Supercritical fluid technology as a strategy for nifedipine solid dispersions formulation: In vitro and in vivo evaluation

Supercritical fluid technology (SFT) is an insufficiently investigated approach for the production of solid dispersions, it is environmentally acceptable and has a high potential for application in the pharmaceutical industry. The aim of this work was to formulate and characterize nifedipine solid dispersions (SDs) produced by the SFT and compare the results with ones obtained by the classical solvent based kneading method. The following in vitro tests were conducted: assay and yield, solvent residues, solid state characterization (FTIR, DSC, XRD), flowability, hygroscopicity, solubility, dissolution and stability. Additionally, bioavailability was examined on an animal model (Wistar rats). The formulation selection for in vivo study was performed using the multilevel categoric experimental design and the health risk assessment. Solid state characterization revealed that formulation obtained by the SFT method and higher ratio of polymer (1:5) have had nifedipine in completely amorphous form. Polymer ratio and method of SDs preparation do influence the investigation characteristics. Dissolution rate was fastest in SDs prepared by the SFT and higher polymer ration (1:5). In vivo data of selected SDs prepared by the kneading (ratio 1:1) and the SFT (ratio 1:5) showed alteration in pharmacokinetic profile after i.v. and p.o. application.

Do people diagnosed with psychosis spectrum disorders share the same personality space as the general population? Big Five complemented by the proneness to psychotic-like experiences/behaviors

OBJECTIVE

Disintegration is a recently proposed broad, trait-like reconceptualization of the proneness to psychotic-like experiences/behaviors.

METHODS

We tested the assumption that the 6-factor model (Five-Factor traits plus Disintegration) was the most adequate one and that it was invariant across clinical and non-clinical populations. The clinical sample (n = 161) consisted of patients who had at least one psychotic episode, duration of illness less than 10 years, currently in remission. The general population (n = 409) was matched with the patient sample by age, gender, and education. NEO PI-R and DELTA were used to measure personality dimensions in both samples. Invariance of one to six-factor solutions was tested by Exploratory Structural Equation Modeling.

RESULTS

We found that: (a) several criteria for deciding on the number of factors to retain converged to the conclusion that the assumed 6-factor model was the most adequate one, (b) the assumed factorial structure appeared to satisfy the criteria for the scalar invariance across the two samples, (c) all nine Disintegration subdimensions separated from the Big Five, forming the Disintegration factor, and (d) Disintegration was unrelated to Openness.

CONCLUSION

The Big Five personality structure-complemented with disintegration-was invariant across individuals from the general population and patients with psychosis.

Dental Resin-Based Luting Materials-Review

As cementation represents the last stage of the work involved in making various indirect restorations (metal ceramic crowns and bridges, full ceramic crowns and bridges, inlays, onlays, and fiber posts), its quality significantly contributes to the clinical success of the therapy performed. In the last two decades, the demand for ceramic indirect restorations in everyday dental practice has considerably increased primarily due to the growing significance of esthetics among patients, but also as a result of hypersensitivity reactions to dental alloys in some individuals. In this context, it is essential to ensure a permanent and reliable adhesive bond between the indirect restoration and the tooth structure, as this is the key to the success of aesthetic restorations. Resin-based luting materials benefit from excellent optical (aesthetic) and mechanical properties, as well as from providing a strong and durable adhesive bond between the restoration and the tooth. For this reason, resin cements are a reliable choice of material for cementing polycrystalline ceramic restorations. The current dental material market offers a wide range of resin cement with diverse and continually advancing properties. In response, we wish to note that the interest in the properties of resin-based cements among clinicians has existed for many years. Yet, despite extensive research on the subject and the resulting continued improvements in the quality of these materials, there is still no ideal resin-based cement on the market. The manuscript authors were guided by this fact when writing the article content, as the aim was to provide a concise overview of the composition, properties, and current trends, as well as some future guidelines for research in this field that would be beneficial for dental practitioners as well as the scientific community. It is extremely important to provide reliable and succinct information and guidelines for resin luting materials for dental dental practitioners.

