.0) (p=0.03) and DAI-10 scores of patients who were considering about treatment discontinuation were lower (1.4+4.9; 5.2+3.4; p<0.001). Duration of illness were also shorter (10.3+9.3 year) for the patients who were considering about treatment discontinuation than the other group (15.7 + 9.0 year) (p=0.01). There was no significant difference in caregiver burden, side effects, quality of life and reasons for treatment discontinuation between typical and atypical antipsychotics. According to the regression analysis results, PANSS score (ß=0.553, p<0.001) and male gender (ß= 0.225, p=0.003) were positive predictors of ZCBS scores. CONCLUSION: It is observed that the attitude towards drugs and psychotic symptom severity were the most important factors for treatment discontinuation in patients with schizophrenia using LAI antipsychotics. Atypical and typical antipsychotics were not different with respect to quality of life and caregiver burden for the patients on regular treatment with LAI antipsychotics.


Assuntos
Antipsicóticos , Esquizofrenia , Antipsicóticos/uso terapêutico , Fardo do Cuidador , Pré-Escolar , Preparações de Ação Retardada , Humanos , Lactente , Masculino , Qualidade de Vida , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico
14.
Molecules ; 27(18)2022 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-36144791

RESUMO

Strawberries are an important fruit in the European diet because of their unique taste and high content of essential nutrients and bioactive compounds. The anthocyanins are known to be colorful phenolics in strawberries. In 17 samples of six strawberry cultivars produced in Serbia, i.e., the common varieties Alba, Asia, and Clery as well as promising breeding materials (11.29.11, 11.34.6, and 11.39.3), the anthocyanin profile as well as antimicrobial and antioxidative activity profiles were determined. All investigated extracts showed antioxidative and antibacterial activities against Gram-negative Aliivibrio fischeri. The responses were quite similar in number and intensity. The HPTLC-DPPH• scavenging assay and HPTLC-Aliivibrio fischeri bioassay coupled with high-resolution mass spectrometry identified pelargonidin-3-O-glucoside (Pg-3-glc) as the main anthocyanin and prominent antioxidative and antimicrobial compound in strawberries. The density functional theory calculations at the M06-2X/6-31+G(d,p) level showed that Pg-3-glc quenches free radicals via sequential proton loss electron transfer mechanism in water and in pentyl ethanoate, where the 5-OH group is the most reactive site for proton and hydrogen atom transfer. The results were confirmed via spectrophotometry. The highest total phenolic content was found in Clery and 11.39.3, while statistically significant differences between the genotypes regarding the antioxidant activity were not confirmed. Although very similar in the anthocyanin, antioxidative, and antimicrobial profile patterns, the strawberry genotypes were successfully classified using principal component analysis.


Assuntos
Antipsicóticos , Fragaria , Antocianinas/análise , Antibacterianos/análise , Antibacterianos/farmacologia , Antioxidantes/química , Quimiometria , Cromatografia , Fragaria/química , Frutas/química , Glucosídeos/análise , Fenóis/análise , Melhoramento Vegetal , Prótons , Água/análise
15.
Front Public Health ; 10: 983733, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36159297

RESUMO

Objective: Quality of life (QoL) has been always an important way to evaluate the outcomes of schizophrenia, but there have been few previous longitudinal studies and few in middle-income countries. This study aimed to explore the QoL in Chinese patients with schizophrenia treated in primary mental health care and the risk factors of QoL over time. Methods: Patients with schizophrenia treated in primary mental health care in rural/regional areas in Luoding, Guangdong, PR China, were evaluated with an extended questionnaire including the Chinese version of the World Health Organization Quality of Life (WHOQOL-BREF) at baseline and 2-year follow-up. Bivariate and multivariate analyses were conducted including Generalized Estimated Equation analyses (GEE). Results: Four hundred and ninety-one patients with schizophrenia in primary care completed the 2-year follow up evaluation. The QoL physical, environmental, and social relationships domains showed improvement after the 2-year period, but the psychological domain did not. GEE results showed that earlier age of onset, older age, being employed, being unmarried, the thicker waist circumference, less use of clozapine or other SGAs, fewer hospitalizations, more frequent insomnia, more severe depressive and negative symptoms as well as worse treatment insight were independently associated with poor QoL in patients with schizophrenia. Conclusion: According to our results, to improve the quality of life of patients with schizophrenia in primary care, we should pay more attention to the treatment of depression, negative and insomnia symptoms of schizophrenia, the choice and dosage of antipsychotic medication and improvement in the treatment compliance. The combined use of educational and behavioral strategies may improve treatment adherence.


