Assessment of adverse drug events of atypical antipsychotics in cases with schizophrenia

Background: Atypical antipsychotics are the drug of choice to manage schizophrenia in general clinical practice. Antipsychotics cause various side effects, including metabolic syndrome, extrapyramidal symptoms, hyperlipidemia, weight gain, and hypotension in patients treated for schizophrenia. Aims and Objectives: The aim of the study was to assess the side effects due to antipsychotic drugs and their effect on the outcome in schizophrenia cases. Materials and Methods: A total of 200 cases with the diagnosis of schizophrenia were recruited. Cases were divided into five groups based on administered drugs (Asenapine, Iloperidone, Olanzapine, Aripiprazole, and Ziprasidone). Treatment procedure and side effect profile were documented. Drug side effects were assessed by a standard antipsychotic side-effects evaluation questionnaire. Cases were followed up for the status of side effects at the end of 1st month, 3rd month, 6th month, 9th month, and 12th month. Results: The rates of weight gain were 20%, 30%, 50%, 25%, and 15% and menstrual complications were seen at 2.5%, 7.5%, 7.5%, 7.5%, and 1% in all five groups, respectively. Lactation disturbance was observed in 5%, 5%, 12.5%, and 5% iloperidone, olanzapine, aripiprazole, and ziprasidone, respectively. The extrapyramidal symptoms were higher in the iloperidone group compared to the asenapine, olanzapine, aripiprazole, and ziprasidone drug groups. Conclusion: Atypical antipsychotic drug consumption leads to considerable weight gain and few metabolic abnormalities. Clinicians should estimate the adverse events associated with atypical antipsychotics and compare the benefits of antipsychotics versus the quality of life of cases.

NEUROLEPTIC MALIGNANT SYNDROME: AN UNUSUAL CASE TO INCREASE CLINICAL ATTENTION

A 26-year-young man was taken to the hospital with symptoms of schizophrenia, and treatment began with a high dose of antipsychotic medication. After receiving medication for 3–4 days, the patient experienced persistently high body temperatures, tight muscles, and raised blood levels of CK-MB and CK-NAC. The results of all other investigations were normal. A rare Neuroleptic Malignant Syndrome (NMS) was made and treatment started with immediate withdrawal of the causative drug, and timely supportive therapy led to a successful recovery. This case illustrates the importance of adopting a broad differential diagnosis for fever, carefully reviewing the prescription lists of all patients, and taking NMS into account in patients who have both fever and stiffness.

It is story time!! Storytelling – Narrative session by medical students, an effective way of reflection of learning pharmacology

Background: Pharmacology, the study of drugs, is loaded with thousands of drug names, their mechanism of action, and adverse effects to be memorized, among which the drugs acting on central nervous system, especially antipsychotics, is a night mare for every medical student. “The Storytelling method” is implemented to increase the knowledge of students on antipsychotic drugs using storytelling method as an effective teaching strategy. Aims and Objectives: The aims of this study were to evaluate the effect of reflective writing in learning Pharmacology, among 2nd year MBBS students in the form of storytelling. Materials and Methods: Fifty students from 2nd year MBBS Students were involved in this teaching strategy. Students were randomly divided into ten groups (five per group). They were instructed to frame their own story/case scenario of a psychotic person treated with a P (Personalized) drug of their choice, the specific adverse effect encountered, and the methods to combat it. A time duration of 15 min was given and one person from each group had to narrate their story with voice modulation and hand gestures, for a maximum of 5 min. Results: Validated questionnaire is used for assessing the effectiveness of “storytelling method.” Six of the questions were quantitative and two were qualitative. More than 90% (n = 45) students described the storytelling session as “Creative and Fun filled” when compared to routine classes. Ninety-four percentage (n = 47) of students responded that “Storytelling” session improved their creative thinking on the subject. Conclusion: Storytelling strategy in pharmacology can help students in better understanding of the drug action and their adverse effects than traditional teaching methods.

