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1.
BMC Med ; 22(1): 274, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38956514

RESUMO

BACKGROUND: The COVID-19 pandemic has had a significant impact on mental health, with evidence suggesting an enduring mental health crisis. Studies worldwide observed increased usage of antidepressants, anxiolytics, and hypnotics during the pandemic, notably among young people and women. However, few studies tracked consumption post-2021. Our study aimed to fill this gap by investigating whether the surge in the number psychotropic drug consumers in France persisted 2 years after the first lockdown, particularly focusing on age and gender differences. METHODS: We conducted a national retrospective observational study based on the French national insurance database. We retrieved all prescriptions of anxiolytics, hypnotics, and antidepressants dispensed in pharmacies in France for the period 2015-2022. We performed interrupted time series analyses based on Poisson models for five age classes (12-18; 19-25; 26-50; 51-75; 76 and more) to assess the trend before lockdown, the gap induced and the change in trend after. RESULTS: In the overall population, the number of consumers remained constant for antidepressants while it decreased for anxiolytics and hypnotics. Despite this global trend, a long-term increase was observed in the 12-18 and 19-25 groups for the three drug classes. Moreover, for these age classes, the increases were more pronounced for women than men, except for hypnotics where the trends were similar. CONCLUSIONS: The number of people using antidepressants continues to increase more than 2 years after the first lockdown, showing a prolonged effect on mental health. This effect is particularly striking among adolescents and young adults confirming the devastating long-term impact of the pandemic on their mental health.


Assuntos
COVID-19 , Psicotrópicos , Humanos , França/epidemiologia , Feminino , COVID-19/epidemiologia , Estudos Retrospectivos , Adolescente , Adulto , Adulto Jovem , Pessoa de Meia-Idade , Psicotrópicos/uso terapêutico , Criança , Masculino , Idoso , Antidepressivos/uso terapêutico , Ansiolíticos/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Pandemias , SARS-CoV-2 , Fatores Sexuais
2.
J Int AIDS Soc ; 27(7): e26247, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38978392

RESUMO

INTRODUCTION: Despite the increasing availability of new psychoactive substances (hereafter referred to as "salts") in Eastern Europe and Central Asia, there is a dearth of epidemiological data on the relationship between injecting "salts" and HIV risk behaviours. This is particularly relevant in settings where injection drug use accounts for a substantial proportion of the HIV burden, such as in Kyrgyzstan, a former Soviet Republic. This study assessed whether injecting "salts" is associated with sexual and injection-related HIV risk behaviours among people who inject drugs in Kyrgyzstan. METHODS: The Kyrgyzstan InterSectional Stigma Study is a cohort of people who inject drugs in Kyrgyzstan's capital of Bishkek and the surrounding rural administrative division of Chuy Oblast. We conducted a cross-sectional analysis using survey data collected from cohort participants between July and November 2021, which included information on injection drug use (including "salts") and HIV risk behaviours. To minimize confounding by measured covariates, we used inverse-probability-weighted logistic and Poisson regression models to estimate associations between recent "salt" injection and HIV risk behaviours. RESULTS: Of 181 participants included in the analysis (80.7% men, 19.3% women), the mean age was 40.1 years (standard deviation [SD] = 8.8), and 22% (n = 39) reported that they had injected "salts" in the past 6 months. Among people who injected "salts," 72% (n = 28) were men, and most were ethnically Russian 59% (n = 23), with a mean age of 34.6 (SD = 9.6). Injecting "salts" was significantly associated with a greater number of injections per day (adjusted relative risk [aRR] = 1.59, 95% confidence interval [CI] = 1.30-1.95) but lower odds of using syringe service programmes in the past 6 months (adjusted odds ratio [aOR] = 0.20, 95% CI = 0.12-0.32). Injecting "salts" was also significantly associated with lower odds of condomless sex in the past 6 months (aOR = 0.42, 95% CI = 0.24-0.76) and greater odds of having ever heard of pre-exposure prophylaxis (aOR = 4.80, 95% CI = 2.61-8.83). CONCLUSIONS: (PWID) people who inject drugs who inject "salts" are a potentially emergent group with increased HIV acquisition risk in Kyrgyzstan. Targeted outreach bundled with comprehensive harm reduction and pre-exposure prophylaxis services are needed to prevent transmission of HIV and other blood-borne viruses.


Assuntos
Infecções por HIV , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa , Humanos , Masculino , Infecções por HIV/transmissão , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Adulto , Estudos Transversais , Feminino , Abuso de Substâncias por Via Intravenosa/epidemiologia , Quirguistão/epidemiologia , Adulto Jovem , Pessoa de Meia-Idade , Comportamento Sexual/estatística & dados numéricos , Estudos de Coortes , Adolescente , Psicotrópicos/administração & dosagem
3.
Psychopharmacol Bull ; 54(3): 8-59, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38993656

