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Ferré S, Winkelman JW, García-Borreguero D, Belcher AM, Chang JH, Earley CJ. Restless legs syndrome, neuroleptic-induced akathisia, and opioid-withdrawal restlessness: shared neuronal mechanisms? Sleep 2024; 47:zsad273. [PMID: 37864837 PMCID: PMC10925952 DOI: 10.1093/sleep/zsad273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/27/2023] [Indexed: 10/23/2023] Open
Abstract
Restlessness is a core symptom underlying restless legs syndrome (RLS), neuroleptic-induced akathisia, and opioid withdrawal. These three conditions also share other clinical components suggesting some overlap in their pathophysiology. Recent prospective studies demonstrate the frequent incidence of RLS-like symptoms during opioid withdrawal and supervised prescription opioid tapering. Based on the therapeutic role of µ-opioid receptor (MOR) agonists in the three clinical conditions and recent preclinical experimental data in rodents, we provide a coherent and unifying neurobiological basis for the restlessness observed in these three clinical syndromes and propose a heuristic hypothesis of a key role of the specific striatal neurons that express MORs in akathisia/restlessness.
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Affiliation(s)
- Sergi Ferré
- Integrative Neurobiology Section, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - John W Winkelman
- Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Annabelle M Belcher
- Division of Addiction, Research, and Treatment, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Joy H Chang
- Substance Abuse Consultation Service, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Christopher J Earley
- Department of Neurology and Sleep Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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2
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Quintin L, Ghignone M. Letter to the editor: "Clonidine is associated with faster first resolution of incident ICU delirium than antipsychotics". J Crit Care 2024; 79:154465. [PMID: 37993386 DOI: 10.1016/j.jcrc.2023.154465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Affiliation(s)
- L Quintin
- Critical Care, Hôpital d'Instruction des Armées Desgenettes, Lyon, France.
| | - M Ghignone
- Anesthesia/Critical Care, JF Kennedy North Hospital, West Palm Beach, FL, USA
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3
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Markowicz-Piasecka M, Kubisiak M, Asendrych-Wicik K, Kołodziejczyk M, Grzelińska J, Fabijańska M, Pietrzak T. Long-Acting Injectable Antipsychotics-A Review on Formulation and In Vitro Dissolution. Pharmaceutics 2023; 16:28. [PMID: 38258037 PMCID: PMC10820045 DOI: 10.3390/pharmaceutics16010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/08/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Long-acting injectable (LAI) neuroleptics constitute an effective therapeutical alternative for individuals suffering from persistent mental illness. These injectable pharmaceuticals help patients manage their condition better and improve long-term outcomes by preventing relapses and improving compliance. This review aims to analyse the current formulation aspects of LAI neuroleptics, with particular emphasis on analysis of drug release profiles as a critical test to guarantee drug quality and relevant therapeutical activity. While there is no officially approved procedure for depot parenteral drug formulations, various dissolution tests which were developed by LAI manufacturers are described. In vitro dissolution tests also possess a critical function in the estimation of the in vivo performance of a drug formulation. For that reason, thorough inspection of the in vitro-in vivo correlation (IVIVC) is also discussed.
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Affiliation(s)
| | - Marcin Kubisiak
- Liquid Dosage Form Laboratory, Research and Development Department, Polfa Warszawa S.A., Karolkowa 22/24, 01-207 Warsaw, Poland; (M.K.); (K.A.-W.); (J.G.); (T.P.)
| | - Katarzyna Asendrych-Wicik
- Liquid Dosage Form Laboratory, Research and Development Department, Polfa Warszawa S.A., Karolkowa 22/24, 01-207 Warsaw, Poland; (M.K.); (K.A.-W.); (J.G.); (T.P.)
- Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszynskiego 1, 90-151 Lodz, Poland
| | - Michał Kołodziejczyk
- Department of Drug Form Technology, Medical University of Lodz, ul. Muszynskiego 1, 90-151 Lodz, Poland;
| | - Joanna Grzelińska
- Liquid Dosage Form Laboratory, Research and Development Department, Polfa Warszawa S.A., Karolkowa 22/24, 01-207 Warsaw, Poland; (M.K.); (K.A.-W.); (J.G.); (T.P.)
| | - Małgorzata Fabijańska
- Department of Bioinorganic Chemistry, Medical University of Lodz, ul. Muszynskiego 1, 90-151 Lodz, Poland;
| | - Tomasz Pietrzak
- Liquid Dosage Form Laboratory, Research and Development Department, Polfa Warszawa S.A., Karolkowa 22/24, 01-207 Warsaw, Poland; (M.K.); (K.A.-W.); (J.G.); (T.P.)
- Faculty of Chemistry, Warsaw University of Technology, Noakowskiego 3, 00-664 Warsaw, Poland
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4
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Sadlonova M, Beach SR, Funk MC, Rosen JH, Ramirez Gamero AF, Karlson RA, Huffman JC, Celano CM. Risk Stratification of QTc Prolongation in Critically Ill Patients Receiving Antipsychotics for the Management of Delirium Symptoms. J Intensive Care Med 2023:8850666231222470. [PMID: 38130132 DOI: 10.1177/08850666231222470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Patients experiencing significant agitation or perceptual disturbances related to delirium in an intensive care setting may benefit from short-term treatment with an antipsychotic medication. Some antipsychotic medications may prolong the QTc interval, which increases the risk of potentially fatal ventricular arrhythmias. In this targeted review, we describe the evidence regarding the relationships between antipsychotic medications and QTc prolongation and practical methods for monitoring the QTc interval and mitigating arrhythmia risk. METHODS Searches of PubMed and Cochrane Library were performed to identify studies, published before February 2023, investigating the relationships between antipsychotic medications and QTc prolongation or arrhythmias. RESULTS Most antipsychotic medications commonly used for the management of delirium symptoms (eg, intravenous haloperidol, olanzapine, quetiapine) cause a moderate degree of QTc prolongation. Among other antipsychotics, those most likely to cause QTc prolongation are iloperidone and ziprasidone, while aripiprazole and lurasidone appear to have minimal risk for QTc prolongation. Genetic vulnerabilities, female sex, older age, pre-existing cardiovascular disease, electrolyte abnormalities, and non-psychiatric medications also increase the risk of QTc prolongation. For individuals at risk of QTc prolongation, it is essential to measure the QTc interval accurately and consistently and consider medication adjustments if needed. CONCLUSIONS Antipsychotic medications are one of many risk factors for QTc prolongation. When managing agitation related to delirium, it is imperative to assess an individual patient's risk for QTc prolongation and to choose a medication and monitoring strategy commensurate to the risks. In intensive care settings, we recommend regular ECG monitoring, using a linear regression formula to correct for heart rate. If substantial QTc prolongation (eg, QTc > 500 msec) is present, a change in pharmacologic treatment can be considered, though a particular medication may still be warranted if the risks of discontinuation (eg, extreme agitation, removal of invasive monitoring devices) outweigh the risks of arrhythmias. AIMS This review aims to summarize the current literature on relationships between antipsychotic medications and QTc prolongation and to make practical clinical recommendations towards the approach of antipsychotic medication use for the management of delirium-related agitation and perceptual disturbances in intensive care settings.
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Affiliation(s)
- Monika Sadlonova
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Scott R Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Margo C Funk
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Jordan H Rosen
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Andres F Ramirez Gamero
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rebecca A Karlson
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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5
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Sampogna G, Di Vincenzo M, Giuliani L, Menculini G, Mancuso E, Arsenio E, Cipolla S, Della Rocca B, Martiadis V, Signorelli MS, Fiorillo A. A Systematic Review on the Effectiveness of Antipsychotic Drugs on the Quality of Life of Patients with Schizophrenia. Brain Sci 2023; 13:1577. [PMID: 38002537 PMCID: PMC10669728 DOI: 10.3390/brainsci13111577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Pharmacological antipsychotic drug interventions represent the cornerstone of the management of patients with schizophrenia and other psychotic spectrum disorders. The choice of the "best" treatment should be made on the basis of several clinical domains. However, despite available treatments, the quality of life reported by patients with schizophrenia taking antipsychotics is still very poor, and this outcome is rarely taken into account in trials assessing the efficacy and effectiveness of antipsychotic treatments. Therefore, we performed a systematic review in order to assess the impact of antipsychotic treatment on patients' quality of life. In particular, we aimed to identify any differences in the improvement in quality of life according to the (a) type of formulation of antipsychotic drugs (i.e., oral vs. depot vs. long-acting injectable); (b) type of the drug (first vs. second vs. third generation); and (c) patients' clinical characteristics. One hundred and eleven papers were included in the review. The main findings were as follows: (1) quality of life is usually considered a secondary outcome in trials on the efficacy and effectiveness of drugs; (2) second-generation antipsychotics have a more positive effect on quality of life; and (3) long-acting injectable antipsychotics are associated with a more stable improvement in quality of life and with a good safety and tolerability profile. Our systematic review confirms that quality of life represents a central element for selecting the appropriate treatment for people with schizophrenia. In particular, the availability of new treatments with a better tolerability profile, a proven effectiveness on patients' cognitive and social functioning, and with a more stable blood concentration might represent the appropriate strategy for improving the quality of life of people with schizophrenia.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Giulia Menculini
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy
| | - Emiliana Mancuso
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Eleonora Arsenio
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Salvatore Cipolla
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Bianca Della Rocca
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
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6
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Rissardo JP, Vora N, Mathew B, Kashyap V, Muhammad S, Fornari Caprara AL. Overview of Movement Disorders Secondary to Drugs. Clin Pract 2023; 13:959-976. [PMID: 37623268 PMCID: PMC10453030 DOI: 10.3390/clinpract13040087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
Drug-induced movement disorders affect a significant percentage of individuals, and they are commonly overlooked and underdiagnosed in clinical practice. Many comorbidities can affect these individuals, making the diagnosis even more challenging. Several variables, including genetics, environmental factors, and aging, can play a role in the pathophysiology of these conditions. The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD) are the most commonly used classification systems in categorizing drug-induced movement disorders. This literature review aims to describe the abnormal movements associated with some medications and illicit drugs. Myoclonus is probably the most poorly described movement disorder, in which most of the reports do not describe electrodiagnostic studies. Therefore, the information available is insufficient for the diagnosis of the neuroanatomical source of myoclonus. Drug-induced parkinsonism is rarely adequately evaluated but should be assessed with radiotracers when these techniques are available. Tardive dyskinesias and dyskinesias encompass various abnormal movements, including chorea, athetosis, and ballism. Some authors include a temporal relationship to define tardive syndromes for other movement disorders, such as dystonia, tremor, and ataxia. Antiseizure medications and antipsychotics are among the most thoroughly described drug classes associated with movement disorders.
