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2.
Rev. psiquiatr. Urug ; 85(1): 28-42, oct. 2021. graf, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1343130

ABSTRACT

El tratamiento farmacológico de demostrada eficacia en la esquizofrenia es el antipsicótico. Sin embargo, en muchas ocasiones se requiere medicación concomitante que depende de comorbilidades y efectos adversos. Se realizó un estudio cuantitativo, longitudinal, retrospectivo, considerando el año 2006 y 2016, en una población de usuarios con esquizofrenia de la Policlínica del Hospital Vilardebó, analizando los tratamientos con psicofármacos. Se diferenciaron los tratamientos según monoterapia antipsicótica y polifarmacia con 2 antipsicóticos, y polifarmacia con más de 2 antipsicóticos, antidepresivos, estabilizantes del humor, benzodiacepinas y anticolinérgicos. La población inicial en 2006 fue de 621 pacientes y 398 pacientes continuaban en tratamiento en 2016. Mantuvieron el trata-miento con antipsicóticos 377 pacientes; 184 mantuvieron benzodiacepinas; 59 se mantuvieron con anticolinérgicos; 49, con estabilizantes del humor y 47, con antidepresivos. La monoterapia antipsicótica se presentó en torno al 50 % de la población estudiada. Se deberían revisar aquellas prácticas que se infieren a partir de este estudio, como el uso prolongado de anticolinérgicos, benzodiacepinas, y polifarmacia con más de 2 antipsicóticos, que está extendida en los usuarios con esquizofrenia. El tratamiento con clozapina fue el más estable y no parece aumentar la mortalidad en estos pacientes


Antipsychotics are the proved effective therapy for schizophrenia. However, on many occasions, associated drugs are required depending on comorbidities and side effects. A retrospective longitudinal quantitative study of drug prescription for 2006 and 2016 in patients with schizophrenia diagnosis was carried out in an outpatient clinic at Hospital Vilardebó. Treatments were classified as antipsychotic monotherapy, two antipsychotic drugs polypharmacy and polypharmacy with two antipsychotic drugs, antidepressants, mood stabilizers, benzodiazepines and anticholinergic drugs. Initial population in 2006 included 621 patients, 398 were still being treated in 2016. Antipsychotic drugs were still being received in 377 patients, benzodiazepines in 184, anticholinergic drugs in 59, mood stabilizers in 49, and anti-depressants in 47. Antipsychotic monotherapy was 50% of the population. Those practices that can be inferred from this study, with lengthy use of anticholinergic drugs, benzodiazepines, and the use of more than 2 antipsychotic drugs in patients with schizophrenia diagnosis should be revised. Clozapine therapy was the most stable and does not seem to increase mortality.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Schizophrenia/drug therapy , Antipsychotic Agents/therapeutic use , Drug Therapy/statistics & numerical data , Phenothiazines/therapeutic use , Chlorpromazine/therapeutic use , Epidemiology, Descriptive , Retrospective Studies , Cohort Studies , Clozapine/therapeutic use , Risperidone/therapeutic use , Polypharmacy , Age and Sex Distribution , Tiapride Hydrochloride/therapeutic use , Quetiapine Fumarate/therapeutic use , Aripiprazole/therapeutic use , Olanzapine/therapeutic use , Haloperidol/therapeutic use , Methotrimeprazine/therapeutic use
4.
Rev. colomb. psiquiatr ; 50(1): 47-51, Jan.-Mar. 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1251633

ABSTRACT

ABSTRACT Introduction: Major neurocognitive disorder (MNCD) affects millions of people worldwide. However, the pharmacological options for its management are limited, ineffective and frequently associated with severe adverse reactions. Case report: An 85-year-old man with history of multiple chronic brain injuries (alcohol-use disorder, haemorrhagic stroke, brain trauma, chronic use of benzodiazepines) developed an MNCD, reaching 7 points on the Reisberg Global Deterioration Scale. He had minimal response to antidepressants, antipsychotics and anticholinergic medications. After the use of mother tincture of Indian hemp (cannabis), a significant improvement was found in his cognitive function, ability to carry out activities of daily living and independence. Discussion: The endocannabinoid system seems to be implicated in age-related cognitive decline. In addition, the evidence derived from in-vitro and animal models suggest that this system could play an important role in the management of MNCD of different causes. Conclusions: Cannabinoid treatment for MNCD emerges as a promising therapeutic approach that may benefit a growing number of patients who do not have other treatment options. It is therefore necessary to encourage more research efforts that will help to remove political and scientific barriers to its clinical use.


