Olanzapine as a prophylactic antiemetic for preventing postoperative nausea and vomiting after general anesthesia: A systematic review and metaanalysis

Abstract Background: The antiemetic effectiveness of olanzapine, as a prophylactic off-label antiemetic drug, for Postoperative Nausea and Vomiting (PONV) is unknown. In this systematic review and meta-analysis, the authors evaluate the efficacy and side effects of olanzapine as a prophylactic antiemetic in adult patients who undergo general anesthesia and assess adverse effects. Methods: A systematic search was done on electronic bibliographic databases in July 2023. Randomized controlled trials of olanzapine as a prophylactic antiemetic for PONV in adults who underwent general anesthesia were included. The authors excluded non-RCTs and retracted studies. The authors set no date of publication or language limits. The outcomes were the incidence of PONV within 24 h postoperatively and the safety of olanzapine. The risk of bias was assessed according to the tool suggested by the National Heart, Lung, and Blood Institute. Results: Meta-analysis included 446 adult patients. Olanzapine reduced on average 38 % the incidence of PONV. The estimated risk ratio (95 % CI) of olanzapine versus control was 0.62 (0.42-0.90), p = 0.010, I2 = 67 %. In the subgroup meta-analysis, doses of olanzapine (10 mg) reduced on average 49 % of the incidence of PONV (RR = 0.51 [0.34-0.77], p = 0.001, I2 = 31 %). Conclusion: This systematic review with meta-analysis indicated that olanzapine as a prophylactic antiemetic alone or combined with other antiemetic agents reduced the incidence of postoperative nausea and vomiting. However, this conclusion must be presented with some degree of uncertainty due to the small number of studies included. There was a lack of any evidence to draw conclusions on side effects.

Progress and perspective of potential anti-coronavirus activity of phenothiazines / 药学学报

Coronaviruses (CoVs) are associated with some mammalian infectious diseases, which have caused several outbreaks of respiratory system infectious diseases in recent years. There is no effective vaccine or approved drug treatment against coronaviruses, and the development of anti-coronavirus agents is an urgent priority. Phenothiazines are a class of antipsychotic drugs, which were found that they have some other biological activities, like promising antibacterial, antifungal, anticancer, antiviral, etc. They can be used for drug repurposing. This review summarizes current researches on the potential anti-coronavirus activity of phenothiazine, discusses the mechanisms and some research difficulties, and provides a foundation for developing anti-coronavirus drugs which use phenothiazine as the lead compound.

Prevalence of Sexual Dysfunction in Schizophrenic Patients Taking Antipsychotic Drugs / 대한정신분열병학회지

OBJECTIVES: Sexual dysfunction is said to affect the compliance of drug and quality of life. This study is a research to investigate the prevalence of sexual dysfunction and affecting factors that can occur when schizophrenic and schizoaffective patients have taken drugs. METHODS: Subjects were 300 patients who have been taken inpatient or outpatient treatment in national seoul hospital. We used UKU-S, ASEX scale for evaluating the prevalence of sexual dysfunction and CGI-S, PANSS negative scale and CES-D for investigating the influence of psychopathology and depressive symptoms on sexual dysfunction. RESULTS: It was reported sexual dysfunction 82.7% in male and 92.2% in female with 7 items of UKU-S. The prevalence of sexual dysfunction with criteria of ASEX was 47.72% in male and 65.05% in female. Sexual dysfunction was more prevalent in patients taking prolactin-elevation drugs. In the factor analysis for the sexual dysfunction it was investigated that age, onset time, CGI-S, PANSS negative scale, and CES-D can affect the sexual dysfunction in both male and female. CONCLUSION: This study reported that many patients complained of sexual dysfunction. On considering the influence of sexual dysfunction to compliance and quality of life, clinicians evaluate sexual side effects more actively because patients are more likely not spontaneously tell the sexual side effects in comparison to others.

Pharmacotherapy of Bipolar Disorder with Quetiapine: A Recent Literature Review and an Update

Bipolar disorder is a chronic, recurrent condition with the usual onset during adolescence or early adulthood. In the Diagnostic and Statistical Manual of Mental Disorders 5th edition, it is conceptualized as a spectrum disorder usually associated with such comorbidities as anxiety disorders and substance use disorders. It is a relatively prevalent condition often complicated by mixed episodes, rapid cycling, subsyndromal symptoms, and treatment refractoriness. In spite of carrying substantial morbidity and mortality, effective treatments are few and far between and conventional mood stabilizers are often unsuccessful in controlling the various manifestations of the disorder. In this scenario, second generation antipsychotics are emerging as treatments with valid efficacy in all phases of bipolar disorder. Quetiapine is a versatile atypical antipsychotic which was first approved for the treatment of schizophrenia, but latter on the basis of controlled studies earned United States Food and Drug Administration's approval for acute as well as maintenance treatment of this difficult to treat condition. In this review, recently published studies in the last 10 years were examined to update the knowledge about the efficacy and safety of quetiapine in the treatment of bipolar disorder. The medication's clinical pharmacology was first considered followed by a literature review summarizing its uses in bipolar disorder. The conclusion was that quetiapine was efficacious in manic, mixed and depressive episodes and as a maintenance agent with a good tolerability profile.