RESUMO

Introduction Since the last edition of the Black Book, several innovative agents have been approved or are poised to be approved in the coming year. These include novel antidepressants, the first muscarine agonist for the treatment of schizophrenia, the first psychedelic which may be approved for the treatment of PTSD (Post Traumatic Stress Disorder), and the first disease modifying drug for the treatment of Alzheimer's disease. Three new antidepressants have come to the market in the past 18 months. The first of those, Auvelity, the combination of bupropion and dextromethorphan, takes advantage of a pharmacokinetic and pharmacodynamic synergism between the two drugs.85 Dextromethorphan has several pharmacodynamic properties including actions on the NMDA receptor and the Sigma 1 receptor, adding to the indirect norepinephrine agonist properties of bupropion. How Dextromethorphan is rapidly metabolized via the CYP2D6 isoenzyme to dextrophan that may have mu opioid agonist properties. The combination with bupropion, a CYP2D6 inhibitor, inhibits the metabolism of dextromethorphan allowing for more consistent therapeutic levels. The combination of dextromethorphan 45 mg twice per day and bupropion SR 105 mg twice daily appears to be more effective than an equivalent dose of bupropion alone both in speeding up antidepressant response and achieving remission. However, it's not clear at this time how the combination would compare with a more typical dose of bupropion of 300-450 milligrams a day range. The phase III program for Auvelity, showed that the drug was well tolerated with the most common side effects being dizziness, headache, and dry mouth.86 Another novel antidepressant agent approved in 2023 is zuranolone (Zurzuvae). Zuranolone is an oral analog of IV brexanalone, and like brexanolone, was approved for the treatment of post-partum depression.83 The advantages of zuranolone over brexanalone are many. While brexanolone is a 60-hour intravenous infusion that must be administered in a health care facility, zuranolone is a once/day oral medication that is usually taken at home. Like brexanolone, and unlike most antidepressants, zuranolone has a short course of treatment, lasting just 14 days. Zuranolone's, as does brexanolone, is thought to act primarily as allosteric modulator of the GABA-a receptors. Despite only 14 days of treatment, zuranolone produced in depression in post-partum patients a clinically and significantly meaningful improvement at day 15 and continued to day 45 or 1 month past the end of treatment. Zuranolone is a schedule IV drug. The most common side effect in clinical trials was somnolence with 36% of participants reporting this side effect vs only 6% of those on placebo.84 Other common side effects included dizziness, diarrhea and fatigue. While the FDA declined to approve zuranolone as monotherapy or as an adjunctive treatment to standard antidepressants in major depression itself, there are positive studies in non-post-partum major depression albeit with smaller effect sizes and less consistent duration of activity. It is likely that zuranolone will continue to be studied in other depressive syndromes such as depression with anxious distress. The third "new" antidepressant approved late 2023 was gepirone (Exxua). Gepirone is not exactly a new or novel antidepressant and originally sought approval in the US about 20 years ago.88 There had been two positive studies of gepirone during the original NDA application but also a number of failed, negative, or non-informative studies as well. Thus, the FDA declined to originally approve the drug. However, failed and negative trials are common with antidepressants and after much internal debate, the FDA ultimately agreed to approve the drug based on the positive trials and a relatively favorable side effect profile. Gepirone, like buspirone, is a partial agonist of the 5HT1a receptor and a 5HT2 antagonist. As such, gepirone does not tend to be associated with sexual side effects, weight gain, or sedation. The most common side effects are dizziness, nausea, and insomnia which tend to improve in many patients over time. Second generation antipsychotics (SGAs) continue to be the only class of agents [other than esketamine (Spravato)] approved in adjunctive treatment of resistant major depression. In addition to olanzapine (combined with fluoxetine; Symbyax), aripiprazole (Abilify), quetiapine (Seroquel), brexpiprazole (Rexulti), cariprazine (Vraylar) became the latest SGA to be approved in 2022.90 Adjunctive cariprazine at 1.5 mg daily was significantly more effective than adjunctive placebo in patients with MDD who had failed to achieve an adequate response with an antidepressant alone after 6 weeks of treatment. Interestingly, a 3 mg dose of cariprazine was less consistently effective.91 The major advantage of cariprazine over some of the other approved adjunctive SGA's is easy dosing, with the starting 1.5 mg dose being the optimal therapeutic dose for most people, and a lower metabolic side effect burden with most subjects having limited or no weight gain in short term trials. The most common side effect were akathisia/restlessness, fatigue, and nausea. Lumateperone (Caplyta) is also has positive phase III data in the adjunctive treatment of major depression and is expective file for approval in late 2024. Another recent major development in psychopharmacology is the reemergence of psychedelics in the treatment of psychiatric disorders. The first of these is MDMA (phenethylamine 3,4-methylenedioxymethamphetamine) assisted psychotherapy for the treatment of PTSD. A New Drug Application (NDA) was accepted by the FDA for MDMA in the treatment of PTSD in late 2023.87 Because the drug is being fast tracked as a "breakthrough" treatment by the FDA, it was expected to see approval in the summer of 2024. The phase II and III data for MDMA assisted psychotherapy in the treatment of PTSD have been quite consistent and impressive. However, independent reviews have pointed to significant deficiencies in these studies including the bias introduced because of functional unblinding; virtually all patients in psychedelic studies can guess whether they got the active drug or placebo. The functional unblinding, the lack of standardization of adjunctive psychotherapy as well as the abuse potential of MDMA, may delay an FDA approval. The typical regimen in these trials included 3 preparatory psychotherapy sessions followed by once/month dosing sessions (lasting about 8 hours) and using doses of 120-160 mg in a split dose. There were typically 3 monthly dosing sessions, each followed by 3 integrative psychotherapy sessions to help subjects process and understand their experiences during the dosing sessions. In the most recent phase 3 trials, over 70% of subjects no longer met criteria for PTDS compared to 46% of those treated with psychotherapy and placebo alone.89 The only approved medications for treating PTSD are two SSRIs, paroxetine and sertraline. These drugs effect only some dimensions of PTSD with only 20-30% achieving a remission level response with these drugs. Thus, MDMA assisted psychotherapy appears to achieve much higher levels of remission and response than has been true for the SSRIs. Since MDMA is not taken continuously, side effects from MDMA tend to be short lived. Side effects have included muscle tightness, nausea, diminished appetite, excessive sweating, feeling cold and dizziness among others. Since MDMA is currently a schedule I drug, it is likely that a rigorous Risk Evaluation Mitigation (REMs) program will be put in place and a limited number of centers and clinicians will be designated to perform MDMA assisted psychotherapy for PTSD. In addition to MDMA, psilocybin-assisted psychotherapy is in phase 3 trials for treating resistant depression but unlikely to be available before late 2025 at the earliest. An argument can be made that there has not been a truly novel antipsychotic since the introduction of clozapine in the US in 1990. All first-generation antipsychotics have been dopamine 2 antagonists and second-generation drugs have involved some ratio of 5HT2 antagonism to D2 blockade. In 2023, the FDA accepted the application of xenomaline/tropsium (KarXT) which may become the first muscarinic M1M4 agonist approved for the treatment of schizophrenia.82,83 Tropsium is added as a muscarine antagonist to block the peripheral cholinergic effects of a muscarine agonist. Xenomaline/tropsium appears to be effective in treating both positive and negative symptoms of schizophrenia. In a phase 3 study of 407 patients with schizophrenia, xenomaline/tropsium at doses of xenomaline/50 mg/tropsium 20 mg twice daily up to 125 mg/30 mg twice daily was significantly more effective than placebo in treating both and negative symptoms over 5 weeks of treatment. As would be expected, the side effect profile of xenomaline/tropsium is very different that all currently available antipsychotics. There is no risk of EPS as it is not a dopamine antagonist, and xenomaline/tropsium is not associated with significant metabolic effects. The side effects are cholinergic in nature and include constipation, dry mouth, and nausea. A decision is expected in September of 2024. The year 2023 also saw the approval of the first disease modifying drug in the treatment of Alzheimer's disease, lecanemab (Lequembi). While acetylcholinesterase inhibitors and memantine have been available for decades, these drugs modestly improve cognition in Alzheimer's disease patients and do not alter the progressive course of the illness. Lecanemab is an IV monoclonal antibody that targets the removal of beta-amyloid in the brain as well proto-fibrils that are also known to be toxic to neuronal tissue. When given early in the course of the illness, patients treated with Lecanemab showed 27% less decline on some measures of cognition and function thandid patients treated with a placebo over 18 months (about 1 and a half years). It is not known whether treatment for longer than 18 months would show lesser or greater decline over time. However, there are simulation studies that suggest that Lecanemab may modestly reduce the number of patients who progress to severe Alzheimer's disease and require institutional care. The standard dose is 10 mg/kg given via IV over one hour every 2 weeks for 18 months. Lecanemab is typically administered in an infusion center so that side effects can be monitored. The most serious side effects of Lecanemab are amyloid related imaging abnormalities (ARIA) that are associated with brain edema and microhemorrhages. ARIA can occur in up to 15% of patients. More common side effects are headache and nausea. While it remains to be seen how useful these new agents will be in clinical practice, they do represent an approach to treating neuropsychiatric disorders that are a notable departure from the pharmacotherapy of the past half century. It seems likely that some patients who have not been able to respond to or tolerate traditional pharmacotherapy will find hope in these new medications.


