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Abel N, Stern F, Tal S. On-admission serum 25(OH)D level and mortality within one year in older patients. BMC Geriatr 2024; 24:664. [PMID: 39118005 PMCID: PMC11308204 DOI: 10.1186/s12877-024-05166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 06/21/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Mounting evidence suggests that vitamin D deficiency is associated with a higher risk of many chronic non-skeletal, age-associated diseases as well as mortality. AIM To determine, in older patients aged ≥ 80, the prevalence of vitamin D deficiency and its association with comorbidity, laboratory tests, length of stay and mortality within one year from blood withdrawal on admission to acute geriatrics ward. METHODS We retrospectively surveyed electronic hospital health records of 830 older patients. The recorded data included patient demographics (e.g., age, sex, stay duration, readmissions number, death within one year from blood withdrawal on admission), medical diagnoses, laboratory results, including 25-hydroxyvitamin D [25(OH)D], and medications. We compared the characteristics of the patients who survived to those who died within one year. RESULTS On admission, in 53.6% patients, vitamin D levels were lower than 50 nmol/L, and in 32%, the levels were ≤ 35 nmol/L. Persons who died were likely to be older, of male sex, were likely to be admitted for pneumonia or CHF, were likely to have lower level of albumin or hemoglobin, lower level of vitamin D or higher vitamin B12 and higher level of creatinine, were also likely to have had a lengthier hospitalization stay, a greater number of hospitalizations in the last year, a higher number of comorbidities, to have consumption of ≥5 drugs or likely to being treated with insulin, diuretics, antipsychotics, anticoagulants or benzodiazepines. Higher age, male sex, on-admission CHF, higher number of drugs, lower albumin, higher vitamin B12, vitamin D < 50 nmol/L, and consumption of antipsychotics and anticoagulants - were predictors of mortality. CONCLUSION Hypovitaminosis D is predictive of mortality in older patients within one year from hospitalization in the acute geriatric ward, but a causal relationship cannot be deduced. Nevertheless, older patients in acute care settings, because of their health vulnerability, should be considered for vitamin D testing. In the acutely ill patients, early intervention with vitamin D might improve outcomes. Accurate evaluation of mortality predictors in this age group patients may be more challenging and require variables that were not included in our study.
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Affiliation(s)
- Nadav Abel
- Geriatric Department, Hartzfeld Hospital at Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, Rehovot, Israel
| | - Felicia Stern
- The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Sari Tal
- Acute Geriatrics Department, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, Rehovot, Israel.
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Apetroaei MM, Fragkiadaki P, Velescu BȘ, Baliou S, Renieri E, Dinu-Pirvu CE, Drăgănescu D, Vlăsceanu AM, Nedea MI(I, Udeanu DI, Docea AO, Tsatsakis A, Arsene AL. Pharmacotherapeutic Considerations on Telomere Biology: The Positive Effect of Pharmacologically Active Substances on Telomere Length. Int J Mol Sci 2024; 25:7694. [PMID: 39062937 PMCID: PMC11276808 DOI: 10.3390/ijms25147694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Telomeres are part of chromatin structures containing repeated DNA sequences, which function as protective caps at the ends of chromosomes and prevent DNA degradation and recombination, thus ensuring the integrity of the genome. While telomere length (TL) can be genetically inherited, TL shortening has been associated with ageing and multiple xenobiotics and bioactive substances. TL has been characterised as a reliable biomarker for the predisposition to developing chronic pathologies and their progression. This narrative review aims to provide arguments in favour of including TL measurements in a complex prognostic and diagnostic panel of chronic pathologies and the importance of assessing the effect of different pharmacologically active molecules on the biology of telomeres. Medicines used in the management of cardiovascular diseases, diabetes, schizophrenia, hormone replacement therapy at menopause, danazol, melatonin, and probiotics have been studied for their positive protective effects against TL shortening. All these classes of drugs are analysed in the present review, with a particular focus on the molecular mechanisms involved.
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Affiliation(s)
- Miruna-Maria Apetroaei
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (M.-M.A.); (C.E.D.-P.); (D.D.); (A.M.V.); (M.I.N.); (D.I.U.); (A.L.A.)
| | - Persefoni Fragkiadaki
- Laboratory of Toxicology and Forensic Sciences, Medical School, University of Crete, Voutes, 71003 Heraklion, Greece; (P.F.); (S.B.); (E.R.); (A.T.)
