bluuebunny/crossref_metadata_2025 huggingface dataset:
Levetiracetam showed lower depression, insomnia and mood instability incidence than phenytoin after supratentorial tumour neurosurgery
Authors: Bellido I. , Dominguez M. , Bellido V. , Gómez-Luque A.
Published: May 2011

Background

Phenytoin used to prevent seizures linked to brain cancer neurosurgery has shown many undesirable side effects and drug interactions with chemotherapy.

Aim

To evaluate the incidence of depression, insomnia, mood instability and early post surgery seizures, after Phenytoin (PHE) vs. Levetiracetam (LEV) monotherapy in patients with brain tumour subjected to a supratentorial brain tumour resection.

Methods

A prospective study in patients with supratentorial cancer diagnosis subjected to neurosurgery of resection was done. Patients were consecutive randomized to be treated with PHE (n = 26) 15 ml/kg IV-bolus, 125 mg/8 h IV x48 h, 100 mg/8 h O x7 days or with LEV (n = 34) 500 mg/12 h IV x48 h, 500 mg/12 h O x 7 days. Clinical, histological, TAC, EEG, seizures and undesirable side effects were analyzed.

Results and discussion

60 patients (53% male, aged 52.5 ± 20 years) with glioblastoma multiform 45%, meningioma 43%, Ewing's sarcoma 6.7%, others 5.3% (size between 3–6 cm, in the right brain site-65.2%, in the frontal lobe-56.2%) were subjected to followed for a week after tumour resection. Undesirable side effects (USE) were (%LEV/%PHE): total (7.3%/31.5%), somnolence (0%/32.8%), headache (6.1%/22.3%), dizziness (0%/25.6%), difficulty with coordination (0%/23.5%), depression (6.2%/18.7%), lack of energy/strength (12.5%/33.8%), insomnia (11.3%/37.9%), mood instability (12.5%/22,6%), leukopenia (0%/16.9%) after surgery (p < 0.05). None of the patients taking Levetiracetam vs. 4 of the patients taking Phenytoin (0% vs. 15.3%) had seizures after surgery (p < 0.05).

Conclusion

Levetiracetam showed lower depression, insomnia, mood instability and seizures incidence than Phenytoin after supratentorial tumour neurosurgery.
Antipsychotic injectable treatment in patients with involuntary ambulatory treatment
Authors: Borreda Belda L. , Borreda L. , Maravall R. , Perez J.F. , Grau M. , Hernandez M.
Published: May 2011

Introduction

Involuntary Ambulatory Treatment (IAT) is a judicial measure existing in Spain. Its aim is to ensure the adherence to treatment of seriously ill patients, with poor insight and repeated hospitalization. This is done by means of the regular and involuntary administration of antipsychotic intramuscular medication.

Objectives

To assess the treatment used in patients undergoing IAT in a local clinic, to assess the type of medicaments and their dosage and to verify adherence to treatment and evolution.

Material and method

A revision was made of the clinical backgrounds of all the patients of a psychiatric outpatient clinic who have been submitted to IAT (n = 37). A note was made of socio-demographic variables as well as psychiatric diagnoses according to DSM-IV-TR criteria and the number of hospitalizations and treatments used.

Results

All but one patient had been hospitalized and average of 3.53 times before IAT. Since undergoing IAT only 6 patients have been admitted (16%). Four of them relapsed having abandoned treatment.

In seven cases (19%) the patients gained insight and the antipsychotic treatment was changed from injectable to oral treatment at the patients’ request. In these cases IAT was ceased.

The antipsychotic prescribed in 59% of the cases was Long-Acting Injectable Risperidone. This percentage was higher in non- schizophrenic patients (84%).

Conclusions

In our environment IAT could be an effective tool for severe patients with nil insight, since it can bring about an improvement in treatment adherence and evolution, as well as insight.
Opioidergic system and N-methyl D-aspartate receptor (NMDA-R) hypofunction: Translational implications for the pathophysiology of psychosis and drug addiction
Authors: Buonaguro E.F. , Marmo F. , Avvisati L. , Latte G. , Rossi R. , Patrì A. , Sarappa C. , Iasevoli F. , Aloj L. , de Bartolomeis A.
Published: May 2011

Enkephalin is an opioidergic neuromodulator that has been implicated in long-term behavioural sensitization after administration of drugs of abuse. Enkephalin is also a molecular marker of GABAergic neurons in the striato-pallidal pathway that is involved in sensory-motor gating and has been considered dysfunctional in the pathophysiology of psychosis.

In this study we investigated in male Sprague Dawley rats putative changes in Enkephalin transcripts by in situ hybridization after acute or subchronic administration of ketamine in either high or low subanaesthetic doses (50 mg/kg and 12 mg/kg respectively). Ketamine is a non-competitive NMDA-R antagonist that perturbs glutamate neurotransmission and provides a preclinical model of psychosis-like behaviour in rats.

In the acute paradigm the expression of Enkephalin was reduced in the motor, premotor, somatosensory cortices as well as in anterior cingulate. In the subchronic paradigm Enkephalin expression was reduced in the premotor cortex, in the ventromedial caudate-putamen and in the shell of nucleus accumbens. Comparative analysis showed that the relative decrement in gene expression was not significantly different between the acute and subchronic paradigm for each region of interest.