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Affiliation(s)
| | - Nilofar Vora
- Medicine Department, Terna Speciality Hospital and Research Centre, Navi Mumbai 400706, India;
| | - Bejoi Mathew
- Medicine Department, Sri Devaraj Urs Medical College, Kolar Karnataka 563101, India;
| | - Vikas Kashyap
- Medicine Department, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India;
| | - Sara Muhammad
- Neurology Department, Mayo Clinic, Rochester, MN 55906, USA;
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7
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Herrera-Imbroda J, Flores-López M, Requena-Ocaña N, Araos P, Ropero J, García-Marchena N, Bordallo A, Suarez J, Pavón-Morón FJ, Serrano A, Mayoral F, Rodríguez de Fonseca F. Antipsychotic Medication Influences the Discriminative Value of Acylethanolamides as Biomarkers of Substance Use Disorder. Int J Mol Sci 2023; 24:ijms24119371. [PMID: 37298321 DOI: 10.3390/ijms24119371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/01/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Plasma acylethanolamides (NAEs), including the endocannabinoid anandamide (AEA), have been proposed as circulating biomarkers of substance use disorders. However, the concentration of these lipid transmitters might be influenced by the use of drugs prescribed for either the treatment of addiction or the associated psychiatric co-morbidities such as psychosis. As an example, neuroleptics, used for attenuation of psychotic symptoms and sedation, might theoretically interfere with the monoamine-mediated production of NAEs, obstructing the interpretation of plasma NAEs as clinical biomarkers. To solve the lack of information on the impact of neuroleptics on the concentration of NAEs, we evaluated the concentrations of NAEs in a control group and compared them to those present in (a) substance use disorders (SUD) patients that are not prescribed with neuroleptics, and (b) SUD patients (both alcohol use disorder and cocaine use disorder patients) using neuroleptics. The results demonstrate that SUD patients exhibited greater concentrations of NAEs than the control population, affecting all species with the exception of stearoylethanolamide (SEA) and palmitoleoylethanolamide (POEA). Neuroleptic treatment enhanced the concentrations of NAEs, especially those of AEA, linoleoylethanolamide (LEA), and oleoylethanolamide (OEA). This effect of neuroleptic treatment was observed independently of the drug addiction that motivated the demand for treatment (either alcohol or cocaine). This study remarks the need to control the current use of psychotropic medication as a potential confounding variable when considering the use of NAEs as biomarkers in SUD.
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Affiliation(s)
- Jesús Herrera-Imbroda
- Grupo de Neuropsicofarmacología, IBIMA-Plataforma BIONAND, 29590 Málaga, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, IBIMA-Plataforma BIONAND, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Facultad de Medicina, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
| | - María Flores-López
- Grupo de Neuropsicofarmacología, IBIMA-Plataforma BIONAND, 29590 Málaga, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, IBIMA-Plataforma BIONAND, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Nerea Requena-Ocaña
- Grupo de Neuropsicofarmacología, IBIMA-Plataforma BIONAND, 29590 Málaga, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, IBIMA-Plataforma BIONAND, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Pedro Araos
- Grupo de Neuropsicofarmacología, IBIMA-Plataforma BIONAND, 29590 Málaga, Spain
- Departamento de Psicología Básica, Facultad de Psicología, Universidad de Málaga, 29071 Málaga, Spain
| | - Jessica Ropero
- Grupo de Neuropsicofarmacología, IBIMA-Plataforma BIONAND, 29590 Málaga, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, IBIMA-Plataforma BIONAND, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Nuria García-Marchena
- Grupo de Neuropsicofarmacología, IBIMA-Plataforma BIONAND, 29590 Málaga, Spain
- Departamento de Psicobiología y Metodología, Facultad de Psicología, Universidad Complutense de Madrid, 28223 Madrid, Spain
| | - Antonio Bordallo
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, IBIMA-Plataforma BIONAND, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Juan Suarez
- Grupo de Neuropsicofarmacología, IBIMA-Plataforma BIONAND, 29590 Málaga, Spain
- Departamento de Anatomía, Medicina Legal e Historia de la Ciencia, Facultad de Medicina, Universidad de Málaga, 29071 Málaga, Spain
| | - Francisco Javier Pavón-Morón
- Unidad Clínica Área del Corazón, Hospital Universitario Virgen de la Victoria, IBIMA-Plataforma BIONAND, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Antonia Serrano
- Grupo de Neuropsicofarmacología, IBIMA-Plataforma BIONAND, 29590 Málaga, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, IBIMA-Plataforma BIONAND, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Fermín Mayoral
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, IBIMA-Plataforma BIONAND, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Fernando Rodríguez de Fonseca
- Grupo de Neuropsicofarmacología, IBIMA-Plataforma BIONAND, 29590 Málaga, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Unidad Clínica de Neurología, Hospital Regional Universitario de Málaga, IBIMA-Plataforma BIONAND, 29010 Málaga, Spain
- Andalusian Network for Clinical and Translational Research in Neurology [NEURO-RECA], 29001 Málaga, Spain
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8
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Strbe S, Smoday IM, Krezic I, Kalogjera L, Vukovic V, Zizek H, Gojkovic S, Vranes H, Barisic I, Sikiric S, Tepes M, Oroz K, Brkic F, Drinkovic M, Beketic Oreskovic L, Popic J, Boban Blagaic A, Skrtic A, Staresinic M, Seiwerth S, Sikiric P. Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy. Pharmaceuticals (Basel) 2023; 16:788. [PMID: 37375736 DOI: 10.3390/ph16060788] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Even before behavioral disturbances, neuroleptics, amphetamine, and domperidone application rapidly emerged severe occlusion/occlusion-like syndrome, shared innate vascular and multiorgan failure in rats, comparable to occlusion/occlusion-like syndrome described with vessel(s) occlusion or similar noxious procedures application. As therapy, i.e., activation of the collateral pathways, "bypassing key" (activated azygos vein pathway, direct blood flow delivery), the stable gastric pentadecapeptide BPC 157 is a novel solution. Recently, BPC 157 therapy particularly counteracted neuroleptic- or L-NAME-induced catalepsy, lithium intoxication, and schizophrenia positive and negative symptoms (amphetamine/methamphetamine/apomorphine/ketamine). In rats with complete calvariectomy, medication (BPC 157 10 µg/kg, 10 ng/kg ip or ig) was given 5 min after distinctive dopamine agents (mg/kg ip) (haloperidol (5), fluphenazine (5), clozapine (10), risperidone (5), olanzapine (10), quetiapine (10), or aripiprazole (10), domperidone (25), amphetamine (10), and combined amphetamine and haloperidol) and assessed at 15 min thereafter. All neuroleptic-, domperidone-, and amphetamine-induced comparable vascular and multiorgan failure severe syndrome was alleviated with BPC 157 therapy as before major vessel(s) occlusion or other similar noxious procedures. Specifically, all severe lesions in the brain (i.e., immediate swelling, hemorrhage), heart (i.e., congestion, arrhythmias), and lung (i.e., congestion, hemorrhage), as well as congestion in the liver, kidney, and gastrointestinal (stomach) tract, were resolved. Intracranial (superior sagittal sinus), portal, and caval hypertension and aortal hypotension were attenuated or eliminated. BPC 157 therapy almost annihilated arterial and venous thrombosis, peripherally and centrally. Thus, rapidly acting Virchow triad circumstances that occur as dopamine central/peripheral antagonists and agonist essential class-points, fully reversed by BPC 157 therapy, might be overwhelming for both neuroleptics and amphetamine.
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Affiliation(s)
- Sanja Strbe
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Maria Smoday
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Krezic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Luka Kalogjera
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Vlasta Vukovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Helena Zizek
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Slaven Gojkovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Hrvoje Vranes
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Barisic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Suncana Sikiric
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Marijan Tepes
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Katarina Oroz
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Filip Brkic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Martin Drinkovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Jelena Popic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Alenka Boban Blagaic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Anita Skrtic
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Mario Staresinic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Sven Seiwerth
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Predrag Sikiric
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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9
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Candeliere-Merlicco A, Villaverde-González R, Hidalgo-Pérez PV, Escobar-Arias FH, Aparicio-Castro E, Lastres-Arias MC. Dimethyl fumarate induced Wells syndrome. A case report. Rev Neurol 2023; 76:337-339. [PMID: 37165530 PMCID: PMC10478105 DOI: 10.33588/rn.7610.2022323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Wells syndrome, also known as eosinophilic cellulitis, is a rare dermatosis with approximately 200 cases previously described in the literature. Here, we present a case of a patient with multiple sclerosis with Wells syndrome induced by dimethyl fumarate (DMF). CASE REPORT A 41-year-old Caucasian woman was treated with DMF in July 2021. One week later, she experienced itching on her upper and lower right arm, followed by the appearance of erythematous plaques covered with vesicles. The complete blood count showed an increased eosinophil count of up to 2,000 µL. The histological images demonstrated dermal eosinophil infiltration concordant with Wells syndrome. The clinical course was benign, with complete resolution of the lesions and normalization of the eosinophil count within four weeks. Administration of corticosteroids was not necessary. CONCLUSIONS Eosinophilia is rare in patients with multiple sclerosis treated with DMF and usually does not require dosage adjustments. Although clinical manifestations of eosinophilia in these patients are very rare, it is important for practitioners to recognize the symptoms. Many neuroleptic drugs can induce eosinophilia and systemic symptoms; therefore, physicians must be aware of the risks associated with DMF and neuroleptic drugs, particularly for quetiapine, which contains fumarate.
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10
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De Masi R, Orlando S, Toni V, Costa MC. Fluphenazine-Induced Neurotoxicity with Acute Almost Transient Parkinsonism and Permanent Memory Loss: Lessons from a Case Report. Int J Mol Sci 2023; 24. [PMID: 36769288 DOI: 10.3390/ijms24032968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/11/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
We report the singular case of a 31-year-old woman who developed very serious Fluphenazine-induced parkinsonism over a few days due to a doubly incongruent drug prescription by indication and dosage having been applied to a healthy subject over one week instead of seven months. Unlike gradual drug-induced parkinsonism, our patient experienced acute extrapyramidal syndrome (EPS), reaching significant motor and sphincter disability in just a few days, followed by a gradual incomplete recovery over more than six months. In fact, after drug discontinuation, hypomimia and slight left hemi-somatic rigidity with bradykinesia remained, as well as stable non-progressive memory disturbances. Despite bio-humoral and instrumental investigations and DaTScan were negative, MRI post-analysis evidenced a 6.5% loss in brain volume. Specifically, irreversible cortical and sub-cortical grey matter reduction and cerebrospinal fluid space enlargement with spared white matter were found. Our observations suggest that the sudden availability of Fluphenazine results in a kind of plateau effect of parkinsonism presentation, partially reversible due to the neurotoxic drug effect on the cortical and sub-cortical grey matter, resulting in asymmetric EPS and stable memory loss, respectively. Our report confirms the debated neurotoxicity of first-generation neuroleptics and the postulated theory of differential susceptibility to the cytotoxic stressors on the central nervous system.
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Zaremba M, Serafin P, Kleczkowska P. Antipsychotic Drugs Efficacy in Dextromethorphan-Induced Psychosis. Biomedicines 2023; 11:biomedicines11010123. [PMID: 36672631 PMCID: PMC9855940 DOI: 10.3390/biomedicines11010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Psychosis is known as a broad term of symptoms that cause serious disorganization of behavior, thinking, and perception of reality. One of the medicines that recently gained much attention in terms of its psychotic potential is dextromethorphan (DXM). DXM, a widely used antitussive drug, is a commonly abused drug because of its euphoric, hallucinogenic, and dissociative properties. To date, DXM is a legally marketed cough suppressant that is neither a controlled substance nor a regulated chemical under the Controlled Substances Act. The management of DXM-related psychosis is dependent on the type of psychotic symptoms. Atypical neuroleptics (i.e., olanzapine, risperidone, quetiapine) and typical haloperidol have been used in symptomatic treatment due to their efficacy, especially in positive symptoms (hallucinations and delusions). These agents are also recognized as the preferred option in the symptomatic treatment of DXM-related psychosis due to their better efficacy and safety profile than typical haloperidol in the short-term course. The focus of the present review concerns the current stage of knowledge about DXM psychotic potency as well as the management of DXM-related psychoses with a special emphasis on atypical antipsychotic drugs (i.e., olanzapine, risperidone, quetiapine, and haloperidol).
