bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical health monitoring of patients on antipsychotic medication in community - findings of an audit
Authors: Paul M. , Philip D. , Garcia J. 
Published: May 2011

IntroductionPatients with severe mental illness are at increased risk of cardiovascular disease because of lifestyle, co-morbidity and medication effects.Aim/objectivesThe aim of this audit is to ascertain the regularity of blood tests (u&e's, fasting blood glucose, lipid profile)among patients on Antipsychotic medication under North Durham Psychosis team.MethodAccording to audit standards (based on NICE guidelines-Schizophrenia and Maudsley guidelines), All patients on antipsychotic medication should have Urea & Electorates, Fasting blood glucose and Fasting Lipid profile done at least once a year. All 67 patients in North Durham Psychosis Team were included. We searched for these readings between 1st September 2008 to 30th August 2009 in patient records. Of the 67 patients, notes were retrieved for 50. Of the 50, 46 were on antipsychotic medications.ResultsOf 46 patients, 58% had urea & electorates, 58% had Fasting blood glucose and 46%had fasting lipid profile recorded.ConclusionBecause of lifestyle, co-morbidity and medication effects, patients with severe mental illness are at increased risk of cardiovascular disease. Our audit identified a need for systemic assessment of physical health with appropriate blood investigations and follow up with appropriate management plan (lifestyle education, lipid modification therapy) which are critical to minimising risks and preventing long term adverse health consequences. This results may also reflect a lack of communication between primary care and secondary care as the physical health for these clients are primarily managed by General Practitioners. It may be that these investigations are conducted but not communicated to secondary care.
Use of atypical antipsychotics and movement disorders: a case of aripiprazole induced chorea
Authors: Pomponi M. , Soleti F. , Raja M. , Bentivoglio A.R. 
Published: May 2011

We describe a 66-year-old woman with a 33-year history of treatment with antipsychotic drugs (she was reportedly affected by psychiatric symptoms, dominated by “depression”), who presented with severe, generalized chorea, which started after shifting from haloperidol to aripiprazole.Since 1974, she had been treated with several antipsychotics (including haloperidol and risperidone) and antidepressants, in different combinations; moreover she underwent electroconvulsive therapy. In 2003, after shifting from haloperidol to aripiprazole, she presented facial dyskinesias, which progressively diffused to all the body regions and, after a few months. In 2006, aripiprazole was discontinued and olanzapine was introduced, with a dramatic increase of choreic dyskinesias. The picture was so severe that the patient could barely stand, walk, talk and eat.MRI of the brain revealed minimal signs of diffuse atrophy and chronic leucoencefalopathy. Genetic testing for HD and the screening for Wilson's disease were negative; so the diagnosis was a severe tardive syndrome (orolingual dyskinesias, pelvic dyskinesias and generalized chorea).Olanzapine (10 mg/die) was discontinued, and a low dose of clozapine (12,5 mg/die) was introduced, without any exacerbation of the psychiatric disorder, and without modification of chorea. After a few days, tetrabenazine was introduced and gradually titrated up to 75 mg/die in two weeks. After two weeks, a dramatic improvement of dyskinesias was evident (video).To explain the case of our patient, we hypothesize that chronic administration of neuroleptics would lead to dopamine D2-receptor hypersensitivity in the nigrostriatal pathway and favor the agonist profile of aripiprazole to promote the activation of dopamine D2-receptors.
Screening of metabolic side effects of antipsychotics in patients with mental disorder
Authors: Reddy H.T. , Edwards R. 
Published: May 2011

This audit was undertaken to evaluate what screening is undertaken for metabolic side effects of antipsychotic drugs in patients under the care of Ceredigion Community Mental Health.Raise awareness with Local health Board regarding metabolic screening Raise awareness regarding four aspects of metabolic syndrome.Audit tool based on POMH (Prescribing Observatory for Mental Health) Topic 2B Audit Data was collected from medical notes, abstracted and inputted into Microsoft Excel. The sample consisted of 15 service users; 11(73%) male and 4(27%) female.Most individuals where of white British/Irish ethnicity, (14, 93%).Most (14, 93%) patients primary clinical psychiatric diagnosis based on the ICD10 category was F20–F29.Six (40%) individuals in the sample smoked, of which two (33%) were offered help with smoking cessation. There was evidence of diabetes in three case notes. In one (33%) case note it was Mental Health services that uncovered the diabetes. One service users file had evidence of a known diagnosis of Hypertension. This was not discovered by Mental Health services. Three service users had evidence of a disturbed lipid profile. In two (66%) of these notes it was Mental Health services that discovered the disturbed lipid profile.Lifestyle management pack: guidance and resources for staff and service users around diet, exercise, smoking cessation and other health lifestyle issues. Physical health check reminder cards: A patient-held card to record the results of physical health checks and due dates for new appointments.
Review of high dose anti psychotic prescription and monitoring at north end house, durham
Authors: Reddy J. 
Published: May 2011