The Influence of Soft Segment Structure on the Properties of Polyurethanes

A series of polyurethanes (PU) were synthesised via one-step polymerisation without a chain extender, using toluene diisocyanate as well as a variety of soft segments composed of different macrodiols. Poly(D,L-lactide) (PDLLA) and polycaprolactone diol (PCL) were synthesised as a polyester type polyols to obtain soft segments. The process of varying the molar ratio of newly synthesised PDLLA in soft segments has been confirmed as a powerful tool for fine-tuning the final properties of PU. Fourier-transformed infrared spectroscopy was used for evaluation of molecular structures of synthesised PDLLA polyol and final PU. Nuclear magnetic resonance spectrometry was used to confirm the presumed structure of PU. The influence of soft segment composition on polyurethane thermal characteristics was examined using thermogravimetric analysis and differential scanning calorimetry. The composition of soft segments had little impact on the thermal stability of PU materials, which is explained by the comparable structures of both polyester polyols. Wide-angle X-ray scattering was utilised to evaluate the effect of amorphous PDLLA on the degree of crystallinity of PCL in soft PU segments. It was discovered that not only did the PDLLA ratio in the soft segment have a substantial influence on the degree of microphase separation in the soft and hard segments, but it also influenced the crystallisation behaviour of the materials. Furthermore, the restriction of crystallisation of the PCL soft segment has been verified to be dependent on the hard segment concentration and the ratio of PDLLA/PCL polyols. The sample with pure PCL as the polyol component achieved the highest degree of crystallinity (34.8%). The results demonstrated that the composition of soft segments directly affected the properties of obtained polyurethane films. These results can be utilised to easily achieve a desirable set of properties required for application in biomaterials.

The chemical characterisation of nettle (Urtica dioica L.) seed oil

The past decade has seen increasing interest in plant oils in the food, pharmaceutical, and cosmetic industries due to their diverse functional and nutritional properties, as well as the high levels of consumer acceptance. As a result, there has been a spike in research interest in finding new sources of oils with good potential for industrial use. In this paper, the chemical characterisation (saponification, iodine, acid and ester numbers, as well as fatty acid composition) of nettle seed oil was given. Oil was analysed for its thermooxidative stability by differential scanning calorimetry. The kinetic parameters of oxidation (Ea, A, and k) were also determined. The results showed that nettle seed oil belongs to the group of edible oils of the linoleic type and it is nutritionally highly valuable, it has pronounced thermooxidative stability and could be an alternative source of raw material for the food, cosmetics, and other non-food industries.

Temperature-Sensitive Hydrogels as Carriers for Modulated Delivery of Acetaminophen

The purposes of this study are the polymerization of temperature-sensitive copolymers based on N-isopropyl acrylamide and 10 mol % of 2-hydroxypropylmethacrylate, characterisations of their thermal, morphological and swelling properties, as well as the analysis of potential application in drug-delivery systems. Acetaminophen, the representative of non-steroidal anti-inflammatory drugs, was used as a model drug in this study. It is a common pain relief drug, which is also used for fever treatment. However, oral administration comes with certain health risks, mainly the overdose and frequent administration of up to four times a day. The goal of applying temperature-sensitive hydrogel is to enable extended administration once a day, depending on the body temperature. The swelling behavior of the obtained poly(N-isopropyl acrylamide-co-2-hydroxypropylmethacrylate) (p(NIPA/HPMA)) hydrogels and their temperature-sensitivity, kinetics and order of swelling processes at 18 and 38 °C were analyzed. The thermal properties of these hydrogels were observed by the DSC method, and the obtained thermograms showed both melting and glass transitions. The drug delivery system of p(NIPA/HPMA) hydrogels with loaded acetaminophen was analyzed using scanning electron microscopy and Fourier transform infrared spectroscopy methods. Structural analysis of FTIR spectra indicates that non-covalent intermolecular interactions of the type of hydrogen bonds were formed among functional groups of acetaminophen and side-chains of p(NIPA/HPMA) hydrogels. The surface structure of p(NIPA/HPMA) hydrogels after drug loading indicates the acetaminophen presence into the pores of the hydrogel network, and their loading efficiency was higher than 92%. Qualitative and quantitative analysis of acetaminophen, determined by the high-pressure liquid chromatography method, showed that about 90-99% of the loaded amount was released from p(NIPA/HPMA) hydrogels within 24 h. Kinetic parameters of the acetaminophen release under simulated gastrointestinal conditions were determined. Based on obtained results, the drug delivery system of temperature-sensitive p(NIPA/HPMA) hydrogels with loaded acetaminophen could be suitable for additional investigation for modulated drug administration, e.g., for extended drug administration.