Changes in distribution of Enkephalin expression and correlation analysis of functionally related brain regions suggest that Enkephalin transcripts reduction may be implicated in the motivational aspects of drug addiction and may help explaining some aspects of the pathophysiology in ketamine-induced psychosis.
QT prolongation: Which psychotropics?
Authors: Campos Mendes J. , Prata J.
Published: May 2011

Prolongation of the ventricular repolarisation manifests itself as a prolongation of the QT intervall on the surface ECG and represents a major risk for a special form of ventricular tachycardia called “torsades de pointes”, that are often self limited and are associated with palpitations, dizziness or syncope, but degeneration into ventricular fibrillation and sudden cardiac death can occur. Psychotropics are among the most common causes of drug induced acquired long QT syndrome. Blockage of Human ether-a-go-go-related gene (HERG) potassium channel by psychoactive drugs appears to be related to this adverse effect. Antipsychotics such as haloperidol, thioridazine, sertindole, pimozide, risperidone, ziprasidone, quetiapine, olanzapine and antidepressants such as amitriptyline, imipramine, doxepin, trazadone, fluoxetine depress the delayed rectifier potassium current (IKr) in a dose dependent manner in experimental models. The frequency of QTc prolongation (more than 456ms) in psychiatric patients is estimated to be 8%. In large epidemiological controlled studies a dose dependent increased risk of sudden death has been identified in current users of antipsychotics (conventional and atypical) and of TCA. The authors propose to further explore this theme, in a review of existing literature.
Sudden death and antipsychotic treatment: Typical and atypical antipsychotic drugs’ safety in the real world
Authors: Cattaneo C.I. , Verde A. , Castignoli G.
Published: May 2011

The most up-to-date guidelines recommend to use atypical antipsychotic drugs (APDs). This is due to their better tolerability and safety, especially as far as the risk of sudden death is concerned. Nevertheless, in clinical practice several patients are still treated with typical APDs. Aim of this study is to evaluate the QTc in the real world, where psychotic Pts are still treated with typical APDs. 169 consecutive acute psychotic inpatients (mean age 39 ± 12.5, 84 female), hospitalized in psychiatric ward from January 2005 to December 2007, and treated for at least 6 months with APDs (haloperidol n = 43, risperidone n = 41, aripiprazole n = 42, olanzapine n = 43) underwent ECG recording. Pts with family history of SD or treated with QTc altering drugs were excluded. Three different cardiologists performed blinded QTc measurement for all Pts in order to asses the risk of SD. There were no statistical differences among the QTc values measured by the three cardiologists. 2 out of 169 Pts showed borderline QTc. 2 out of 169 Pts had a high risk QTc. Female gender and age were well distributed in the treatment groups as well as serum electrolytes were in normal range.

ANOVA test showed no consistent statistical differences in the QTc between the use of Haloperidol or other atypical APDs. In our experience, the cohorts of Pts treated with Haloperidol or other atypical APDs have no differences in QTc and therefore the risk of SD dose not depend on the choice of the antipsychotic drug.
Improving physical health of patients with mental health problems
Authors: Cheema F. , Graham J. , Moffat D. , Gordon C.
Published: May 2011

It is well recognised that individuals with severe mental health difficulties have increased risks of significant physical health problems and that some of the treatments for mental health problems can cause physical health difficulties as side effects. It is also known that people with mental health difficulties do not present themselves regularly for physical health monitoring as suggested by national and international guidelines. We show how a secondary care community mental health service cooperated with primary care general medical services to increase the take up of physical health monitoring by patients with severe and enduring mental health problems.

Staff in the community mental health team which served a rural/small urban population identified patients with severe and enduring mental health difficulties or those patients on medications linked to physical problems and contacted the primary care physicians responsible for the patients’ general care with patient details and encouraged patient attendance for physical health monitoring. Physical monitoring included blood pressure, ECG, glucose, thyroid, lipids, height and weight. Post-intervention attendance figures show an increase of 30% in patients attending physical health reviews compared with pre-intervention figures. The intervention has been now rolled out to a larger catchment area of 25000 persons.

[Physical health monitoring by individual parameter]
Neuroleptic malignant syndrome
Authors: Cruz A.
Published: May 2011

Introduction

Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal idiosyncratic drug reaction usually defined as a complication of treatment with antipsychotics. It is manifested by altered mental status, hyperpyrexia, rigidity and autonomic instability. This syndrome occurs in response to administration of drugs that induce dopamine blockage.

Objectives

Study the risk factors, diagnosis, treatment and complications of NMS, by performing a literature review.

Aims

Summarize the main aspects of NMS that may have importance in usual clinical practice.

Methods

PubMed was used to identify NMS articles published after 2000, associated with the MeSH terms “neuroleptic malignant syndrome” and “antipsychotic agents”.