IntroductionA single or more than two Antipsychotics above the recommended dose is known as High Dose prescription. Regular review of these patients is necessary due to the potential side effects.ObjectiveReviewing of the HDAT prescription and monitoring process between June and July 2010.Standard - TEWV NHS Trust guidelines suggest that patients on High Dose Antipsychotics should have1)Documentation of Medical history and Physical examination at the Well Being Clinic2)Medication Alert on PARIS (Trust intranet)3)Documentation on Visual display Board4)Regular Blood tests and ECGMethodologyReferring Case notes, PARIS entries and Visual Display board.ResultsOf the 8 patients at Well Being Clinic, Male −4, Female −4.Details of medical history & physical examination were recorded for all patients.Medication alerts were documented on PARIS.Visual display board was up to date with dates for bloods & ECG. Bloods tests - FBC,U&E, LFT, Lipids, Blood glucose & Prolactin. The tests were done at baseline, repeated on 1,2,3,6,9,12 months & at dose increment. All the blood tests & ECGs were up to date. 2 male patients were discharged following dose review. Once the patients were discharged, the alert on PARIS was removed.1 male patient was referred to GP for physical examination as the patient was quite obese. Prolactin levels of 2 patients were high. They were followed up with further blood investigations.Conclusion•Side effect monitoring scales like “LUNSERS” to be used•Arrange educational meetings to the Support workers.
How to treat patients with adult attention-deficit/hyperactivity disorder (ADHD) comorbid with psychosis? a case report
Authors: Holler M. , Foff C. , Rittmannsberger H. 
Published: May 2011

IntroductionIt is not uncommon that patients suffering from psychosis reveal a comorbidity of attention-deficit/hyperactivity disorder (ADHD). There is lack of evidence how to treat these patients as amphetamines are considered contraindicated for patients with psychosis.Objective/aims/methodsTo provide the case history of such a comorbid patient.ResultsA 21 year old male patient is committed to the psychiatric clinic displaying massive assaultive behavior. He has been consuming cannabis heavily over the last few years; for a couple of days now he has been displaying psychotic features. Occasional aggressive outbursts have been known to occur since childhood. The patient’s own accounts and those of his relatives also make an ADHD highly probable. During inpatient stay there are massive, dangerous aggressive assaults without detectable reasons along with complete disorganized behavior and massive thought disorders on three different occasions. Medication with very high doses of antipsychotics, benzodiazepines as well as mood stabilizers could not prevent the patient from his aggressive outbursts. The lack of efficacy of conventional treatment led us to propose to the patient a trial dose of methylphenidate, which calmed the patient instantly. Psychotic symptom, aggression and symptoms of ADHD improved during further treatment with methylphenidate, which was replaced by atomoxetine later. The patient was dismissed on a regimen of atomoxetine, Risperidone and Valproate and was well at a follow-up investigation 2 months later.ConclusionsThe use of methylphenidate in patients with adult ADHD comorbid with psychosis seems to be possible and helpful on some occasions.
Adherence to antidepressant treatment in depressive patients with comorbid psychiatric disorders
Authors: Roca M. , Armengol S. , García-García M. , Salva J. , Monzón S. , Bauzá N. , Gili M. 
Published: May 2011