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Affiliation(s)
- Malgorzata Zaremba
- Military Institute of Hygiene and Epidemiology, 01-163 Warsaw, Poland
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research (CBP), Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Pawel Serafin
- Military Institute of Hygiene and Epidemiology, 01-163 Warsaw, Poland
| | - Patrycja Kleczkowska
- Military Institute of Hygiene and Epidemiology, 01-163 Warsaw, Poland
- Maria Sklodowska-Curie, Medical Academy in Warsaw, Solidarnosci 12 Str., 03-411 Warsaw, Poland
- Correspondence: ; Tel.: +48-690-888-774
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Lin Y, Roy K, Ioka S, Otani R, Amezawa M, Ishikawa Y, Cherasse Y, Kaushik MK, Klewe-Nebenius D, Zhou L, Yanagisawa M, Oishi Y, Saitoh T, Lazarus M. Positive allosteric adenosine A 2A receptor modulation suppresses insomnia associated with mania- and schizophrenia-like behaviors in mice. Front Pharmacol 2023; 14:1138666. [PMID: 37153764 PMCID: PMC10155833 DOI: 10.3389/fphar.2023.1138666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023] Open
Abstract
Background: Insomnia is associated with psychiatric illnesses such as bipolar disorder or schizophrenia. Treating insomnia improves psychotic symptoms severity, quality of life, and functional outcomes. Patients with psychiatric disorders are often dissatisfied with the available therapeutic options for their insomnia. In contrast, positive allosteric modulation of adenosine A2A receptors (A2ARs) leads to slow-wave sleep without cardiovascular side effects in contrast to A2AR agonists. Methods: We investigated the hypnotic effects of A2AR positive allosteric modulators (PAMs) in mice with mania-like behavior produced by ablating GABAergic neurons in the ventral medial midbrain/pons area and in a mouse model of schizophrenia by knocking out of microtubule-associated protein 6. We also compared the properties of sleep induced by A2AR PAMs in mice with mania-like behavior with those induced by DORA-22, a dual orexin receptor antagonist that improves sleep in pre-clinical models, and the benzodiazepine diazepam. Results: A2AR PAMs suppress insomnia associated with mania- or schizophrenia-like behaviors in mice. A2AR PAM-mediated suppression of insomnia in mice with mania-like behavior was similar to that mediated by DORA-22, and, unlike diazepam, did not result in abnormal sleep. Conclusion: A2AR allosteric modulation may represent a new therapeutic avenue for sleep disruption associated with bipolar disorder or psychosis.
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Affiliation(s)
- Yang Lin
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Koustav Roy
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Shuji Ioka
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Rintaro Otani
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Mao Amezawa
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Yukiko Ishikawa
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Yoan Cherasse
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Mahesh K. Kaushik
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Daniela Klewe-Nebenius
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Li Zhou
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Masashi Yanagisawa
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Yo Oishi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tsuyoshi Saitoh
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- *Correspondence: Tsuyoshi Saitoh, ; Michael Lazarus,
| | - Michael Lazarus
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- *Correspondence: Tsuyoshi Saitoh, ; Michael Lazarus,
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13
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Giger M, Anliker M, Bartelt G. [Polypharmacy and Neuroleptics in Swiss Nursing Homes in the Years 2019 and 2020]. Praxis (Bern 1994) 2022; 111:612-617. [PMID: 35975411 DOI: 10.1024/1661-8157/a003909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Polypharmacy and Neuroleptics in Swiss Nursing Homes in the Years 2019 and 2020 Abstract. We present data from 92404 clinical assessments from 619 Swiss nursing homes . The data were collected in 2019 and 2020 from over 65-year-old residents. Two-thirds of those studied had severe cognitive limitations, one quarter had significant behavioral disorders and just over half of the assessed patients showed signs of emotional instability or depression. 46% were treated with nine or more different drugs, 37% received a neuroleptic in 85% for more than 90 days. There is a positive correlation between the number of drugs taken, age, cognitive impairment and susceptibility to falls. Since neuroleptics are administered in 30% under uncertain indication and the susceptibility to falls is increased by 40% under neuroleptics, their use should be reduced in the course of structured interprofessional processes.
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Abstract
Hemichorea-hemiballism associated with hyperglycemia is a syndrome characterized by a sudden occurrence of hemichorea, or its more severe expression hemiballism, in patients with non-ketotic hyperglycemia. Hemichorea-hemiballism tends to occur more commonly among elderly people and women of Asian origin. The authors present two rare cases of patients who manifested choreiform and ballistic movements of the limbs and concomitant non-ketotic hyperglycemia. Radiological findings were congruent with hyperglycemia etiology. These cases show that it is important to be aware of hemichorea-hemiballism associated with hyperglycemia, as there is a possible treatment and, if detected early on, a direct impact on prognosis.
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Affiliation(s)
- Maria Maia
- Internal Medicine, Hospital Beatriz Ângelo, Lisboa, PRT
| | | | | | | | - José Araújo
- Internal Medicine, Hospital Beatriz Ângelo, Lisboa, PRT
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15
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Górski KM, Klimczyk J, Mokros Ł, Witusik A, Pietras T. Effect of haloperidol and amisulpride on the production of malondialdehyde in reaction to free radical attack on deoxyrybosis. Pol Merkur Lekarski 2021; 49:426-429. [PMID: 34919086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Knowledge of free radicals has a huge impact on the development of medicine not only because of diseases caused by reactive oxygen species, but also because of their harmful role in the pharmacotherapy of various diseases. Hence, many researchers are looking for both the mechanisms responsible for induction of oxidative stress in the body, and an effective method to scavenge free radicals. AIM The aim of our study was to test the in vitro antioxidant properties of two known neuroleptics - haloperidonol and amisulpride, which are commonly used in the treatment of schizophrenia. MATERIALS AND METHODS The study took advantage of the properties of hydroxyl radical degrading deoxyrybosis to malondialdehyde (MDA). Fenton reaction was used to produce the free radical. For this purpose, deoxyrybosis was incubated under appropriate conditions with FeSO4 (0.5mM), EDTA (1mM), H2O2 (14mM) and haloperidol or amisulpride at 1, 5, 20 or 50 umol/l concentrations. A clean system (containing no medicines) was a positive control. Thiobarbituric acid (TBA) was subsequently added to the reaction mixtures in the presence of trichloroacetic acid. RESULTS The study took advantage of the properties of hydroxyl radical degrading deoxyrybosis to malondialdehyde (MDA). Fenton reaction was used to produce the free radical. For this purpose, deoxyrybosis was incubated under appropriate conditions with FeSO4 (0.5mM), EDTA (1mM), H2O2 (14mM) and haloperidol or amisulpride at 1, 5, 20 or 50 umol/l concentrations. A clean system (containing no medicines) was a positive control. Thiobarbituric acid (TBA) was subsequently added to the reaction mixtures in the presence of trichloroacetic acid. CONCLUSIONS The results demonstrated that both haloperidol and amisulpride inhibit the degradation of deoxyrybosis to MDA, so they show antioxidant properties under the test conditions.
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Affiliation(s)
| | - Joanna Klimczyk
- Department of Clinical Pharmacology, Medical University of Lodz, Poland
| | - Łukasz Mokros
- Department of Clinical Pharmacology, Medical University of Lodz, Poland
| | - Andrzej Witusik
- Faculty of Music Creation, Interpretation, Education and Production, Chair of Music Therapy, Academy of Music in Lodz, Poland
| | - Tadeusz Pietras
- 2nd Department of Psychiatry, Institute of Psychiatry and Neurology in Warsaw, Poland
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16
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Akid I, Nesbit S, Nanavati J, Bienvenu OJ, Smith TJ. Prevention of Steroid-Induced Neuropsychiatric Complications With Neuroleptic Drugs: A Review. Am J Hosp Palliat Care 2021; 39:472-476. [PMID: 34387114 DOI: 10.1177/10499091211034771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Corticosteroids are used for a multitude of indications in palliative patients. In this narrative review, we aim to review literature on the treatment and prevention of neuropsychiatric complications of steroids. For prevention, only lamotrigine had a positive effect in a small number of studies. For treatment, olanzapine appears to be nearly universally effective at low doses, but randomized trial evidence is lacking. Further randomized clinical trials are necessary to elucidate data-driven guidelines for prevention and treatment of corticosteroid-induced neuropsychiatric symptoms. Until further data are available, it is reasonable to consider low dose olanzapine for any patient taking 40 mg of prednisone or its equivalent, especially those with a history of depression or neuropsychiatric symptoms.
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Affiliation(s)
- Ivy Akid
- Johns Hopkins Palliative Care Program, the Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Suzanne Nesbit
- Johns Hopkins Palliative Care Program, the Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Julie Nanavati
- Johns Hopkins Palliative Care Program, the Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Oscar Joseph Bienvenu
- Johns Hopkins Palliative Care Program, the Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Thomas J Smith
- Johns Hopkins Palliative Care Program, the Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Harry J. Duffey Family Patient and Family Services Program of the Sidney Kimmel Comprehensive Cancer Program, 588543Johns Hopkins Medical Institutions, Baltimore, MD, USA
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17
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Stäuble CK, Lampert ML, Mikoteit T, Hatzinger M, Hersberger KE, Meyer zu Schwabedissen HE. Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report. Int J Mol Sci 2021; 22:ijms22126480. [PMID: 34204223 PMCID: PMC8233787 DOI: 10.3390/ijms22126480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/21/2022] Open
Abstract
We report two cases of patients who developed severe adverse drug reactions including persistent movement disorders, nausea, and vertigo during treatment with quetiapine at maximum daily doses ranging between 300 and 400 mg. The extensive hepatic metabolism of quetiapine is mainly attributed to cytochrome P450 3A4 (CYP3A4). However, there is recent evidence supporting the idea of CYP2D6 playing a role in the clearance of the quetiapine active metabolite norquetiapine. Interestingly, both patients we are reporting of are carriers of the CYP2D6*4 variant, predicting an intermediate metabolizer phenotype. Additionally, co-medication with a known CYP2D6 inhibitor and renal impairment might have further affected quetiapine pharmacokinetics. The herein reported cases could spark a discussion on the potential impact of a patient's pharmacogenetic predisposition in the treatment with quetiapine. However, further studies are warranted to promote the adoption of pharmacogenetic testing for the prevention of drug-induced toxicities associated with quetiapine.
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Affiliation(s)
- Céline K. Stäuble
- Biopharmacy, Department of Pharmaceutical Sciences, University of Basel, 4056 Basel, Switzerland;
- Pharmaceutical Care, Department of Pharmaceutical Sciences, University of Basel, 4001 Basel, Switzerland; (M.L.L.); (K.E.H.)
- Institute of Hospital Pharmacy, Solothurner Spitäler, 4600 Olten, Switzerland
- Correspondence:
| | - Markus L. Lampert
- Pharmaceutical Care, Department of Pharmaceutical Sciences, University of Basel, 4001 Basel, Switzerland; (M.L.L.); (K.E.H.)