Journey from seclusion to inclusion: Development of mental health services in India since independence

Mental health is an integral and essential component of “Health”. It is more than the mere absence of mental disorders or disabilities. It determines the quality of life of the individuals. The progress and prosperity of a nation depend on the overall quality of health of its citizens. However, until early twentieth century the issues of mental health and well-being were inadequately addressed. Often people with psychological ailments were considered to be non-productive people, confined in asylums, received inhumane treatment and were completely secluded from the mainstream society. Since independence initiatives have been taken by individuals and by the central government and the state governments, to develop the mental health services in India. This paper reviewed published articles, book-chapters and books to explore the development of mental health services in India since Independence. It was observed that measures were taken to improve the conditions of the mental hospitals. A trend towards deinstitutionalization was set by the Government of India and that initiated the creation of general hospital psychiatric units and community mental health services. Humanistic approach in treatment, development of psychotropic drugs and psychotherapies facilitated the management and care of the patients with psychiatric diseases, thereby improving their quality of life.

Effects of CYP1A2 Gene Polymorphisms on Blood Concentrations of Antipsychotic Drugs ：A Meta-analysis / 中国药房

OBJECTIVE：To systematically evaluate the effects of CYP1A2 gene polymorphisms on blood concentrations of antipsychotic drugs （haloperidol，clozapine，olanzapine），and to provide evidence-based reference for the clinical drug use . METHODS：Retrieved from Cochrane Library ，PubMed，Embase，CBM，CNKI and Wanfang data ，during the inception to Nov. 2019，cross-sectional study was conducted to investigate the effects of CYP1A2 gene polymorphisms on blood concentrations of antipsychotic drugs （haloperidol，clozapine，olanzapine）were collected. After screening the literature ，extracting the data and quality evaluation with Q-Genie tool ，Meta-analysis was performed by using Rev Man 5.3 software. RESULTS ：A total of 11 cross-sectional studies were included ，with a total of 914 patients. Of these ，haloperidol was used in 2 studies，clozapine was used in 5 studies，and olanzapine was used in 4 studies. Meta-analysis showed that there was no statistically significant difference in the blood concentration of haloperidol between CYP1A2（－2964G＞A）G/G type and G/A+A/A type [SMD ＝－0.22，95％CI（－0.66， 0.23），P＝0.35]. The blood concentration of clozapine in CYP1A2（－163C＞A）A/C type was significantly lower than C/C type [SMD ＝0.31，95％CI（0.01，0.62），P＝0.04]；there was no statistical significance in blood concentration of clozapine between A/A type and C/C type [SMD ＝0.09，95％CI（－0.21，0.40），P＝0.56]，between A/A type and A/C type [SMD ＝－0.22，95％CI（－0.55， 0.10），P＝0.18]，between CYP1A2（－2467delT）delT/delT type and T/T type [SMD ＝－0.11，95％CI（－0.75，0.52），P＝0.72]， between delT/T type and T/T type [SMD ＝0.01，95％CI（－0.33，0.34），P＝0.97]，between delT/delT type and delT/T type [SMD ＝ －0.15，95％CI（－0.80，0.05），P＝0.66]. The blood concentration of olanzapine in CYP1A2（－163C＞A）A/A type was signifi- cantly lower than A/C type [SMD ＝－0.31，95％CI（－0.55， － 0.08），P＝0.009]；there was no statistically significant difference in the blood concentration of olanzapine between A/A liukefeng-num.1@163.com type and C/C type [SMD ＝－0.20，95％CI（－0.61，0.21），P＝ 0.34]，between A/C type and C/C type [SMD ＝0.06，95％CI E-mail：hnmuzj@163.com （－0.35，0.47），P＝0.77]，between CYP1A2（－2467delT）delT/T type and T/T type [SMD ＝0.28，95％CI（－0.15，0.71），P＝0.20]. CONCLUSIONS：CYP1A2（－163C＞A）A/C type is related to the reduction of clozapine blood concentration ，and A/A type is related to the reduction of olanzapine blood concentration. CYP1A2 （－163C＞A）gene polymorphism is significance for guiding individualized medication of schizophrenia patients.