Effect of discontiguous naikan cognitive therapy combined with antipsychotic agent on the patients who had been in the recovery status of paranoid schizophrenia / 中华行为医学与脑科学杂志

ObjectiveTo explore the influence of clinical symptoms and applicability of discontiguous naikan cognitive therapy(DNCT) among convalescent schizophrenic patients.MethodsApplying DNCT,100 convalescent paranoid schizophrenic patients with convalescent clinical state were consecutively recruited.All the patients were randomly divided into DNCT group and control group and were pretreated with antipsychotic agent therapy,40 patients in DNCT group and 49 patients in control group entered the statistic analysis,11 lost.In DNCT group,the patients received DNCT for successive 28 days.In control group,the patients only received antipsychotic agent therapy.Positive and Negative Syndrome Scale (PANSS),Nurses'Observation Scale for Inpatient Evaluation (NOSIE) were administered to all subjects pre- and post-treatment.ResultsAfter treatment,in the study group,total PANSS scales ( (54.00 ± 10.19 ) vs (45.05 ± 5.28 ),t =5.430,P ＜ 0.01 ),the positive symptom item ((11.00±3.33) vs (9.53 ±1.85),t=3.670,P=0.01),negative symptoms item((12.15 ±4.38) vs (9.40± 2.15 ),t =4.371,P ＜ 0.01 ),general psychopathology item ( (26.90 ± 5.66) vs (22.65 ± 3.07 ) 分,t =4.494,P＜0.01 ) scored lower than before,The difference was statistically significant.PANSS study group after treatment,total scores( (45.05 ±5.28 ) vs (52.04 ± 10.36),t=-3.876 P＜0.01 ),negative symptom item score( t =- 3.789,P ＜ 0.01 ),composite item ( t =2.251,P =0.027 ),the general psychopathology item ( t =- 3.336,P =0.01 ),score significantly lower than the control group.After twelve weeks follow-up study,in the study group,PANSS total scores ( t =4.764,P ＜ 0.01 ),item score of positive symptoms ( t =2.335,P =0.025 ),negative symptoms item score( t =3.083,P =0.004) ),genial psychopathology item score ( t =4.325,P ＜ 0.01 ) was still significantly lower than before treatment,the difference was statistically significant.In study group,after treatment,NOSIE Scale total negative factors scores( t =3.083,P =0.004) were significantly lower than before,total positive factors( t =-2.446,P=0.019),the total estimated factor in the disease scores ( t =-4.730,P ＜ 0.001 )were significantly higher than before treatment.After treatment,in the study group,negative factors ( t =-3.953,P=0.000) were significantly lower than the control group,twelve weeks follow-up,study group total negative factors of NOSIE scale score( t =2.126,P =0.040) was still lower than before treatment,the difference was statistically significant,total positive factor( t =- 2.054,P =0.047 ) still higher than before treatment,the difference was statistically significant.ConclusionDNCT can possibly improve part clinical symptoms of patients with convalescent schizophrenia to a certain extent,especially negative symptom,and the impact remained to the twelve weeks,but need to further prove the effect of naikan cognitive therapy.

Clinical Correlates of Metabolic Syndrome in Patients with Chronic Schizophrenia / 대한정신약물학회지

OBJECTSIVE: This study investigated the frequency of metabolic syndrome, associated factors and its risk for cardiovascular morbidity in schizophrenic patients. METHODS: In this cross-sectional study, nineteen-six patients with schizophrenia defined by DSM-IV criteria were included. All subjects were assessed for the presence of metabolic syndrome by means of the criteria of the National Cholesterol Education Program-Adult Treatment Panel III. In addition, we compared clinical characteristics, laboratory variables and risk for cardiovascular morbidity between patients with and without metabolic syndrome. RESULTS: Of patients, 43% had metabolic syndrome. Metabolic syndrome was associated with illness chronicity and current status of antipsychotic agents use, total duration of atypical agents used, but not with daily chlorpromazine equivalent dose. Compared with the patients without metabolic syndrome, patients with metabolic syndrome had higher risk for cardiovascular morbidity. CONCLUSION: This study suggests that metabolic syndrome is common among patients with chronic schizophrenia. Clinicians should be cautious to aware the increased risk for the metabolic syndrome and intervene actively to prevent and treat metabolic morbidity among chronic patients with schizophrenia.