Results

NMS is not dose-related and its aetiology is still unknown. There are many risk factors associated with the syndrome, such as demographic, individual, genetic and environmental factors and medication. In order to evaluate the medical situation, an accurate clinical history and physical examination should be fulfilled. NMS is also characterized by changes in laboratory investigation. There are no patognomonic findings, thus other different diagnosis should be considered. Specific treatment remains controversial. Treatment should be individualized for each patient, regarding characteristics, duration and severity of the clinical signs and symptoms. Resolution is usually verified in one to two weeks. Though there are cases in which the symptoms persist and comorbid process may occur.

Conclusions

Although NMS is a rare complication of antipsychotic therapy, early diagnosis and treatment is essential to improve prognosis.
Antipsychotics in obsessive-compulsive disorder - an auspicious approach for treatment-resistant patients?
Authors: Dold M. , Aigner M. , Lanzenberger R. , Kasper S.
Published: May 2011

Introduction

Because only 40 – 60% of all patients with obsessive-compulsive disorder (OCD) respond to selective serotonin reuptake inhibitors (SSRIs), the evaluation of alternative therapy methods in the presence of treatment resistance has high clinical relevance. In this context, many studies have examined additive medication with antipsychotics.

Method

All double-blind randomised controlled trials (DBRCTs) that evaluated the efficacy of a combination therapy of antipsychotics and SSRIs in treatment-resistant OCD were covered by systematic literature searches.

Results

A total of ten DBRCTs were identified (four for quetiapine, three for risperidone, two for olanzapine and one for haloperidol) with a participant collective comprising in total 316 treatment-resistant OCD patients. After the augmentation therapy, significantly more subjects in the intervention group (antipsychotic + SSRI), 32% of the patients, fulfilled the response criterion (reduction in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) ≥ 35%) than in the control group (placebo + SSRI) (relative risk (RR) = 2.08; 95% CI: 1.3 – 3.32). The standardised mean difference (SMD) of the Y-BOCS reduction between the pooled two study-groups revealed an effect size of 0,62. The sub-group analyses showed significant efficacy only for haloperidol and risperidone. Further significant differences existed regarding the duration of SSRI medication before the augmentation phase.

Conclusion / Discussion

Based on the favourable benefit-risk-ratio, risperidone can be regarded as the agent of first choice for augmentation treatment with an SSRI. Overall, about one third of patients benefit from this therapy option. However, further scientific studies are needed before sufficiently empirically secured pharmacological treatment recommendations can be expressed.
The portuguese psychiatry in the european setting: Study of a hospital drug formulary in the beginning of the 20th century
Authors: Pita J.R. , Pereira A.L. , Ferreira J.S. , Morgado J.
Published: May 2011

The results of an investigation conducted on the Formulario Especial dos Medicamentos para o Hospital de alienados em Rilhafoles (1901), a mental disease drug formulary for the oldest Portuguese psychiatric hospital, are presented. The study considered the Portuguese situation within the European setting.

This study quantifies the number of drugs and pharmaceutical forms and establishes a comparison with the most commonly used international psychiatric medication at the time. The present study aims at contributing to the history of psychiatric drug therapy before the advent of psychoactive drugs. The most commonly used pharmaceutical forms and therapeutic groups in psychiatry are evaluated. Furthermore, we also wish to contribute to the evaluation of how Portugal received and implemented innovations in drug therapy.

Quantitative and qualitative document analysis of the above mentioned formulary, using the comparative method.

The edition of this formulary arose from the need to standardize specific medication for mental patients. In the Formulario, 61 medicinal products are proposed. There were 8 different pharmaceutical forms. The potions were the most commonly referred (32). Hypnotics represented approximately half of the medicinal products (28), followed by hypokinetics (9), and analgesics and antipyretics (8).

The formulary was in line with foreign scientific innovations. Pharmacotherapeutic variety of drugs was short and resorting to non-drug therapies was also usual. The edition of this formulary was mainly due to the work conducted by the psychiatrist Miguel Bombarda (1851–1910), a prominent public figure in medicine and in the political and cultural arena.
P03-69 The introduction of psychoactive drugs in portugal in the 1950's
Authors: Pita J.R. , Pereira A.L. , Ferreira J.S. , Gaio R.
Published: May 2011

The authors present some results of an ongoing research on the introduction of psychoactive drugs in Portugal during the 1950's.

This study analyses medical papers published in the 1950s on the issue of psychoactive drugs in Portugal. Our research focused on some of the main medical journals and articles published by some of the most important Portuguese psychiatrists. Discussions on the validity of psychoactive drugs and the introduction of psychoactive drugs in therapy are analysed.

We aim at contributing to the history of psychoactive drugs in therapy, as well as to the history of psychoactive drug reception in Portugal and its relation with the problem of deinstitutionalization.

Qualitative documental analysis of medical papers published in Portuguese general medicine journals, such as A Medicina C-rânea, O Médico, Jornal do Médico, as well as in some specialized psychiatry journals. Systematization of confronting arguments. The introduction of psychoactive drugs in Portugal underwent several discussions on their validity, efficacy, safety and effects in the process of patient deinstitutionalization.