Development of Light-Polymerized Dental Composite Resin Reinforced with Electrospun Polyamide Layers

As the mechanical properties of resin-based dental composite materials are highly relevant in clinical practice, diverse strategies for their potential enhancement have been proposed in the extant literature, aiming to facilitate their reliable use in dental medicine. In this context, the focus is primarily given to the mechanical properties with the greatest influence on clinical success, i.e., the longevity of the filling in the patient's mouth and its ability to withstand very strong masticatory forces. Guided by these objectives, the goal of the present study was to ascertain whether the reinforcement of dental composite resins with electrospun polyamide (PA) nanofibers would improve the mechanical strength of dental restoration materials. For this purpose, light-cure dental composite resins were interspersed with one and two layers comprising PA nanofibers in order to investigate the influence of such reinforcement on the mechanical properties of the resulting hybrid resins. One set of the obtained samples was investigated as prepared, while another set was immersed in artificial saliva for 14 days and was subsequently subjected to the same set of analyses, namely Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and differential scanning calorimetry (DSC). Findings yielded by the FTIR analysis confirmed the structure of the produced dental composite resin material. They also provided evidence that, while the presence of PA nanofibers did not influence the curing process, it strengthened the dental composite resin. Moreover, flexural strength measurements revealed that the inclusion of a 16 μm-thick PA nanolayer enabled the dental composite resin to withstand a load of 3.2 MPa. These findings were supported by the SEM results, which further indicated that immersing the resin in saline solution resulted in a more compact composite material structure. Finally, DSC results indicated that as-prepared as well as saline-treated reinforced samples had a lower glass transition temperature (Tg) compared to pure resin. Specifically, while pure resin had a Tg of 61.6 °C, each additional PA nanolayer decreased the Tg by about 2 °C, while the further reduction was obtained when samples were immersed in saline for 14 days. These results show that electrospinning is a facile method for producing different nanofibers that can be incorporated into resin-based dental composite materials to modify their mechanical properties. Moreover, while their inclusion strengthens the resin-based dental composite materials, it does not affect the course and outcome of the polymerization reaction, which is an important factor for their use in clinical practice.

Analysis of the Relationship between Higher-Order Factor Structure of Personality Disorders and the Five-Factor Model of Personality

The growing body of evidence on the dimensional classification of personality disorders (PD) has resulted in its acceptance in the ICD-11 classification, which abolished categories and retains only a general description of PD. Specifying the type of PD is optional, and the suggested domains represent maladaptive variants of the five-factor model of personality (FFM). The aim of our study was to explore the existence of a joint structure between maladaptive and normal personality traits, and to investigate how these structures are integrated. The study included 223 patients who had been diagnosed with PD and completed the Structured Clinical Interview for DSM-5 Personality Disorders and the NEO Personality Inventory-Revised (NEO-PI-R). To determine the degree of overlap between PD domains and NEO PI–R scales, a canonical analysis of covariance was conducted. Our findings showed a relationship between the internalizing PD spectrum (consisting of avoidant, dependent, and borderline traits with detached and anankastic traits) and high neuroticism, low conscientiousness, and moderately low agreeableness and extroversion, suggesting the existence of a broad personality disorder factor. However, the internalizing dimensions exhibited a more pronounced effect within this construct. Furthermore, we identified a second function that demonstrated a link between the externalizing PD spectrum (including narcissistic, histrionic, and antisocial traits) and high extraversion, high openness, and low agreeableness, suggesting the existence of an externalizing factor. Overall, our findings provide evidence for a joint structure of maladaptive and normal personality traits in a sample of personality disorders and emphasize the importance of integrating the FFM model in PD evaluation in clinical practice, suggesting that differentiating between major subgroups could assist in adjusting therapeutic approaches.