Assuntos
Antipsicóticos , Clozapina , Esquizofrenia , Distúrbios do Início e da Manutenção do Sono , Antipsicóticos/uso terapêutico , China , Clozapina/efeitos adversos , Estudos de Coortes , Humanos , Saúde Mental , Qualidade de Vida/psicologia , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico
16.
Scanning ; 2022: 5415775, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36160325

RESUMO

Schizophrenia presents a chronic progressive course and requires long-term treatment. The current treatment of schizophrenia is mainly based on antipsychotic drugs, but drugs are ineffective for the negative symptoms and cognitive dysfunction of schizophrenia, and long-term medication may increase the burden on the endocrine and circulatory systems of patients. Repetitive transcranial magnetic stimulation is a noninvasive, painless, safe, efficacious, and economical physical therapy measure that has achieved good results in the treatment of schizophrenia. This paper reviews the progress of research on the clinical application of transcranial magnetic stimulation in the treatment of schizophrenia.


Assuntos
Antipsicóticos , Esquizofrenia , Antipsicóticos/uso terapêutico , Humanos , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico , Estimulação Magnética Transcraniana/métodos
17.
Cochrane Database Syst Rev ; 9: CD008936, 2022 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-36130734

RESUMO

BACKGROUND: Pharmacological interventions for disordered and problem gambling have been employed in clinical practice. Despite the availability of several reviews of the efficacy of pharmacological interventions for disordered or problem gambling, few have employed systematic search strategies or compared different categories of pharmacological interventions. Systematic reviews of high-quality evidence are therefore essential to provide guidance regarding the efficacy of different pharmacological interventions for disordered or problem gambling. OBJECTIVES: The primary aims of the review were to: (1) examine the efficacy of major categories of pharmacological-only interventions (antidepressants, opioid antagonists, mood stabilisers, atypical antipsychotics) for disordered or problem gambling, relative to placebo control conditions; and (2) examine the efficacy of these major categories relative to each other.  SEARCH METHODS: We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and PsycINFO (all years to 11 January 2022). SELECTION CRITERIA: We included randomised trials evaluating a pharmacological intervention for the treatment of disordered or problem gambling. Eligible control conditions included placebo control groups or comparisons with another category of pharmacological intervention. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures, including systematic extraction of included study characteristics and results and risk of bias assessment. Our primary outcome was reduction in gambling symptom severity. Our secondary outcomes were reduction in gambling expenditure, gambling frequency, time spent gambling, depressive symptoms, anxiety symptoms, and functional impairment; and responder status. We evaluated treatment effects for continuous and dichotomous outcomes using standardised mean difference (SMD) and risk ratios (RR), respectively, employing random-effects meta-analyses. A minimum of two independent treatment effects were required for a meta-analysis to be conducted (with only meta-analytic findings reported in this abstract). MAIN RESULTS: We included 17 studies in the review (n = 1193 randomised) that reported outcome data scheduled for end of treatment. Length of treatment ranged from 7 to 96 weeks.  