Drug utilization study and prescribing patterns in psychiatry patients at a tertiary care hospital

Background: The Drug utilization research (DUR) compares drug use between different countries and regions and is used to assess the rationality of prescribing pattern of the drug therapy. With this background we decided to evaluate antipsychotic drugs prescribing pattern in the psychiatric patients in a tertiary care hospital.Methods: The study was carried out at Department of Psychiatry, DSMCH. It was open label, cross - sectional, prescribed Documents based study. Duration of the study was one month (May-2017). Out-Patient number, age, sex, diagnosis, prescribed generic name, brand name, dose, route of administration, duration of therapy obtained from the Prescription register of Out - Patient Department of the Psychiatry.Results: The clinical experiences of the Psychiatrist I, II and III were 17 years, 35 years and 10 years respectively. The Psychiatrist I, II and III prescribed treatment for 36 (31.9%), 61 (54%) and 16 (14.2%) patients respectively. Among overall (n=113) patients (average age 38.9 years), male n=56 (49.6%) and female=57 (50.4%) were treated by all the three psychiatrists. The percentage of prescription of various drugs used were: Escitalopram (15.7%), Clonazepam (14.6%), Sertraline (8.7%), Risperidone (7.5%), Propranolol (6.7%), Olanzapine (6.3%), Quetiapine (5.9%), Trihexyphenidyl (5.5%), Amitriptyline (5.1%) and Other prescribed drugs, were between (0.4 to 2.8%).Conclusions: From this study, it can conclude that rational usage of drugs were followed in this study. All three prescribers (Psychiatrist I, II, and III) prescriptions were found to be rationale.

Usefulness of Pharmacogenetic Analysis in Psychiatric Clinical Practice: A Case Report

There are many factors involved in the effectiveness and efficiency of psychiatric drug treatment. One of them is psychotropic drug metabolism, which takes place mostly in the liver through the P450 enzyme system. However, there are genotypic variants of this system’s enzymes that can directly affect both the efficacy and the onset of side effects of a given therapeutic regimen. These genotypic changes could partly explain the lack of efficacy of treatment in certain patients. We report the case of a patient diagnosed with bipolar type I disorder that presented multiple and frequent manic episodes in which the efficacy and tolerability of several pharmacological regimens with mood stabilizers and antipsychotics was scarce. The choice of medical treatment should be based on its efficacy and side effect profile. This decision can be made more accurately using the information provided by pharmacogenetic analysis. This case illustrates the importance of pharmacogenetic studies in clinical practice. The results of pharmacogenetic analysis helped to decide on a better treatment plan to achieve clinical improvement and reduce drug-induced adverse effects.

Comparative evaluation of pancreatic histopathology of rats treated with olanzapine, risperidone and streptozocin

Olanzapine and risperidone are widely prescribed atypical antipsychotics used in the treatment of schizophrenia and various other psychiatric disorders. Both of these drugs have been extensively reported to cause Type 2 diabetes mellitus and pancreatitis, however, the mechanism of olanzapine and risperidone-induced toxicity has not been so far unveiled. We, therefore, compared the streptozocin-induced pancreatic damage with that of pancreas isolated from olanzapine and risperidone treated rats. It was noticed that fibrotic growth, necrosis and derangement of the pancreatic islet cells caused by streptozocin were more pronounced than olanzapine and risperidone.

Research progress of role of Pi3k/Akt pathway in mechanism of atypical antipsychotic drugs / 上海交通大学学报（医学版）

The alterations of Pi3k/Akt pathway may be critical in the pathogenesis of schizophrenia. Furthermore, atypical antipsychotic drugs can modify Pi3k/Akt pathway, which have been received wide attention. This review mainly focused on four aspects, i.e. metabolic syndrome, changes in immune function, cognitive impairment and neuroprotective effect, and summarized the research progress of role of Pi3k/Akt pathway in the mechanism of atypical antipsychotic drugs.