In Portugal, the reception of psychoactive drugs proceeded quickly after its industrialization, and was accompanied by some theoretical discussions. In the beginning of the 1960s, the use of psychoactive drugs is clearer and discussions are less divergent.
Meta-analysis on the dissection table
Authors: Friedrich M.-E. , Kasper S.
Published: May 2011

Introduction

Determination of the best evidence involves a systematic, comprehensive review and synthesis of the research literature as performed in high-quality meta-analysis. In a recently published multiple-treatment meta-analysis by Cipriani and collegues (Lancet, 2009) the authors finally concluded to favour sertralin over escitalopram due to lower costs.

Objectives/aims

Based on the example published by Cipriani et al. we tried to highlight possible pitfalls, the clinican with limited time might not be able to spot easily whilst skimming the results of meta-analysis.

Results

Escitalopram had the best efficacy and tolerability profile in the study. Sertraline was recommanded as first choice because of the most favourable balance between benefits, acceptability and acquisition costs. Analyzing study-design, statistical procedures and knowledge such as the early launching of generics of escitalopram lead to a different view of the interpretation by Cipriani and collegues.

Conclusions

We concluded that the findings of Cipriani et al. have limited generalizability due to problematic study design issues including statistical concerns. Despite the fact that meta-analysis might provide best evidence-based information, the findings of the latter should always be interpreted with caution as the quality of them can only be as good as the studies included and the study design implemented.
Pharmacological approach of chronic psychosis
Authors: Gago E. , Santos M. , Ribeiro A.E.
Published: May 2011

Introduction

Psychosis is a mental condition characterized by the presence of hallucinations, delusions, and thought disorders. It spans diagnostic entities that respond to similar therapeutic approaches. Most patients who develop schizophrenia and related psychotic disorders are at very high risk of relapse in the absence of antipsychotic treatment. Yet, chronic psychosis is an entity that has not been well established until today.

Evidence indicates that sustained treatment is associated with fewer relapses than is targeted intermittent treatment; however guidelines do not give definite recommendations about treatment duration. Indefinite maintenance antipsychotic medication is recommended for patients who have had multiple prior episodes or two episodes within five years. Adjunctive medications are commonly prescribed for comorbid conditions.

Aims

The authors aim to study the therapeutic approach of patients with chronic psychosis.

Methods

Cross-sectional study and clinical records review of a sample of patients with the diagnosis of schizophrenia and other chronic psychotic disorders.

Results

The sample consists of 154 psychotic patients, 71% males, with mean age of 45,9 years. 43, 5% of patients are under treatment with more than one antipsychotic agent, and 59% are treated with long-lasting antipsychotic medications (LLA).

Conclusions

The considerable decrease in hospitalization days, and the need to avoid covert non-compliance justifies the increased number of patients under LLA treatment. This sample presents with a high percentage of patients treated with more than one antipsychotic medication, despite the fact that there is minimal evidence supporting this therapeutic option.
Reconceptualizing medication adherence: six phases of dynamic adherence
Authors: Gearing R. , Townsend L. , Mackenzie M. , Charach A.
Published: May 2011

Introduction

Nonadherence is the Achilles heel of effective psychiatric treatment. The meaning of the term “adherence” has evolved over time and is now associated with a variety of definitions and measurement methods. This has resulted in a poorly operationalized and non-standardized term that is often interpreted differently by providers and patients.

Objectives/Aims

This abstract aims to: 1) describe changes in the concept of adherence; 2) present a more comprehensive definition of adherence which recognizes the influence of patient-provider transactions; 3) introduce dynamic adherence, a six-phase model, which incorporates the influence of transactional processes and econometrics on patients’ adherence decisions; and 4) provide recommendations for providers to improve their relationships with patients and in turn, medication adherence.

Methods

A review of the scientific mental health literature.

Results

Despite the prevalence, seriousness, and costs associated with medication nonadherence, the construct of adherence remains poorly operationalized and lacks cogent standardization. Drawing from psychiatric research, a dynamic model of medication adherence across six phases is presented.

Conclusions

This model of adherence highlights the importance of the patient-provider relationship and the transactional processes that comprise what is a dynamic developmental system. Dynamic adherence is intended to foster movement toward a more coherent and unified set of definitions and clinical strategies that will provide the potential to more fully elucidate the risk and protective mechanisms impacting adherence, and the subsequent development and refinement of best practices in increasing the odds of stable medication adherence.
Pysa syndrome: a case report
Authors: Gutierrez F. , Losada C. , López M. , Rozados C. , Olivares J.M. , Calado M. , Cinos C.
Published: May 2011

Pisa syndrome is known to be a condition in which there is sustained involuntary flexion of the body and head to one side and slight rotation of the trunk so the person appears to lean like the Leaning Tower of Pisa.

The development of Pisa syndrome is most commonly associated with prolonged treatment with antipsychotics. Although less frequently, Pisa syndrome has been reported, in patients who are receiving other medications (such as cholinesterase inhibitors and antiemetics), in those not receiving medication (idiopathic Pisa syndrome) and also patients with neurodegenerative disorders like Alzheimer's disease and multiple system atrophy.