- Lifeplus S.A., Science & Technological Park of Crete, C Building, Vassilika Vouton, 70013 Heraklion, Greece
| | - Bruno Ștefan Velescu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (M.-M.A.); (C.E.D.-P.); (D.D.); (A.M.V.); (M.I.N.); (D.I.U.); (A.L.A.)
| | - Stella Baliou
- Laboratory of Toxicology and Forensic Sciences, Medical School, University of Crete, Voutes, 71003 Heraklion, Greece; (P.F.); (S.B.); (E.R.); (A.T.)
- Lifeplus S.A., Science & Technological Park of Crete, C Building, Vassilika Vouton, 70013 Heraklion, Greece
| | - Elisavet Renieri
- Laboratory of Toxicology and Forensic Sciences, Medical School, University of Crete, Voutes, 71003 Heraklion, Greece; (P.F.); (S.B.); (E.R.); (A.T.)
- Lifeplus S.A., Science & Technological Park of Crete, C Building, Vassilika Vouton, 70013 Heraklion, Greece
| | - Cristina Elena Dinu-Pirvu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (M.-M.A.); (C.E.D.-P.); (D.D.); (A.M.V.); (M.I.N.); (D.I.U.); (A.L.A.)
| | - Doina Drăgănescu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (M.-M.A.); (C.E.D.-P.); (D.D.); (A.M.V.); (M.I.N.); (D.I.U.); (A.L.A.)
| | - Ana Maria Vlăsceanu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (M.-M.A.); (C.E.D.-P.); (D.D.); (A.M.V.); (M.I.N.); (D.I.U.); (A.L.A.)
| | - Marina Ionela (Ilie) Nedea
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (M.-M.A.); (C.E.D.-P.); (D.D.); (A.M.V.); (M.I.N.); (D.I.U.); (A.L.A.)
| | - Denisa Ioana Udeanu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (M.-M.A.); (C.E.D.-P.); (D.D.); (A.M.V.); (M.I.N.); (D.I.U.); (A.L.A.)
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Artistidis Tsatsakis
- Laboratory of Toxicology and Forensic Sciences, Medical School, University of Crete, Voutes, 71003 Heraklion, Greece; (P.F.); (S.B.); (E.R.); (A.T.)
- Lifeplus S.A., Science & Technological Park of Crete, C Building, Vassilika Vouton, 70013 Heraklion, Greece
| | - Andreea Letiția Arsene
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (M.-M.A.); (C.E.D.-P.); (D.D.); (A.M.V.); (M.I.N.); (D.I.U.); (A.L.A.)
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Fisher DW, Dunn JT, Dong H. Distinguishing features of depression in dementia from primary psychiatric disease. DISCOVER MENTAL HEALTH 2024; 4:3. [PMID: 38175420 PMCID: PMC10767128 DOI: 10.1007/s44192-023-00057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
Depression is a common and devastating neuropsychiatric symptom in the elderly and in patients with dementia. In particular, nearly 80% of patients with Alzheimer's Disease dementia experience depression during disease development and progression. However, it is unknown whether the depression in patients with dementia shares the same molecular mechanisms as depression presenting as primary psychiatric disease or occurs and persists through alternative mechanisms. In this review, we discuss how the clinical presentation and treatment differ between depression in dementia and as a primary psychiatric disease, with a focus on major depressive disorder. Then, we hypothesize several molecular mechanisms that may be unique to depression in dementia such as neuropathological changes, inflammation, and vascular events. Finally, we discuss existing issues and future directions for investigation and treatment of depression in dementia.
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Affiliation(s)
- Daniel W Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA
| | - Jeffrey T Dunn
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA.
- Department of Neurology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA.
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Ang CS, Yuen AZD. A qualitative study of dementia caregivers' lived experiences in Singapore. Home Health Care Serv Q 2023; 42:124-141. [PMID: 36594495 DOI: 10.1080/01621424.2022.2164540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Globally, the number of people living with dementia is expected to triple by 2050 owing primarily to the aging population. Dementia is a chronic and progressive disease that affects an estimated 5-8% of the general population aged 60 and above at any given time. This qualitative study aimed to investigate caregivers' overall perceptions, challenges, and coping strategies in dementia care in Singapore. Purposive sampling was used to select the study's sample. Eight Singaporeans were interviewed in semi-structured, in-depth interviews. Three themes emerged from the data analysis for each research question: overall perceptions (i.e. less freedom, strained family relationships, and improved self-competency), challenges (i.e. managing dementia symptoms, emotional drain, and decision-making), and coping mechanisms (i.e. making time for myself, religious belief, and seeking external support). Knowing about these challenges and coping mechanisms allows practitioners to help caregivers to reduce personal struggles, thus improving the patient's and caregiver's quality of life.