Manejo de la excitación psicomotriz en niños y adolescentes / Management of psychomotor excitement in children and adolescents

La agitación o excitación psicomotriz (EPM) es un síndrome que no constituye en sí mismo una enfermedad, sino que se trata de una manifestación de una gran variedad de trastornos psiquiátricos y orgánicos. Se caracteriza por aumento desorganizado de la motricidad acompañado de una activación vegetativa (sudoración, taquicardia, midriasis) y ansiedad severa. Constituye uno de los cuadros de presentación más frecuente en salas de urgencia psiquiátricas y generales. El objetivo del presente artículo es revisar los aspectos clínicos del síndrome, describir las diferentes causas y plantear su manejo en los diferentes ámbitos de la práctica clínica y medidas de seguridad. Se consideran las medidas terapéuticas no farmacológicas (intervenciones verbales, sujeción física) y medicamentosas, mencionando las vías de administración, las opciones de drogas y sus dosis según la presunción diagnóstica. Es una urgencia donde se debe actuar con rapidez para garantizar la seguridad del paciente y del entorno (AU)

Psychomotor agitation or excitation (PMA) is not a disorder in itself but a manifestation of a broad variety of psychiatric and organic disorders. It is characterized by increased disorganization of motor activity associated with vegetative activation (sweating, increased heart rate, mydriasis) and severe anxiety. It is one of the most common disorders presenting in general and psychiatric emergency departments. The aim of this study was to review the clinical aspects of the entity, to describe possible causes, and to evaluate management in different settings of clinical practice as well as safety measures. Non-pharmacological interventions (verbal interventions, physical restraint) and medications are considered, describing routes of administration, options of drugs and drug doses according to the presumed diagnosis. PMA is an urgency in which fast intervention is warranted for the safety of the patient and their environment (AU)

Observation on the effect of venlafaxine combined with antipsychotics on the treatment of negative symptoms of schizophrenia / 中国生化药物杂志

Objective To investigate the effect of venlafaxine combined with antipsychotic drugs in the treatment of negative symptoms of schizophrenia.Methods In this study, 60 patients with schizophrenia who were treated and diagnosed in ankang hospital of Hangzhou public security bureau from June 2015 to November 2016 were randomly divided into the experimental group and the control group according to the time of admission.The control group was only given antipsychotic(risperidone);enrolifloxacin combined with antipsychotics(risperidone)was used in the experimental group.The patients were evaluated with the positive and negative symptoms scale, and the side effects were assessed by the Adverse Reaction Symptom Scale(TESS).A 12-week study was conducted.Results Compared with the results of this experiment, the scores of PANSS and the scores of the two groups were not different between the two groups before and after treatment.4,8,12 weekend negative group of experimental group and the difference was very significant before treatment;8,12 weekend negative control group score and before treatment is relatively poor.There were significant differences in negative factor scores between the two groups at 4, 8 and 12 weeks.There was significant difference between the two groups (P<0.05).Conclusion Risperidone combined with venlafaxine is effective in the treatment of schizophrenia with negative symptoms.It has good curative effect and high safety.It is worth popularizing in clinic.

Effects of antipsychotic drugs combined with psychological intervention on postoperative acute mental disorders in elderly men / 中国生化药物杂志

Objective To study the effect of antipsychotic drugs combined with psychological intervention on the elderly patients with acute mental disorders after surgery operation.Methods 100 cases of elderly male patients undergoing surgery in our hospital from January 2015 to December 2016 as the object of study in the course of the study,were randomly divided into control group and experimental group,with 50 cases in each group.The control group received routine care,antipsychotic drug combined with psychological nursing intervention for patients in the experimental group,focusing on the psychological status of patients,strengthen exchanges and communication with patients,patients with heart to eliminate negative emotions,help patients recover as soon as possible.The anxiety and depression of the experimental group and the control group were compared and analyzed.Results After the corresponding nursing,the experimental group of patients with anxiety self rating scale and self rating Depression Scale score was significantly better than before nursing, the difference was statistically significant(P<0.05).The self rating depression scale of the experimental group was(44.23±3.78),and the self rating Anxiety Scale score was(42.35±5.98).In the control group,the depression score was(48.73±2.53),and the anxiety score was(45.94±4.92).The anxiety score and depression score of the experimental group were significantly better than those of the control group,and the difference was statistically significant(P<0.05).Conclusion Antipsychotic drugs combined with psychological intervention can help the elderly male surgical acute mental disorders recovered to a certain extent,ease the patients with depression and anxiety,with further clinical promotion and application significance.

