Prevalence and Correlates Of Sexual Dysfunction Among Patients With Schizophrenia Spectrum Disorder on Antipsyhotic Medications in Maiduguri, Northeastern Nigeria.

OBJECTIVES: Despite the importance of a satisfying sexual life, most patients with schizophrenia spectrum disorders do not discuss sexual issue with their clinicians. The current study seeks to determine the prevalence and socio-clinical correlates of sexual dysfunction among patients with schizophrenia spectrum disorders receiving typical and atypical antipsychotic medications. The second objective is to determine the frequency and correlates of specific sexual dysfunction (desire, arousal, erection/lubrication and orgasm) by gender and drug type using the Arizona Sexual Experience Scale. METHODOLOGY: This cross-sectional study used standardized structured interviewer based survey to assess sexual dysfunction among patients with schizophrenia that are both sexually active and inactive at a tertiary hospital in Maiduguri from December 2020 to April 2021. Participants were also assayed for prolactin using ELISA Kit for a possible association with sexual dysfunction. RESULTS: The overall prevalence of sexual dysfunction among patients with schizophrenia spectrum disorder receiving antipsychotics was 34% with patients on typical and atypical antipsychotics reporting rates of 36.8% and 24.6%, respectively. Among the typical and atypical antipsychotics, patients receiving haloperidol (40.3%) and risperidone (37.5%) reported a relatively higher frequency of sexual dysfunction compared to those receiving clozapine (18.2%). Independent correlates of sexual dysfunction were: female gender (OR = 1.89, 95% CI = 1.17-3.06; P = .010), being unmarried (OR = 1.51, 95% CI = 1.17-1.96; P = .001), pseudoparkinsonism (OR = 1.66, 95% CI = 1.02-2.69; P = .008), prolactin (OR = 2.15, 95% CI = 1.34-3.43; P = .001) and severity of illness (OR = 1.34, 95% CI = 1.03-1.75; P = .030). CONCLUSION: Sexual dysfunction is prevalent among patients with schizophrenia spectrum disorder receiving either typical or atypical antipsychotics.

NEUROPSYCHOLOGICAL PRINCIPLES OF COGNITIVE AND COMMUNICATIVE ACTIVITIES DIAGNOSIS IN ADULTS WITH EXTRAPYRAMIDAL SYSTEM DISORDERS.

OBJECTIVE: The aim is to determine the neuropsychological peculiarities of cognitive and communicative activities in adults with the extrapyramidal system disorders. PATIENTS AND METHODS: Materials and methods: The research was conducted during 2018-2021, during which a retrospective analysis of medical treatment records of the patients with extrapyramidal disorders of various etiologies was performed. The research involved 137 adult patients with extrapyramidal disorders: 93 persons with Parkinson's disease, 36 people with manganese encephalopathy, 5 persons with progressive supranuclear palsy and 3 people with Wilson-Konovalov disease. RESULTS: Results: A significant difference between the indicators of preservation of cognitive and communicative activities and the communicative and semantic component in the group of patients with Parkinson's disease without speech disorders and Parkinson's disease and between the groups of patients with Parkinson's disease without speech disorders and progressive supranuclear palsy indicates the need for experimental correctional and rehabilitation work to restore cognitive and communicative activities of the patients with extrapyramidal disorders. CONCLUSION: Conclusions: The most preserved communicative and speech function was found in the patients who had initial and mild stages of the disease, in particular in the patients with Parkinson's disease without speech disorders. It should be emphasized that the diagnosis of cognitive and communicative activities and the communicative and semantic component in adults with extrapyramidal disorders is a necessary prerequisite for the organization of the process of comprehensive rehabilitation treatment.

Apomorphine hydrochloride: a sublingual tablet for the OFF episodes in Parkinson's disease.

Parkinson's disease is one of the commonest neurodegenerative disorders, particularly in those over 60 years of age. Although the introduction of levodopa was a tremendous advance in its treatment, the condition is a progressive one. It has been found that the longer patients have the condition and are treated with levodopa, the more likely they are to develop OFF episodes in which their ability to do things becomes increasingly limited. The development of a sublingual apomorphine hydrochloride film (APL-130277, Kynmobi) was designed to alleviate this OFF condition by allowing the patients to experience rapid relief of their OFF episodes up to 5 times a day.

Movement disorders induced by psychiatric drugs that do not block dopamine receptors.

Most movement disorders in psychiatric patients are induced by neuroleptic antipsychotic medications, all of which are dopamine D2 receptor blocking drugs. These include: acute onset disorders: dystonic reactions, akathisia and the neuroleptic malignant syndrome (NMS); non-acute onset parkinsonism; and the tardive syndromes. However, many other medications, when used at recommended doses, also induce movement disorders, with tremor being the most common. With the exception of serotonin syndrome, they are rarely as severe or disabling as the neuroleptic extrapyramidal syndromes may be. The serotonin reuptake inhibiting (SSRI) drugs are associated with the serotonin syndrome, a life-threatening disorder, but may also cause tremor and akathisia. While SSRI's have been thought to occasionally cause a tardive dyskinesia-like syndrome, this almost never occurs without prior or concurrent neuroleptic exposure as well. There also are few reliable data to support an association between antidepressants and parkinsonism. Valproic acid has been shown to cause parkinsonism, and lithium may as well, in addition to both having the well-known side effect of tremors. Myoclonus and asterixis are usually induced by toxic levels of medications but may appear with therapeutic levels, particularly with anticonvulsant mood stabilizers, and clozapine. Ataxia rarely occurs with non-toxic levels of drug, particularly anticonvulsants, benzodiazepines and lithium.