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Affiliation(s)
- Chin-Siang Ang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Tal S. Mortality in the Oldest-Old Adults After Discharge From Acute Geriatric Ward. Gerontol Geriatr Med 2023; 9:23337214231156300. [PMID: 37250599 PMCID: PMC10214041 DOI: 10.1177/23337214231156300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 05/31/2023] Open
Abstract
Aim: To examine risk factors for post-discharge mortality in the oldest-old patients. Methods: We have assessed the risk factors for mortality after discharge from acute geriatric ward in 448 patients aged ≥90. Results: Low albumin, high urea, and full dependence were risk factors for mortality within 1 month and within 1 year after discharge from hospital. Age-adjusted Charlson Comorbidity Index score, neuroleptic drug treatments and frailty were specific risk factors for post-discharge mortality within 1 year. By Cox regression analysis, the risk factors associated with higher hazard ratios for post-discharge mortality within 14 years follow-up were age-adjusted Charlson Comorbidity Index score, poor functional status, anemia and dementia as comorbidities, neuroleptic drug treatments, low albumin, high urea, and high vitamin B12. Conclusion: Optimal treatment of the condition due to which the patient has been hospitalized and of the medical complications that occurred during hospitalization, while preventing functional decline, might secure longer post-discharge survival.
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Affiliation(s)
- Sari Tal
- Geriatrics Department, Kaplan Medical
Center, Affiliated With the Hebrew University of Jerusalem, Rehovot, Israel
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Manzano-Palomo S, Agüera-Ortiz LF, García-Caballero A, Martínez-Raga J, Ojea-Ortega T, Sánchez-Valle R, Antón-Jiménez M, Monge-Argilés JA, Ramos-García I. Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus. Dement Geriatr Cogn Disord 2020; 49:573-582. [PMID: 33176326 PMCID: PMC8117381 DOI: 10.1159/000510866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/11/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are difficult to manage and associated with poor outcome. OBJECTIVES The aim of this study was to reach consensus on the use of antipsychotics in patients with BPSD in Spain. METHODS A qualitative, multicenter, two-round Delphi study was carried out, with the participation of specialists involved in the care of dementia patients throughout Spain. They completed a 76-item questionnaire related to the identification of BPSD, treatment with antipsychotics, follow-up of patients, barriers for the use of atypical antipsychotics, and effects of antipsychotics on quality of life. RESULTS A total of 162 specialists in neurology, psychiatry, and geriatrics (61% men) with a mean (SD) age of 45.9 (10) years participated in the study. Almost all participants (96.9%) strongly agreed that atypical antipsychotics are safer and better tolerated than typical antipsychotics. There was agreement on the importance to review the indication and dose of the antipsychotic drug at least every 3 months. There was consistent high rate of agreement on the beneficial impact of atypical antipsychotics on the quality of life of patients with dementia and their caregivers. A consensus was also reached on the need of detecting BPSD in patients with dementia as it decreases the quality of life of both patients and caregivers, and the need to routinely screen for dementia in elderly patients with no previous psychiatric history in the presence of suggestive symptoms of BPSD. Finally, the participants in the study agreed that administrative barriers for the prescription of atypical antipsychotics in Spain hinder the access to this drug group and favor the prescription of typical antipsychotics. CONCLUSIONS The participants in the study agreed that atypical antipsychotics should be preferred to typical antipsychotics in the management of BPSD. Wide consensus was reached about the importance of early identification of BPSD in persons with cognitive impairment, the use and management of atypical antipsychotic drugs and their favorable impact on patients and caregiver's quality of life.