We report a case of a 67 year- old male diagnosed with Schizophrenia for 20 years. He has been following a treatment with Clozapine 400 mg/day for 4 years. Amisulpiride was added to the established regimen of antipsychotic and increased during the last month reaching the doses of 600 mg/day. Three weeks later he was observed walking with a tilt toward the right. A first physical examination revealed sustained tonic flexion of the trunk to the right side. No deficits or mental status changes during neurological exploration were shown. We prescribed biperidene hydrochloride therapy. After 24 hour side effects disappeared.

As far as we know, no many cases of amisulpride-induced Pisa syndrome in the literature have been reported. This abstract presents a case of amisulpride induced Pisa syndrome.
Psychopharmacotherapy characteristics of alcoholics treated on psychiatry department tuzla from 01.01.2005. to 31.12.2009. with brain comuterized tomography
Authors: Hasanović M. , Pajević I. , Zukić S. , Hamidović J. , Kuldija A. , Delić A. , Kravić N.
Published: May 2011

Introduction

Treatment of alcoholics is complex and difficult, very often it demands complex psychopharmacotherapy.

Aim

To investigate characteristics of psychopharmacotherapy of inpatients alcoholics with brain computerized tomography (CT) during hospitalization on Psychiatry Department in Tuzla.

Methodology

We investigated 86 record files of inpatients that were treated from 01.01.2005 to 31.12.2009 year on Psychiatry Department, who had dismissed diagnosis Alcohol dependency F 10.2 according ICD-10, to whom computerized tomography of brain has been done durin hospitalization. Targeted variables were: age, marital status, working status, involvement in war fighting's, CT diagnosis, psychological findings, laboratory findings and characteristics of psychopharmacotherapy.

Results

The mean age of observed patients was 50.1 ± 6.6 years. Age of inpatients was in positive correlation with duration of work, presence of silent ischemic stroke and brain cortex atrophy. Presence of PTSD was in positive correlation with involvement in the combatants, with cognitive disturbances, with depressiveness and somatic complains. Brain cortex atrophy positively correlated with silent stroke and glucose blood level.

There were 72 (83.7%) inpatients that treated with antidepressants, 45 (52.3%) with sedating antipsychotic drugs, 10 (11.7%) atypical antipsychotics 12 (13.0%) with typical antipsychotics, 53 (61.6%) with hypnotics, 37 (43.0%) tranquilizers, 23 (26.7%) vitamin B. There was the most frequent combinations of antidepressants SSRI with promazine in 41 (47.7%), with diazepam 25 (29.1%), with zolpidem 20 (23.3%) and nitrazepam in 17 (19.8%) patients.

Conclusion

SSRI antidepressants were the most frequent used psychopharmacotherapy drugs, then sedating neuroleptics and hypnotics. The most frequent drug combinations were antidepressants, sedating neuroleptic or tranquillisers and hypnotics.
Meta-analysis: fact or fiction?
Authors: Huf W. , Kalcher K. , Pail G. , Friedrich M.-E. , Filzmoser P. , Kasper S.
Published: May 2011

Introduction

Over the recent years, meta-analysis has become a very influential tool to synthesize information from multiple primary studies of similar design. Widespread use of increasingly complex statistical methods makes it ever more challenging to adequately assess the results reported and conclusions drawn in meta-analyses of psychopharmacological studies.

Objectives/aims

This study aimed to identify potential fallacies of meta-analytic reporting and interpretation by in-depth examination of recent publications on anti-depressant medication.

Methods

Published meta-analytic datasets were re-analysed and the results and possible interpretations obtained in this way were compared with the published results and interpretations.

Results

Several widespread methodological problems were identified in the example studies. As most important among these appear the choice of effect size measures and modeling approaches, as well as the related risk of data dredging. Concerning the level of granularity, two pitfalls encountered were inappropriate aggregation of original data and lack of adequate subgroup analyses. Finally, a low level of transparency regarding data and methodology often hampers re-analysis and cross-checking of reported findings by peers.

Conclusions

The difficulty of replicating meta-analytic results on independent data leads to the often conclusive nature of meta-analytic findings, and therefore a realistic assessment of the limitations of the respective analysis is pertinent. To this end, practically relevant quality criteria for readers to bear in mind when dealing with meta-analytic publications are summarized in a ten point checklist for a rough assessment of the quality of meta-analyses by the reader.
Treatment of ADHD secondary to traumatic brain injury
Authors: Irastorza L.J.
Published: May 2011

Attention-deficit/hyperactivity disorder secondary to traumatic brain injury (ADHD/TBI) is one of the most common neurobehavioral consequences of TBI, occurring in 20% to 50% of individuals post-injury. Some of the most persistent problems include impairment in memory, attention and concentration, language, executive skills, social judgment, social behavior, and impulsiveness.

A female patient is presented with TBI and cognitive symptoms and behavior compatible with ADHD. The treatment with methylphenidate was useful for the behavioral problems. The 23 years old woman suffered 3 years earlier a car accident, causing severe TBI and polytrauma. She was in a coma with a CGS of 4 and 41 days in the intensive care unit. She received rehabilitation and continued to suffer from diplopia and posture alteration, semantic paraphasia, child-like behavior, and neuropsychological problems (reading comprehension, slow mental processing, inhibition control deficit, and memory loss).

