Suchergebnisse

© Copyright 2015 Physicians Postgraduate Press, Inc.Objective: Antipsychotic medications have been increasingly prescribed for off-label uses, including treatment of posttraumatic stress disorder (PTSD). Given limited knowledge about their use in returning Iraq and Afghanistan veterans with PTSD, we explored rates of antipsychotic use in this population and correlations with sociodemographic, military service, and psychiatric factors. Method: Iraq and Afghanistan veterans with a PTSD diagnosis based on ICD-9-CM codes enrolled in Veterans Administration care between January 1, 2007, and September 30, 2011, were followed through September 30, 2012. Patients with a comorbid diagnosis of schizophrenia or bipolar disorder were excluded. Poisson regression models evaluated factors associated with prescriptions for antipsychotic versus other psychiatric medications (primary outcome). Results: The mean age of our study population was 29.3 years, and 9.4% were women. Of 186,460 veterans with PTSD diagnoses examined, 19.9% received no psychiatric medications, and the remainder received psychiatric medications that excluded (61.2%) or included (18.9%) antipsychotics. In adjusted models, several factors were independently associated with antipsychotic use, including male sex (adjusted relative risk = 1.25; 95% CI, 1.20-1.30) and enlisted rank (1.44; 95% CI, 1.35-1.53). Increased likelihood of antipsychotic prescribing was associated with suicidal ideation (4.77; 95% CI, 4.59-4.95) and comorbid psychiatric diagnoses including personality disorder (4.27; 95% CI, 4.09-4.46), drug use disorder (3.56; 95% CI, 3.43-3.69), and alcohol use disorder (2.75; 95% CI, 2.65-2.84). Conclusions: A substantial minority of Iraq and Afghanistan veterans diagnosed with PTSD received antipsychotics. Male veterans, those of enlisted rank, and those with suicidal ideation and psychiatric comorbidities were more likely to receive antipsychotics than other types of psychiatric medications. Providers should be cautious about antipsychotic use, given their known metabolic risks and questionable benefits for PTSD.

Study Objective. To investigate the relative numbers and clinical characteristics of pancreatitis in patients treated with the atypical antipsychotic agents, clozapine, olanzapine, and risperidone, versus the conventional neuroleptic, haloperidol. Design. Pharmacovigilance study of pooled, spontaneously reported adverse events. Setting. Government‐affiliated drug evaluation center. Patients. One hundred ninety‐two patients who developed pancreatitis during treatment with one or more antipsychotic agents. Intervention. Patients were identified with the Food and Drug Administration's MedWatch surveillance program and a MEDLINE search. Measurements and Main Results. Most cases of pancreatitis occurred within 6 months after the start of therapy with one or more antipsychotic agents. Of the reports of pancreatitis occurring in conjunction with these drugs, 40%, 33%, 16%, and 12% were in patients receiving treatment with clozapine, olanzapine, risperidone, and haloperidol, respectively. In 50% of the patients receiving haloperidol, an atypical antipsychotic was listed as a concomitant drug. Valproate was administered concomitantly in 23% of patients. Hyperglycemia and acidosis, although uncommon, developed with all the drugs except haloperidol. Twenty‐two patients died. In contrast to patients who developed pancreatitis while receiving an atypical antipsychotic, those who developed the disease while receiving haloperidol were women and tended to be older. Conclusion. The number of reports involving the three atypical antipsychotic agents and the relative paucity of reports involving haloperidol, despite its more extensive patient exposure, suggest that atypical antipsychotics may precipitate pancreatitis. However, the risk may not be the same with all agents; pancreatitis was reported most frequently with clozapine, followed by olanzapine, and then risperidone. The temporal relationship of the onset of pancreatitis with the start of drug therapy further supports a cause‐and‐effect relationship.