Preliminary Assessment of Pre-Electroconvulsive Therapy Evaluation Practices in European Countries: The Need for Guidelines

OBJECTIVES

Pre-electroconvulsive therapy (ECT) evaluation is an essential part of ECT preparation, a standard treatment in the psychiatric field. However, no routine pre-ECT evaluation has been published so far. This preliminary study aimed to explore different practices in pre-ECT evaluation across European countries.

METHODS

The data were collected as a snowball sample approach using an online survey from September 2019 to April 2020. The final analysis included data from 18 clinics placed in 16 European countries.

RESULTS

Regulations on the pre-ECT evaluation were found in 9 countries. All clinics reported doing complete blood count, serum electrolytes, and renal function analysis as a part of regular laboratory testing, alongside with a cardiovascular assessment. Ten clinics reported using psychiatric scales. Six clinics reported doing a cognitive assessment, of which all had regulations on the pre-ECT evaluation. Not one evaluation had the same sets of procedures and diagnostics.

CONCLUSIONS

The differences in assessment approaches mirror high variability of the pre-ECT evaluation practice across Europe. Cognitive assessment and objectification of psychiatric symptoms should be a regular part of the pre-ECT evaluation because of the monitoring of the most common adverse effect and observing the clinical response to ECT. Standardization of the pre-ECT evaluation and ECT in general would remove criticisms and opposition to the treatment, make it based on the best of our knowledge, and provide a method respectful of patients' best interests and rights.

Electrospun PEO/rGO Scaffolds: The Influence of the Concentration of rGO on Overall Properties and Cytotoxicity

Reduced graphene oxide (rGO) is one of the graphene derivatives that can be employed to engineer bioactive and/or electroactive scaffolds. However, the influence of its low and especially high concentrations on scaffolds’ overall properties and cytotoxicity has yet to be explored. In this study, polyethylene oxide (PEO)-based scaffolds containing from 0.1 to 20 wt% rGO were obtained by electrospinning. Morphological, thermal and electrical properties of the scaffolds were characterized by SEM, Raman spectroscopy, XRD, DSC and electrical measurements. The diameter of the fibers decreased from 0.52 to 0.19 µm as the concentration of rGO increased from 0.1 wt% to 20 wt%. The presence of rGO above the percolation threshold (5.7 wt%) resulted in a significantly reduced electrical resistivity of the scaffolds. XRD and Raman analysis revealed delamination of the graphene layers (interlayer spacing increased from 0.36 nm to 0.40–0.41 nm), and exfoliation of rGO was detected for the samples with an rGO concentration lower than 1 wt%. In addition, an evident trend of increasing cell viability as a function of the rGO concentration was evidenced. The obtained results can serve as further guidance for the judicious selection of the rGO content incorporated into the PEO matrix for constructing electroactive scaffolds.

Cost-effectiveness of implementing a digital psychosocial intervention for patients with psychotic spectrum disorders in low- and middle-income countries in Southeast Europe: Economic evaluation alongside a cluster randomised trial

Background

DIALOG+ is a digital psychosocial intervention aimed at making routine meetings between patients and clinicians therapeutically effective. This study aimed to evaluate the cost-effectiveness of implementing DIALOG+ treatment for patients with psychotic disorders in five low- and middle-income countries in Southeast Europe alongside a cluster randomised trial.

Methods

Resource use and quality of life data were collected alongside the multi-country cluster randomised trial of 468 participants with psychotic disorders. Due to COVID-19 interruptions of the trial’s original 12-month intervention period, adjusted costs and quality-adjusted life years (QALYs) were estimated at the participant level using a mixed-effects model over the first 6 months only. We estimated the incremental cost-effectiveness ratio (ICER) with uncertainty presented using a cost-effectiveness plane and a cost-effectiveness acceptability curve. Seven sensitivity analyses were conducted to check the robustness of the findings.