During her visits to my MHC, she was often euphoric and made inappropriate comments and occasionally became angry. She did not have psychiatric antecedents prior to the TBI. Scales were used to diagnose post-traumatic ADHD. The patient was then treated with methylphenidate. After titration, the dosage reached was 0,3 mg/kg. After 4 months, the child-like behavior disappeared and interpersonal relations became more fluid, with less irritability.

Stimulants have frequently been used in the treatment of behavioral and cognitive consequences of TBI in both children and adults. This clinical case demonstrates that the use of methylphenidate is favored for an extended period of time in patients suffering from behavioral and emotional consequences of TBI.
Efficiency of atypical antipsychotic in therapy schizophrenia
Authors: Ivic B.M.
Published: May 2011

The aim of this report is to show the efficiency of using Clozapine for resistant appearances of schizophrenia with patients who had take two different typical antipsychotic previously, and therapy response was unsatisfying or the endurance was slight.

The time of observation was 18(eighteen) months. Daily doses are from 100(a hundred) up to 300(three hundred) mg.

Some patients with Clozapine take butirofenonic preparations and some patients have got monotherapy with Clozapine. The result which have been obtained give evidence that Clozapine improve cognitive functions (attention, verbal possibilities, learning, memory, reasoning) it also stimulates the possibility for social integration. It improves social activity and capability to work, and in such a way, it effects on impovent of life quality at all.

A combination of Clozapine and intramuscular depo-preparations of butirofenon type has given the exceptional results with “positive syndromes” schizophrenia, while monotherapy has given excellent results with “negative syndrome”.

It should be known that Clozapine therapy does not heal patients only in the sense of elimination of symptoms causes because of which they were brought to the hospital, but it also protects them not to become helpless victims who are closed inside institutions, how they would be able to come back in their previous working and social surrounding.
How do european psychiatry trainees prescribe when treating depression, and what influences decision-making? (Survey of the European Federation of Psychiatric Trainees Research Group)
Authors: Jauhar S. , Guloksuz S. , Marques J.G. , Nawka A. , Roventa C. , Psaras R. , Andlauer O. , Lydall G. , De Vriendt N. , Mendonca L. , Van Zanten J. , Dumiterscu I. , Nwachukwu I. , Riese F. ,   European Federation of Psychiatric Trainees Research Group
Published: May 2011

Objectives

Despite recent recent evidence and subsequent guidelines that have suggested factors such as side-effect profile and cost should be taken into account when prescribing antidepressant medication, relatively little evidence exists on decision-making in clinical practice.

Our Pan-European Research Group looked at clinical practice regarding antidepressants amongst Psychiatry trainees, treatments trainees would desire themselves, and factors influencing decision-making.

Methods

A semi-structured survey was constructed from recent literature, was piloted, and a homogenous sample size of at least 50 agreed upon from each country, with 50% the minimum response rate. It was distributed via web-link, questioning preference of antidepressant for patients, and factors influencing choice. Trainees were asked for their preference should they develop a moderate to severe depressive episode, and require medication.

Results

Treatment choices are summarised in Table 1. 79% of trainees would prescribe similar antidepressants for themselves as for patients.

Factors influencing decision-making mapped onto three main domains: cost, efficacy and side-effect profile (5% other reasons). 86% (n = 548) of those who responded felt efficacy most important, 38% (n = 237) felt side-effect profile most important and 6% (n = 33) considered cost of most importance.

Conclusions

Some differences exist in choice of antidepressant for European trainees and their patients, and factors affecting choice conflict with evidence base and guideline suggestions.
Risperidone long-acting injection vs. conventional depot injections
Authors: Jensen S.O.W. , Nielsen J. , Friis R. , Correll C.U.
Published: May 2011

Introduction

Risperidone long acting injection (RLAI) has in recent years gained widespread use in the treatment of schizophrenia and schizoaffective disorder. It is considered safe, tolerable, and the efficacy has been established in several studies. However, all these studies were funded by the manufacturer of RLAI.

Objectives

To compare the efficiency of RLAI vs. conventional depot antipsychotics (CAD).

Methods

This study includes 9197 patients with schizophrenia being treated with depot injections in Denmark from January, 1996 until December, 2007. Prescription data were obtained from the national prescription database which contains information of sold defined daily dosages (DDD).

Of the 9197 patients 1056 had originally received a CAD treatment (zuclopentixole, haloperidol, perphenazine, fluphenazine or flupenthixol), but where switched to RLAI. The two periods were compared with regard to number of admissions and time spent in hospital. A Cox regression analysis of any-cause-discontinuation was performed on 9105 incident depot antipsychotic periods.

Results

When receiving CAD treatment patients had 0.08 (95% CI [0.07; 0.08]) admissions to hospital per month vs. 0.50 (95% CI [0.47; 0.54]) when treated with RLAI. On average the patients spent 33 percent (95% CI [32; 35]) of the time during the CAD-period as admitted to hospital vs. 48 percent (95% CI [46; 50]) during the RLAI-period. Of the 1056 patients 83% where eventually switched back to a CAD.

Furthermore the RLAI patients have a higher hazard of discontinuing their treatment than the CAD patients (HR = 2.26, 95% CI [2.05; 2.48]).