RESUMEN Introducción: El trastorno neurocognitivo mayor (TNM) afecta a millones de personas a nivel mundial. Sin embargo, las opciones farmacológicas para su manejo son limitadas, poco efectivas y se asocian a importantes reacciones adversas. Caso clínico: Se presenta el caso clínico de un hombre de 85 años, con antecedente de múltiples lesiones cerebrales crónicas (abuso de alcohol, enfermedad cerebrovascular, traumatismo cerebral, uso crónico de benzodiacepinas), quien desarrolló un TNM clasificado con 7 puntos en la Reisberg Global Deterioration Scale. Tuvo poca respuesta al manejo con antidepresivos, antipsicóticos y anticolinérgicos. Tras el uso de tintura madre de cáüamo índico (cannabis), se evidenció una mejoría en la función cognitiva, la capacidad de cuidado para las actividades de la vida diaria y la independencia. Discusión: El sistema endocanabinoide parece estar relacionado con los procesos de deterioro cognitivo asociados con la edad. Además, la evidencia derivada de modelos in vitro y animales sugiere que podría tener un papel importante en el manejo del TNM de diferentes etiologías. Conclusiones: El uso de cannabinoides en el TNM se presenta como una pista terapéutica prometedora. Por lo tanto, es necesario promover procesos de investigación que contribuyan a eliminar las barreras políticas y científicas para su uso clínico, beneficiando a un número creciente de pacientes que no poseen opciones terapéuticas eficaces.


Subject(s)
Humans , Male , Aged, 80 and over , Cannabinoids , Cognition , Neurocognitive Disorders , Antipsychotic Agents , Benzodiazepines , Cannabis , Brain Injury, Chronic , Stroke , Endocannabinoids , Alcoholism , Brain Injuries, Traumatic , Antidepressive Agents
5.
Rev. colomb. psiquiatr ; 50(1): 43-46, Jan.-Mar. 2021.
Article in English | LILACS, COLNAL | ID: biblio-1251632

ABSTRACT

A B S T R A C T Ayahuasca is a psychotropic infusion prepared by boiling the bark of Amazonian plants and has many psychopharmacological effects not fully understood. Some of those effects are used as treatment for different diseases. However, the side effects of ayahuasca, including ayahuasca-induced psychosis, are an important issue. Here we report the case of a patient who had a psychotic episode after taking ayahuasca and who was successfully treated with antipsychotic medication. Given the current spread of ayahuasca consumption in developed societies, the present case highlights the need for better understanding and regulation of the social-legal condition of ayahuasca and the need for further research. Additionally, psycho-education seems advisable in order to create awareness of the potential risks of the use of ayahuasca.


RESUMEN La ayahuasca es una bebida psicotrópica preparada a través de la cocción de plantas de la cuenca amazónica que tiene muchos efectos psicofarmacológicos no del todo estudiados. Algunos de esos efectos son usados como tratamiento de diversas patologías. Sin embargo, existen efectos secundarios de la ayahuasca que deben ser tenidos en cuenta, entre ellos psicosis inducida por ayahuasca. Reportamos un caso de un paciente que, tras autoadministración de ayahuasca, presentó un episodio psicótico y que fue satisfactoriamente tratado con antipsicóticos. Dada el uso cada vez más frecuente de ayahuasca en las sociedades desarrolladas, el caso actual resalta las necesidades de entender, regular e investigar el uso de la ayahuasca. Además, crear conciencia de los potenciales riesgos del uso de ayahuasca a través de la psicoeducación debería ser implementado.