Assuntos
Dextrometorfano , Humanos , Dextrometorfano/administração & dosagem , Dextrometorfano/farmacologia , Psicotrópicos/administração & dosagem , Psicotrópicos/farmacologia , Psicotrópicos/farmacocinética , Monitoramento de Medicamentos/métodos , Antidepressivos/administração & dosagem , Antidepressivos/farmacologia
4.
Psychooncology ; 33(7): e6369, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38960607

RESUMO

OBJECTIVE: Prostate cancer can significantly impact mental wellbeing, creating uncertainty and morbidity. This study described patterns of psychotropic medication and mental health service use, as a proxy measure for mental health problems, 5 years before and 5 years after prostate cancer diagnosis. METHODS: Population-based registry data were linked with Pharmaceutical Benefits Scheme and Medicare Benefits Schedule data for all prostate cancer patients diagnosed in South Australia between 2012 and 2020 (n = 13,693). We estimated the proportion and rates of psychotropic medication and mental health service use before and after diagnosis. Multivariable adjusted interrupted time series analyses (ITSA) were conducted to uncover temporal patterns. RESULTS: Fifteen percent of men commenced psychotropic medications and 6.4% sought out mental health services for the first time after diagnosis. Psychotropic medication use rose from 34.5% 5 years before to 40.3% 5 years after diagnosis, including an increase in use of antidepressants (from 20.7% to 26.0%) and anxiolytics (from 11.3% to 12.8%). Mental health service use increased from 10.2% to 12.1%, with the increase mostly being general practice mental health visits (from 7.8% to 10.6%). Multivariable ITSA indicated a significant rise in medication and service utilisation immediately before and in the first 2 years following prostate cancer diagnosis. CONCLUSION: There is a clear increase in psychotropic medication use and mental health service use around the time of prostate cancer diagnosis. Mental health outcomes of men with prostate cancer may be improved with early mental health screening, particularly during the diagnosis process, to enable early intervention.


Assuntos
Serviços de Saúde Mental , Neoplasias da Próstata , Psicotrópicos , Humanos , Masculino , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/terapia , Idoso , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Psicotrópicos/uso terapêutico , Austrália do Sul , Idoso de 80 Anos ou mais , Saúde Mental , Transtornos Mentais/epidemiologia , Transtornos Mentais/tratamento farmacológico , Sistema de Registros , Análise de Séries Temporais Interrompida , Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
6.
Int J Mol Sci ; 25(11)2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38892053

RESUMO

This study reports the first application of in silico methods to assess the toxicity of 4-chloromethcathinone (4-CMC), a novel psychoactive substance (NPS). Employing advanced toxicology in silico tools, it was possible to predict crucial aspects of the toxicological profile of 4-CMC, including acute toxicity (LD50), genotoxicity, cardiotoxicity, and its potential for endocrine disruption. The obtained results indicate significant acute toxicity with species-specific variability, moderate genotoxic potential suggesting the risk of DNA damage, and a notable cardiotoxicity risk associated with hERG channel inhibition. Endocrine disruption assessment revealed a low probability of 4-CMC interacting with estrogen receptor alpha (ER-α), suggesting minimal estrogenic activity. These insights, derived from in silico studies, are critical in advancing the understanding of 4-CMC properties in forensic and clinical toxicology. These initial toxicological findings provide a foundation for future research and aid in the formulation of risk assessment and management strategies in the context of the use and abuse of NPSs.