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Affiliation(s)
| | - Luis F Agüera-Ortiz
- Department of Psychiatry, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital Universitario 12 de Octubre (imas12), CIBERSAM, Madrid, Spain
| | | | - José Martínez-Raga
- Department of Psychiatry, Hospital Universitario Doctor Peset, Universitat de València, Valencia, Spain
| | - Tomás Ojea-Ortega
- Department of Neurology, Hospital Regional Universitario Málaga, Málaga, Spain
| | - Raquel Sánchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Department of Neurology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Manuel Antón-Jiménez
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain
| | - José A Monge-Argilés
- Department of Neurology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Isabel Ramos-García
- Department of Psychiatry, Hospital Clínico Universitario San Carlos, Madrid, Spain
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Perehudoff K, Azermai M, Wauters M, Van Acker S, Versluys K, Steeman E, Petrovic M. The psychotropic education and knowledge test for nurses in nursing homes: striving for PEAK performance. Aging Ment Health 2016. [PMID: 26213245 DOI: 10.1080/13607863.2015.1068738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The psychotropic education and knowledge test for nurses in acute geriatric care (PEAK-AC) measures knowledge of psychotropic indications, doses and adverse drug reactions in older inpatients. Given the low internal consistency and poor discrimination of certain items, this study aims to adapt the PEAK-AC, validate it in the nursing home setting and identify factors related to nurses' knowledge of psychotropics. METHOD This study included nurses and nurse assistants employed by nursing homes (n = 13) and nursing students at educational institutions (n = 5) in Belgium. A Delphi technique was used to establish content validity, the known groups technique for construct validity (nrespondents = 550) and the test-retest procedure for reliability (nrespondents = 42). Internal consistency and item analysis were determined. RESULTS The psychotropic education and knowledge test for nurses in nursing homes (PEAK-NH) (nitems = 19) demonstrated reliability (κ = 0.641) and internal consistency (Cronbach's α = 0.773). Significant differences between-group median scores were observed by function (p < 0.001), gender (p = 0.019), educational background (p < 0.001), work experience (p = 0.008) and continuing education (p < 0.001) for depression, delirium and pharmacotherapy topics. Items were acceptably difficult (nitems = 15) and well-functioning discriminators (nitems = 17). Median PEAK-NH score was 9/19 points (interquartile range 6-11 points). Respondents' own estimated knowledge was related to their PEAK-NH performance (p < 0.001). CONCLUSION The PEAK-NH is a valid and reliable instrument to measure nurses' knowledge of psychotropics. These results suggest that nurses have limited knowledge of psychotropic use in nursing homes and are aware of their knowledge deficits. The PEAK-NH enables educational initiatives to be targeted and their impact on nurses' knowledge to be tracked.
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Affiliation(s)
- Katrina Perehudoff
- a Department of Geriatrics , Ghent University Hospital , Ghent , Belgium
| | - Majda Azermai
- b Department of Pharmacology, Heymans Institute of Pharmacology , Ghent University , Ghent , Belgium
| | - Maarten Wauters
- b Department of Pharmacology, Heymans Institute of Pharmacology , Ghent University , Ghent , Belgium
| | - Sandra Van Acker
- c Department of Public Health , Ghent University , Ghent , Belgium
| | - Karen Versluys
- a Department of Geriatrics , Ghent University Hospital , Ghent , Belgium
| | - Els Steeman
- c Department of Public Health , Ghent University , Ghent , Belgium
| | - Mirko Petrovic
- a Department of Geriatrics , Ghent University Hospital , Ghent , Belgium
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Meigal AY, Miroshnichenko GG, Kuzmina AP, Rissanen SM, Georgiadis SD, Karjalainen PA. Nonlinear parameters of surface EMG in schizophrenia patients depend on kind of antipsychotic therapy. Front Physiol 2015; 6:197. [PMID: 26217236 PMCID: PMC4498039 DOI: 10.3389/fphys.2015.00197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/23/2015] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED We compared a set of surface EMG (sEMG) parameters in several groups of schizophrenia (SZ, n = 74) patients and healthy controls (n = 11) and coupled them with the clinical data. sEMG records were quantified with spectral, mutual information (MI) based and recurrence quantification analysis (RQA) parameters, and with approximate and sample entropies (ApEn and SampEn). Psychotic deterioration was estimated with Positive and Negative Syndrome Scale (PANSS) and with the positive subscale of PANSS. Neuroleptic-induced parkinsonism (NIP) motor symptoms were estimated with Simpson-Angus Scale (SAS). Dyskinesia was measured with Abnormal Involuntary Movement Scale (AIMS). We found that there was no difference in values of sEMG parameters between healthy controls and drug-naïve SZ patients. The most specific group was formed of SZ patients who were administered both typical and atypical antipsychotics (AP). Their sEMG parameters were significantly different from those of SZ patients taking either typical or atypical AP or taking no AP. This may represent a kind of synergistic effect of these two classes of AP. For the clinical data we found that PANSS, SAS, and AIMS were not correlated to any of the sEMG parameters. CONCLUSION with nonlinear parameters of sEMG it is possible to reveal NIP in SZ patients, and it may help to discriminate between different clinical groups of SZ patients. Combined typical and atypical AP therapy has stronger effect on sEMG than a therapy with AP of only one class.