Subject(s)
Humans , Male , Adult , Plants , Psychotic Disorders , Self Administration , Social Control, Formal , Awareness , Therapeutics , Antipsychotic Agents , Banisteriopsis
6.
SMAD, Rev. eletrônica saúde mental alcool drog ; 17(1): 39-47, jan.-mar. 2021. ilus
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1280639

ABSTRACT

OBJETIVO: caracterizar os idosos atendidos em um Serviço de Urgência e Emergência Psiquiátrica quanto ao perfil sociodemográfico, diagnóstico psiquiátrico, prescrição de medicamentos e conduta médica e avaliar suas associações com o sexo. MÉTODO: estudo transversal, quantitativo, em que os dados foram obtidos a partir dos prontuários de pacientes atendidos no referido serviço, entre julho/2015 e junho/2016. A variável independente foi o sexo e as dependentes foram: idade; procedência; informante; tratamento psiquiátrico anterior; diagnóstico; medicamentos prescritos e conduta. RESULTADOS: nos 152 prontuários analisados, observam-se idade prevalente entre 60 a 69 anos, maioria de mulheres, procedência do município local e comparecimento com acompanhante. Os diagnósticos prevalentes são a esquizofrenia e os transtornos mentais e comportamentais decorrentes do uso de substâncias psicoativas. As medicações prescritas com maior frequência são da classe dos antipsicóticos e anti-histamínicos, seguidas dos ansiolíticos/sedativos. O critério de Beers considera a prescrição de medicamentos do grupo dos benzodiazepínicos, antipsicóticos e anti-histamínicos inapropriada para idosos. A principal conduta foi a alta, sem encaminhamento a outro serviço. CONCLUSÃO: embora haja incentivo do Ministério da Saúde, com a criação de novas políticas de saúde mental, muitos profissionais mantêm o modelo de atendimento baseado na queixa e conduta, dificultando a reabilitação psicossocial dos pacientes.


OBJECTIVE: characterize the elderly treated in a Psychiatric Emergency and Urgency Service regarding their sociodemographic profile, psychiatric diagnosis, prescription of medication and medical conduct and evaluate their associations with sex. METHOD: a cross-sectional, quantitative study in which data was obtained from the medical records of patients seen in the referred service, between July/2015 and June/2016. The independent variable was gender and dependents were: age; origin; informant; previous psychiatric treatment; diagnosis; prescribed drugs and conduct. RESULTS: in the 152 medical records analyzed, the prevailing age is between 60 and 69 years old, most of them women, coming from the local municipality and attending with a companion. The prevalent diagnoses are schizophrenia and mental and behavioral disorders resulting from the use of psychoactive substances. The most frequently prescribed medications are in the class of antipsychotics and antihistamines, followed by anxiolytics/sedatives. Beers' criteria consider the prescription of benzodiazepine, antipsychotic and antihistamine medications inappropriate for the elderly. The main conduct was discharge, without referral to another service. CONCLUSION: although there is encouragement from the Ministry of Health, with the creation of new mental health policies, many professionals maintain the model of care based on complaint and conduct, hindering the psychosocial rehabilitation of patients.


OBJETIVO: caracterizar a los ancianos atendidos en un servicio psiquiátrico de emergencia y urgencia en relación con el perfil sociodemográfico, el diagnóstico psiquiátrico, la prescripción de medicamentos y la conducta médica; y evaluar sus asociaciones con el sexo. MÉTODO: un estudio cuantitativo y transversal en el que se obtuvieron datos de los registros médicos de los pacientes tratados en el citado servicio, del 2015 al 2016 de julio. La variable independiente era el sexo y los dependientes eran: edad, procedencia, informante, tratamiento psiquiátrico previo, diagnóstico, medicamentos recetados y conducta. RESULTADOS: de los 152 registros médicos analizados, se observa que: la edad predominante es de 60 a 69 años, la mayoría de ellos son mujeres, desde el municipio local y atendido a la atención de un acompañante. Los diagnósticos prevalentes son la esquizofrenia y los trastornos mentales y conductuales resultantes del uso de sustancias psicoactivas. Los medicamentos recetados con mayor frecuencia son la clase antipsicótica y anti-histamina, seguida de ansiolíticos/sedantes. El criterio de Beers considera que la prescripción de fármacos del grupo de benzodiazepinas, antipsicóticos y antihistaminas, es inadecuada para los ancianos. La conducta principal era alta, sin remisión a otro servicio. CONCLUSIÓN: aunque hay aliento del Ministerio de salud con la creación de nuevas políticas de salud mental, muchos profesionales mantienen el modelo de cuidado basado en la queja y la conducta, obstaculizando la rehabilitación psicosocial de los pacientes.