Assuntos
Simulação por Computador , Psicotrópicos , Psicotrópicos/toxicidade , Psicotrópicos/química , Humanos , Animais , Cardiotoxicidade/etiologia , Propiofenonas/toxicidade , Propiofenonas/química , Receptor alfa de Estrogênio/metabolismo , Disruptores Endócrinos/toxicidade , Disruptores Endócrinos/química , Dano ao DNA/efeitos dos fármacos
7.
AAPS J ; 26(4): 70, 2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38862871

RESUMO

Synthetic cathinones represent one of the largest and most abused new psychoactive substance classes, and have been involved in numerous intoxications and fatalities worldwide. Methcathinone analogues like 3-methylmethcathinone (3-MMC), 3-chloromethcathinone (3-CMC), and 4-CMC currently constitute most of synthetic cathinone seizures in Europe. Documenting their consumption in clinical/forensic casework is therefore essential to tackle this trend. Targeting metabolite markers is a go-to to document consumption in analytical toxicology, and metabolite profiling is crucial to support investigations. We sought to identify 3-CMC, 4-CMC, and 4-bromomethcathinone (4-BMC) human metabolites. The substances were incubated with human hepatocytes; incubates were screened by liquid chromatography-high-resolution tandem mass spectrometry and data were mined with Compound Discoverer (Themo Scientific). 3-CMC-positive blood, urine, and oral fluid and 4-CMC-positive urine and saliva from clinical/forensic casework were analyzed. Analyses were supported by metabolite predictions with GLORYx freeware. Twelve, ten, and ten metabolites were identified for 3-CMC, 4-CMC, and 4-BMC, respectively, with similar transformations occurring for the three cathinones. Major reactions included ketoreduction and N-demethylation. Surprisingly, predominant metabolites were produced by combination of N-demethylation and ω-carboxylation (main metabolite in 3-CMC-positive urine), and combination of ß-ketoreduction, oxidative deamination, and O-glucuronidation (main metabolite in 4-CMC-positive urine). These latter metabolites were detected in negative-ionization mode only and their non-conjugated form was not detected after glucuronide hydrolysis; this metabolic pathway was never reported for any methcathinone analogue susceptible to undergo the same transformations. These results support the need for comprehensive screening strategies in metabolite identification studies, to avoid overlooking significant metabolites and major markers of consumption.


Assuntos
Hepatócitos , Humanos , Hepatócitos/metabolismo , Hepatócitos/efeitos dos fármacos , Espectrometria de Massas em Tandem/métodos , Propiofenonas/farmacocinética , Propiofenonas/metabolismo , Cromatografia Líquida/métodos , Detecção do Abuso de Substâncias/métodos , Metanfetamina/análogos & derivados , Metanfetamina/metabolismo , Metanfetamina/administração & dosagem , Metanfetamina/farmacocinética , Psicotrópicos/farmacocinética , Psicotrópicos/metabolismo , Psicotrópicos/administração & dosagem , Metabolômica/métodos , Alcaloides/metabolismo , Drogas Ilícitas
8.
J Appl Res Intellect Disabil ; 37(4): e13266, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38863266

RESUMO

BACKGROUND: Prader-Willi syndrome (PWS) is commonly associated with intellectual disability, but also with a specific behavioural phenotype and a high predisposition to psychiatric comorbidity. This study examines the psychiatric care situation of people with PWS. METHOD: A structured online questionnaire was administered to carers of people with PWS living in Germany, asking about demographic, diagnostic and treatment parameters as well as personal experiences. RESULTS: Of 77 people with PWS, 44.2% had at least one psychiatric comorbid diagnosis. The main reasons for seeking psychiatric care were emotional outbursts and aggressive behaviour. 34.9% reported that they were currently seeking psychiatric care without success. However, 32.5% of PWS had been treated with psychotropic medication, mainly antipsychotics. CONCLUSIONS: Psychiatric comorbidity appears to be undertreated in PWS, especially in the ambulatory setting. Uncertainty among mental health care providers may also lead to frequent off-label use of psychotropic medications.


Assuntos
Comorbidade , Transtornos Mentais , Síndrome de Prader-Willi , Humanos , Síndrome de Prader-Willi/tratamento farmacológico , Masculino , Feminino , Adulto , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Adulto Jovem , Alemanha/epidemiologia , Adolescente , Psicotrópicos/uso terapêutico , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde
9.
Open Biol ; 14(6): 240063, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38864245

RESUMO

Frontotemporal lobe abnormalities are linked to neuropsychiatric disorders and cognition, but the role of cellular heterogeneity between temporal lobe (TL) and frontal lobe (FL) in the vulnerability to genetic risk factors remains to be elucidated. We integrated single-nucleus transcriptome analysis in 'fresh' human FL and TL with genetic susceptibility, gene dysregulation in neuropsychiatric disease and psychoactive drug response data. We show how intrinsic differences between TL and FL contribute to the vulnerability of specific cell types to both genetic risk factors and psychoactive drugs. Neuronal populations, specifically PVALB neurons, were most highly vulnerable to genetic risk factors for psychiatric disease. These psychiatric disease-associated genes were mostly upregulated in the TL, and dysregulated in the brain of patients with obsessive-compulsive disorder, bipolar disorder and schizophrenia. Among these genes, GRIN2A and SLC12A5, implicated in schizophrenia and bipolar disorder, were significantly upregulated in TL PVALB neurons and in psychiatric disease patients' brain. PVALB neurons from the TL were twofold more vulnerable to psychoactive drugs than to genetic risk factors, showing the influence and specificity of frontotemporal lobe differences on cell vulnerabilities. These studies provide a cell type resolved map of the impact of brain regional differences on cell type vulnerabilities in neuropsychiatric disorders.


