RESUMO
Olanzapine treatment sometimes produces transient liver biochemistry abnormalities, and such drug-induced liver injuries are mainly monitored by measuring blood levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), whereas alpha-glutathione-S-transferase (α-GST) is not routinely measured in clinics, even though it can serve as an earlier and more specific biomarker of liver damage. Susceptibility to drug-induced liver injury can much depend on the gene polymorphisms regulating the activity of DNA detoxification and repair enzymes. The aim of this study was to evaluate which of the three liver enzymes - α-GST, ALT, and AST - is the most sensitive biomarker of olanzapine-induced liver injury and how their blood levels are affected by the GSTT1, GSTM1, GSTP1, and OGG1 gene polymorphisms in 30 olanzapine-treated patients. Contrary to our hypothesis, the increase in serum α-GST levels was not significantly greater than that of the transaminases. ALT turned out to be an earlier biomarker of liver injury than the other two enzymes. No significant association was found between gene polymorphisms and liver enzyme levels, save for GSTP1 Ile/Val + Val/Val and ALT, which points to this genotype as a risk factor for drug-induced liver injury. Future studies might help to identify the underlying mechanisms of transient liver enzyme increase associated with this genotype.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas , Polimorfismo Genético , Humanos , Olanzapina , Glutationa Transferase/genética , Glutationa S-Transferase pi/genética , Fatores de Risco , Biomarcadores , Doença Hepática Induzida por Substâncias e Drogas/genética , Estudos de Casos e Controles , Predisposição Genética para DoençaRESUMO
Objective: To evaluate the efficacy of cognitive behavioral therapy in the treatment of generalized anxiety disorder during pregnancy and its effects on gestational age and birth weight. Methods: The sample included 28 untreated patients and 23 patients treated with CBT. Psychiatric diagnoses were determined through the Structured Clinical Interview for the DSM-IV. Symptom severity was assessed with standardized rating scales. Results: Post-treatment levels of anxiety symptoms were significantly lower than baseline. There was no significant difference in gestational age or newborn birth weight between the cognitive behavioral therapy group and the untreated group. Conclusions: Cognitive behavioral therapy appears to be a safe and effective treatment for generalized anxiety disorder during pregnancy.