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Rásky É, Stolz E, Jagsch C. [Mortality of gerontopsychiatric inpatients in Graz, Austria-a retrospective case-control study]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2020; 34:22-26. [PMID: 31970717 DOI: 10.1007/s40211-019-00329-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite the demographic development and the increasing number of psychiatric diseases in older people, there are only few scientific investigations on the characteristics of patients in gerontopsychiatry and their mortality. In this retrospective case control study patient data were examined in order to establish which features of patients who died in a department of gerontopsychiatry show differences to those of patients who were discharged. METHOD A total of 284 patient files from the department of gerontopsychiatry and geriatric psychotherapy of the State Hospital Graz II were evaluated. Between 1 January 2015 and 31 December 2017, a total of 51 women and 91 men died (= cases) in hospital. These patients were compared with 142 sex-matched patients (control group) who were discharged during the same period of time. The evaluation was carried out using logistic regression models. RESULTS Patients who died on the geriatric psychiatry ward were clearly older and were in a clearly poorer physical state of health than the discharged patients. The deceased patients had a 2.7-fold higher chance of an ischemic cardiac disease as well as a 2.5-fold and 3.5-fold higher chance of being referred from a nursing home or hospital, respectively. They also had a threefold higher chance for a lower functional status, a fourfold increased chance of higher C‑reactive protein (CRP) values and a diagnosis of delirium compared to discharged patients. CONCLUSION The deceased patients had a substantially poorer state of health and tended to suffer more from delirium compared to the discharged patients. Structural health policy precautions must be undertaken so that unnecessary transfers to gerontopsychiatry departments do not become necessary.
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Affiliation(s)
- Éva Rásky
- Institut für Sozialmedizin und Epidemiologie, Medizinische Universität Graz, Graz, Österreich.
| | - Erwin Stolz
- Institut für Sozialmedizin und Epidemiologie, Medizinische Universität Graz, Graz, Österreich
| | - Christian Jagsch
- Abteilung für Alterspsychiatrie und Alterspsychotherapie, LKH Graz II, Graz, Österreich
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Curto M, Lionetto L, David MC, Maiese A, Ferracuti S, Simmaco M, Baldessarini RJ. Sudden Death Associated with Complex Treatment of Acute Mania: Case Report and Toxicological Findings. ACTA ACUST UNITED AC 2019. [DOI: 10.2174/2211556008666190916093915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Antipsychotic drugs, mood-stabilizers, and sedatives are used routinely
to treat acute mania, sometimes in combinations, most of which are poorly evaluated
for efficacy and safety.
Objective:
We report a case of sudden death in a 40-year-old man with acute mania treated
aggressively with combinations of drugs that resulted in in potentially toxic, high serum
drug concentrations.
Method:
After the autopsy, analysis were conducted to determine levels of the administered
medications using GC-MS and LC-MS/MS.
Results:
Although dosed within recommended ranges, circulating concentrations of some
antipsychotic drugs given were excessive, suggesting possible pharmacokinetic interactions.
In particular, valproate may have increased serum levels of haloperidol, clozapine,
and promazine. The proposed cause of death was cardiac arrest, to which the high concentrations
of antipsychotics may have contributed.
Conclusion:
This case suggests caution in the aggressive treatment of mania with combinations
of psychotropic drugs and highlights the need of further clinical studies to identify
consequences of drug-drug interactions of antimanic drugs, even when given at recommended
doses.
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Affiliation(s)
- Martina Curto
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Universita 30, 00185, Rome, Italy
| | - Luana Lionetto
- Mass Spectrometry Laboratory, Sant'Andrea University Hospital, Rome, Italy
| | - Maria Chiara David
- Forensic Science Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | | | - Stefano Ferracuti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Universita 30, 00185, Rome, Italy
| | - Maurizio Simmaco
- Mass Spectrometry Laboratory, Sant'Andrea University Hospital, Rome, Italy
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3
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Rehman M, Vodret S, Braga L, Guarnaccia C, Celsi F, Rossetti G, Martinelli V, Battini T, Long C, Vukusic K, Kocijan T, Collesi C, Ring N, Skoko N, Giacca M, Del Sal G, Confalonieri M, Raspa M, Marcello A, Myers MP, Crovella S, Carloni P, Zacchigna S. High-throughput screening discovers antifibrotic properties of haloperidol by hindering myofibroblast activation. JCI Insight 2019; 4:123987. [PMID: 30996132 PMCID: PMC6538355 DOI: 10.1172/jci.insight.123987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/14/2019] [Indexed: 12/23/2022] Open
Abstract
Fibrosis is a hallmark in the pathogenesis of various diseases, with very limited therapeutic solutions. A key event in the fibrotic process is the expression of contractile proteins, including α-smooth muscle actin (αSMA) by fibroblasts, which become myofibroblasts. Here, we report the results of a high-throughput screening of a library of approved drugs that led to the discovery of haloperidol, a common antipsychotic drug, as a potent inhibitor of myofibroblast activation. We show that haloperidol exerts its antifibrotic effect on primary murine and human fibroblasts by binding to sigma receptor 1, independent from the canonical transforming growth factor-β signaling pathway. Its mechanism of action involves the modulation of intracellular calcium, with moderate induction of endoplasmic reticulum stress response, which in turn abrogates Notch1 signaling and the consequent expression of its targets, including αSMA. Importantly, haloperidol also reduced the fibrotic burden in 3 different animal models of lung, cardiac, and tumor-associated fibrosis, thus supporting the repurposing of this drug for the treatment of fibrotic conditions.