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Affiliation(s)
- Alexander Yu. Meigal
- Laboratory for Novel Methods in Physiology, Institute of High-Tech Biomedical Solutions, Petrozavodsk State UniversityPetrozavodsk, Russia
| | - German G. Miroshnichenko
- Biosignal Analysis and Medical Imaging Group, Department of Applied Physics, Faculty of Science and Forestry, University of Eastern FinlandKuopio, Finland
| | | | - Saara M. Rissanen
- Biosignal Analysis and Medical Imaging Group, Department of Applied Physics, Faculty of Science and Forestry, University of Eastern FinlandKuopio, Finland
| | - Stefanos D. Georgiadis
- Biosignal Analysis and Medical Imaging Group, Department of Applied Physics, Faculty of Science and Forestry, University of Eastern FinlandKuopio, Finland
| | - Pasi A. Karjalainen
- Biosignal Analysis and Medical Imaging Group, Department of Applied Physics, Faculty of Science and Forestry, University of Eastern FinlandKuopio, Finland
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Porsolt RD, Castagné V, Hayes E, Virley D. Nonhuman primates: translational models for predicting antipsychotic-induced movement disorders. J Pharmacol Exp Ther 2013; 347:542-6. [PMID: 24030013 DOI: 10.1124/jpet.113.207209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Repeated haloperidol treatment administered to nonhuman primates (NHPs) over several months or even years leads to the gradual appearance of drug-induced dystonic reactions in the orofacial region (mouth opening, tongue protrusion or retraction, bar biting) and in the whole body (writhing of the limbs and trunk, bar grasping). The propensity of antipsychotics to induce dystonia in NHPs is not correlated with their propensity to induce catalepsy in rodents, suggesting that the two types of effects are dissociated and may represent distinct aspects of the extrapyramidal symptoms induced by antipsychotics. In view of the clear homology to clinically observed phenomena, antipsychotic-induced dystonias in antipsychotic-primed NHPs would appear to possess a high degree of translational validity. These NHP phenomena could therefore serve as a useful model for predicting the occurrence of similar abnormal movements with novel substances developed for the treatment of schizophrenia or other psychotic disorders. Moreover, the NHP dystonia model could possibly serve as a biomarker for substances that will eventually cause tardive dyskinesia in patients.
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Affiliation(s)
- Roger D Porsolt
- Porsolt Research Center, Porsolt SAS (France), Le Genest-Saint-Isle, France
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Vasilyeva I, Biscontri RG, Enns MW, Metge CJ, Alessi-Severini S. Movement disorders in elderly users of risperidone and first generation antipsychotic agents: a Canadian population-based study. PLoS One 2013; 8:e64217. [PMID: 23696870 PMCID: PMC3656145 DOI: 10.1371/journal.pone.0064217] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/12/2013] [Indexed: 11/18/2022] Open
Abstract
Background Despite concerns over the potential for severe adverse events, antipsychotic medications remain the mainstay of treatment of behaviour disorders and psychosis in elderly patients. Second-generation antipsychotic agents (SGAs; e.g., risperidone, olanzapine, quetiapine) have generally shown a better safety profile compared to the first-generation agents (FGAs; e.g., haloperidol and phenothiazines), particularly in terms of a lower potential for involuntary movement disorders. Risperidone, the only SGA with an official indication for the management of inappropriate behaviour in dementia, has emerged as the antipsychotic most commonly prescribed to older patients. Most clinical trials evaluating the risk of movement disorders in elderly patients receiving antipsychotic therapy have been of limited sample size and/or of relatively short duration. A few observational studies have produced inconsistent results. Methods A population-based retrospective cohort study of all residents of the Canadian province of Manitoba aged 65 and over, who were dispensed antipsychotic medications for the first time during the time period from April 1, 2000 to March 31, 2007, was conducted using Manitoba's Department of Health's administrative databases. Cox proportional hazards models were used to determine the risk of extrapyramidal symptoms (EPS) in new users of risperidone compared to new users of FGAs. Results After controlling for potential confounders (demographics, comorbidity and medication use), risperidone use was associated with a lower risk of EPS compared to FGAs at 30, 60, 90 and 180 days (adjusted hazard ratios [HR] 0.38, 95% CI: 0.22–0.67; 0.45, 95% CI: 0.28–0.73; 0.50, 95% CI: 0.33–0.77; 0.65, 95% CI: 0.45–0.94, respectively). At 360 days, the strength of the association weakened with an adjusted HR of 0.75, 95% CI: 0.54–1.05. Conclusions In a large population of elderly patients the use of risperidone was associated with a lower risk of EPS compared to FGAs.
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Affiliation(s)
- Irina Vasilyeva
- Faculty of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert G. Biscontri
- Department of Accounting and Finance, Asper School of Business, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murray W. Enns
- Department of Psychiatry, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Colleen J. Metge
- Faculty of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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