BackgroundDepression is associated with high rates of comorbidity with other psychiatric disorders. Adherence to antidepressant medication regimens has been associated to different factors. Few studies have analyzed the influence of comorbid psychiatric disorders and adjunctive pharmacological treatments on antidepressant adherence.AimThe study evaluates the association of comorbid psychiatric disorder and pharmacological treatments with adherence rates to antidepressants in a large sample of depressive outpatients.Method3606 depressive patients were included in a cross-sectional epidemiological study, involving a stratified sample of 750 psychiatrists selected to participate. Patients were included if they met DSM-IV criteria for current single or recurrent non-psychotic major depressive disorder. Simplified Medication Adherence Questionnaire (SMAQ) and Hamilton Depression Rating Scale (HDRS) were used to assess adherence and depression severity.ResultsAdherence rates are lower in depressive patients with psychiatric comorbidity (62.8%) than in patients without comorbidity (69.1%) (Chi-square = 15.9, p < 0.001, OR = 1.6, 1.2–1.8). There are no significant differences in adherence rates between those patients taking or not benzodiacepines.ConclusionsPsychiatric comorbidity plays a negative role in adherence to antidepressant treatment. Benzodiazepine use has no influence on adherence rates. Special attention should be paid to the symptom overlapping between anxiety and depression and to the benzodiazepine prescription in comorbid depressive patients.
Involvement of the lateral septal nucleus and GABAa receptors in the antidepressant-like effects of allopregnanolone in wistar rats
Authors: Rodríguez-Landa J.F. , Contreras C.M. , Bernal-Morales B. , Gutiérrez-García A.G. , García-Ríos R.I. 
Published: May 2011

IntroductionPharmacological and non-pharmacological antidepressant therapies increase the firing rate of lateral septal nucleus neurons (a brain structure involved in mood state regulation) and reduce immobility in the forced swim test (FST), whereas the neurosteroid allopregnanolone appears to produce antidepressant-like effects through actions at GABAA receptors.ObjectiveTo explore the participation of the lateral septal nucleus and GABAA receptors in the antidepressant-like effects of allopregnanolone in Wistar rats.MethodsFirst, the minimally effective dose of allopregnanolone that produces antidepressant-like effects in the FST was determined. Second, the effect of this minimally effective dose in the FST was evaluated on the firing rate of lateral septal neurons. Third, the antidepressant-like effects of microinjection of allopregnanolone (1.0 μg/rat) into the lateral septal nucleus was evaluated in the FST. Fourth, we explored whether the effects of allopregnanolone on the lateral septal neuron firing rate and FST are blocked by picrotoxin or bicuculline, two GABAA receptor antagonists.ResultsThe minimally effective dose of allopregnanolone with antidepressant-like effects in the FST was 1.0 mg/kg (i.p.) and significantly increased the firing rate of lateral septal neurons. Microinjection of allopregnanolone into the lateral septal nucleus produced antidepressant-like effects in the FST. Pretreatment with picrotoxin and bicuculline blocked the increase in lateral septal neuron firing rate and the antidepressant-like effects of allopregnanolone in the FST.ConclusionThe lateral septal nucleus participates in the antidepressant-like effects of allopregnanolone through actions on GABAA receptors in Wistar rats.
Does antipsychotic medication affect white matter in schizophrenia and bipolar disorder? a review of diffusion tensor imaging literature
Authors: Kyriakopoulos M. , Samartzis L. , Dima D. , Hayes D. , Corrigall R. , Barker G. , Correll C.U. , Frangou S. 
Published: May 2011

IntroductionWhite matter (WM) abnormalities are considered integral to the pathophysiology of Schizophrenia (SZ) and Bipolar Disorder (BD), but there is ongoing uncertainty about the contribution of medication to these findings.ObjectivesDiffusion Tensor Imaging (DTI) is a neuroimaging technique that provides quantitative indices of the structural and orientational characteristics of WM. These indices include mean diffusivity (MD), which is a directionally averaged measure of the apparent diffusion coefficient, and fractional anisotropy (FA), which summarizes the orientational dependence of diffusivity. We wanted to determine if these indices are affected by antipsychotic medication.AimsOur aim was to examine the available literature in order to differentiate antipsychotic effects from disorder-specific WM abnormalities on DTI measures.MethodsWe conducted a systematic qualitative review of the DTI literature in Bipolar Disorder (BD) and Schizophrenia (SZ), between 1998 and 2010 and included only studies where the relationship between DTI measures and antipsychotic medication was explicitly examined and reported.ResultsWe identified 40 studies in SZ and 8 in BD. All studies were cross-sectional and involved relatively small patient samples. 32 studies (80%) did not find any relationship between antipsychotic medication (dose, cumulative exposure) and FA or MD.ConclusionsCurrent evidence does not indicate a major impact of antipsychotic treatment on DTI indices of WM integrity. However, the lack of longitudinal, within-subject designs is a major gap in the current literature.
Adherence and satisfaction survey in outpatients on treatment with antipsychotics
Authors: de Muniain M. Sanchez , Ramos R. Molina , Hernandez B. , Lliteras M. , Chada C. , Millan M. , Giner D. , Castillo C. 
Published: May 2011