Assuntos
Lobo Frontal , Transtornos Mentais , Psicotrópicos , Lobo Temporal , Humanos , Psicotrópicos/farmacologia , Lobo Frontal/metabolismo , Lobo Frontal/patologia , Lobo Temporal/metabolismo , Lobo Temporal/patologia , Transtornos Mentais/genética , Transtornos Mentais/metabolismo , Neurônios/metabolismo , Receptores de N-Metil-D-Aspartato/metabolismo , Receptores de N-Metil-D-Aspartato/genética , Predisposição Genética para Doença , Perfilação da Expressão Gênica , Transcriptoma , Regulação da Expressão Gênica , Esquizofrenia/genética , Esquizofrenia/metabolismo , Transtorno Bipolar/genética , Transtorno Bipolar/metabolismo
10.
PLoS One ; 19(6): e0305392, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38870104

RESUMO

The use of psychotropic drugs among students is well known, but very few studies have been carried out outside North America, and data on Switzerland are particularly scarce. This study investigates the factors that determine the use of drugs and psychotropic substances among students at the University of Lausanne. Our hypotheses were that study pressure could lead to psychotropic drug use; that use could be either regular or experimental; and that users and non-users would have different opinions about the reasons for use and the consequences. Based on a convenience sample (n = 1199) collected by Master's students from other university students as part of a course given in 2019, our three hypotheses were confirmed. The use of psychotropic drugs is well associated with poorer academic performance. Regarding frequency of use, certain types of psychotropic drugs are used regularly (e.g. antidepressants), while others are used on occasionally (e.g. tranquilizers). Psychotropic substances such as cannabis and cocaine, on the other hand, are mainly used irregularly. Finally, the majority of psychotropic drug users report that they use them as part of their medical treatment, while the majority of non-users suggest that they use them mainly to reduce anxiety and stress in everyday life and at school. Our results show that Switzerland, like other countries, is affected by the phenomenon of psychotropic drug use by students, even outside medical supervision. Accordingly, better information on the negative effects of these substances should then be provided to all university students.


Assuntos
Psicotrópicos , Estudantes , Humanos , Suíça , Psicotrópicos/uso terapêutico , Estudantes/psicologia , Universidades , Masculino , Feminino , Adulto Jovem , Adulto , Adolescente , Inquéritos e Questionários , Ansiedade
11.
J Forensic Sci ; 69(4): 1392-1399, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38853356

RESUMO

Novel psychoactive substances (NPS) are everchanging and plague forensic laboratories who must identify an unending variety of emerging substances and evolve current methodologies to detect these substances. Identifying potential regional NPS targets and timely examining trends in seized drug data could help mitigate the burden laboratories face. Over 17 months, NPS seized drug data were processed and categorized from three laboratories located across the United States to determine any NPS regional similarities and prevalent NPS drug categories: the South Carolina Law Enforcement Division (SLED), the Sedgwick County Regional Forensic Science Center (SCRFSC), and the Orange County Crime Laboratory (OCCL). Seized drug materials, including pills, powders, and plant material, were primarily analyzed for NPS via gas chromatography-mass spectrometry and Fourier transform infrared spectroscopy. From June 2022 to October 2023, 1940 NPS seized drug identifications were reported by these laboratories with 63 different NPS reported. Novel synthetic opioids (NSO) were the most prevalent NPS class across all three laboratories (55%), with fluorofentanyl accounting for 74% of NSO identifications. This is unsurprising given the fentanyl epidemic in the United States. Furthermore, these data highlighted varying regional NPS seized drug trends: eutylone, a synthetic cathinone, was one of the most frequently identified NPS in SLED, SCRFSC observed the most diverse set of synthetic cannabinoids, and OCCL observed an increased prevalence in the designer benzodiazepine, bromazolam. NPS scope recommendations are a valuable resource for forensic laboratories; however, most focus on a national perspective. Timely analysis and reporting of NPS seized drug data may help to develop regional NPS scope recommendations laboratories may employ.


Assuntos
Toxicologia Forense , Cromatografia Gasosa-Espectrometria de Massas , Drogas Ilícitas , Psicotrópicos , Humanos , Psicotrópicos/análise , Drogas Ilícitas/análise , Toxicologia Forense/métodos , Estados Unidos , Espectroscopia de Infravermelho com Transformada de Fourier , Laboratórios , Canabinoides/análise
12.
Forensic Sci Int ; 360: 112074, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823217

RESUMO

Synthetic cathinones, which are novel psychoactive substances, have caused major social problems worldwide. A substance called 2-methyl-4'-(methylthio)-2-morpholinopropiophenone (MMMP), which is employed as a commercial industrial photoinitiator for triggering polymerization, has a basic cathinone backbone; however, few reports regarding MMMP have been published. In the current study, three potential metabolites of MMMP-namely hydroxy-MMMP (HO-MMMP), HO-MMMP-sulfoxide (HO-MMMP-SO), and HO-MMMP-sulfone (HO-MMMP-SO2)-were successfully synthesized, and MMMP and these three potential metabolites were used as standards to establish an analytic method based on liquid chromatography-tandem mass spectrometry for the quantitative analysis of urine. This analytic method and related parameters-including dynamic range, limit of quantification, selectivity, precision, accuracy, carryover effect, matrix effect, interference, and dilution integrity-were optimized and validated. Forty urine samples from 1,691 individuals who abused drugs were determined to contain MMMP, HO-MMMP, HO-MMMP-SO, or HO-MMMP-SO2; the results of this study indicate that approximately 2.37 % of drug abusers in Taiwan consumed MMMP in 2023. These 40 urine samples were analyzed to investigate the metabolism of MMMP in humans. The results indicate that HO-MMMP-SO is the main metabolite in human urine. This study recommends HO-MMMP-SO with a concentration of 2 ng/mL as a target and cutoff value, respectively, for identifying individuals who have consumed MMMP.