Subject(s)
Humans , Male , Female , Aged , Anxiety Disorders/drug therapy , Schizophrenia/therapy , Antipsychotic Agents/therapeutic use , Anti-Anxiety Agents/therapeutic use , Mentally Ill Persons , Psychiatric Rehabilitation , Mental Disorders/therapy
7.
Article in Portuguese | LILACS, CONASS | ID: biblio-1358133

ABSTRACT

Tecnologia: Aripiprazol, antipsicóticos disponíveis no Sistema Único de Saúde (SUS). Indicação: Tratamento da esquizofrenia em adultos. Pergunta: O Aripiprazol é mais eficaz e seguro para promover controle sintomático, que os antipsicóticos disponíveis no SUS? Métodos: Levantamento bibliográfico foi realizado em bases de dados PUBMED, com estratégias estruturadas de busca, e a qualidade metodológica das revisões sistemáticas foi avaliada com a ferramenta AMSTAR II. Resultados: Foram identificados 109 resumos de revisões sistemáticas. Após leitura dos mesmos, foram selecionadas 2 revisões sistemáticas. Conclusão: Aripiprazol tem eficácia e segurança similar à Ziprasidona e Haloperidol, mas eficácia semelhante e maior segurança metabólica que a Quetiapina, Olanzapina, Clozapina e Risperidona. Ziprasidona apresenta vantagem sobre o Aripiprazol, pois tem menor risco de efeito colateral de mudanças na função sexual. Considerando que o perfil de eficácia e segurança do Aripiprazol é muito parecido com o dos outros antipsicóticos disponíveis no SUS, com mínimas diferenças, e seu custo de tratamento é inferior ao da Ziprasidona e Quetiapina, essa droga poderia estar disponível no SUS


Technology: Aripiprazole, antipsychotics available in the Brazilian Public Health System (BPHS). Indication: Treatment of schizophrenia in adults. Question: Is Aripiprazole more effective and safer to promote symptomatic control than antipsychotics available in BPHS? Methods: A bibliographic survey was carried out in PUBMED databases, with structured search strategies, and the methodological quality of systematic reviews was assessed using the AMSTAR II tool. Results: 109 abstracts of systematic reviews were identified. After reading them, 2 systematic reviews were selected. Conclusion: Aripiprazole has identical effectiveness and safety to Ziprasidone and Haloperidol, but similar efficacy and greater safety than Quetiapine, Olanzapine, Clozapine and Risperidone. Ziprasidone has an advantage over Aripiprazole as it has a lower risk of side effects of changes in sexual function. Since the Aripiprazole's effectiveness and safety profile is very similar to profile of others antipsychotics available in BPHS, with minimal differences, and it has cost lower than Ziprasidone and Quetiapine, this drug could be available in BPHS


Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Schizophrenia/drug therapy , Antipsychotic Agents , Comparative Effectiveness Research , Aripiprazole/therapeutic use , Unified Health System , Clozapine/therapeutic use , Risperidone/therapeutic use , Quetiapine Fumarate/therapeutic use , Olanzapine/therapeutic use , Haloperidol/therapeutic use
8.
Article in English | AIM, AIM | ID: biblio-1342017

ABSTRACT

Lipophilicity is an important physicochemical parameter of biological relevance; although its in- vivo predictive capability is dependent on accuracy and reliability of platforms used for its determination. This work examines biomimetic attribute of isocratic chromatographic hydrophobicity index (ICHI), experimental logarithm of octanol ­ water partition coefficient (LogP) and some computed lipophilicity indices for eight (8) selected antipsychotic agents and their predictive capability in drug discovery. The retention behavior of 5 first-generation and 3 second-generation antipsychotics was determined on reversed-phase chromatographic platform using methanol-phosphate buffer (pH 6.8) mobile phase. The retardation factor obtained was transformed to Rm, and plotted against volume fraction of organic modifier in the mobile phase to generate linear graph whose x- intercept is ICHI. Experimental LogP values were curled from literature while computed LogP were obtained using respective software. The experimentally determined LogPoctanol/water and ICHI were first correlated with index of brain permeability (BBB); before all lipophilicity indices were comparatively evaluated and correlated with in-vivo-normalized pharmacokinetic parameters curled from literature. ICHI gave better correlation with BBB index (r = 0.976) compared to Log Poctanol/water (r = 0.557). Comparative lipophilicity evaluation shows clustered pattern for second generation antipsychotics compared to first generation. In vivo correlation was poorer for the 8 drugs (r < 0.7), better with subset of phenothiazine homologues (r = 0.51 to 0.97). The ALogP, LogPoctanol/water, cLogP and ICHI gave highest correlation with the pharmacokinetic parameters. The biomimetic attributes of ICHI is better than for LogPoctanol/water in predicting brain permeability, but lower for in-vivo pharmacokinetic prediction.