Purpose - This article aims to give an opinion on the cause of still the case of pasung in Indonesia, physical restraint and reduction in people with mental illness (called pasung in indonesia), still found in indonesia, government program †indonesia free of pasung†still can not erase indonesia from pasung. Design/methodology/approach -The approach to literature study causes the escape especially social stigma that occurs to make the case of the pipe still continues to exist Findings -The findings of many literature studies suggest that social stigma is a cause of social restraint in patients with severe psychiatric disorders Originality/value -The value of this study envolve Empowering people with mental disorders through social intervention can reduce the side effects of antipsychotic drugs and simultaneously help self-stigma in people with mental disorders

ABSTRACTObjectivesTo examine the characteristics of children who are prescribed antipsychotic medication.
ApproachA cohort study using routine data from general practitioner and hospital records linked with education records. All children in Wales between the years 1999 to 2014 were included in the analysis, demographic characteristics and outcomes of children were stratified by intellectual disability/autism (identified using education records and GP records) and antipsychotic use. All data were linked and held in the Secure Anonymised Information Linkage (SAIL) Databank in Wales
ResultsOf children with intellectual disability 2.4 % (360/14428) have been prescribed an antipsychotic and 75 % of these have a diagnosis of autism. This compares with 0.19% (1126/602320) of children without intellectual disability who are prescribed an antipsychotic. Children, predominantly boys (78.1% (281/360) of those with intellectual disability prescribed an antipsychotic were boys compared to 67.12% (9442/14068) of those not prescribed antipsychotics), with aggression codes (17.5% of those on an antipsychotic had aggression codes compared to 1.36% of those without antipsychotic) were more likely to be prescribed antipsychotics. Those with intellectual disabilities were prescribed antipsychotics at a younger age (58 % of those with intellectual disability started the drug before the age of 14 compared to 29 % of those without intellectual disability) but were less likely to be from a deprived area compared to those prescribed antipsychotics but without intellectual disability/autism (22.5 % and 28.4 %, were in the lowest fifth of deprivation, intellectual disability and non- intellectual disability, respectively). Antipsychotic use was associated with more visits to the GP for epilepsy, diabetes and injury (post drug compared to prior to drug) and higher deaths in childhood (compared to those not give antipsychotics).
ConclusionsThe linkage of the education records allowed intellectual disability to be used as an explanatory factor in analysis looking at drug prescriptions. The majority of children prescribed antipsychotics do not have psychotic or mental disorder diagnosis codes but have a diagnosis of behavioural problems, attend special schools and have intellectual difficulties. In the group with intellectual disability/autism there is evidence that the use of antipsychotics may be associated with more visits to the GP for epilepsy, diabetes, injury (post drug compared to prior to drug) and is associated with more deaths in childhood. These findings support concerns that antipsychotics may be over used for managing predominately behavioural problems.

Background: Today's treatment of acute psychosis usually includes short-term hospitalization and anti-psychotic drug treatment. The Soteria project compared this form of treatment (control) with that of a small, home-like social environment, usually without neuroleptics (experimental). Method: Newly diagnosed, young, unmarried persons with DSM-11 schizophrenia were randomly assigned to treatment in two experimental and two control settings. Subjects and families were assessed at admission on 29 independent variables. Treatment environments were studied by means of Moos', COPES or WAS scales. Three dependent six week psychopathology outcome measures were collected. Results: The groups were comparable on 25 of 29 admission variables. The environments of the two experimental and two control settings were different from each other. The milieus were similar to each other within each condition. At six weeks, psychopathology in both groups had improved significantly, and similarly, and overall change was the same. Conclusion: Specially designed, replicable milieus were able to reduce acute psychotic symptomatology within six weeks, usually without antipsychotic drugs, as effectively as usual hospital ward treatment that included routine neuroleptic drug use.

The prefrontal cortex (PFC) is involved in behavioural control and cognitive processes that are altered in schizophrenia. The brainstem monoaminergic systems control PFC function, yet the cells/networks involved are not fully known. Serotonin (5-HT) and norepinephrine (NE) increase PFC neuronal activity through the activation of α1-adrenergic receptors (α1ARs) and 5-HT2A receptors (5-HT2ARs), respectively. Neurochemical and behavioural interactions between these receptors have been reported. Further, classical and atypical antipsychotic drugs share nm in vitro affinity for α1ARs while having preferential affinity for D2 and 5-HT2ARs, respectively. Using double in situ hybridization we examined the cellular expression of α1ARs in pyramidal (vGluT1-positive) and GABAergic (GAD65/67-positive) neurons in rat PFC and their co-localization with 5-HT2ARs. α1ARs are expressed by a high proportion of pyramidal (59-85%) and GABAergic (52-79%) neurons. The expression in pyramidal neurons exhibited a dorsoventral gradient, with a lower percentage of α1AR-positive neurons in infralimbic cortex compared to anterior cingulate and prelimbic cortex. The expression of α1A, α1B and α1D adrenergic receptors was segregated in different layers and subdivisions. In all them there is a high co-expression with 5-HT2ARs (∼80%). These observations indicate that NE controls the activity of most PFC pyramidal neurons via α1ARs, either directly or indirectly, via GABAergic interneurons. Antipsychotic drugs can thus modulate the activity of PFC via α1AR blockade. The high co-expression with 5-HT2ARs indicates a convergence of excitatory serotonergic and noradrenergic inputs onto the same neuronal populations. Moreover, atypical antipsychotics may exert a more powerful control of PFC function through the simultaneous blockade of α1ARs and 5-HT2ARs. © 2012 CINP. ; This study was supported by the Innovative Medicine Initiative Joint Undertaking under grant agreement no. 115008 of which resources are composed of EFPIA in-kind contribution and financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013). Support from grant SAF 2007-62378 and Generalitat de Catalunya (2009-SGR220) and the Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) and the Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) is also acknowledged. N. S. is supported by CIBERSAM. ; Peer Reviewed