- Institute of Hospital Pharmacy, Solothurner Spitäler, 4600 Olten, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Services Solothurn, Solothurner Spitäler and Department of Medicine, University of Basel, 4503 Solothurn, Switzerland; (T.M.); (M.H.)
| | - Martin Hatzinger
- Psychiatric Services Solothurn, Solothurner Spitäler and Department of Medicine, University of Basel, 4503 Solothurn, Switzerland; (T.M.); (M.H.)
| | - Kurt E. Hersberger
- Pharmaceutical Care, Department of Pharmaceutical Sciences, University of Basel, 4001 Basel, Switzerland; (M.L.L.); (K.E.H.)
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Lim AKH, Azraai M, Pham JH, Looi WF, Wirth D, Ng ASL, Babu U, Saluja B. Severe Tachycardia Associated with Psychotropic Medications in Psychiatric Inpatients: A Study of Hospital Medical Emergency Team Activation. J Clin Med 2021; 10:jcm10071534. [PMID: 33917515 PMCID: PMC8038822 DOI: 10.3390/jcm10071534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/29/2022] Open
Abstract
The use of antipsychotic medications is associated with side effects, but the occurrence of severe tachycardia (heart rate ≥ 130 per minute) is not well described. The aim of this study was to determine the frequency and strength of the association between antipsychotic use and severe tachycardia in an inpatient population of patients with mental illness, while considering factors which may contribute to tachycardia. We retrospectively analyzed data from 636 Medical Emergency Team (MET) calls occurring in 449 psychiatry inpatients in three metropolitan hospitals co-located with acute medical services, and used mixed-effects logistic regression to model the association between severe tachycardia and antipsychotic use. The median age of patients was 42 years and 39% had a diagnosis of schizophrenia or psychotic disorder. Among patients who experienced MET calls, the use of second-generation (atypical) antipsychotics was commonly encountered (70%), but the use of first-generation (conventional) antipsychotics was less prevalent (10%). Severe tachycardia was noted in 22% of all MET calls, and sinus tachycardia was the commonest cardiac rhythm. After adjusting for age, anticholinergic medication use, temperature >38 °C and hypoglycemia, and excluding patients with infection and venous thromboembolism, the odds ratio for severe tachycardia with antipsychotic medication use was 4.09 (95% CI: 1.64 to 10.2).
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Affiliation(s)
- Andy K. H. Lim
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia
- Correspondence:
| | - Meor Azraai
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Jeanette H. Pham
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Wenye F. Looi
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Daniel Wirth
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Ashley S. L. Ng
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Umesh Babu
- Department of Psychiatry, Monash Health, Clayton, VIC 3168, Australia; (U.B.); (B.S.)
| | - Bharat Saluja
- Department of Psychiatry, Monash Health, Clayton, VIC 3168, Australia; (U.B.); (B.S.)
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Achenbach J, Saft C, Faissner S. Longitudinal Evaluation of the Effect of Tricyclic Antidepressants and Neuroleptics on the Course of Huntington's Disease-Data from a Real World Cohort. Brain Sci 2021; 11:413. [PMID: 33805940 PMCID: PMC8064332 DOI: 10.3390/brainsci11040413] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/12/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Reducing the progress of neurodegeneration is a key goal in Huntington´s disease (HD). A previously performed systematic screening for medications with neuroprotective features identified tricyclic antidepressants and neuroleptics as neuroprotective and mitochondrioprotective agents. Here, we analyzed the characteristics of disease manifestation, progression and potential beneficial effects in HD patients treated with afore-mentioned medications compared to un- and otherwise treated motor-manifest patients in a large real-world cohort over two years. Methods: We analyzed cross-sectional data of the largest cohort worldwide of motor-manifest HD patients using the ENROLL-HD database, including demographic, moleculargenetic, clinical-motoric, cognitive and functional data. Longitudinal data of up to two years were obtained to analyze potential effects on disease progression between groups with different medications used. Data were analyzed using repeated ANOVA-analyses while controlling for the co-variates age and CAG-repeat length. Results: We identified n = 7397 motor-manifest HD patients using no or different medication (HD-ctrl) and subgroups treated with clomipramine (n = 56), clozapine (n = 66), chlorpromazine (n = 17), doxepine (n = 34) and desi-, imi- or trimipramine (n = 19). Demographic parameters, disease onset and CAP-score did not differ. Total motor scores (TMS) at baseline were higher in patients treated with clozapine (p < 0.001), chlorpromazine and clomipramine (p < 0.05) compared to HD-ctrl with higher sub scores for bradykinesia (all p < 0.01) and dystonia in clozapine treated patients (p < 0.001). Functional and cognitive capacities were worse in medication groups in comparison to HD-ctrl at baseline (p < 0.001). Repeated measures analysis of variance documented no differences regarding motoric, functional and cognitive disease progressions between groups. Conclusions: We identified group differences, potentially caused by side effects or potential selection bias in terms of bradykinetic motoric symptoms, more dystonia and lower functional and cognitive performance in some treatment groups at baseline, which were not entirely explained because of underlying fundamental characteristics. Disease progression regarding clinical, functional and cognitive outcomes over two years was not affected by any of the treatment groups compared to HD-ctrl. Our data do not support our hypothesis of a potential neuroprotective effect of these drugs on disease progression.
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Affiliation(s)
- Jannis Achenbach
- Huntington Center North Rhine-Westphalia, Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Gudrunstraße 56, 44791 Bochum, Germany; (C.S.); (S.F.)
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20
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Olson BJ, Dhariwal MS. Neuroleptic Malignant Syndrome: A Case of Unknown Causation and Unique Clinical Course. Cureus 2021; 13:e14113. [PMID: 33927924 PMCID: PMC8075770 DOI: 10.7759/cureus.14113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Neuroleptic malignant syndrome (NMS) is a rare, potentially lethal syndrome known to be related to the initiation of dopamine antagonist medications or rapid withdrawal of dopaminergic medications. It is a diagnosis of exclusion with a known sequela of symptoms, but not all patients experience these characteristic symptoms making it difficult at times to diagnose and treat. Herein, we present a unique case of NMS with unclear etiology and a unique clinical course. Our case report also raises the question of whether or not adjusting doses of previously prescribed neuroleptic medications can provoke NMS, providing valuable information for providers treating these complex patients.
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Affiliation(s)
- Brooke J Olson
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
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21
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Taube M. Case Report: Severe Side Effects Following Treatment With First Generation Antipsychotics While Cariprazine Leads to Full Recovery. Front Psychiatry 2021; 12:804073. [PMID: 34970176 PMCID: PMC8713645 DOI: 10.3389/fpsyt.2021.804073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/24/2021] [Indexed: 12/16/2022] Open
Abstract
Schizophrenia is a psychiatric disorder characterized by positive, negative, cognitive and affective symptoms. Patient cooperation with health care professionals, compliance with the treatment regime, and regular use of medications are some of the preconditions that need to be met for a favorable disease course. A negative experience following the use of a first-generation antipsychotic to treat first-episode psychosis can negatively affect a patient's motivation for further medication use. In the clinical case reported here, cariprazine was able to restore one such patient's confidence in therapy and facilitated their cooperation with the physician, thereby ensuring effective control of negative and positive symptoms and good functioning for a period of 1 year. Cariprazine may be a good option for maintenance therapy following first-episode psychosis, especially in situations in which a patient has had a negative first experience associated with antipsychotic medication use.
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Affiliation(s)
- Maris Taube
- Department of Psychiatry and Narcology, Riga Stradinš University, Riga, Latvia
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22
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Rangel JPP, Monteiro ER, Bitti FS, Junior JSN, Campagnol D. Hemodynamic effects of incremental doses of acepromazine in isoflurane-anesthetized dogs. Vet Anaesth Analg 2020; 48:167-173. [PMID: 33388251 DOI: 10.1016/j.vaa.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/07/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effects of incremental doses of acepromazine on hemodynamics in isoflurane-anesthetized dogs. STUDY DESIGN Prospective, experimental study. ANIMALS Healthy, adult, mixed-breed dogs (two male and four female) weighing 16.8 ± 5.1 kg (mean ± standard deviation). METHODS Dogs were anesthetized with propofol (7 mg kg-1) intravenously (IV) and isoflurane. Thermodilution and arterial catheters were placed for hemodynamic monitoring and arterial blood sampling for blood gas analysis. Baseline measurements were performed with stable expired concentration of isoflurane (Fe'Iso) at 1.8%. Each dog was then administered four incremental acepromazine injections (10, 15, 25 and 50 μg kg-1) IV, and measurements were repeated 20 minutes after each acepromazine injection with Fe'Iso decreased to 1.2%. The four acepromazine injections resulted in cumulative doses of 10, 25, 50 and 100 μg kg-1 (time points ACP10, ACP25, ACP50 and ACP100, respectively). RESULTS Compared with baseline, cardiac index (CI) increased significantly by 34%, whereas systemic vascular resistance index (SVRI) decreased by 25% at ACP50 and ACP100. Arterial oxygen content (CaO2) was significantly lower than baseline after all acepromazine injections (maximum decreases of 11%) and was lower at ACP50 and ACP100 than at ACP10. No significant change was found in heart rate, stroke index, oxygen delivery index and systolic, mean and diastolic blood pressures. Hypotension (mean arterial pressure < 60 mmHg) was observed in one dog at baseline, ACP10, ACP25 and ACP100, and in two dogs at ACP50. CONCLUSIONS AND CLINICAL RELEVANCE Compared with isoflurane alone, anesthesia with acepromazine-isoflurane resulted in increased CI and decreased SVRI and CaO2 values. These effects were dose-related, being more pronounced at ACP50 and ACP100. Under the conditions of this study, acepromazine administration did not change blood pressure.
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Affiliation(s)
- Julia P P Rangel
- School of Veterinary Medicine, University of Vila Velha, Vila Velha, ES, Brazil
| | - Eduardo R Monteiro
- School of Veterinary Medicine, University of Vila Velha, Vila Velha, ES, Brazil.
| | - Flavia S Bitti
- School of Veterinary Medicine, University of Vila Velha, Vila Velha, ES, Brazil
| | - Juarez S N Junior
- School of Veterinary Medicine, University of Vila Velha, Vila Velha, ES, Brazil
| | - Daniela Campagnol
- School of Veterinary Medicine, University of Vila Velha, Vila Velha, ES, Brazil
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23
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Ishiki H, Hamano J, Nagaoka H, Matsuda Y, Tokoro A, Matsuoka H, Izumi H, Sakashita A, Kizawa Y, Oyamada S, Yamaguchi T, Iwase S. Prevalence of Extrapyramidal Symptoms in Cancer Patients Referred to Palliative Care: A Multicenter Observational Study (JORTC PAL12). Am J Hosp Palliat Care 2020; 38:823-829. [PMID: 32940536 DOI: 10.1177/1049909120960441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neuroleptics are commonly used in palliative care settings. However, adverse events of neuroleptics, known as extrapyramidal symptoms (EPSs), might be overlooked in clinical practice. We conducted this study to explore the prevalence of EPSs in palliative care setting. METHODS This multicenter, prospective, observational study included patients who 1) were referred to either a specialist palliative care team or a palliative care unit, 2) had a diagnosis of cancer, and 3) were ≥20 years of age. We investigated the prevalence of EPSs and medications used. The primary outcome was the overall Drug-Induced Extrapyramidal Symptom Scale (DIEPSS) score. RESULTS Between November 2015 and October 2016, 149 patients from 5 centers in Japan were enrolled. The median age was 67 years (range: 21-88 years) and the study population included 81 men (54.4%). The cancer types included lung (55 patients, 36.9%), upper gastrointestinal tract (5, 3.3%), hepatobiliary (19, 12.8%); breast (12, 8.1%); head and neck (10, 6.7%), gynecologic (10, 6.7%), genitourinary (10, 6.7%), and others (28, 18.8%). The median Karnofsky performance status was 60 (20-100). Most patients (86.6%) did not experience delirium. Thirty-nine (26.2%) patients received one or more EPS-inducing medications. EPSs occurred in 4 (2.7%) patients with a cutoff score of 5 points for 5 parkinsonism items in DIEPSS. CONCLUSION A lower frequency (<3%) of patients than expected in this population had EPSs. Therefore, we concluded that an interventional study is not feasible. However, medications that cause EPSs are often used in palliative care; therefore, a longitudinal study is warranted. TRIAL REGISTRATION This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) (UMIN000019810) on 16, November, 2015.