Subject(s)
Humans , Biomimetics , Hydrophobic and Hydrophilic Interactions , Permeability , Antipsychotic Agents , Pharmacokinetics
9.
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1344538

ABSTRACT

Tecnologia: Aripiprazol, antipsicóticos atípicos disponíveis no Sistema Único de Saúde, outras classes de potencializadores de tratamento depressivo. Indicação: Depressão refratária. Pergunta: Há diferenças de eficácia e segurança entre o Aripiprazol, Ziprasidona, Olanzapina, Quetiapina e Risperidona como agente potencializador do tratamento de depressão refratária? Há diferenças de eficácia e segurança entre as principais classes de drogas potencializadoras do tratamento de depressão refratária? Métodos: Levantamento bibliográfico foi realizado na base de dados PUBMED, seguindo estratégias de buscas predefinidas. Foi feita a avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta Assessing the Methodological Quality of Systematic Reviews version 2. Resultados: Foram selecionadas 3 revisões sistemáticas, que atendiam aos critérios de inclusão. Conclusão: Na potencialização do tratamento antidepressivo, o Aripiprazol, em dose padrão ou dose diária reduzida, não é superior à Quetiapina, Olanzapina/Fluoxetina ou Risperidona em desfechos de eficácia ou segurança para casos de depressão refratária com pelo menos uma falha terapêutica prévia. As diferentes classes de potencializadores de antidepressivos não diferem entre si nos desfechos de eficácia para casos de depressão refratária com duas ou mais falhas terapêuticas prévias. Ziprasidona e Quetiapina se mostraram mais eficazes que o placebo e seguros para promover remissão sintomática da depressão refratária


Technology: Aripiprazole, atypical antipsychotics available in the Brazilian Public Health System, other classes of augmentative antidepressant agent. Indication: Treatment-resistant depression (TRD). Question: Are there differences in efficacy and safety between Aripiprazole, Ziprasidone, Olanzapine, Quetiapine, and Risperidone as augmentative agent in the treatment of TRD? Are there differences in efficacy and safety between the main classes of augmentative drugs that enhance the treatment of TRD? Methods: A bibliographic survey was carried out in the PUBMED database, following predefined search strategies. The methodological quality of systematic reviews was assessed using the Assessing the Methodological Quality of Systematic Reviews version 2 tool. Results: 3 systematic reviews were selected that met the inclusion criteria. Conclusion: In potentiating antidepressant treatment, Aripiprazole, in standard dose or reduced daily dose, is not superior to Quetiapine, Olanzapine/fluoxetine or Risperidone in efficacy or safety outcomes for cases of TRD with at least one previous therapeutic failure. The different classes of antidepressant enhancers do not differ in efficacy outcomes for cases of TRD with two or more prior therapeutic failures. Ziprasidone and Quetiapine were more effective than placebo and safer for the outcome of symptomatic remission of TRD


Subject(s)
Humans , Antipsychotic Agents/therapeutic use , Depressive Disorder, Treatment-Resistant/drug therapy , Aripiprazole/therapeutic use , Efficacy , Risperidone/therapeutic use , Quetiapine Fumarate/therapeutic use , Olanzapine/therapeutic use
10.
Rev. med. Risaralda ; 26(2): 148-153, jul.-dic. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1150022