Effects of serum cytokines on antipsychotic medication treatment in schizophrenia patients / 国际检验医学杂志

Objective To study the levels of serum cytokines in schizophrenic patients and their changes in antipsychotic medica-tion treatment .Methods The levels of serum cytokines including IL-10 ,IL-6 ,IL-13 ,IL-4 ,IFN ,TNF-α,IL-1a and IL-1RA were de-tected in 34 healthy adults and 53 schizophrenia patients by adopting the flow fluorescence method .Results The serum levels of IL-6 ,IL10 and TNF-αbefore treatment in schizophrenic patients were significantly higher than those in the control group (P<0 .05) . After treatment ,the levels of serum IL-1a ,IL-6 and TNF-α in schizophrenic patients were significantly lower than those before treatment(P<0 .05) .Conclusion Serum IL-6 and TNF-α levels are correlated with the disease condition of schizophrenia .IL-10 plays a role in early anti-inflammation of schizophrenia .

Curative effect analysis of Linggui Zhugan Decoction in the treatment of metabolic syndrome induced by antipsychotic drugs / 新乡医学院学报

Objective To observe the effectiveness and safety of Linggui Zhugan Decoction in the treatment of metabolic syndrome(MS) induced by antipsychotics.Methods Sixty MS patients were enrolled who also matched the diagnostic criteria for phlegm stagnation type.These 60 patients who were treated in the Second Affiliated Hospital of Xinxiang Medical University were randomly divided into the observation group and control group,each group included 30 patients.The patients in the observation group were given the treatment of Linggui Zhugan Decoction in addition to antipsychotic treatment,while the patients in the control group were only given antipsychotic treatment.After two weeks or four weeks of treatment,the levels of triglyceride (TG),high density lipoprotein (HDL),fasting plasma glucose,insulin,C-peptide and insulin resistance index (HOMA-IR) were compared between the two groups before and after treatment.Results After two weeks or four weeks treatment,the levels of TG,fasting plasma glucose,insulin,C-peptide and HOMA-IR significantly increased and that of HDL decreased significantly in the control group patients compared with those before treatment (P ＜ 0.05),while the results in the observation group were opposite (P ＜ 0.05).In the control group patients,the levels of insulin,HOMA-IR and C-peptide after four weeks treatment were significantly higher than those after two weeks treatment (P ＜ 0.05).However,in the observation group patients,the levels of insulin,HOMA-IR and C-peptide after four weeks treatment were significantly lower than those after two weeks treatment (P ＜ 0.05).Compared with the control group,after two weeks or four weeks treatment the levels of TG,fasting plasma glucose,insulin,C-peptide and HOMA-IR decreased significantly in the observation group patients and that of HDL increased significantly (P ＜ 0.05).The treatment emergent symptom scale score of the observation group was lower than that of the control group at the end of four weeks (P ＜ 0.05).Conclusion Linggui Zhugan Dcoction can improve MS caused by antipsychotics and has good safety.

Changes and clinical significance of serum LDL-C ,TG and TC levels before and after taking antipsychotic drugs in patients with schizophrenia / 国际检验医学杂志