Conclusions

RLAI was inferior compared to conventional depot antipsychotics.
Children and adolescents with major depressive disorders: are some second generation antidepressants better than others?
Authors: Kaminski A. , Gartlehner G.
Published: May 2011

Introduction

Since the black box warning of the FDA (Food and Drug Administration) regarding an increased risk of suicidality in children and adolescents treated with antidepressants, cautious prescription of antidepressant drugs in young patients became even more important. In the light of potentially severe side effects the comparative effectiveness and harms of antidepressants should be known to clinicians to provide optimal treatment.

Objectives

To compare the benefits and harms of second-generation antidepressants for the treatment of Major Depressive Disorder (MDD) in children and adolescents.

Aims

To provide an evidence base for clinicians and policymakers when making informed decisions regarding the prescription of Selective Serotonin Reuptake Inhibitors and other newer antidepressants.

Methods

We updated a comparative effectiveness report of the Oregon Drug Effectiveness Review Project searching MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts up to August 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias.

Results

We could not identify any head-to-head trials. There is insufficient evidence to compare one second-generation antidepressant to another in pediatric outpatients with MDD. Evidence from a systematic review of published and unpublished data indicates, that in children and adolescents only fluoxetine shows a good risk-benefit ratio.

Conclusions

To date, the evidence is insufficient to make any clear inferences about the comparative benefits and harms of second-generation antidepressants for the treatment of MDD in children. Clinicians must be aware of the small benefits and the high potential risks when prescribing antidepressant medications to children and adolescents.
Correlation between lipid profile and different types of aggressive behaviour in combatants
Authors: Kolov S. , Ostapenko A.
Published: May 2011

Objectives

At present there is a discussion whether cholesterol level, aggression and violence are connected for they are characteristic behavioral patterns in combatants suffering particularly from PTSD.

Method

With the help of the Aggressive Behaviour Assessment Scale we examined 337 combatants and 116 healthy people, also we held an additional investigation of serum concentration of lipid profile. Reliability of results was evaluated by the Mann-Whitney U-test. Also the correlation analysis (Spearman rank correlation coefficient) was carried out.

Results

Combatants showed an integrated overall index of aggression twice as much in comparison with the control group (2,44 ± 0,09 and 1,08 ± 0,08, Ð < 0,00001), impulsive aggression was five times greater (2,08 ± 0,12 and 0,39 ± 0,06, Ð < 0,00001), premeditated aggression was 1,7-fold (3,15 ± 0,11 and 1,78 ± 0,13, Ð < 0,00001). The highest points of emotional (impulsive, hostile) aggressive behaviour revealed negative links with concentrations of cholesterol (r = −0,109, Ð < 0,05), LDL total cholesterol (r = −0,109, Ð < 0,05), triglycerides (−0,137 ≥ r ≥ −0,108, Ð < 0,05). Certain positions of premeditated (instrumental) aggression positively correlated with level of total cholesterol (0,140 ≥ r ≥ 0,126, Ð < 0,01), LDL total cholesterol (0,141 ≥ r ≥ 0,161, Ð < 0,01).

Conclusions

Reduction of cholesterol level and its most atherogenic fractions increases intensity of impulsive aggression and diminishes instrumental aggression of aggressive behaviour whereas increase of lipid profile leads to opposite results. The obtained data can be of great importance for treatment and prophylaxis of cardio-vascular disorders which are so typical for combat veterans.
Bupropion in treatment of depression - patient stopped smoking: case report
Authors: Kozumplik O. , Uzun S. , Jakovljevic M.
Published: May 2011

Aim

To present a case of a patient with depression who stopped smoking during therapy with bupropion.

Case report

Patient, 55 years old, diagnosed with depression, was in psychiatric treatment for two year before she discontined her treatment. She decided to discontinue psychiatric treatment and stopped taking antidepressants because she was feeling better and was functioning at work and in her social environment. For the past one year she was taking only lorazepam occasionally. She came again to our hospital when avolition and fatigue intensified, along with depressed mood. She was not able to function at work any more. She smoked about 20 cigarettes daily and tried to stop smoking on several occasions, but unsuccessfully. Because of worsening of symptoms of depression, treatment with bupropion was initiated in daily dosage of 150 mg. After five days of such treatment daily dosage of bupropion was elevated to 300 mg. The patient reported having headache for the first two days of treatment with bupropion, but after the headache stopped. After ten days of treatment she reported feeling better and was smoking less cigarettes (five per day). She said that didn’t have such pleasurable feeling any more when smoking. Also, after smoking she felt mild nausea. At control examination, after one month of treatment with bupropion, the patient reported feeling well, without symptoms of depression and that she stopped smoking. She continued outpatient treatment regularly and was functioning well again at work and in her social environment.
Frequency of sexual dysfunction related to different antidepressants. Results from a multicentric pragmatic study in 2000 patients in spain: the SALSEX-I study
Authors: Majadas S. , Montejo A.L. , Hernandez A.I. , Calama J. ,   SALSEX-I Project Working Group
Published: May 2011

Introduction

Antidepressant-related sexual dysfunction (ADr-SD) is a frequent and underestimated adverse event that may lead to medication non-adherence.