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Affiliation(s)
- Hiroto Ishiki
- Department of Palliative Medicine, 68380Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Hamano
- Center for Palliative and Supportive Care, 38515University of Tsukuba Hospital, Tsukuba, Japan
| | - Hiroka Nagaoka
- Center for Palliative and Supportive Care, 38515University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization 73782Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Akihiro Tokoro
- Department of Psychosomatic Internal Medicine, National Hospital Organization 73782Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Hiromichi Matsuoka
- Palliative Care Center, Cancer Center, 12872Kindai University Hospital, Osaka, Japan.,Faculty of Health, University of Technology Sydney, Australia
| | - Hiroaki Izumi
- Palliative Care Center, Cancer Center, 12872Kindai University Hospital, Osaka, Japan.,Division of Medical Oncology, Sasaki Foundation Kyoundo Hospital, Tokyo, Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine, 12885Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, 12885Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Takuhiro Yamaguchi
- Division of Biostatistics, 13101Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, 68380Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,Department of Palliative Medicine, Saitama Medical University, Saitama, Japan
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24
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Rothenberger A, Roessner V. Psychopharmacotherapy of Obsessive-Compulsive Symptoms within the Framework of Tourette Syndrome. Curr Neuropharmacol 2020; 17:703-709. [PMID: 30152283 PMCID: PMC7059153 DOI: 10.2174/1570159x16666180828095131] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/30/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022] Open
Abstract
While Behavioral Therapy (BT) should be recommended as the first step in the treatment of OCD as well as TS, medication can be added for augmentation and in certain situations (e.g. family preference, BT not available or feasible) the priority may even reverse. This narrative review is given on the complexity of drug treatment in patients comorbid with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) and other tic problems. OCD with TS is a co-occurring combination of the two generally delimitable, but in detail, also overlapping disorders which wax and wane with time but have different courses as well as necessities and options of treatment. Distinct subtypes like “tic-related OCD” are questionable. Obsessive-compulsive symptoms (OCS) and tics are frequently associated (OCS in TS up to 90%, tics in OCD up to 37%). Sensory-motor phenomena like urges and just-right feelings reflect some behavioral overlap. The main additional psychopathologies are attention-deficit hyperactivity disorder (ADHD), mood problems and anxiety. Also, hair pulling disorder and skin picking disorder are related to OCD with TS. Hence, the assessment and drug treatment of its many psychopathological problems need high clinical experience, careful planning, and ongoing evaluation/adaptation. Drugs are able to reduce clinical symptoms but cannot cure the disorders, which should be treated in parallel in their own right; i.e. for OCD serotonin reuptake inhibitors (SSRI) and for TS (tics), certain antipsychotics can be successfully prescribed. In cases of OCD with tics, when OCS responds only partially, an augmentation with antipsychotics (recommended: risperidone and aripiprazole) may improve OCS as well as tics. Also, the benzamide sulpiride, an atypical antipsychotics, may be beneficial in treating the combination of OCS, tics and anxious-depressive problems. Probably, any additional psychopathologies of OCD might attenuate the effectiveness of SSRI on OCS; on the other hand, in cases of OCD with tics, SSRI may reduce not only OCS but also stress sensitivity and emotional problems and thus leading to better selfregulatory abilities, useful to improve tic suppression. In sum, some clinical guidance can be given, but there remain many uncertainties because of a scarce database for psychopharmacotherapy in OCD with TS.
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Affiliation(s)
- Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Gottingen, Gottingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, TU Dresden, Germany
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25
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Meixensberger S, Tebartz van Elst L, Schweizer T, Maier SJ, Prüss H, Feige B, Denzel D, Runge K, Nickel K, Matysik M, Venhoff N, Domschke K, Urbach H, Perlov E, Endres D. Anti-N-Methyl-D-Aspartate-Receptor Encephalitis: A 10-Year Follow-Up. Front Psychiatry 2020; 11:245. [PMID: 32477169 PMCID: PMC7242611 DOI: 10.3389/fpsyt.2020.00245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/12/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Anti-N-methyl-D-aspartate-receptor (NMDA-R) encephalitis is an autoimmune disease of the brain first described in 2007. The aim of this paper is to present a 10-year follow-up case history. CASE PRESENTATION The authors present the case of a 39-year-old female patient who developed an anti-NMDA-R encephalitis in 2009 with predominant severe catatonic symptoms. Anti-inflammatory therapy led to the disappearance of catatonic symptoms and was discontinued during the course of the disease. After acute therapy, the patient achieved an almost full recovery presenting with ongoing discrete symptoms of sensory overload, subtle cognitive deficits, and fatigue/reduced energy levels. The follow-up investigation in 2019 showed inconspicuous findings in laboratory diagnostics and magnetic resonance imaging. Electroencephalography (EEG) analysis using independent component analysis detected left hemispherical spike-wave complexes and intermittent slowing. Regarding the sensory overload and reduced energy level, the patient benefited from low-dose neuroleptics (risperidone, amisulpride). In terms of sensory overload associated with experiences of panic, cognitive deficits and coping with the disease, she improved with cognitive behavioral therapy (CBT). CONCLUSION Anti-inflammatory treatment led to almost full recovery with persistent disappearance of catatonic symptoms; however, a dysexecutive syndrome led to ongoing relevant problems with good response to low-dose atypical neuroleptics and CBT. The patient had persistent EEG alterations that indicated continuing neuronal network instability. Therefore, the case demonstrates the importance of multidisciplinary outpatient treatment following acute therapy for anti-NMDA-R encephalitis in patients with ongoing psychiatric deficits. For the symptomatic treatment of executive dysfunctions, "classical" psychiatric treatment may be helpful in the course of the disease.
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Affiliation(s)
- Sophie Meixensberger
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tina Schweizer
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon J Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Harald Prüss
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Bernd Feige
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominik Denzel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kimon Runge
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Matysik
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Centre for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Clinic for Psychiatry Luzern, St. Urban, Switzerland
| | - Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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26
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Fry BR, Russell N, Gifford R, Robles CF, Manning CE, Sawa A, Niwa M, Johnson AW. Assessing Reality Testing in Mice Through Dopamine-Dependent Associatively Evoked Processing of Absent Gustatory Stimuli. Schizophr Bull 2020; 46:54-67. [PMID: 31150554 PMCID: PMC6942166 DOI: 10.1093/schbul/sbz043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Impairments in reality testing are core features of numerous neuropsychiatric conditions. However, relatively few animal models have been developed to assess this critical facet of neuropsychiatric illness, thus impeding our understanding of the underlying central systems and circuits. Using mice in which dominant-negative Disrupted-in-Schizophrenia-1 is expressed throughout central nervous system circuitry (DN-DISC1-PrP), the capacity for an auditory conditioned stimulus (CS) to evoke perceptual processing of an absent sucrose solution was examined. At test, during CS presentations, DN-DISC1-PrP mice consumed more water and displayed a licking profile that is more typically revealed while ingesting a sweet-tasting solution. DN-DISC1-PrP mice also displayed greater c-fos expression in the insular (gustatory) cortex when consuming water in the presence of the CS. This capacity for the CS to more readily substitute for the taste features of the absent sucrose solution in DN-DISC1-PrP mice was attenuated following systemic treatment with the antipsychotic haloperidol. Conversely, social isolation during adolescence promoted the manifestation of these effects. These results provide strong validation for using associative learning procedures to examine dopamine-mediated reality testing associated with insular cortex activation.
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Affiliation(s)
- Benjamin R Fry
- Department of Psychology, Michigan State University, East Lansing, MI
| | - Nicollette Russell
- Department of Psychology, Michigan State University, East Lansing, MI,Neuroscience Program, Michigan State University, East Lansing, MI
| | - Ryan Gifford
- Department of Psychology, Michigan State University, East Lansing, MI
| | - Cindee F Robles
- Department of Psychology, Michigan State University, East Lansing, MI
| | - Claire E Manning
- Neuroscience Program, Michigan State University, East Lansing, MI
| | - Akira Sawa
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Neuroscience, Biomedical Engineering, and Genetic Medicine, Johns Hopkins University School of Medicine. Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Minae Niwa
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD,Present address: Department of Psychiatry and Behavioral Neurobiology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Alexander W Johnson
- Department of Psychology, Michigan State University, East Lansing, MI,Neuroscience Program, Michigan State University, East Lansing, MI,To whom correspondence should be addressed; tel: +1-517-432-8446; fax: +1-517-432-4744, e-mail:
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27
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Lasut B, Palasz A, Filipczyk L, Arias-Carrion O, Rojczyk E, Savchyna M, Bogus K, Worthington JJ, Krzystanek M, Wiaderkiewicz R. Long-term Treatment with Olanzapine Increases the Number of Sox2 and Doublecortin Expressing Cells in the Adult Subventricular Zone. CNS Neurol Disord Drug Targets 2019; 17:458-463. [PMID: 29952270 DOI: 10.2174/1871527317666180627113544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/23/2018] [Accepted: 06/21/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND & OBJECTIVE Continuously active neurogenic regions in the adult brain are located in the subventricular zone (SVZ) of the lateral ventricles and subgranular zone of the hippocampal dentate gyrus. Neurogenesis is modulated by many factors such as growth factors, neurotransmitters and hormones. Neuropsychiatric drugs, especially antidepressants, mood stabilizers and antipsychotics may also affect the origin of neuronal cells. METHOD The purpose of this study was to determine the effects of chronic olanzapine treatment on adult rat neurogenesis at the level of the SVZ. The number of neuroblasts was evaluated using immunohistochemical and fluorescent detection of sex determining region Y-box 2 and doublecortin expressing cells. RESULTS & CONCLUSION The results indicate that olanzapine has proneurogenic effects on the adult rat SVZ, as the mean number of sex determining region Y-box 2 and doublecortin-positive cells increased significantly, while there was a similar tendency in the subgranular zone. Collectively, these results suggest that long-term treatment with olanzapine may stimulate neurogenic stem cell formation in the SVZ which supports adult neurogenesis.
