Differences in autonomic nervous system activity between long-acting injectable aripiprazole and oral aripiprazole in schizophrenia.

BACKGROUND: Distinct oral atypical antipsychotics have different effects on autonomic nervous system (ANS) activity. Among them, oral aripiprazole has been linked to dysfunction of the ANS in schizophrenia. Long-acting injectable aripiprazole is a major treatment option for schizophrenia, but the effect of the aripiprazole formulation on ANS activity remains unclear. In this study, we compared ANS activity between oral aripiprazole and aripiprazole once-monthly (AOM) in schizophrenia. METHODS: Of the 122 patients with schizophrenia who participated in this study, 72 received oral aripiprazole and 50 received AOM as monotherapy. We used power spectral analysis of heart rate variability to assess ANS activity. RESULTS: Patients who received oral aripiprazole showed significantly diminished sympathetic nervous activity compared with those who received AOM. Multiple regression analysis revealed that the aripiprazole formulation significantly influenced sympathetic nervous activity. CONCLUSION: Compared with oral aripiprazole, AOM appears to have fewer adverse effects, such as sympathetic nervous dysfunction.

The association of genetic polymorphisms in CYP1A2, UGT1A4, and ABCB1 with autonomic nervous system dysfunction in schizophrenia patients treated with olanzapine.

BACKGROUND: Use of the antipsychotic drug olanzapine by patients with schizophrenia is associated with autonomic nervous system (ANS) dysfunction. It is presumed that there are interindividual differences in ANS dysfunction that correspond to pharmacogenetics. In this study, we investigated whether genetic polymorphisms in ABCB1, CYP1A2, and UGT1A4 are associated with this observed ANS dysfunction. METHODS: A total of 91 schizophrenia patients treated with olanzapine monotherapy participated in this study. A power spectral analysis of heart rate variability was used to assess ANS activity. The TaqMan system was used to genotype seven single nucleotide polymorphisms (SNPs) in CYP1A2 (rs2069514 and rs762551), UGT1A4 (rs2011425), and ABCB1 (rs1045642, rs1128503, rs2032582, rs2235048). RESULTS: Sympathetic nervous activity was significantly higher in individuals with the UGT1A4 rs2011425 G allele than in those with the UGT1A4 rs2011425 non-G allele (sympathetic activity, p = .001). Furthermore, sympathetic nervous activity was also significantly associated with UGT1A4 rs2011425 genotype as revealed by multiple regression analysis (sympathetic activity, p = .008). CONCLUSIONS: We suggest that the UGT1A4 rs2011425 polymorphism affects olanzapine tolerability because it is associated with the observed side effects of olanzapine in schizophrenia patients, namely sympathetic dysfunction.

Exploring the Objective Signs of Imminent Suicide Risk in Psychiatric In-patients.

Objective: This study retrospectively explores the objective signs of imminent suicide risk in psychiatric in-patients. Design: The study analysed the diagnostic and nursing records of a psychiatric hospital that covered the last 14 days before the suicide attempts of 18 people, who, between March 2008 and July 2019, were found to have died by suicide during their hospital stay. Methods: Three professionals used a fishbone diagram to separately identify the factors that led to each person's suicide, the objective signs that indicated imminent suicide risk, possible preventive strategies, and other observations. They compared their findings and used the KJ method (Kawakita Jiro Method) to categorise the items on which they all agreed. Results: Objective signs of imminent suicide risk were condensed into five categories: 'signs emanating from the patient', 'signs gleaned through engagement', 'signs from response to treatment', 'signs associated with reports from the family', and 'signs inferred from multiple sources of information'. Five categories describing issues with the way in which the hospital staff handled information were extracted, namely 'omission in diagnostic records during admission', 'omission in conference records', 'communication lapse during transfer', 'need for integrated information', and 'systemic issues'. Conclusions: The findings offer insights on assessing suicide risk and preventing suicide.

Components of ether-insoluble resin glycoside (rhamnoconvolvulin) from rhizoma jalapae braziliensis.

Alkaline hydrolysis of the ether-insoluble resin glycoside (convolvulin) fraction of the roots of Ipomoea operculata (GOMES) MART. (Convolvulaceae) afforded a glycosidic acid named operculinic acid H along with isovaleric, tiglic, and exogonic (3,6:6,9-diepoxydecanoic) acids. Operculinic acid H was characterized to be 3S,12S-dihydroxyhexadecanoic acid 12-O-beta-D-glucopyranosyl-(1-->3)-O-alpha-L-rhamnopyranosyl-(1-->2)-[O-beta-D-glucopyranosyl-(1-->3)]-O-beta-D-glucopyranosyl-(1-->2)-[O-alpha-L-rhamnopyranosyl-(1-->6)]-O-beta-D-glucopyranoside on the basis of spectroscopic data and chemical evidence. The absolute configuration of exogonic acid determined from the alpha-methoxy-alpha-trifluoromethylphenylacetic acid esters of the hydrogenolysis products revealed that exogonic acid exists as a mixture (ca. 1 : 1) of two epimers, (3S,6S,9R)- and (3S,6R,9R)-diepoxydecanoic acids.