Antidepressants: Six studies (n = 268) evaluated antidepressants, with very low to low certainty evidence suggesting that antidepressants were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.32, 95% CI -0.74 to 0.09, n = 225), gambling expenditure (SMD -0.27, 95% CI -0.60 to 0.06, n = 144), depressive symptoms (SMD -0.19, 95% CI -0.60 to 0.23, n = 90), functional impairment (SMD -0.15, 95% CI -0.53 to 0.22, n = 110), and responder status (RR 1.24, 95% CI 0.93 to 1.66, n = 268). Opioid antagonists: Four studies (n = 562) evaluated opioid antagonists, with very low to low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.46, 95% CI -0.74 to -0.19, n = 259), but no difference between groups in responder status (RR 1.65, 95% CI 0.86 to 3.14, n = 562). Mood stabilisers: Two studies (n = 71) evaluated mood stabilisers (including anticonvulsants), with very low certainty evidence suggesting that mood stabilisers were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.92, 95% CI -2.24 to 0.39, n = 71), depressive symptoms (SMD -0.15, 95% CI -1.14 to 0.83, n = 71), and anxiety symptoms (SMD -0.17, 95% CI -0.64 to 0.30, n = 71). Atypical antipsychotics:Two studies (n = 63) evaluated the atypical antipsychotic olanzapine, with very low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.59, 95% CI -1.10 to -0.08, n = 63). Comparative effectiveness: Two studies (n = 62) compared antidepressants with opioid antagonists, with very low certainty evidence indicating that antidepressants were no more effective than opioid antagonists on depressive symptoms (SMD 0.22, 95% CI -0.29 to 0.72, n = 62) or anxiety symptoms (SMD 0.21, 95% CI -0.29 to 0.72, n = 62) at post-treatment. Two studies (n = 58) compared antidepressants with mood stabilisers (including anticonvulsants), with very low certainty evidence indicating that antidepressants were no more effective than mood stabilisers on depressive symptoms (SMD 0.02, 95% CI -0.53 to 0.56, n = 58) or anxiety symptoms (SMD 0.16, 95% CI -0.39 to 0.70, n = 58) at post-treatment. Tolerability and adverse events: Several common adverse effects were reported by participants receiving antidepressants (e.g. headaches, nausea, diarrhoea/gastrointestinal issues) and opioid antagonists (e.g. nausea, dry mouth, constipation). There was little consistency in the types of adverse effects experienced by participants receiving mood stabilisers (e.g. tiredness, headaches, concentration difficulties) or atypical antipsychotics (e.g. pneumonia, sedation, increased hypomania). Discontinuation of treatment due to these adverse events was highest for opioid antagonists (10% to 32%), followed by antidepressants (4% to 31%), atypical antipsychotics (14%), and mood stabilisers (13%). AUTHORS' CONCLUSIONS: This review provides preliminary support for the use of opioid antagonists (naltrexone, nalmefene) and atypical antipsychotics (olanzapine) to produce short-term improvements in gambling symptom severity, although a lack of available evidence precludes a conclusion regarding the degree to which these pharmacological agents can improve other gambling or psychological functioning indices. In contrast, the findings are inconclusive with regard to the effects of mood stabilisers (including anticonvulsants) in the treatment of disordered or problem gambling, and there is limited evidence to support the efficacy of antidepressants. However, these conclusions are based on very low to low certainty evidence characterised by a small number of included studies, high risk of bias, modest pooled sample sizes, imprecise estimates, moderate between-study heterogeneity, and exclusion of participants with psychiatric comorbidities. Moreover, there were insufficient studies to conduct meta-analyses on many outcome measures; to compare efficacy across and within major categories of interventions; to explore dosage effects; or to examine effects beyond post-treatment. These limitations suggest that, despite recommendations related to the administration of opioid antagonists in the treatment of disordered or problem gambling, pharmacological interventions should be administered with caution and with careful consideration of patient needs. A larger and more methodologically rigorous evidence base with longer-term evaluation periods is required before definitive conclusions can be drawn about the effectiveness and durability of pharmacological treatments for disordered or problem gambling.