ABSTRACT

Resumen Los agentes antipsicóticos son considerados como el principal tratamiento farmacológico para el manejo de mantenimiento y el tratamiento de casos agudos de la esquizofrenia y otros trastornos mentales. Estos medicamentos están clasificados en dos grupos: los antipsicóticos de primera generación o antipsicóticos típicos (AT) y los antipsicóticos de segunda generación o antipsicóticos atípicos (AA). En relación con el uso de los antipsicóticos típicos (AT), se han descrito importantes efectos adversos, sobre todo síntomas extrapiramidales (EPS), lo cual ha relegado su uso y fomenta el mayor empleo en la práctica clínica de los antipsicóticos atípicos (AA) gracias a la adecuada efectividad clínica demostrada hasta el momento. Sin embargo, estos medicamentos están asociados con diferentes alteraciones metabólicas, entre las cuales se encuentra un mayor riesgo de diabetes; para lo cual se han propuesto varios mecanismos etiopatogénicos. En esta revisión narrativa, se presenta un resumen actualizado de la literatura de los últimos 5 años sobre el uso de antipsicóticos atípicos y la diabetes mellitus tipo 2, haciendo énfasis en las diferentes hipótesis reportadas hasta el momento que involucran el aumento de peso y diferentes efectos mediados por hormonas, receptores de neurotransmisores y neuropéptidos que impactan en la génesis de los estados hiperglucémicos y de insulinorresistencia.


Abstract Antipsychotic agents are currently considered as the main pharmacological treatment that helps the maintenance management of acute schizophrenia and other mental disorders. These drugs are classified into two groups: First-generation antipsychotics (FGAs) or typical antipsychotics, and Second-generation antipsychotics (SGAs) also known as atypical antipsychotics (AAP). In relation to the use of typical antipsychotics, some relevant adverse effects have been described, especially in terms of extrapyramidal side effects (EPS), which has downgraded their use and encourages the treatment of atypical antipsychotics (AAP) due to the adequate clinical effectiveness demonstrated so far in the practice. However, these drugs have been associated with different metabolic alterations such as the increased risk of suffering from diabetes; thus, several etiopathogenic mechanisms have been proposed. In this narrative review, we seek to present an updated summary of the literature of the last five years about the use of atypical antipsychotics and type 2 diabetes mellitus. Here it has been emphasized the different hypotheses reported so far that involve weight gain and different effects mediated by hormones, neurotransmitter receptors, and neuropeptides that impact on the genesis of hyperglycemia and insulin resistance states


Subject(s)
Humans , Therapeutics/adverse effects , Antipsychotic Agents , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Schizophrenia , Neuropeptides , Insulin Resistance , Acute Disease , Hormones , Hyperglycemia
11.
Medicina (B.Aires) ; 80(6): 670-680, dic. 2020. graf
Article in English | LILACS | ID: biblio-1250290

ABSTRACT

Abstract Hyperprolactinemia may be associated with psychiatric disorders in the context of two scenarios: antipsychotic-induced hyperprolactinemia and psychiatric disorders arising from the medical treatment of hyperprolactinemia. Both situations are particularly common in psychiatric and endocrine clinical practice, albeit generally underestimated or unrecognized. The aim of this article is to provide tools for the diagnosis and treatment of hyperprolactinemia associated with psychiatric disorders to raise awareness, especially among psychiatrists and endocrinologists, so that these professionals can jointly focus on the appropriate management of this clinical entity.


Resumen La hiperprolactinemia puede asociarse con trastornos psiquiátricos en el contexto de dos escenarios: la hiperprolactinemia inducida por antipsicóticos y trastornos psiquiátricos surgidos por el tratamiento médico de la hiperprolactinemia. Ambas situaciones son particularmente comunes en la práctica clínica psiquiátrica y endocrinológica, aunque generalmente subestimadas o inadvertidas. El objetivo de este artículo es proporcionar herramientas de diagnóstico y tratamiento de la hiperprolactinemia asociada a trastornos psiquiátricos, para concientizar particularmente a psiquiatras y endocrinólogos a enfocar en conjunto el manejo apropiado de esta entidad.


Subject(s)
Humans , Antipsychotic Agents/adverse effects , Hyperprolactinemia/diagnosis , Hyperprolactinemia/chemically induced , Hyperprolactinemia/drug therapy , Mental Disorders/etiology , Mental Disorders/drug therapy , Prolactin/metabolism
12.
Gac. méd. boliv ; 43(2): 207-214, dic. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1249985