A first step towards personalized medicine is to consider whether, for some disorders, the safest and most effective treatment of women needs to differ from standard guideline recommendations developed on the basis of clinical trials conducted, for the most part, in men. A second step is to consider how women's reproductive stages—pre-pubertal years, menstrual phases, pregnancy trimesters, lactation and postpartum periods, menopausal and postmenopausal/aging status—affect the optimal choice of treatment. This review focuses on these two steps in the treatment of psychosis, specifically schizophrenia. It discusses genetics, precursors and symptoms of schizophrenia, reproductive and associated ethical issues, antipsychotic drug response and adverse effects, substance abuse, victimization and perpetration of violence, and issues of immigration and of co-morbidity. The conclusions, while often based on clinical experience and theoretical considerations rather than strictly on the evidence of randomized controlled trials, are that clinical recommendations need to consider clinical and role differences that exist between men and women and make appropriate correction for age and reproductive status.

Based on the author's extensive clinical, forensic and research experience, this article addresses the scientific and moral question of whether it is ever in the best interests of a child to be given a psychiatric drug. The focus is on the diagnosis Attention Deficit Hyperactivity Disorder (ADHD) and stimulant drugs, and on the diagnosis Bipolar Disorder and antipsychotic (neuroleptic) drugs. The conclusion is that we should work towards a prohibition against giving psychiatric drugs to children, and instead focus on safe and effective alternative ways of meeting the needs of children within their families, schools and society.

Background: Schizophrenia is a lifelong condition with acute exacerbations and varying degrees of functional disability. Acute and long-term treatments are based on antipsychotic drugs, even if some domains of personal and social functioning are not addressed by psychopharmacotherapy. In fact, psychosocial interventions show a positive impact on patient's functioning and clinical outcome. In addition, psychosocial interventions are significantly associated with a lower number of relapses and hospitalizations in schizophrenia. Methods: An analytical review of the International Guidelines on Psychosocial Interventions in Schizophrenia has been performed; we included the National Institute for Health and Care Excellence (NICE) guidelines, the Scottish Intercollegiate Guidelines Network (SIGN) guidelines, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines, the Schizophrenia Patient Outcomes Research Team (PORT) guidelines and the American Psychiatric Association (APA) guidelines. Results: The international guidelines recommend psychosocial interventions as supportive treatments alongside pharmaceutical or psychotherapeutic ones. Conclusion: More research studies need to be conducted and included in the updated version of the international guidelines to confirm the effectiveness of psychosocial interventions in the long-term outcome of schizophrenia.

In March of 1969, a Black man from Detroit named Abdul-Rasheed Karim arrived at Ionia State Hospital for the Criminally Insane in Ionia, Michigan, after spending two years locked up in prison and a psychiatric ward for a fight that started when he was assaulted by three White boys, then brutalized by the police who responded. Mr. Karim, who suffered two broken ribs, a cracked tooth, and a deep skull laceration, made the mistake of hitting one of the officers who were beating him with clubs. As Metzl quotes, the clinical evaluation that led to Mr. Karim's transfer to Ionia noted "cultural retardation is thus a significant factor in his schizophrenic disease" because he had been "socialized toward ghetto survival" (p. 143) as a child. The doctor interpreted Mr. Karim's Islamic beliefs as "religious delusions," writing, "his identification with the Black Muslim group is a projection of his feelings of inadequacy" (p. 143). Once at Ionia, doctors treated Mr. Karim's hostility toward authority figures by confining him to a maximum supervision ward where he was injected daily with escalating doses of antipsychotic drugs.