Study aim

To explore ADr-SD in regular clinical practice.

Objectives

1.

To stablish the prevalence of sexual dysfunction (SD) in patients following antidepressant treatment.

2.

To compare ADr-SD between different antidepressants.

Methods

Cross-sectional multicentric naturalistic study. Patients in antidepressant treatment from at least two months before inclusion without previous SD were included. SD was evaluated with the specific questionnaire PRSexDQ (SALSEX, Montejo 2001).

Results

1988 out of 2000 patients recruited resulted eligible for the analysis. According to PRSexDQ criteria, most of the antidepressants recorded in the sample (venlafaxine, duloxetine, escitalopram, citalopram, paroxetine, fluoxetine, fluvoxamine, sertraline and clomipramine) were associated to high rates of moderate to severe SD (>70%), with the exception of bupropion (39.6%) and mirtazapine (44.4%). Orgasm delay and reduced libido were the most affected areas of sexual function in all cases. Based on PRSexDQ mean global score bupropion and mirtazapine were associated to a lesser extent of SD vs. the other antidepressants (p < 0.01). Some risk of discontinuing treatment was showed by 8.5%–23.6% of patients presenting SD, depending on the antidepressant.

Conclusions

These results stress the relevance of SD related to most of the antidepressants, showing both bupropion and mirtazapine a better profile regarding this adverse event. Given that ADr-SD may lead to medication non-adherence, individual patient's perception of sexual life and the profile of each antidepressant regarding SD should be considered by clinicians before initiating any antidepressant treatment.
Metabolic syndrome in schizophrenia -impact of antipsychotic medication
Authors: Maria-Silvia T.M.-S.
Published: May 2011

Metabolic syndrome generally includes some or all of the following: elevated blood pressure, abdominal obesity, diabetes or “prediabetes” (impaired glucose tolerance, impaired fasting glucose or insulin resistance), dyslipidemia (high levels of triglycerides and/or HDL), and inflammatory markers

P.S. a 34 year old, diagnosed with Paranoid schizophrenia. The patient comes from a disorganised family. The disease started at 18 years with psychotic symptoms - delirious, psychotic behavior, aggression, neglect of personal hygiene. He received almost continuous antipsychotic medication. In recent years received the second generation antipsychotic medication. Under this medication increased weight reaching 160 kg in weight. The most significant weight gain occurred in recent years under neuroleptic medication with clozapinum. Hypertension (max 200/120) appeared as a complication of increased weight, requiring antihypertensive medication. Has not other endocrine problems. Laboratory values increased cholesterol, triglyceride, and lipid. Glycemia remained normal. In the last six months patient received amisulpiridum 800 mg/day. In same conditions of life the patient has lost 40 kg in weight reaching 140 kg. Family history- mother obesity and HTA;Weight and (BMI) initially 160kg/180 cm then 120 kg/180 cm;Waist circumference 140 cm;Blood pressure initially 200/120 mm Hg then160 /110 mmhg;Fasting lipids increased,glucose normal Conclusion: Assessment of risk factors is necessary before prescription of antipsychotics. Especially weight, BMI, family history for obesity, and ethnicity should be evaluated. People taking antipsychotics that increase the risk of MetS should be educated on this subject. They should be advised about their diet and lifestyle, about how to recognize symptoms of MetS and its consequences.
The neuroprotective potentially of agomelatine - animal model study
Authors: Marinescu D. , Mogoanta L. , Udristoiu T. , Udristoiu I. , Pirici D.
Published: May 2011

Background

Major depressive disorder associated the increase of cortisol level and high level of cortisolemia is correlated with the decrease of neuroprotection. Hippocampus low volume is a marker for depressive disorder. The cognitive impairment in depression is linked with hippocampus - enthorinal structures-frontal cortex disconectivity. Melatoninic agonists can increase the neuroprotection and improve depressive mood.

Methods

We formed 2 study lots each constitued of 5 male adults rats (200–250 g), held through the study duration in temperature, humidity, food and ambient stress less conditions, compared to a control lot. The studied substances were administrated intraperitoneal, daily, for 10 days, saline solution equivalent to dexametasone (0.20 mg/kg/day) (N1); 14 days we administered 10 mg/kg/daily of agomelatine through a stomach tube and the following 10 days of dexametasone and agomelatine in the same dosage (N2). The N1 lot was sacrificed in the day 11, and the N2 lot was sacrificed in the day 25.

The sample brain was histopathologically processed: formalin (10%) and ethyl alcohol (96%) fixation and paraffine embeded. Microtome slices were stained in hematoxyline-eosine, trichromicGS, PAS-hematoxyline, toluidine blue and methylen blue for Nissle corpuscles. The obtained slices were studied with optical microscopy, the target of our study was hippocampus and frontal cortex.

Results

The hippocampus and frontal cortex presents important histopathological abnormalities (neuronal death, vacuolisation, axonal fragmentation) for N1 after dexametasone. These changes are decreased in N2.

Conclusions

Agomelatine on the animal model actioned with a neuroprotective effect in the hippocampus and frontal cortex front of cortisolic aggresion (marker for depression).