Effects of a Safety Letter on Metoclopramide Use in Korea: An Interrupted Time-Series Analysis.

BACKGROUND: The Korean Ministry of Food and Drug Safety (MFDS) issued a safety letter regarding metoclopramide use and its adverse drug event of extrapyramidal disorder in October 2013. However, this safety letter had controversial effects on pharmacovigilance and management policies. The objective of this study was to estimate the impact of this government safety letter on the use of metoclopramide. PATIENTS AND METHODS: We conducted an interrupted time-series analysis using national claims data from January 2011 to December 2015 to assess the difference in metoclopramide utilization (ie, the total number of prescriptions per month, the average administration period per prescription per month, and the average dose per prescription per month) before and after the publication of the safety letter in October 2013. RESULTS: The number of prescriptions, the average administration period per prescription, and the average dose per prescription of metoclopramide decreased after the publication of the safety letter. Notably, the decrease in the average administration period per prescription after the safety letter was statistically significant. CONCLUSION: Our results indicate that the changes in the number of prescriptions, dose, and the duration of prescription may have occurred as a result of the restrictions and recommendations in the safety letter. Further research is needed to optimize the use of metoclopramide and to identify the risk of adverse drug events since the safety letter was issued.

Istradefylline: adenosine A2A receptor antagonist to reduce "OFF" time in Parkinson's disease.

Parkinson's disease (PD) is an extremely common degenerative disease with a progressive course. Unfortunately, the longer patients are treated with levodopa, the more likely they are to suffer from increasingly long periods of immobility or "OFF" time. For over 30 years Kyowa Kirin Co., Ltd. (formerly Kyowa Hakko Kirin Co., Ltd.) has been researching the possibility of finding drugs that affect adenosine receptors and that can be used successfully as additional drugs in the treatment of PD. Istradefylline is an adenosine A2A receptor antagonist that significantly reduces the "OFF" time and improves the motor function of patients with PD, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS) Part III, while increasing the time without troublesome dyskinesia. It was approved for use in PD in Japan in 2013 and in the United States in 2019.

Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology.

Catatonia is a psychomotor syndrome that has been reported to occur in more than 10% of patients with acute psychiatric illnesses. Two subtypes of the syndrome have been identified. Catatonia of the retarded type is characterized by immobility, mutism, staring, rigidity, and a host of other clinical signs. Excited catatonia is a less common presentation in which patients develop prolonged periods of psychomotor agitation. Once thought to be a subtype of schizophrenia, catatonia is now recognized to occur with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders. In many cases, the catatonia must be treated before any underlying conditions can be accurately diagnosed. Most patients with the syndrome respond rapidly to low-dose benzodiazepines, but electroconvulsive therapy is occasionally required. Patients with longstanding catatonia or a diagnosis of schizophrenia may be less likely to respond. The pathobiology of catatonia is poorly understood, although abnormalities in gamma-aminobutyric acid and glutamate signaling have been suggested as causative factors. Because catatonia is common, highly treatable, and associated with significant morbidity and mortality if left untreated, physicians should maintain a high level of suspicion for this complex clinical syndrome. Since 1989, we have systematically assessed patients presenting to our psychiatry service with signs of retarded catatonia. In this paper, we present a review of the current literature on catatonia along with findings from the 220 cases we have assessed and treated.

Reliability and validity of an instrument for the assessment of bradykinesia.

Bradykinesia is associated with reduced quality of life and medication non-compliance, and it may be a prodrome for schizophrenia. Therefore, screening/monitoring for subtle bradykinesia is of clinical and scientific importance. This study investigated the validity and reliability of such an instrument. Included were 70 patients with psychotic disorders. Inertial sensors captured mean cycle duration, amplitude and velocity of four movement tasks: walking, elbow flexion/extension, forearm pronation/supination and leg agility. The concurrent validity with the Unified Parkinson's Disease Rating Scale (UPDRS) bradykinesia subscale was determined using regression analysis. Reliability was investigated with the intra-class correlation coefficient. The duration, amplitude and velocities of the four tasks measured by the instrument explained 67% of the variance on the UPDRS bradykinesia subscale. The instrument test-retest reliability was high. The instrument investigated in this study is a valid and reliable alternative to observer-rated scales. It is an ideal tool for monitoring bradykinesia as it requires little training and experience to achieve reliable results.

Cognitive dysfunction and REM sleep behavior disorder: key findings in the literature and preliminary longitudinal findings.

A considerable proportion of subjects initially diagnosed with idiopathic REM sleep behavior disorder (iRBD) are reported to convert to a neurodegenerative disorder, mainly synucleinopathies. It is unclear whether cognitive deficits in iRBD represent an associated feature or a marker predictive of subsequent development of a synucleinopathy. Cross-sectional studies indicate that a proportion of iRBD patients show cognitive deficits similar to those typically found in patients with synucleinopathies. The available longitudinal data suggest that cognitive dysfunction in iRBD tends to progress over time, with this progression probably being underpinned by a neurodegenerative process. Furthermore, within the framework of Parkinson's disease, RBD has been shown to be a risk factor for progressive cognitive decline even advancing to dementia. This paper addresses the multifaceted issue of cognitive dysfunction in RBD. Taking into account some key literature findings and preliminary longitudinal observations of our own, it shows that cognitive deterioration, mainly involving visuospatial abilities (learning as a stable deficit and copying as an evolving deficit), non-verbal logic, attention and executive functions can be observed in iRBD follow-up, suggesting an underlying evolving degenerative process. Large cohort studies with more prolonged follow-ups and greater methodological uniformity are needed to provide more reliable and robust findings.