Results

The average cost of delivering DIALOG+ was €91.11 per participant. DIALOG+ was associated with an incremental health gain of 0.0032 QALYs (95% CI –0.0015, 0.0079), incremental costs of €84.17 (95% CI –8.18, 176.52), and an estimated ICER of €26,347.61. The probability of DIALOG+ being cost-effective against three times the weighted gross domestic product (GDP) per capita for the five participating countries was 18.9%.

Conclusion

Evidence from the cost-effectiveness analyses in this study suggested that DIALOG+ involved relatively low costs. However, it is not likely to be cost-effective in the five participating countries compared with standard care against a willingness-to-pay threshold of three times the weighted GDP per capita per QALY gained.

Implementing a digital mental health intervention for individuals with psychosis - a multi-country qualitative study

BACKGROUND

Implementation of psychosocial interventions in mental health services has the potential to improve the treatment of psychosis spectrum disorders (PSD) in low- and middle-income countries (LMICs) where care is predominantly focused on pharmacotherapy. The first step is to understand the views of key stakeholders. We conducted a multi-language qualitative study to explore the contextual barriers and facilitators to implementation of a cost-effective, digital psychosocial intervention, called DIALOG+, for treating PSD. DIALOG+ builds on existing clinician-patient relationships without requiring development of new services, making it well-fitting for healthcare systems with scarce resources.

METHODS

Thirty-two focus groups were conducted with 174 participants (patients, clinicians, policymakers and carers), who were familiarized with DIALOG+ through a presentation. The Southeast European LMICs included in this research were: Bosnia and Herzegovina, Kosovo, (Kosovo is referred throughout the text by United Nations resolution) North Macedonia, Montenegro and Serbia. Framework analysis was used to analyse the participants' accounts.

RESULTS

Six major themes were identified. Three themes (Intervention characteristics; Carers' involvement; Patient and organisational benefits) were interpreted as perceived implementation facilitators. The theme Attitudes and perceived preparedness of potential adopters comprised of subthemes that were interpreted as both perceived implementation facilitators and barriers. Two other themes (Frequency of intervention delivery; Suggested changes to the intervention) were more broadly related to the intervention's implementation. Participants were exceedingly supportive of the implementation of a digital psychosocial intervention such as DIALOG+. Attractive intervention characteristics, efficient use of scarce resources for its implementation and potential to improve mental health services were seen as the main implementation facilitators. The major implementation barrier identified was psychiatrists' time constrains.

CONCLUSIONS

This study provided important insights regarding implementation of digital psychosocial interventions for people with PSD in low-resource settings by including perspectives from four stakeholder groups in five LMICs in Southeast Europe - a population and region rarely explored in the literature. The perceived limited availability of psychiatrists could be potentially resolved by increased inclusion of other mental health professionals in service delivery for PSD. These findings will be used to inform the implementation strategy of DIALOG+ across the participating countries. The study also offers insights into multi-country qualitative research.

Comprehensive Profiling of Microbiologically Induced CaCO3 Precipitation by Ureolytic Bacillus Isolates from Alkaline Soils

Microbiologically induced CaCO3 precipitation (MICP) is a well-known bio-based solution with application in environmental, geotechnical, and civil engineering. The significance of the MICP has increased explorations of process efficiency and specificity via natural bacterial isolates. In this study, comprehensive profiling of five soil ureolytic Bacillus strains was performed through a newly formed procedure that involved six steps from selection and identification, through kinetic study, to the characterization of the obtained precipitates, for the first time. To shorten the whole selection procedure of 43 bioagents with the MICP potential, Standard Score Analysis was performed and five selected bacteria were identified as Bacillus muralis, B. lentus, B. simplex, B. firmus, and B. licheniformis by the MALDI-TOF mass spectrometry. Despite following the targeted activity, kinetic studies were included important aspects of ureolysis and the MICP such as cell concentration, pH profiling, and reduction in calcium ion concentration. At the final step, characterization of the obtained precipitates was performed using FTIR, XRD, Raman, DTA/TGA, and SEM analysis. Although all tested strains showed significant potential in terms of precipitation of calcite or calcite and vaterite phase, the main differences in the MICP behavior can be observed at the bacterial strain level. B. licheniformis showed favorable behavior compared to the reference Sporosarcina pasteurii DSM 33.