IntroductionOne of the problems of many studies and clinical trials is that don’t reflect the patient's opinion about the medication that they receive and their satisfaction.Objetive and aimsThe aim of this study was to assess the degree of outpatients satisfaction with antipsychotic treatment in four outpatients clinics in Mallorca. The adherence rates was estimated from information provided by the patients and their psychiatrists.MethodsA cross.-sectional and descriptive study was conducted during one month, from May to June 2010, by administering several questionnaires to outpatients with psychotic disorders. It was designed a case report data which recorded the following variables: age, gender, diagnosis (schizophreniform, schizophrenia, schizoaffective disorder, delusional, psychotic disorder not otherwise specified), time since diagnosis, substance use, number of antipsychotic drugs, type of antipsychotic (oral and / or im), number of doses per day and number of tablets, via of administration (buttocks or deltoid). The psychometric instruments used were: the Morisky-Green test, Haynes-Sacket test, the MSQ (Medication Satisfaction Questionnaire) and CGI (Clinical Global Impression).ResultsThe sample was of 92 patients with a mean age of 42.1 years (SD 12.2): 57.6% male and the most frequent diagnosis was schizophrenia in 65.2%. The duration of treatment from diagnosis was more than 5 years in 66.3%.ConclusionsThe patients on maintenance monotherapy with RLAI showed better adherence rates and more insight, evaluated by their psychiatrits.78% of patients receiving antipsychotic medication injections were satisfied with the treatment.Patients with RLAI administrating in deltoid were satisfied in 65.7%.
Antiepileptic effects of quinine in the pentylenetetrazole model of seizure
Authors: Torabinejad B. , Nassiri-Asl M. , Zamansoltani F. 
Published: May 2011

IntroductionQuinine, is an anti-malarial drug that specifically blocks connexin 36 at gap junction channels.ObjectiveQuinine has suppressed ictal epileptiform activity in vitro without decreasing neuronal excitability.AimWe considered the possible anticonvulsant effects of quinine in the pentylenetetrazole (PTZ) model of seizure.MethodsIn five groups, the mice were given quinine at the doses of 20, 30, 40, 50, or 60 mg/kg 30 min before the administration of PTZ (90 mg/kg). Two groups were injected with diazepam, the positive control (0.5, 1 mg/kg) and one group, the control group, was injected with saline + Tween 80 before the administration of PTZ. The onset of a general clonus was used as the endpoint. The general clonus was characterized by forelimb clonus followed by full clonus of the body.ResultsIn the PTZ model, quinine at the dose of 60 mg/kg increased the latency of seizure. However, quinine at 40-60 mg/kg decreased the duration of seizure, dose dependently.ConclusionThe present study provides evidence for anticonvulsant activity of quinine in the generalized clonic seizure of PTZ model. As a result of these finding, we suggest that gap junctions represent an appropriate target for the development of drugs aimed at decreasing epileptiform synchronization and preventing epileptogenesis.
Treatment of patient with depressive disorder - therapy with duloxetine
Authors: Uzun S. , Kozumplik O. , Jakovljevic M. 
Published: May 2011