Assuntos
Psicotrópicos , Espectrometria de Massas em Tandem , Humanos , Psicotrópicos/urina , Psicotrópicos/análise , Cromatografia Líquida , Propiofenonas/urina , Detecção do Abuso de Substâncias/métodos , Drogas Ilícitas/análise , Morfolinas/urina , Morfolinas/análise , Limite de Detecção
13.
Int J Mol Sci ; 25(12)2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38928021

RESUMO

Drug repurposing, rebranding an existing drug for a new therapeutic indication, is deemed a beneficial approach for a quick and cost-effective drug discovery process by skipping preclinical, Phase 1 trials and pharmacokinetic studies. Several psychotropic drugs, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), were studied for their potential application in different diseases, especially in cancer therapy. Fluoxetine (FLX) is one of the most prescribed psychotropic agents from the SSRIs class for the treatment of several neuropsychiatric disorders with a favorable safety profile. FLX exhibited different oncolytic effects via mechanisms distinct from its main serotonergic activity. Taking advantage of its ability to rapidly penetrate the blood-brain barrier, FLX could be particularly useful in brain tumors. This was proved by different in vitro and in vivo experiments using FLX as a monotherapy or combination with temozolomide (TMZ) or radiotherapy. In this review of the literature, we summarize the potential pleiotropic oncolytic roles of FLX against different cancers, highlighting the multifaceted activities of FLX and its ability to interrupt cancer proliferation via several molecular mechanisms and even surmount multidrug resistance (MDR). We elaborated on the successful synergistic combinations such as FXR/temozolomide and FXR/raloxifene for the treatment of glioblastoma and breast cancer, respectively. We showcased beneficial pharmaceutical trials to load FLX onto carriers to enhance its safety and efficacy on cancer cells. This is the first review article extensively summarizing all previous FLX repurposing studies for the management of cancer.


Assuntos
Reposicionamento de Medicamentos , Fluoxetina , Humanos , Reposicionamento de Medicamentos/métodos , Fluoxetina/uso terapêutico , Fluoxetina/farmacologia , Animais , Neoplasias/tratamento farmacológico , Antineoplásicos/uso terapêutico , Antineoplásicos/farmacologia , Psicotrópicos/uso terapêutico , Psicotrópicos/farmacologia , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Inibidores Seletivos de Recaptação de Serotonina/farmacologia
14.
Nihon Yakurigaku Zasshi ; 159(4): 225-228, 2024.
Artigo em Japonês | MEDLINE | ID: mdl-38945905

RESUMO

Growing evidence has indicated that delta opioid receptor (DOP) agonists are potential psychotropic drugs such as for depression, anxiety, and PTSD. In rodent studies, we have also demonstrated that DOP agonists exhibit potent anxiolytic-like effects via the inhibition of the excitatory neuronal activity which projects to the amygdala from the prelimbic prefrontal cortex and facilitate extinction learning of contextual fear memory through PI3K-Akt signaling pathway in the infralimbic prefrontal cortex and MEK-ERK signaling pathway in the amygdala. In this article, we introduce the functional mechanisms underlying antidepressant-like effects and anti-stress effects of DOP agonists. Then, we employed a valid animal model of depression, chronic vicarious social defeat stress (cVSDS) mice, and investigated that the influence of DOP activation on pathopsychological factors in depression such as the adult hippocampal neurogenesis, hypothalamic-pituitary-adrenal (HPA) axis, and neuroinflammation. First, repeated administrations after the stress period to cVSDS mice with a selective DOP agonist, KNT-127, improved social interaction behaviors and reduced hyperactivation of the HPA axis without affecting hippocampal neurogenesis. Meanwhile, repeated KNT-127 administrations during the cVSDS period prevented the exacerbation of social interaction behaviors, dysregulation of the HPA axis, and excessive new-born neuronal cell death in the hippocampal dentate gyrus. Moreover, in both administration paradigms, KNT-127 suppressed microglial overactivation in the dentate gyrus of cVSDS mice. These results indicate that the underlying mechanism of DOP-induced antidepressant-like effects differ from those of conventional monoaminergic antidepressants. Furthermore, we propose that DOP agonists might have prophylactic effects as well as therapeutic effects on pathophysiological changes in depression.


Assuntos
Psicotrópicos , Receptores Opioides delta , Animais , Receptores Opioides delta/agonistas , Receptores Opioides delta/metabolismo , Psicotrópicos/farmacologia , Humanos , Camundongos , Estresse Psicológico/tratamento farmacológico
15.
Ann Med ; 56(1): 2357232, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38833339

RESUMO

INTRODUCTION: Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. METHODS: Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. RESULTS: The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). CONCLUSIONS: Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.


Assuntos
Benzodiazepinas , Prescrição Inadequada , Casas de Saúde , Polimedicação , Humanos , Casas de Saúde/estatística & dados numéricos , Benzodiazepinas/uso terapêutico , Benzodiazepinas/efeitos adversos , Benzodiazepinas/administração & dosagem , Prescrição Inadequada/estatística & dados numéricos , Masculino , Feminino , Idoso de 80 Anos ou mais , Idoso , Croácia/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Prevalência , Psicotrópicos/uso terapêutico , Psicotrópicos/efeitos adversos , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/normas
16.
Sci Rep ; 14(1): 14257, 2024 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-38902395