Objective To analyze and investigate the changes of serum related lipid levels before and after taking antipsychotic drugs in the patients with schizophrenia .Methods The clinical data of 63 patients with schizophrenia treated in our hospital from August 2014 to August 2016 were retrospectively analyzed .Results The LDL-C ,TG and TC levels at 8 weeks after taking medica-tion in the observation group were significantly increased ,the difference was statistically significant compared with before treatment (P0 .05);the PANSS and ADL scores after medication had statistically significant difference between the two groups ;the concerned different symptoms scores ,general psychopathology and total scores of the observation group were significantly lower than those of the control group (P<0 .05) ,the life quality SF-36 health questionnaire score and comparison after 1 months of medication showed that the scores of various indexes in the observation group were significantly higher than those in the control group ,the differences between groups were significantly significant (P<0 .05) .Conclusion The study shows that tak-ing Risperidone Orally Disintegrating Tablets combined with oxazepam can obtain ideal clinical effect in treating schizophrenia .The combined treatment regimen can better improve the clinical symptoms of the patients ,increases the ability of daily living and quality of life ,effectively improves the LDL-C ,TG and TC levels ,effectively reduces various adverse reactions ,and is a safe and effective treatment regimen and worthy of promotion .

A Study on Discontinuation Rate on Maintenance Treatment of Antipsychotic Agents in Schizophrenic Patients / 대한정신분열병학회지

OBJECTIVES: Relapse prevention is a major therapeutic goal in the treatment of schizophrenia. However, many patients experience multiple functional impairments and treatment resistance due to recurrence. This study was designed to investigate the follow-up of patients with using antipsychotic drugs and to compare the total treatment failure rate, withdrawal reasons, and duration period of antipsychotic drugs. METHODS: The subjects were 1963 patients who taking antipsychotic drugs under the diagnosis of schizophrenia. We selected 1836 patients using 10 antipsychotic drugs according to frequency of using. The rate of total treatment failure of them was divided into 6-month, 1-year, 2-year, 3-year, and 5-year according to the time of drug withdrawal. We compared the total treatment failure rate at 1 and 3-year between 10 antipsychotic drugs. RESULTS: The total treatment failure rate of clozapine was lowest compared with the other 9 antipsychotic drugs in all the surveyed periods. When evaluating actual number of subjects, olanzapine, sulpiride, risperidone, aripiprazole, amisulpride, and haloperidol were lower significantly compared with ziprasidone at 1-year in the total treatment failure rate, but there was no significant difference between them except clozapine at 3-year. The results of the analysis based on the number of prescriptions showed that the total treatment failure rate of the atypical antipsychotic drug was lower than that of the typical antipsychotic drug at 1-year, but the difference was decreased over time except quetiapine and ziprasidone. CONCLUSION: In conclusion, although there is some controversy about which drug to prescribe to the patient, the clinician needs a proper prescription considering various factors such as efficacy, side effects, price, and formulations of each drug.

A Study on Discontinuation Rate on Maintenance Treatment of Antipsychotic Agents in Schizophrenic Patients / 대한정신분열병학회지

OBJECTIVES: Relapse prevention is a major therapeutic goal in the treatment of schizophrenia. However, many patients experience multiple functional impairments and treatment resistance due to recurrence. This study was designed to investigate the follow-up of patients with using antipsychotic drugs and to compare the total treatment failure rate, withdrawal reasons, and duration period of antipsychotic drugs. METHODS: The subjects were 1963 patients who taking antipsychotic drugs under the diagnosis of schizophrenia. We selected 1836 patients using 10 antipsychotic drugs according to frequency of using. The rate of total treatment failure of them was divided into 6-month, 1-year, 2-year, 3-year, and 5-year according to the time of drug withdrawal. We compared the total treatment failure rate at 1 and 3-year between 10 antipsychotic drugs. RESULTS: The total treatment failure rate of clozapine was lowest compared with the other 9 antipsychotic drugs in all the surveyed periods. When evaluating actual number of subjects, olanzapine, sulpiride, risperidone, aripiprazole, amisulpride, and haloperidol were lower significantly compared with ziprasidone at 1-year in the total treatment failure rate, but there was no significant difference between them except clozapine at 3-year. The results of the analysis based on the number of prescriptions showed that the total treatment failure rate of the atypical antipsychotic drug was lower than that of the typical antipsychotic drug at 1-year, but the difference was decreased over time except quetiapine and ziprasidone. CONCLUSION: In conclusion, although there is some controversy about which drug to prescribe to the patient, the clinician needs a proper prescription considering various factors such as efficacy, side effects, price, and formulations of each drug.