AimTo present a case of a patient with depression who recovered during treatment with duloxetine.Case reportPatient, 68 years old, was treated for the past 20 years because of depression. The patients described that worsening in mental condition usually started with depressed mood, followed by prostration and loss of motivation. So far, she was treated with different antidepressants, with partial therapeutic response. On the control examination, depressed mood, anxiety, fatigue, prostration, insomnia and loss in motivation were noticed. The patient reported spending most of the time in bed, with lack of interest for daily activities. Also, she reported indistinct pain in the back. She was afraid that there was no adequate cure for her condition. Treatment with duloxetine was initiated, in daily dosage of 60 mg. The patient was advised to take the medication along with the richest meal, so she started taking duloxetine after lunch. Also, the patient started taking zolpidem 10 mg in the evening because of insomnia. On the next control examination, ten days later, improvement in her mental condition was observed, and she said that she felt better. Her mood improved, as well as motivation, and anxiety was reduced. The patient continued taking duloxetine in daily dosage of 60 mg and on the following control examinations her condition remained stable, pain in the back was reduced, and she reported that she was able to function socially and was satisfied with her condition.
Immediate-release and extended-release formulations of second-generation antidepressants for the treatment of major depressive disorder in adults
Authors: Van Noord M. , Gartlehner G. , Hansen R. , Morgan L. , Thaler K. , Lux L. , Mager U. , Gaynes B. , Thieda P. , Strobelberger M. , Lloyd S. , Reichenpfader U. , Lohr K. 
Published: May 2011

IntroductionExtended-release formulations of antidepressants have been marketed as a strategy to increase patient adherence. Changes in the formulation of drugs, however, could be related to changes in efficacy and tolerability. Among second-generation antidepressants, bupropion, fluoxetine, mirtazapine, paroxetine, and venlafaxine are available in immediate- and extended-release formulations.ObjectivesTo compare the efficacy, tolerability, and adherence of immediate- versus extended-release formulations of second-generation antidepressants for the treatment of major depressive disorder (MDD) in adults.AimTo provide an evidence base for clinicians when choosing immediate- or extended-release formulations of antidepressants for the treatment of MDD.MethodsWe conducted a comparative effectiveness review for the U.S. Agency for Healthcare Research and Quality searching PubMed, EMBASE, The Cochrane Library, and the International Pharmaceutical Abstracts up to May 2010. Two people independently reviewed the literature, abstracted data, and rated the risk of bias.ResultsSix RCTs and one observational study provided evidence about the comparative efficacy, tolerability, and adherence of bupropion SR (sustained release) versus bupropion XL (extended release), fluoxetine daily vs. fluoxetine weekly, paroxetine IR (immediate release) versus paroxetine CR (continuous release), and venlafaxine IR versus venlafaxine XR (extended release). Overall, no substantial differences in efficacy and safety could be detected. Open-label and observational evidence indicated better adherence for bupropion XL and fluoxetine weekly than for immediate-release medications. No differences in adherence could be detected between paroxetine IR and paroxetine CR.ConclusionsOur findings indicate similar efficacy and tolerability between immediate- and extended-release formulations. Whether extended-release formulations lead to better adherence remains unclear.
Valproate and cognitive therapy combined treatment efficacy in pathological gambling
Authors: Vasile D. , Vasiliu O. , Vasile B. , Tudor C. , Grigorescu G. , Mangalagiu A.G. , Ojog D.G. 
Published: May 2011

IntroductionValproate is used in psychiatry as a mood-stabilizer and has efficacy in controlling impulsivity, therefore it seems to be a useful pharmacologic agent in pathologic gambling.ObjectiveTo assess the efficacy of valproate in the treatment of pathologic gambling.MethodsA group of 13 patients, 9 male and 4 female, mean age 32.6, diagnosed with pathologic gambling, according to the DSM-IV-TR criteria, received treatment with flexible dose of valproate (600–1400 mg/day, mean dose 850 mg/day) and 2 times/week cognitive therapy sessions. Patients with other axis I and II conditions were excluded. Also, none of these patients received valproate or structured cognitive therapy prior to this trial. Patients were monitored for 3 months using monthly administered Gambling Symptoms Assessment Scale (G-SAS), Clinical Global Impressions (CGI) and 10 points self-evaluated Visual Analogue Scale (VAS).ResultsValproate was associated with a mean decrease of 10.5 points on G-SAS at week 12, compared to baseline (p < 0.05), while the CGI decreased with only 1.3 points (p = 0.122) and the VAS improved with 2.3 points (p < 0.05). The combined treatment was associated with good tolerability profile, since no drop-out was recorded in the study group due to side events and only 7 reports of mild and medium adverse events were recorded.ConclusionValproate treatment associated with cognitive therapy could be a useful strategy in the management of pathologic gambling. Valproate's tolerability profile is good and the cognitive therapy offer an opportunity to ventilate the negative automatic thoughts, emotional distress and low impulse control strategies.