RESUMO

It is well-recognized that individuals with alcohol-related disorders often use other psychoactive substances; however, systematic research on this topic remains limited. The primary objective was to determine the prevalence of lifetime psychoactive substance use and describe the dependence between concurrent use of alcohol and other drugs on psychiatric comorbidities in the analyzed group. The secondary aim was to try to assess the frequency of seeking psychiatric treatment between individuals declaring the concurrent use of alcohol with other drugs and those declaring the use only alcohol. The study was designed as a retrospective cross-sectional analysis based on discharge reports from psychiatric patients admitted to the Regional Psychiatric Hospital in Olsztyn, Poland. 1015 cases were included and analyzed in the study. Data for the study were collected in specially designed monitoring cards from discharge reports including data from psychiatric examinations, especially anamnesis. The percentage of people declaring lifetime use of psychoactive substances was 17.6%. 2.8% of them were diagnosed with substance-related disorders (F11-19 according to ICD-10). The most frequently declared use was cannabis, followed by amphetamine-type substances, benzodiazepines and new psychoactive substances. In the group of people declaring the lifetime use of psychoactive substances, 13.4% were additionally diagnosed with mental disorders. It was, consequently, 8% in the group of people denying the lifetime use of psychoactive substances. People declaring lifetime use of psychoactive substances were significantly more likely to seek psychiatric treatment, i.e. they were admitted significantly more often on an emergency admission than on an elective one, these people were significantly more likely to have undergone psychiatric treatment in the past and were more often hospitalized in our center during the research period. People who concurrently use alcohol with other drugs significantly more often have psychiatric comorbidity than people who deny the use of other drugs. That group also visibly more often seeks psychiatric treatment than patients who deny taking psychoactive substances.


Assuntos
Alcoolismo , Comorbidade , Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Humanos , Masculino , Feminino , Adulto , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Estudos Transversais , Estudos Retrospectivos , Alcoolismo/epidemiologia , Polônia/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Psicotrópicos/uso terapêutico , Adulto Jovem , Adolescente , Idoso
17.
RECIIS (Online) ; 18(2)abr.-jun. 2024.
Artigo em Português | LILACS, Coleciona SUS | ID: biblio-1561661

RESUMO

Este artigo traz reflexões com base no acervo virtual da Folha de S.Paulo, identificando representações do usuário de substâncias psicoativas veiculadas pelo jornal no período da Ditadura Militar brasileira, anos notáveis por aspectos políticos, culturais, jurídico-legais e médicos diretamente associados às drogas. Nesse contexto, foram selecionadas notícias sobre o assunto veiculadas pela Folha, dada a sua ascensão nacional, na década de 1960, pela fusão da Folha da Manhã e da Folha da Noite, e como empresa de mídia aliada do governo ditatorial. Para isso, foram feitas consultas ao repositório virtual do jornal usando adjetivos que referenciam quem utiliza substâncias psicoativas: "drogado", "toxicômano", "usuário de drogas", "usuário de entorpecentes", "viciado em drogas" e "dependente químico"). Surgiram duas categorias: saúde e crime. Delas derivam as representações do usuário de drogas. Ao longo do texto, reflete-se sobre os processos de sua visibilidade e estigmatização e a maneira como isso impacta atualmente. Reflete-se ainda sobre o caráter democrático do acesso ao repositório digital do jornal, bem como sobre os atuais movimentos nostálgicos do ufanismo existente no período ditatorial e seus impactos nas políticas de drogas.


This article reflects on the virtual archive of Folha de S.Paulo, identifying representations of psychoactive substance users published by that newspaper during the Brazilian Military Dictatorship, years notable for the political, cultural, legal and medical aspects directly associated with drugs. In this context, news on the subject published by Folha was selected, given its national rise in the 1960s through the merger of Folha da Manhã and Folha da Noite, and as a media company allied with the dictatorial government. To do this, the newspaper's virtual repository was searched using adjectives that refer to those who use psychoactive substances: "drugged", "drug addict", "drug user", "illegal narcotics user", "hooked on drugs" and "chemical dependent"). Two categories emerged: health and crime. The representations of drug users derive from these. Throughout this text, we reflect on the processes of their visibility and stigmatisation and the way in which this has an impact today. We also reflect on the democratic nature of access to the newspaper's digital repository, as well as the current nostalgic movements for chauvinism that existed during the dictatorial period and their impact on drug policies.


Este artículo aporta reflexiones basadas en el acervo virtual de la Folha de S.Paulo, identificando las re-presentaciones de los usuarios de sustancias psicoactivas publicadas por el periódico durante la Dictadura Militar brasileña, años destacados por los aspectos políticos, culturales, jurídicos y médicos directamente asociados a las drogas. En este contexto, fueron seleccionadas noticias sobre el tema publicadas por la Folha, dada su proeminencia nacional en la década de 1960 a través de la fusión de Folha da Manhã y Folha da Noite, y como medio de comunicación aliado del gobierno dictatorial. Para hacerlo, se realizó una búsqueda en el repositorio virtual del periódico utilizando adjetivos que hacen referencia a quien consume sustancias psicoactivas: "yonqui", "toxicómano", "usuario de drogas", "usuario de estupefacientes", "dro-gadicto" y "químicamente dependiente"). Surgieron dos categorías: salud y crimen. De ellas se derivan las representaciones de los usuarios de drogas. A lo largo del texto, reflexionamos sobre los procesos de su visibilidad y estigmatización y la forma como esto repercute en la actualidad. También reflexionamos sobre el carácter democrático del acceso al repositorio digital del periódico, así como sobre los actuales movi-mientos nostálgicos del ufanismo que existió durante la dictadura y su impacto en las políticas de drogas.


Assuntos
Psicotrópicos , Autoritarismo , Brasil , Jornalismo , Jornais como Assunto , Transtornos Relacionados ao Uso de Substâncias , Usuários de Drogas
18.
Artigo em Inglês | MEDLINE | ID: mdl-38728674