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Affiliation(s)
| | | | | | - Corrado Guarnaccia
- Biotechnology Development, International Centre for Genetic Engineering and Biotechnology (ICGEB), Padriciano, Trieste, Italy
| | - Fulvio Celsi
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo,” Trieste, Italy
| | - Giulia Rossetti
- Computational Biomedicine Section, Institute of Advanced Simulation IAS-5 and Institute of Neuroscience and Medicine INM-9, Forschungszentrum Jülich GmbH, Jülich, Germany
| | | | | | | | | | | | - Chiara Collesi
- Molecular Medicine, and
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Natasa Skoko
- Biotechnology Development, International Centre for Genetic Engineering and Biotechnology (ICGEB), Padriciano, Trieste, Italy
| | - Mauro Giacca
- Molecular Medicine, and
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giannino Del Sal
- National Laboratory CIB, Area Science Park Padriciano, Trieste, Italy
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Marco Confalonieri
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Marcello Raspa
- National Research Council, CNR-Campus International Development (EMMA-INFRAFRONTIER-IMPC), Monterotondo Scalo, Rome, Italy
| | | | - Michael P. Myers
- Protein Networks Laboratories, International Centre for Genetic Engineering and Biotechnology (ICGEB), Padriciano, Trieste, Italy
| | - Sergio Crovella
- Biotechnology Development, International Centre for Genetic Engineering and Biotechnology (ICGEB), Padriciano, Trieste, Italy
| | - Paolo Carloni
- Computational Biomedicine Section, Institute of Advanced Simulation IAS-5 and Institute of Neuroscience and Medicine INM-9, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Serena Zacchigna
- Cardiovascular Biology
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Teodorescu A, Dima L, Ifteni P, Rogozea LM. Clozapine for Treatment-Refractory Behavioral Disturbance in Dementia. Am J Ther 2018; 25:e320-e325. [PMID: 29401113 DOI: 10.1097/mjt.0000000000000735] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms in dementia significantly contribute to caregiver burden and impose patient hospitalization. The goal of treatment of admitted patients is the rapid remission of symptoms to allow their return to home as soon as possible. Intervention requires an intrusive approach with parenteral treatment and physical restraints, with a negative emotional impact on patients and their families. Despite the large utilization of antipsychotics for behavioral and psychological symptoms, there is no antipsychotic approved by the Food and Drug Administration for agitation in dementia. STUDY QUESTION To evaluate efficacy and tolerability of clozapine in patients with treatment-resistant agitation associated with dementia. STUDY DESIGN Cohort study with 337 patients, admitted between January 1, 2012 and December 31, 2016, with dementia according to The Diagnostic and Statistical Manual of Mental Disorders 4th ed. criteria. Clozapine was given in standard titration, starting with 6.25 or 12.5 mg. MEASURES AND OUTCOMES Efficacy was measured by the need for physical restraints and time to discharge and tolerability by recording all side effects. Data collected included demographics, psychotropics used, physical restraints, length of stay, destination after discharge, and comorbidities. RESULTS Of 337 cases, 315 (93.5%) patients received antipsychotics. There were 27 cases treated with clozapine. Before clozapine initiation, haloperidol was given in 16 cases (55.17%, mean = 7.43 mg/d, SD = ±4.01), and the treatment was stopped mainly because of extrapyramidal side effects. Other antipsychotics used were quetiapine (mean dose = 260 mg/d, SD = ±54.77), risperidone (mean dose = 3.3 mg/d, SD = ±0.57), and olanzapine (mean dose = 8.33 mg/d, SD = ±2.88). Mean dose of clozapine was 59.16 mg/d, (SD = ±40.48), ranging from 12.5 to 200 mg/d. There were a lower number of physical restraints after clozapine initiation than before (12 vs. 34, P < 0.05). CONCLUSIONS Clozapine therapy seemed beneficial in treatment-resistant agitation in patients with dementia. The risk-benefit balance must be well weighed when clozapine is chosen. More studies are needed.
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Affiliation(s)
- Andreea Teodorescu
- Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania.,Psychiatry and Neurology Hospital, Brasov, Romania
| | - Lorena Dima
- Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
| | - Petru Ifteni
- Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania.,Psychiatry and Neurology Hospital, Brasov, Romania
| | - Liliana M Rogozea
- Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
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Greenblatt HK, Greenblatt DJ. Use of Antipsychotics for the Treatment of Behavioral Symptoms of Dementia. J Clin Pharmacol 2016; 56:1048-57. [PMID: 26953213 DOI: 10.1002/jcph.731] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/29/2016] [Indexed: 01/08/2023]
Abstract
Antipsychotic medications are widely used in the management of behavioral and psychological symptoms of dementia. While nonpharmacological interventions should be the first-line treatment for behavioral symptoms of dementia, these are often unfeasible and/or ineffective. Conventional and atypical antipsychotic agents appear to have modest to moderate clinical efficacy in the treatment of these symptoms, though it is unclear which individual agents are most effective. No conclusive evidence exists that any available alternative medications are safer and more effective than antipsychotics. A number of studies have shown an increased risk of mortality associated with antipsychotics in patients with behavioral symptoms of dementia, though the observed risk increase may be partially confounded by illness severity and/or preexisting health determinants. The mechanisms of increased mortality risk are not fully established, but are likely to involve cardiovascular events. It is probable, though not certain, that conventional antipsychotics are associated with a greater number of poor outcomes than atypical antipsychotics. In certain patients with refractory behavioral symptoms, antipsychotics are a viable treatment option. Key considerations for antipsychotic prescribing for this population are published in regulatory guidelines, and include minimization of dosage and duration of treatment, continuous reevaluation of symptoms, and involvement of caregivers.
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Affiliation(s)
- H Karl Greenblatt
- Program in Pharmacology and Experimental Therapeutics, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA
| | - David J Greenblatt
- Program in Pharmacology and Experimental Therapeutics, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA
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