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Affiliation(s)
- Barbara Lasut
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia, ul. Medykow 18, 40-752, Katowice, Poland
| | - Artur Palasz
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia, ul. Medykow 18, 40-752, Katowice, Poland
| | - Lukasz Filipczyk
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia, ul. Medykow 18, 40-752, Katowice, Poland
| | - Oscar Arias-Carrion
- Unidad de Trastornos del Movimiento y Sueno/Centro de Innovacion Medica Aplicada, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, Mexico
| | - Ewa Rojczyk
- Department of Descriptive and Topographic Anatomy, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, ul. Jordana 19, 41-808, Zabrze, Poland
| | - Mariia Savchyna
- Department of Histology and Embryology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Katarzyna Bogus
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia, ul. Medykow 18, 40-752, Katowice, Poland
| | - John J Worthington
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YQ, United Kingdom
| | - Marek Krzystanek
- Department and Clinic of Psychiatric Rehabilitation, School of Medicine in Katowice, Medical University of Silesia, ul. Ziolowa 45/47 40-635,Katowice, Poland
| | - Ryszard Wiaderkiewicz
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia, ul. Medykow 18, 40-752, Katowice, Poland
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28
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Rarrick C, Saccone N, Hebbard A, Jones B. Assessing the Rate of Antipsychotic Use in Ambulatory Care Patients With a Venous Thromboembolism. Ann Pharmacother 2019; 54:97-104. [PMID: 31416330 DOI: 10.1177/1060028019870874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Evidence regarding the use of antipsychotics and associated venous thromboembolism (VTE) risk is inconclusive. Studies finding a relationship lack in-depth analysis; thus, the VTE risk among those treated with antipsychotic remains largely unknown. Objectives: The primary objective of this investigation was to compare the incidence of antipsychotic use in patients who developed a VTE versus those who did not. Methods: Data were collected via retrospective chart review from an ambulatory care clinic between January 2012 and August 2017. All active clinic patients within the study period were included unless they met the following criteria: age <18 years, pregnancy within the study period, and/or current or historical malignancy. The odds ratio (OR) of developing a VTE was determined using multivariate regression analysis controlling for age, gender, obesity, and smoking. Secondary end points were reviewed for participants who were exposed to an antipsychotic and subsequently developed a VTE within the study period. Results: A total of 7079 patients were included in the analysis, of whom 314 developed a VTE. Of these, 45 were exposed to an antipsychotic prior to VTE development. Nearly 25% of patients receiving an antipsychotic did not have a primary psychiatric diagnosis. Results suggest that antipsychotic use was significantly associated with increased risk of VTE development (OR = 1.481 [95% CI = 1.067 to 2.055]). Conclusion and Relevance: The results of this study suggest an association between antipsychotic use and VTE development. This association should be considered when prescribing antipsychotics and treating patients who develop a VTE after antipsychotic exposure.
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Affiliation(s)
| | - Nicole Saccone
- Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Amy Hebbard
- Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Brittany Jones
- Medical University of South Carolina (MUSC), Charleston, SC, USA
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29
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Dziurkowska E, Wesolowski M. Simultaneous Quantification of Antipsychotic and Antiepileptic Drugs and Their Metabolites in Human Saliva Using UHPLC-DAD. Molecules 2019; 24:E2953. [PMID: 31416290 DOI: 10.3390/molecules24162953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 01/22/2023]
Abstract
Neuroleptics and antiepileptics are excreted in saliva, which can, therefore, be very useful in determining their concentration in the body. This study presents a method developed to simultaneously identify five neuroleptics-olanzapine, quetiapine, risperidone, aripiprazole, and clozapine-and the antiepileptic carbamazepine together with their metabolites: N-demethyl olanzapine, norquetiapine, 9-OH-risperidone, dehydroaripiprazole, N-desmethylclozapine, and carbamazepine-10,11 epoxide. Chlordiazepoxide was used as the internal standard. Strata-X-C columns were used for isolation of the compounds. Chromatographic analysis was carried out using UHPLC with a diode array detector (DAD). A mixture of acetonitrile and water with the addition of formic acid and 0.1% triethylamine was used as the mobile phase. The developed method was validated by determining the linearity for all analytes in the range 10-1000 ng/mL and the value of R2 > 0.99. Intra- and inter-day precision were also determined, and the relative standard deviation (RSD) value in both cases did not exceed 15%. To determine the usefulness of the developed method, saliva samples were collected from 40 people of both sexes treated with the tested active substances both in monotherapy and in polypragmasy. In all cases, the active substances tested were identified.
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30
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Baig AM, Katyara P, Rajabali MN, Khaleeq A, Nazim F, Lalani S. Neuroleptic Drug Targets a Brain-Eating Amoeba: Effects of Promethazine on Neurotropic Acanthamoeba castellanii. ACS Chem Neurosci 2019; 10:2868-2876. [PMID: 30977998 DOI: 10.1021/acschemneuro.9b00100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Acanthamoeba spp. has recently been reported to express diverse group of ion channels and receptors that are expressed by human cells which bind drugs that are used in noninfectious diseases. Bioinformatics computational tools, growth assays, and 3D structural modeling have enabled the discovery of primitive muscarinic receptors, voltage-gated calcium channels, and ion transport pumps such as Na-K ATPase in this protist pathogen. The significance of the reported receptors and ion channels in the biology of Acanthamoeba is yet to be determined. We selected promethazine, which is a known antagonist of proteins like dopaminergic, histaminergic, muscarinic receptors, and calmodulin, to determine its effects on the growth and proliferation of trophozoites and cysts of Acanthamoeba spp. In order to elucidate the receptors involved in the effects produced by promethazine, we also performed individual experiments on Acanthamoeba trophozoites and cysts in the presence of the agonist of the above-mentioned receptors. Our results show that promethazine in the range of 60-100 μg/mL proved to be amoebicidal for Acanthamoeba trophozoites and at slightly higher doses ranging around 125-250 μg/mL also showed partial cysticidal effects. We also show the evidence of homology between the human targets of promethazine and similar targets in Acanthamoeba by the use of bioinformatic computational tools and 3D modeling. Promethazine and its structural analogs, because of being FDA-approved, have a wider margin of safety that can be tested as potential anti- Acanthamoeba agents in diseases like keratitis and encephalitis caused by this protist pathogen.
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Affiliation(s)
- Abdul Mannan Baig
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Preet Katyara
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Mehdia Nadeem Rajabali
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Areeba Khaleeq
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Fizza Nazim
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Salima Lalani
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Abstract
OBJECTIVES: Switching between different antipsychotic therapies is a frequent occurrence in the management of patients with schizophrenia and other psychotic disorders. This paper provides a review of the principles of antipsychotic switching and discusses pharmacological principles underlying adverse events that occur while switching olanzapine to another antipsychotic medication. It offers suggestions for management of switch-associated adverse events in clinical settings. CONCLUSIONS: Few publications explore olanzapine switch-related adverse events, the underlying pharmacological principles and appropriate switching strategies to minimise the risk of adverse events. There is still a need for further studies to verify existing knowledge and assist in the development of 'gold standard' guidelines that outline appropriate switching strategies and duration of the switching process to reduce and avoid adverse events.
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Affiliation(s)
- Lily Xu
- School of Psychiatry, UNSW Medicine, Sydney, NSW, and; Department of Mental Health, Liverpool Hospital, Liverpool, NSW, Australia
| | - Saroja Krishnaswamy
- Senior Consultant Psychiatrist, Monash Health, Clayron, VIC, and; Conjoint Professor, School of Medicine, Western Sydney University, Campbelltown, NSW, and; Associate Conjoint Professor, School of Psychiatry, UNSW Medicine, Sydney, NSW, Australia
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Özdemir HN, Çelebisoy N. Oculogyric Crisis with Downward Deviation - A Photo Essay. Neuroophthalmology 2018; 42:399-401. [PMID: 30524493 PMCID: PMC6276947 DOI: 10.1080/01658107.2018.1424915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/03/2018] [Indexed: 10/17/2022] Open
Abstract
Oculogyric crisis (OGC) describes the clinical phenomenon of sustained dystonic, conjugate and typically upward deviation of the eyes. A few cases with downward or lateral deviations have been described.1,2.
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Affiliation(s)
| | - Neşe Çelebisoy
- Department of Neurology, Ege University Medical School, İzmir, Turkey
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Dziurkowska E, Wesolowski M. Solid Phase Extraction Purification of Saliva Samples for Antipsychotic Drug Quantitation. Molecules 2018; 23:molecules23112946. [PMID: 30424479 PMCID: PMC6278404 DOI: 10.3390/molecules23112946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/09/2018] [Accepted: 11/10/2018] [Indexed: 11/16/2022] Open
Abstract
Saliva is far less popular as a diagnostic material than blood. This has resulted in a lack of procedures for the sampling and handling of saliva, e.g., effective ways to purify endogenous compounds from saliva to enable a simultaneous determination of xenobiotics such as neuroleptics. Therefore, the aim of this study was to develop an analytical procedure to purify saliva samples so that it is then possible to simultaneously determine five neuroleptics (aripiprazole, clozapine, olanzapine, quetiapine and risperidone) and the antiepileptic drug carbamazepine, and their respective metabolites (dehydroaripiprazole, N-desmethylclozapine, N-demethylolanzapine, norquetiapine, 9-OH-risperidone and carbamazepine-10,11-epoxide). A study of three types of solid-phase extraction (SPE) columns showed that the purest eluates were obtained using columns containing ion exchange sorbent. The sorbents were first washed with water then with a mixture of water and methanol (1:1), and the adsorbed residue was eluted with a 5% ammonia solution in methanol. Saliva samples for SPE were diluted with 2% formic acid and a mixture of methanol and water (1:1). This procedure was developed to purify a saliva sample spiked with a mixture of neuroleptics and carbamazepine, and their respective metabolites. A chromatographic analysis confirmed the isolation of all compounds, indicating that this procedure can be used in further development and validation for a method designed to monitor the levels of neuroleptic drugs in saliva and to monitor their uptake by patients.
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Affiliation(s)
- Ewelina Dziurkowska
- Department of Analytical Chemistry, Medical University of Gdansk, Gen. J. Hallera 107, 80-416 Gdansk, Poland.
| | - Marek Wesolowski
- Department of Analytical Chemistry, Medical University of Gdansk, Gen. J. Hallera 107, 80-416 Gdansk, Poland.
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Ahmad R, Sportelli V, Ziller M, Spengler D, Hoffmann A. Tracing Early Neurodevelopment in Schizophrenia with Induced Pluripotent Stem Cells. Cells 2018; 7:E140. [PMID: 30227641 PMCID: PMC6162757 DOI: 10.3390/cells7090140] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 12/29/2022] Open
Abstract
Schizophrenia (SCZ) is a devastating mental disorder that is characterized by distortions in thinking, perception, emotion, language, sense of self, and behavior. Epidemiological evidence suggests that subtle perturbations in early neurodevelopment increase later susceptibility for disease, which typically manifests in adolescence to early adulthood. Early perturbations are thought to be significantly mediated through incompletely understood genetic risk factors. The advent of induced pluripotent stem cell (iPSC) technology allows for the in vitro analysis of disease-relevant neuronal cell types from the early stages of human brain development. Since iPSCs capture each donor's genotype, comparison between neuronal cells derived from healthy and diseased individuals can provide important insights into the molecular and cellular basis of SCZ. In this review, we discuss results from an increasing number of iPSC-based SCZ/control studies that highlight alterations in neuronal differentiation, maturation, and neurotransmission in addition to perturbed mitochondrial function and micro-RNA expression. In light of this remarkable progress, we consider also ongoing challenges from the field of iPSC-based disease modeling that call for further improvements on the generation and design of patient-specific iPSC studies to ultimately progress from basic studies on SCZ to tailored treatments.