RESUMO

Objective: To examine the complexities of psychotropic medication prescription in home-based palliative care for oncology patients.Methods: A retrospective analysis of 125 medical records of patients receiving palliative home care for cancer was conducted at a tertiary hospital, with a specific focus on the prescription patterns of psychotropic medications. The data were collected in September 2023.Results: Among 125 cases, the mean age was 64.4 ± 14.9 years, with 50.4% females. Breast cancer (14.4%) and lung cancer (13.6%) were the most common diagnoses. Psychotropic medication was administered to 35.2% of patients. Treatment was initiated by palliative care doctors in 75% of cases, while psychiatrists handled 25%. Medication selection was predominantly symptom driven (63%), with anxiety prompting benzodiazepine prescriptions in 50% of cases, depression resulting in antidepressant use in 22%, and psychosis leading to antipsychotic treatment in 18%. Specific diagnoses were the target in only 36% of prescriptions, with delirium (27%) being the most prevalent, followed by depression and bipolar disorder. Benzodiazepines were the most commonly prescribed class of medications (56.8%), with clonazepam being the most prevalent (40.9%), followed by alprazolam and lorazepam (15.9%). Atypical antipsychotics made up 43.1% of prescriptions, with quetiapine being the most frequently prescribed (34%), along with olanzapine and risperidone (11%). Antidepressants accounted for 31.8% of prescriptions, including selective serotonin reuptake inhibitors at 18% and mirtazapine and amitriptyline at 6% each. Haloperidol, a typical antipsychotic, was prescribed in 13.6% of cases. Polypharmacy was observed in 35.6% of patients.Conclusion: In palliative home care, psychotropic medications are frequently prescribed by palliative doctors primarily for symptom management, with limited psychiatric consultations and challenges in accessing psychological evaluations. Collaborative efforts among regional or institutional medical bodies, including psychiatrists, psychologists, palliative doctors, and social workers, are needed to establish ethical guidelines for appropriate and effective psychotropic prescription.Prim Care Companion CNS Disord 2024;26(2):23m03668. Author affiliations are listed at the end of this article.


Assuntos
Serviços de Assistência Domiciliar , Neoplasias , Cuidados Paliativos , Psicotrópicos , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Psicotrópicos/uso terapêutico , Idoso , Neoplasias/tratamento farmacológico , Neoplasias/complicações , Prescrições de Medicamentos/estatística & dados numéricos , Adulto , Idoso de 80 Anos ou mais , Padrões de Prática Médica/estatística & dados numéricos
19.
Rev Prat ; 74(4): 420-426, 2024 Apr.
Artigo em Francês | MEDLINE | ID: mdl-38814039

RESUMO

COMMON PHYSICAL HEALTH PROBLEMS IN PSYCHIATRY. Somatic psychiatric care is particularly important as life expectancy declines of 13 to 16 years among individuals with severe mental disorders, primaly due to cardiovascular and cancer-related diseases. They face a triple burden: their mental disorders, reduced life expectancy and limited healthcare access. Common comorbidities related to psychotropic medications, lifestyle and the mental condition itself, affect various organs with complex clinical expressions. The multidimensional vulnerability is attributable to the side-effects of psychotropic drugs, mental disorders, and healthcare system fragmentation, hindering access to care. The proposed solutions aim for a better integration of mental health into general healthcare, with increased awareness among caregivers for a holistic approach to health.


PROBLÈMES COURANTS DE SANTÉ PHYSIQUE EN PSYCHIATRIE. Les soins somatiques en psychiatrie revêtent une importance particulière en raison de la réduction de treize à seize ans de l'espérance de vie chez les personnes atteintes de troubles mentaux sévères, principalement à cause de pathologies cardiovasculaires et cancéreuses. Elles sont exposées à une triple peine : leurs troubles psychiques, la réduction de leur espérance de vie et un accès limité aux soins. Les comorbidités courantes, liées aux psychotropes, au mode de vie et à la pathologie mentale elle-même, touchent divers organes, avec des expressions cliniques complexes. La vulnéra bilité multidimensionnelle de ces patients est attribuable aux effets indésirables des psychotropes, aux troubles psychiques et au cloisonnement du système de santé nuisant à l'accès aux soins. Les solutions proposées visent une meilleure intégration du volet santé mentale dans les soins généraux, avec une sensibilisation accrue des soignants à une approche holistique de la santé.


Assuntos
Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Psicotrópicos/uso terapêutico , Psicotrópicos/efeitos adversos , Doenças Cardiovasculares , Comorbidade , Neoplasias/complicações
20.
Cardiovasc Toxicol ; 24(7): 700-709, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38819736

RESUMO

Cardiovascular disease is a major global burden and a leading cause of premature death among patients with severe mental illness. Over time, research and clinical practice have paid increased attention to the impact of psychiatric medications on cardiac repolarization. In a resource-limited setting, it is common for psychotropic medications to be initiated and maintained in an outpatient setting without baseline or follow up ECG. This study evaluated the determinants and predictors of QT abnormalities among patient taking psychotropic drugs. We conducted a cross-sectional study in a population of 150 psychiatric patients on psychotropics and 75 controls. We studied the effects of various psychotropic drugs on QT dispersion (QTd) and corrected QT interval (QTc) as well as correlation with the types and dosages of psychotropic drugs used. All the subjects had detailed clinical examination and resting electrocardiogram (ECG) at 25 mm/sec done. QTc was determined using Bazett formula and QTd was determined by subtracting shortest from longest QT in 12-lead ECG. The prevalence of prolonged QTc and QTd as well as the mean QTc and QTd were significantly higher in patients than the control group. The mean QTc was significantly higher in patient on typical antipsychotics compared to those on atypical antipsychotics. Age, heart rate and antipsychotic dose in chlorpromazine equivalent were predictors of QTc with the heart rate being the most powerful predictor among them. Psychotropic drugs use is associated with QTc and QTd prolongation with age, heart rate and antipsychotic dose as predictors of QTc.


Assuntos
Antipsicóticos , Eletrocardiografia , Frequência Cardíaca , Síndrome do QT Longo , Centros de Atenção Terciária , Humanos , Nigéria/epidemiologia , Masculino , Feminino , Estudos Transversais , Adulto , Frequência Cardíaca/efeitos dos fármacos , Pessoa de Meia-Idade , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/fisiopatologia , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/epidemiologia , Fatores de Risco , Antipsicóticos/efeitos adversos , Estudos de Casos e Controles , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/fisiopatologia , Psicotrópicos/efeitos adversos , Medição de Risco , Prevalência , Adulto Jovem , Potenciais de Ação/efeitos dos fármacos , Fatores Etários
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