Gender differences in depression, anxiety, and stress during the first wave of the COVID-19 pandemic in serbia - results from an online survey

Introduction

COVID-19 outbreak has significantly affected the mental health of people worldwide. The first wave of the pandemic began during the beginning of March 2020, and included significant preventative measures. Previous research on mental health differences between the genders has found that women were more likely to exhibit symptoms of anxiety during the COVID-19 outbreak.

Objectives

The aim of our study was to assess the differences between the genders in depression, anxiety, and stress.

Methods

An online survey designed for the purposes of this study was distributed using the snowballing method during April and May of 2020. The survey consisted of two parts: sociodemographic and clinical data, and COVID-19 related data. Participants also filled out the Depression, Anxiety and Stress Scale (DASS-21) - a well validated, self-questionnaire instrument. T-test for independent samples was used to evaluate the differences between the genders.

Results

Out of the initially sent 563 surveys, a total of 161 were included in further analyses (28.6% response rate). Mean age of the sample was 42.2±10.2 and 65.2% of the participants were female. Mean scores on DASS-21 were as follows: 8.78±6.66 on depression, 9.78±7.39 on anxiety and 7.76±7.14 on stress. Females scored significantly higher on depression (t=-2.25, p=0.029), anxiety (t=-2.25, p=0.028), stress (t=-2.44, p=0.017), and total DASS-21 score (t=-2.44, p=0.016).

Conclusions

The results of our study imply that female participants exhibit higher levels of depression, anxiety, and stress during the COVID-19 pandemic. Larger, population-based studies could provide a mroe in-depth answer to the importance of these differences for the general population.

Long-Term Benzodiazepine Prescription During Maintenance Therapy of Individuals With Psychosis Spectrum Disorders-Associations With Cognition and Global Functioning

BACKGROUND

Cognitive difficulties have a significant impact on life functioning and overall well-being in patients with psychosis spectrum disorders (PSDs). There are indications that continuous use of benzodiazepines (BZDs) in various patient groups has a detrimental effect on cognition. Our aim was to explore the association between long-term BZD prescription, global functioning, and cognitive functioning in persons with PSD.

METHODS

This exploratory study included 55 PSD patients, recruited from 2 outpatient services in Serbia. Patients were grouped into BZD long-term prescription group and BZD-other group. Brief Psychiatric Rating Scale was used for symptom assessment, functioning was measured by Global Assessment and Functioning Scale, and cognition was assessed by the Global Assessment of Functioning-Cognition in Schizophrenia Scale.

RESULTS

The sample comprised 52.7% patients who were prescribed with BZD for 6 months or more continually (29/55), with a mean daily dose of 3.16 ± 0.66 mg lorazepam equivalents. There were no differences between study groups in any of the sociodemographic characteristics, duration of illness, or antipsychotic daily dosages. The BZD long-term prescription group had lower global (P < 0.01) and cognitive functioning (P < 0.01), higher Brief Psychiatric Rating Scale scores (1.86 vs 1.58, respectively, P < 0.01), and more psychotropic drugs prescribed on a daily basis than the other group (median: 4 vs 2, respectively, P < 0.01).

CONCLUSIONS

The study explored a topic that continues to be underresearched, especially in the Balkans. Prospective studies and comprehensive cognitive batteries are needed to further elucidate the associations between polypharmacy, long-term BZD use, cognitive functioning, and global functioning during maintenance therapy of individuals with PSD.