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Affiliation(s)
- Ruhel Ahmad
- Max Planck Institute of Psychiatry, Translational Psychiatry, 80804 Munich, Germany.
| | - Vincenza Sportelli
- Max Planck Institute of Psychiatry, Translational Psychiatry, 80804 Munich, Germany.
| | - Michael Ziller
- Max Planck Institute of Psychiatry, Translational Psychiatry, 80804 Munich, Germany.
| | - Dietmar Spengler
- Max Planck Institute of Psychiatry, Translational Psychiatry, 80804 Munich, Germany.
| | - Anke Hoffmann
- Max Planck Institute of Psychiatry, Translational Psychiatry, 80804 Munich, Germany.
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Affiliation(s)
- Hans Jürgen Heppner
- Geriatrische Klinik und Tagesklinik, Lehrstuhl für Geriatrie, Universität Witten/Herdecke, Dr.-Moeller-Straße 15, D-58332, Schwelm, Deutschland.
| | - Joachim Zeeh
- Geriatrische Fachklinik Georgenhaus, Meiningen, Deutschland
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Quint R, Lillo-Le Louet A, Pouchot J, Arlet JB. Priapism in sickle cell disease: Beware of neuroleptics. Am J Hematol 2018; 93. [PMID: 29885077 DOI: 10.1002/ajh.25156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/20/2018] [Accepted: 05/27/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Raphaëlle Quint
- Internal medicine department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Agnès Lillo-Le Louet
- Pharmacovigilance center, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Jacques Pouchot
- Internal medicine department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France
- Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Jean-Benoît Arlet
- Internal medicine department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
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Schilter D, Eschle D. [Not Available]. Praxis (Bern 1994) 2018; 107:393-395. [PMID: 29587588 DOI: 10.1024/1661-8157/a002942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Zusammenfassung. Eine 69-jährige Patientin wurde wegen einer wahnhaften Störung mit Neuroleptika behandelt. Sie wurde notfallmässig wegen einer Verschlechterung der Vigilanz in Kombination mit einer erhöhten Körpertemperatur, generalisiertem Rigor und erhöhter Kreatinkinase aus der psychiatrischen Klinik überwiesen. Nach Ausschluss einer Meningitis und anderer Infektionen wurde ein malignes Neuroleptika-Syndrom (MNS) diagnostiziert und mit Amantadin i.v. behandelt. Nach überstandenem MNS persistierte ein invalidisierender Rigor an den Beinen.
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Abstract
INTRODUCTION Chorea is defined as jerk-like movements that move randomly from one body part to another. It is due to a variety of disorders and although current symptomatic therapy is quite effective there are few etiology- or pathogenesis-targeted therapies. The aim of this review is to summarize our own experience and published evidence in the treatment of chorea. Areas covered: After evaluating current guidelines and clinical practices for chorea of all etiologies, PubMed was searched for the most recent clinical trials and reviews using the term 'chorea' cross referenced with specific drug names. Expert commentary: Inhibitors of presynaptic vesicular monoamine transporter type 2 (VMAT2) that cause striatal dopamine depletion, such as tetrabenazine, deutetrabenazine, and valbenazine, are considered the treatment of choice in patients with chorea. Some clinicians also use dopamine receptor blockers (e.g. antipsychotics) and other drugs, including anti-epileptics and anti-glutamatargics. 'Dopamine stabilizers' such as pridopidine and other experimental drugs are currently being investigated in the treatment of chorea. Deep brain stimulation is usually reserved for patients with disabling chorea despite optimal medical therapy.
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Affiliation(s)
- H Bashir
- a Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology , Baylor College of Medicine , Houston , TX , USA
| | - J Jankovic
- a Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology , Baylor College of Medicine , Houston , TX , USA
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Ivanets NN, Lavrinenko OV, Maximova TN. [Treatment of depression complicated by abuse and dependence on alcohol]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:53-58. [PMID: 28805761 DOI: 10.17116/jnevro20171177153-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the efficacy of different treatment regimens of depression complicated by abuse and dependence on alcohol and to identify the most effective tactics of treatment. MATERIAL AND METHODS One hundred patients with depression were studied. Examination of patients was conducted using clinical-psychopathological method, the MADRS (at admission, on the 1st, 2nd, 4th and 6th week of treatment) and CGI scale (in the beginning of treatment and on 6th week). Data analysis using standard statistical indicators was performed. In accordance with the therapeutic tactics, patients were stratified into three groups: patients, treated with a combination of antidepressants, antipsychotics and mood stabilizers (group 1); antidepressants and antipsychotics (group 2); antidepressants and mood stabilizers (group 3). RESULTS In group 1, a reduction in MADRS scores was significantly higher compared to other groups (8.53 points, p≤0.01). On the 6th week, 50% of the patients showed complete or almost complete remission, and the state of 44.7% patients was classified as 'mild disorders'. In group 3, serious condition remained in 16.7% of patients by the end of the 6th week. By the 6th week of treatment, 39.5% of patients of group 1 had 'very significant improvement'. The least treatment efficacy was noted in group 3. CONCLUSION The use of the combination of antidepressants, antipsychotics and mood stabilizers demonstrates the greatest efficacy in terms of reduction of depressive symptoms.
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Affiliation(s)
- N N Ivanets
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - O V Lavrinenko
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - T N Maximova
- Sechenov First Moscow State Medical University, Moscow, Russia
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40
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Abstract
INTRODUCTION Tardive dyskinesia (TD) is a chronic and disabling movement disorder with a complex pathophysiological basis. A significant percentage of patients does not receive correct diagnosis, resulting in delayed or inaccurate treatment and poor outcome. Therefore, there is a critical need for prompt recognition, implementation of efficacious treatment regimens and long-term follow up of patients with TD. Areas covered: The current paper provides an overview of emerging data concerning proposed pathophysiology theories, epidemiology, risk factors, and therapeutic strategies for TD. Expert commentary: Despite considerable research efforts, TD remains a challenge in the treatment of psychosis as the available strategies remain sub-optimal. The best scenario will always be the prophylaxis or prevention of TD, which entails limiting the use of antipsychotics.
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Affiliation(s)
- Haitham Salem
- a Harris County psychiatric center, Department Psychiatry and behavioral sciences, McGovern medical school , The university of texas health science center at Houston , TX , USA.,b Neuropsychiatry program, Department Psychiatry and behavioral sciences, McGovern medical school , The university of texas health science center at Houston , TX , USA
| | - Teresa Pigott
- a Harris County psychiatric center, Department Psychiatry and behavioral sciences, McGovern medical school , The university of texas health science center at Houston , TX , USA
| | - Xiang Y Zhang
- b Neuropsychiatry program, Department Psychiatry and behavioral sciences, McGovern medical school , The university of texas health science center at Houston , TX , USA
| | - Cristian P Zeni
- c Pediatric mood disorder/ADHD program, Department Psychiatry and behavioral sciences, McGovern medical school , The university of texas health science center at Houston , TX , USA
| | - Antonio L Teixeira
- a Harris County psychiatric center, Department Psychiatry and behavioral sciences, McGovern medical school , The university of texas health science center at Houston , TX , USA.,b Neuropsychiatry program, Department Psychiatry and behavioral sciences, McGovern medical school , The university of texas health science center at Houston , TX , USA
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41
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Abstract
INTRODUCTION Tardive dyskinesia (TD) is a hyperkinetic movement disorder that may result from treatment with antipsychotics or other dopamine receptor blocking agents. Underlying pathophysiology is incompletely understood but since the 1970s dopamine depleting agents have been used to reduce involuntary movements. The search for safe, effective treatments for TD is ongoing. Valbenazine, a novel VMAT2 inhibitor, has recently been FDA approved for treatment of TD. Areas covered: An overview of TD, unmet medical needs and current treatment guidelines are presented. The background, chemistry and clinical development of valbenazine to treat TD is detailed. A competitive market is developing as the treatment gap is identified and potential therapies are discussed in context of a broader market overview. Expert opinion: Antipsychotic use is growing among adults and children in the U.S. Consequently, prevalence of TD is expected to rise. Cessation of antipsychotics is often not possible as the psychiatric condition may deteriorate. Increasing doses of an antipsychotic to suppress involuntary movements is not sustainable long term as underlying TD worsens and movements typically recur. There were no FDA approved treatments for TD. The approval of valbenazine to treat TD is a critical step in addressing this gap in neurologic care.
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Affiliation(s)
| | - Robert A Hauser
- b Department of Neurology , University of South Florida , Tampa , FL , USA
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42
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Abstract
The proportion of pregnancies exposed to either second-generation antipsychotics (SGAs) or first-generation antipsychotics (FGAs) varies between 0.3%-2% of all pregnancies, but, until now, little is known about the potential neurobehavioral teratogenicity of antipsychotics. Assessing this safety facet is the aim of this article. PubMed, Scopus, and Google Scholar were searched for eligible articles. PubMed (1954 to May 2016) was searched using several medical subject headings, variously combined. PubMed search results were also limited using the search filter for human studies published in English. Scopus and Google Scholar searches were filtered for article title (antipsychotics/neuroleptics, pregnancy). After excluding duplicates, 9,250 articles were identified and 29 met the following inclusion criteria: only articles that provided original/primary data on neurodevelopmental outcome in human offspring older than 4 months of age, independently of the study design, were selected for review. Indeed, some relevant neurodevelopmental milestones are achieved at this time. Length of study and neurodevelopmental assessment methodology did not influence the study selection. Unfortunately, published data on neurodevelopmental teratogenicity of SGAs mainly derive from case reports and small case-series studies. Even findings emerging from case-control and prospective/retrospective studies are of limited clinical relevance because of their small sample sizes. Limited data are also available on FGAs. Hence, we have to conclude that the long-term neurodevelopmental outcomes for children exposed in utero remain unclear. Low to very low quality evidence of retrieved data makes impossible to confirm or exclude potential long-lasting untoward effects on infant neurocognitive development associate with antenatal exposure to either SGAs or FGAs.
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Salem H, Nagpal C, Pigott T, Teixeira AL. Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges. Curr Neuropharmacol 2017; 15:789-798. [PMID: 27928948 PMCID: PMC5771055 DOI: 10.2174/1570159x14666161208153644] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies.] Method: We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies. CONCLUSION Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent.
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Affiliation(s)
- Haitham Salem
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
- Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Caesa Nagpal
- Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Teresa Pigott
- Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Antonio Lucio Teixeira
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
- Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
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Degli Stefani M, Biasutti M. Effects of Music Therapy on Drug Therapy of Adult Psychiatric Outpatients: A Pilot Randomized Controlled Study. Front Psychol 2016; 7:1518. [PMID: 27774073 PMCID: PMC5054002 DOI: 10.3389/fpsyg.2016.01518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/20/2016] [Indexed: 12/30/2022] Open
Abstract
Objective: Framed in the patients’ engagement perspective, the current study aims to determine the effects of group music therapy in addition to drug care in comparison with drug care in addition to other non-expressive group activities in the treatment of psychiatric outpatients. Method: Participants (n = 27) with ICD-10 diagnoses of F20 (schizophrenia), F25 (schizoaffective disorders), F31 (bipolar affective disorder), F32 (depressive episode), and F60 (specific personality disorders) were randomized to receive group music therapy plus standard care (48 weekly sessions of 2 h) or standard care only. The clinical measures included dosages of neuroleptics, benzodiazepines, mood stabilizers, and antidepressants. Results: The participants who received group music therapy demonstrated greater improvement in drug dosage with respect to neuroleptics than those who did not receive group music therapy. Antidepressants had an increment for both groups that was significant only for the control group. Benzodiazepines and mood stabilizers did not show any significant change in either group. Conclusion: Group music therapy combined with standard drug care was effective for controlling neuroleptic drug dosages in adult psychiatric outpatients who received group music therapy. We discussed the likely applications of group music therapy in psychiatry and the possible contribution of music therapy in improving the psychopathological condition of adult outpatients. In addition, the implications for the patient-centered perspective were also discussed.