Clinical observation on Maren Soft Capsule in treatment of antipsychotic drug-induced constipation / 中草药

Objective: To investigate the clinical effect of Maren Soft Capsule (MSC) in the treatment of constipation induced by antipsychotic drugs. Methods: Totally 192 hospitalized psychiatric patients with constipation caused by antipsychotic drugs were randomly divided into three groups, there wer 64 cases in each group. The first group was treated with MSC, the second group was given Sennae Folium, and the third group was given Phenolphthalein Tablets. The exhaust, defecation time, abdominal pain, and abdominal distension were observed after the treatment. Results: The total effect rates of the three drugs were over 80%. There was no significant difference in the effect of three drugs (P > 0.05), but Sennae Folium and Phenolphthalein Tablets had different degrees of side effects such as diarrhea and abdominal pain. Occurrence of adverse reaction rate of MSC was significantly lower than that of Sennae Folium and Phenolphthalein Tablets (P < 0.01). Conclusion: The effect of MSC in the treatment of antipsychotic drugs-induced constipation is significant, and the incidence of adverse reactions is low.

Clinical Observation of 4 Kinds of the Second-generation Antipsychotic Drugs in the Treatment of Acute Phase of Schizophrenia / 中国药房

OBJECTIVE:To investigate clinical efficacy and adverse reactions(ADRs)of 4 kinds of the second-generation anti-psychotic drugs in the treatment of acute phase of schizophrenia. METHODS:159 patients with schizophrenia were randomly divid-ed into risperidone group(40 cases),olanzapine group(40 cases),aripiprazole group(39 cases)and ziprasidone group(40 cas-es). All groups were given routine dosage of relevant medicine by routine usage for 6 weeks. Mental status of patients were mea-sured by PANSS before treatment and after 2,4 and 6 weeks of treatment. At the same time,blood glucose,blood lipid,prolac-tion and other metabolic and biological indicators were all detected. RSESE,BARS and UKU were adopted to evaluate ADR. RE-SULTS:A total of 100 patients completed the study. Compared with aripiprazole group and ziprasidone group,risperidone and olan-zapine inhibited symptom more rapidly,with statistical significance (P<0.05). After treatment,body mass index and abdominal circumference of olanzapine group were significantly higher than those of other 3 groups,with statistical significance (P<0.05). Low density lipoprotein of olanzapine group was increased significantly,there was statistical significance compared to ziprasidone group and aripiprazole group(P<0.05). Prolactin level of risperidone group was significantly higher than those of other 3 groups, while that of aripiprazole group was significantly lower than those of other 3 groups,with statistical significance(P<0.05). ADRs of 4 drugs were mild or moderate,most of whom could be alleviated by symptomatic treatment. CONCLUSIONS:In the treatment of acute phase schizophrenia,4 drugs of the second-generation have similar curative effect in symptoms control,among which ris-peridone and olanzapine inhibit positive symptom more rapidly while more ADRs that related to lipid and glucose metabolism and prolactin also show. Aripiprazole and ziprasidone induce less ADRs relatively,and patients show better tolerability. Physicians should consider all kinds of factors in drugs selection,and make individualized treatment plan.

Risperidone in a child with untractable emergency delirium: a case report / 대한마취과학회지

A 6-year-old boy was scheduled for thoracic magnetic resonance imaging under deep sedation with midazolam 1.8 mg and propofol 100 µg/kg/min via intravenous injection. He showed emergence delirium in the post-anesthesia care unit. The staff attempted to calm him by administering flumazenil as an antidote for midazolam, propofol for further sedation, and meperidine. However, this was not successful. A psychiatrist recommended the use of antipsychotics. Administration of risperidone led to immediate resolution of the boy's symptoms and relaxed him. The use of antipsychotic drugs is not common for anesthesiologists, but should be considered for treating uncontrolled emergence delirium after anesthesia.