Factorial Structure of the Serbian Version of the Clinical Assessment Interview for Negative Symptoms - Evidence for Three Factors of Negative Symptoms

Introduction: Negative symptoms are a common occurrence in patients with psychosis spectrum disorders. Previous analysis of the latent structure of the Clinical Assessment Interview for Negative Symptoms (CAINS) - which was developed to advance the assessment of negative symptomatology - showed two underlying sub-domains (Motivation and Pleasure; Expression). Recent findings indicate that a more complex structure might be more applicable. Aim: To evaluate the psychometric properties of the Serbian version of the CAINS in a sample of outpatients (N = 67) with psychosis spectrum disorders. Materials and Methods: Negative symptoms and general level of psychopathology were assessed with Serbian translations of the CAINS, the 53-item version of the Brief Symptom Inventory (BSI), and the 24-item version of the Brief Psychiatric Rating Scale (BPRS). Principal component analysis (PCA) was carried out on the CAINS items, and correlation analyses were done to assess its convergent and discriminant validity. Results: Our results showed an excellent internal consistency (Cronbach's alpha = 0.92). PCA revealed a three-component solution consisting of Expressiveness and Motivation for Social and Family Relationships (Factor 1), Motivation for Vocational Activities (Factor 2), and Motivation for Recreation (Factor 3). Convergent validity was supported by significant correlations with the Negative symptoms domain of the BPRS (Factor 1, 0.695, p < 0.01; Factor 2, 0.352, p < 0.05; Factor 3, 0.452, p < 0.01). When assessing discriminant validity, weak correlations were found with BPRS and BSI scores. Conclusion: The Serbian version of CAINS is a valid, reliable and useful tool for the assessment of negative symptomatology. Our findings support a three-factor structure of CAINS, which indicates that the construct is more complex than envisaged by the original conceptualization of two distinct factors.

Maintenance phase treatment of psychotic disorders in outpatients from Serbia - focus on long-term benzodiazepine use

Introduction: Prescribing trends in maintenance therapy of patients with primary psychotic disorders (PSD) may vary worldwide. Present study aimed to investigate prescription patterns in a sample of outpatients with PSD from Serbia.Methods: In a sample of 73 PSD outpatients we analysed the rate of antipsychotic polypharmacy and psychotropic polypharmacy, concomitant continual benzodiazepine use, and associations between therapy, psychotic symptoms and quality of life.Results: Maintenance therapy (median daily dose 321 mg of chlorpromazine equivalents) predominantly consisted of monotherapy with second generation antipsychotics (45.2%), followed by antipsychotic polypharmacy based on first and second generation combination (25.0%). The median number of psychotropic drugs was 3. Benzodiazepines were continually prescribed to more than 60% of patients (mean daily dose 2.9 ± 2.0 mg lorazepam equivalents). Patients with benzodiazepine use had significantly more psychotropic medications and more antipsychotic polypharmacy, poorer quality of life and more severe psychopathology in comparison to another group.Conclusion: The present study demonstrated new information regarding the prescription patterns of psychotropic drugs in outpatients with PSD in Serbia, amplified with clinically relevant information. This study also revealed distinct prescription patterns concerning antipsychotic/benzodiazepine polypharmacy. Overall, such findings are likely to contribute to improving clinical practice and care for patients with PSD in general.KeypointsPresent exploratory research aimed to elucidate trends of antipsychotics polypharmacy and concomitant use of psychotropic medications including benzodiazepines in the maintenance treatment of outpatients with schizophrenia and other psychotic disorders, amplified with clinically relevant information (symptoms and quality of life).'Antipsychotic (AP) polypharmacy' was defined as concurrent use of more than one AP for at least 1 month; 'Psychotropic polypharmacy' was defined as the combination of AP and a different class of psychotropic drugs medication for at least one month.The median number of prescribed psychotropic drugs was 3 (mean 3.1 ± 1.1) and the average AP daily dose was moderate (median 321 mg of chlorpromazine equivalents). However, the rates of AP polypharmacy (45.2%) and benzodiazepine prescription on a continual basis (>60%) found in our sample could be considered relatively high.Outpatients with higher AP daily dose and higher BPRS symptom score were receiving more benzodiazepines.For improvement of the local, as well as general clinical practice and care for patients with psychotic disorders, and for education in psychiatry, such analyses need to be done on a regular basis and on larger samples.