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Affiliation(s)
- Mario Degli Stefani
- Department of Mental Health, 2° Servizio Psichiatrico Ulss 16 Padova, Padova Italy
| | - Michele Biasutti
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova Italy
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45
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Abstract
Antipsychotics represent the first-choice treatment for schizophrenia. However, the cognitive and emotional pathways through which symptom reduction is achieved have remained unclear. We recently proposed that the induction of doubt is a core mechanism of action of antipsychotics. In the framework of a randomized, double-blind, placebo-controlled, crossover design, 39 nonclinical participants filled out a questionnaire tapping into cognitive and emotional changes (Effect of Antipsychotic Medication on Emotion and Cognition-revised (EAMEC-r)) each time they had received one of three substances (haloperidol, placebo, L-dopa). Participants reported more doubt under haloperidol than under L-dopa lending support to the theory that antipsychotics decrease delusional conviction via the reduction of confidence. Key points from this study are: (a) antipsychotics induce doubt, and (b) doubt may represent a core mechanism of action for the reduction of delusional ideas.
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Affiliation(s)
- Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Krzystanek M, Bogus K, Pałasz A, Wiaderkiewicz A, Filipczyk Ł, Rojczyk E, Worthington J, Wiaderkiewicz R. Extended neuroleptic administration modulates NMDA-R subunit immunoexpression in the rat neocortex and diencephalon. Pharmacol Rep 2016; 68:990-5. [PMID: 27391358 DOI: 10.1016/j.pharep.2016.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study aimed to evaluate the effect of extended olanzapine, clozapine and haloperidol administration on NMDA-R subunit immunoexpression in the rat neocortex and diencephalon. METHODS To explore NR1, NR2A and NR2B subunit protein expression, densytometric analysis of immunohistochemically stained brain slices was performed. RESULTS Interestingly, all neuroleptics caused a downregulation of NMDA-R subunit expression in the thalamus but increased the level of NR1 in the hypothalamus. Olanzapine upregulated hypothalamic NR2A expression, while clozapine and haloperidol decreased hypothalamic levels. We observed no significant changes in NR2B immunoreactivity. None of the studied medications had significant influence on NMDA-R subunit expression in the neocortex. CONCLUSIONS Neuroleptic-induced reduction in the expression of thalamic NMDA-R subunits may play an important role in the regulation of glutamatergic transmission disorders in cortico-striato-thalamo-cortical loop in schizophrenia. A decrease in NMDA signaling in this region after long-term neuroleptic administration may also cautiously explain the incomplete effectiveness of these drugs in the therapy of schizophrenia-related cognitive disturbances.
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Affiliation(s)
- Marek Krzystanek
- Department and Clinic of Psychiatric Rehabilitation, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Katarzyna Bogus
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia,, Katowice, Poland
| | - Artur Pałasz
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia,, Katowice, Poland
| | - Anna Wiaderkiewicz
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia,, Katowice, Poland
| | - Łukasz Filipczyk
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia,, Katowice, Poland
| | - Ewa Rojczyk
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia,, Katowice, Poland
| | - John Worthington
- Manchester Immunology Group, Faculty of Life Sciences, University of Manchester, Greater Manchester, UK; Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ryszard Wiaderkiewicz
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia,, Katowice, Poland
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Palasz A, Rojczyk E, Golyszny M, Filipczyk L, Worthington JJ, Wiaderkiewicz R. Long-term treatment with haloperidol affects neuropeptide S and NPSR mRNA levels in the rat brain. Acta Neuropsychiatr 2016; 28:110-6. [PMID: 26467816 DOI: 10.1017/neu.2015.56] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The brainstem-derived neuropeptide S (NPS) has a multidirectional regulatory activity, especially as a potent anxiolytic factor. Accumulating data suggests that neuroleptics affect peptidergic signalling in various brain structures. However, there is no information regarding the influence of haloperidol on NPS and NPS receptor (NPSR) expression. METHODS We assessed NPS and NPSR mRNA levels in brains of rats treated with haloperidol using quantitative real-time polymerase chain reaction. RESULTS Chronic haloperidol treatment (4 weeks) led to a striking upregulation of NPS and NPSR expression in the rat brainstem. Conversely, the NPSR mRNA expression was decreased in the hippocampus and striatum. CONCLUSIONS This stark increase of NPS in response to haloperidol treatment supports the hypothesis that this neuropeptide is involved in the dopamine-dependent anxiolytic actions of neuroleptics and possibly also in the pathophysiology of mental disorders. Furthermore, our findings underline the complex nature of potential interactions between dopamine receptors and brain peptidergic pathways, which has potential clinical applications.
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48
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Allsbrook M, Fries BE, Szafara KL, Regal RE. Do SSRI Antidepressants Increase The Risk of Extrapyramidal Side Effects In Patients Taking Antipsychotics? P T 2016; 41:115-119. [PMID: 26909002 PMCID: PMC4745639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Among antidepressants, selective serotonin reup-take inhibitors (SSRIs) have enjoyed great popularity among clinicians as well as generally wide acceptance and tolerance among patients. A potentially overlooked side effect of SSRIs is the occasional occurrence of extrapyramidal symptoms (EPS), which could be a concern when SSRIs are used with antipsychotics. This study was designed to explore the possible association between SSRI antidepressant use and the incidence of EPS side effects in patients who take concomitant antipsychotic medications. METHODS The University of Michigan conducted a study at the four Michigan state mental health hospitals between May 2010 and October 2010. The Michigan Public Health Institute collected data using the InterRAI Mental Health Assessment (InterRAI MH). The present study is a retrospective cohort analysis of the cross-sectional data that were collected. Within these institutions, 693 residents were using antipsychotics. We measured the observed frequency of seven EPS recorded in the InterRAI MH within three groups of patients: 1) those on antipsychotic drugs who were taking an SSRI antidepressant; 2) those on antipsychotic drugs who were not taking an antidepressant; and 3) those on antipsychotic drugs who were taking a non-SSRI antidepressant. Differences in the prevalence of EPS were tested using one-way analysis of variance. RESULTS There were no significant differences in the observed EPS frequencies among the three groups (F 2,18 = 0.01; P < 0.9901). CONCLUSION In this study, SSRIs did not appear to potentiate the occurrence of EPS in patients using antipsychotics.
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Abstract
OBJECTIVES Links between endorphins and dopaminergic transmission have not been fully explored in schizophrenia. Both endorphins excess and deficiency were postulated. CGRP is probably involved in dopaminergic transmission. The aim of this study was the evaluation of beta-endorphin (BE) and CGRP blood concentrations before and after treatment of severe schizophrenia. METHODS Seventy patients treated with various antipsychotics, with severe symptoms of schizophrenia (51 with positive symptoms, 19 with negative symptoms), 15 first-degree relatives, and 44 healthy controls were included in the study. BE and CGRP blood concentrations were measured during patients severe schizophrenia and in their stable mental state after treatment. The results were compared with relatives and controls. RESULTS BE and CGRP concentrations in patients with negative symptoms were higher than in relatives and in controls. BE levels in patients with positive symptoms were lower than in patients with negative symptoms (P<0.0000) and controls (P<0.0006). No significant changes in CGRP concentration were found in patient samples. CGRP levels in these samples were independent of treatment, but they were significantly higher than in relatives and controls. After the treatment, BE level decreased in patients with negative symptoms (P<0.0001) and increased in patients with positive symptoms (P<0.0000). No differences in BE concentration between patients in stable mental state, their relatives, and controls were found. CONCLUSION Effective antipsychotic treatment results in "normalization" of BE level. Specific changes in BE concentration could be involved in dopaminergic transmission and related to some symptoms of schizophrenia.
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Affiliation(s)
- Małgorzata Urban-Kowalczyk
- Department of Affective and Psychotic Disorders, Healthy Aging Research Centre (HARC), Medical University of Lodz, Lodz, Poland
| | - Janusz Śmigielski
- Department of Geriatrics, Healthy Aging Research Centre (HARC), Medical University of Lodz, Lodz, Poland
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Healthy Aging Research Centre (HARC), Medical University of Lodz, Lodz, Poland
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Montenarh D, Hopf M, Maurer HH, Schmidt P, Ewald AH. Development and validation of a multi-analyte LC-MS/MS approach for quantification of neuroleptics in whole blood, plasma, and serum. Drug Test Anal 2015; 8:1080-1089. [PMID: 26607679 DOI: 10.1002/dta.1923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 11/10/2022]
Abstract
Based on a similar approach for quantification of antidepressants, benzodiazepines, and z-drugs, a liquid chromatography-tandem mass spectrometry (LC-MS/MS) multi-analyte approach with simple liquid-liquid extraction was extended for fast target screening and quantification of neuroleptics in whole blood, plasma, and serum. As this method is part of a multi-analyte procedure for over 100 analytes from different drug classes and as the extracts were additionally used in the authors' laboratory for gas chromatography-mass spectrometry (GC-MS) analysis, one universal stable-isotope-labelled internal standard (SIL-IS) was used to save time and resource. The method was validated with respect to international guidelines. For accuracy and precision, full calibration was performed with ranges from subtherapeutic to toxic concentrations. Selectivity problems could not be observed, but matrix effects ranged from 68 to 211% in all samples. For the low quality control (QC), recovery ranged from 32 to 112%, process efficiency from 31 to 165% and for the high QC recovery from 42 to 141%, process efficiency from 29 to 154%. In addition statistical data evaluation of the variances of the recovery, matrix effects, and process efficiency data between whole blood vs. plasma, whole blood vs. serum, and plasma vs. serum were done. The presented LC-MS/MS approach was applicable for selective detection of 33 neuroleptics as well as accurate and precise quantification of 25 neuroleptics in whole blood, 19 in plasma, and 17 in serum. More significant matrix effects (ME) for neuropletic drugs overall in plasma and serum as compared with whole blood were detected. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Deborah Montenarh
- Institute of Legal Medicine, Saarland University, Kirrberger Straße Building 42, 66421, Homburg (Saar), Germany
| | - Markus Hopf
- Institute of Legal Medicine, Saarland University, Kirrberger Straße Building 42, 66421, Homburg (Saar), Germany
| | - Hans H Maurer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, D-66421, Homburg (Saar), Germany
| | - Peter Schmidt
- Institute of Legal Medicine, Saarland University, Kirrberger Straße Building 42, 66421, Homburg (Saar), Germany
| | - Andreas H Ewald
- Institute of Legal Medicine, Saarland University, Kirrberger Straße Building 42, 66421, Homburg (Saar), Germany.
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