Assuntos
Antipsicóticos , Jogo de Azar , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Jogo de Azar/tratamento farmacológico , Cefaleia , Humanos , Naltrexona , Antagonistas de Entorpecentes/uso terapêutico , Náusea/tratamento farmacológico , Olanzapina
20.
Rev Neurol ; 75(7): 189-197, 2022 Oct 01.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-36169325

RESUMO

INTRODUCTION: Neurodevelopmental disorders have a multifactorial etiology that results from the interaction between biological and environmental factors. The biological basis of many of these disorders is only partially understood, which makes therapeutic interventions, especially pharmacological ones, particularly difficult. The impact of medical cannabis on neurological and psychiatric disorders has been studied for a long time. This study aimed to review the currently available clinical and pre-clinical studies regarding the use of cannabinoids in pediatric neurodevelopmental disorders and to draw attention to the potential therapeutic role of cannabidiol in this field. DEVELOPMENT: Cannabidiol is an endocannabinoid system modulator and exerts its effects on both developing and mature brains through numerous mechanisms. Cannabidiol holds a relatively high toxicity limit and current literature suggests that it may have anxiolytic, antipsychotic, and neuroprotective properties. Clinical evidence suggests that early treatment with cannabidiol might be a promising therapy for neurodevelopmental disorders, including intellectual disability, autism spectrum disorders, tics, and attention/deficit hyperactivity disorder. CONCLUSIONS: This review hopefully draws attention to an emerging body of evidence concerning cannabidiol's significant potential to safely improve many of the common symptoms affecting children and adolescents with neurodevelopmental disorders, especially autism spectrum disorder.


TITLE: El papel de los cannabinoides en los trastornos del neurodesarrollo de niños y adolescentes.Introducción. Los trastornos del neurodesarrollo tienen una etiología multifactorial que resulta de la interacción entre factores biológicos y ambientales. La base biológica de muchos de estos trastornos se comprende sólo parcialmente, lo que hace que las intervenciones terapéuticas, especialmente las farmacológicas, sean particularmente difíciles. El impacto del cannabis medicinal en los trastornos neurológicos y psiquiátricos se ha estudiado durante mucho tiempo. Este estudio tuvo como objetivo revisar los estudios clínicos y preclínicos actualmente disponibles con respecto al uso de cannabinoides en trastornos del neurodesarrollo pediátrico y llamar la atención sobre el posible papel terapéutico del cannabidiol en este campo. Desarrollo. El cannabidiol es un modulador del sistema endocannabinoide y ejerce sus efectos tanto en cerebros en desarrollo como en cerebros maduros a través de numerosos mecanismos. El cannabidiol tiene un límite de toxicidad relativamente alto, y la bibliografía actual sugiere que puede tener propiedades ansiolíticas, antipsicóticas y neuroprotectoras. La evidencia clínica sugiere que el tratamiento temprano con cannabidiol podría ser una terapia prometedora para los trastornos del desarrollo neurológico, incluida la discapacidad intelectual, los trastornos del espectro autista, los tics y el trastorno por déficit de atención/hiperactividad. Conclusiones. Es de esperar que esta revisión llame la atención sobre un cuerpo emergente de evidencia sobre el potencial significativo del cannabidiol para mejorar de manera segura muchos de los síntomas comunes que afectan a niños y adolescentes con trastornos del neurodesarrollo, especialmente el trastorno del espectro autista.


Assuntos
Ansiolíticos , Antipsicóticos , Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Canabidiol , Canabinoides , Maconha Medicinal , Transtornos do Neurodesenvolvimento , Adolescente , Ansiolíticos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Espectro Autista/psicologia , Canabidiol/farmacologia , Canabidiol/uso terapêutico , Canabinoides/farmacologia , Canabinoides/uso terapêutico , Criança , Endocanabinoides , Humanos , Maconha Medicinal/uso terapêutico , Transtornos do Neurodesenvolvimento/tratamento farmacológico
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