A number of schizophrenia patients live untreated in the community in the developing countries. There is little recorded experience of how such patients would respond to treatment after years of untreated illness. A cohort of 72 never-treated chronic schizophrenia patents in Chennai, India were directed to attend a health facility. A substantial proportion of them (68%) came for treatment. Unemployed status of male patients, living in a joint family setting and families initially unaware of the psychiatric nature of the problem were the factors that related to failure to seek treatment. Patients sex, age, education, marital status, economic status, age at onset and duration of illness, degree of disability and clinical symptoms (except self-neglect) were not related to taking treatment. Those who attended were treated with typical antipsychotic drugs and followed up for one year. Evaluation was done using the Present State Examination and Psychiatric History and Sociodemographic Schedule and Disability Assessment Schedule. The clinical outcome was good (Best Remission) in 29%. There was no impairment in social functioning in 35% and 51 % has no impairment in occupational functioning at the end of one year.

AIM: To compare the Neurocognitive effects of typical and atypical antipsychotics among schizophrenic patients. PURPOSE: Schizophrenia is a mental disorder that is characterized by hallucinations, delusions and other cognitive difficulties; it can often be a lifelong struggle. Although it can be treated very effectively, acute aggravations often occur. Antipsychotic drug therapies are fairly effective for decreasing the rate of relapses and neurocognitive difficulties in patients with schizophrenia. This study aimed to compare the typical and atypical antipsychotics used to treat patients with schizophrenia in terms of neurocognitive effects and Quality of life. METHODS: A cross-sectional comparative study is proposed to be conducted in 6 months. All the patients were administered the Morisky Medication Adherence Scale, to evaluate cognitive function by the Mini-Mental State Examination (MMSE). Short Form 36, and the Schedule for Assessing the Neurocognition (Attention, Memory, and Intelligence). SETTING: The study was conducted in the government general hospital, Guntur; an 1170 bedded tertiary care teaching hospital. PARTICIPANTS: The study included 75patients who were taking typical antipsychotics and 75 patients taking atypical antipsychotics for the treatment of schizophrenia. RESULTS: The medication adherence was similar in both groups of patients and perceived scores of the patients treated with atypical antipsychotics were significantly higher than those of the patients treated with typical antipsychotics in terms of neurocognition and quality of life. CONCLUSIONS: Neurocognitive dysfunction is a core feature of schizophrenia and is related to the functional outcome of the illness. In our study, it reveals that atypical antipsychotics therapy was associated with more favourable results of neurocognition and quality of life compared with typical antipsychotics. So Finally, Our study concluded that Patients of Schizophrenia who are taking atypical antipsychotics showed positive results than typical ...

peer-reviewed ; Background The role of the gut microbiome in the biotransformation of drugs has recently come under scrutiny. It remains unclear whether the gut microbiome directly influences the extent of drug absorbed after oral administration and thus potentially alters clinical pharmacokinetics. Methods In this study, we evaluated whether changes in the gut microbiota of male Sprague Dawley rats, as a result of either antibiotic or probiotic administration, influenced the oral bioavailability of two commonly prescribed antipsychotics, olanzapine and risperidone. Findings The bioavailability of olanzapine, was significantly increased (1.8-fold) in rats that had undergone antibiotic-induced depletion of gut microbiota, whereas the bioavailability of risperidone was unchanged. There was no direct effect of microbiota depletion on the expression of major CYP450 enzymes involved in the metabolism of either drug. However, the expression of UGT1A3 in the duodenum was significantly downregulated. The reduction in faecal enzymatic activity, observed during and after antibiotic administration, did not alter the ex vivo metabolism of olanzapine or risperidone. The relative abundance of Alistipes significantly correlated with the AUC of olanzapine but not risperidone. Interpretation Alistipes may play a role in the observed alterations in olanzapine pharmacokinetics. The gut microbiome might be an important variable determining the systemic bioavailability of orally administered olanzapine. Additional research exploring the potential implication of the gut microbiota on the clinical pharmacokinetics of olanzapine in humans is warranted. Funding This research is supported by APC Microbiome Ireland, a research centre funded by Science Foundation Ireland (SFI), through the Irish Government's National Development Plan (grant no. 12/RC/2273 P2) and by Nature Research-Yakult (The Global Grants for Gut Health; Ref No. 626891). ; Science Foundation Ireland