ABSTRACT

El trastorno delirante es un trastorno psiquiátrico poco frecuente y se caracteriza por la presencia de ideas delirantes cuyo contenido puede ser de tipo erotomaníaco, de persecución, celotipia, de grandeza y somática. Tiene un inicio insidioso y tiende a la cronicidad, altera la conducta, repercute en la funcionalidad del individuo y compromete sus relaciones interpersonales. La etiología es desconocida, el diagnóstico se realiza mediante la clínica apoyándose en los criterios del DSM-V o CIE-10 y el tratamiento disponible en la actualidad proporciona una respuesta limitada. En general los pacientes no reconocen el trastorno, no recurren a la atención médica y tienen baja adherencia al tratamiento. El caso clínico que se expone es de un hombre de mediana edad que presenta un Trastorno Delirante tipo celotípico dirigido a su esposa y que gradualmente compromete la calidad de vida del paciente y pone a la familia en riesgo vital; su respuesta al antipsicótico atípico fue parcial, pero con mejoría considerable en la convivencia familiar. La importancia de este caso clínico reside en que es una patología poco prevalente y menos conocida por los profesionales del área de salud u otras disciplinas afines, además que no hay publicaciones en el medio sobre el tema; por lo que es necesario dar a conocer casos como este, proporcionando información para un diagnóstico temprano con tratamiento oportuno, con el fin de mejorar el pronóstico a largo plazo y la calidad de vida del paciente, además de prevenir conductas delictivas, con posibles desenlaces fatales. .


Delusional disorder is a rare psychiatric disorder characterized by the presence of delusional ideas, such as the erotomaniac, persecution, celotype, greatness and somatic type. It has an insidious onset and tends to be chronic. Delusional disorder alters behavior, affecting the functionality of the individual and compromising their interpersonal relationships. The etiology is unknown, the diagnosis is made through the clinic based on the criteria of the DSM-V or ICD-10, and the treatment currently available provides a limited response. In general, patients do not recognize the disorder, do not seek medical attention, and have low adherence to treatment. In one clinical case, for example, a middle-aged man who presents a Celotypic Delusional Disorder directed at his wife gradually compromises the quality of his life and puts the family at vital risk; their response to the atypical antipsychotic was partial, but it improved family life considerably. This clinical case is important because this pathology is not very prevalent or well-understood by professionals in the health area or other related disciplines. There are also no media publications on the subject, so it is necessary to publicize these types of cases and provide information for an early diagnosis with timely treatment. Additional information can be used to improve the long-term prognosis and quality of the patient’s life, in addition to preventing criminal behavior with possible fatal outcomes.


Subject(s)
Male , Adult , Schizophrenia, Paranoid , Mental Disorders , Antipsychotic Agents , Behavior , Jealousy
13.
J. bras. econ. saúde (Impr.) ; 12(3): 195-205, Dezembro/2020.
Article in English | LILACS, ECOS | ID: biblio-1141297

ABSTRACT

Objective: To carry out a cost-effectiveness and budget impact analysis of antipsychotic use in adults to treat schizophrenia from the perspective of the Unified Health System (SUS). Methods: A Markov model simulated the treatment of schizophrenic patients with an initial average age of 25 years and a lifetime horizon. The possibility of combining drugs resulted in 20 pharmacotherapeutic strategies. Results: The lowest-cost strategy, risperidone/olanzapine, obtained values of $45,092.77 with effectiveness of 15.97 QALY. The incremental cost-effectiveness ratio in dollars/QALY of olanzapine/risperidone was 2,470.24, and risperidone/ziprasidone was 352,671.90, compared to the first option. All other therapeutic combinations were dominated. The budgetary impact assessment indicated that the most cost-effective choice could generate savings of US$ 1,555.00 on average, per patient, over five years. Conclusion: The therapeutic proposal with the lowest cost per patient was risperidone combined with olanzapine, revealing these two drugs as a strategy with lower budgetary impact and better cost-effectiveness.


Objetivo: Realizar uma análise de custo-efetividade e impacto orçamentário do uso de antipsicóticos em adultos para o tratamento da esquizofrenia, na perspectiva do Sistema Único de Saúde (SUS). Métodos: Um modelo de Markov simulou o tratamento de pacientes com esquizofrenia, com idade média inicial de 25 anos e horizonte lifetime. Analisaram-se 20 estratégias farmacoterapêuticas. Resultados: A estratégia de menor custo ­ risperidona/olanzapina ­ obteve valores de US$ 45.092,77, eficácia de 15,97 QALY. A relação custo-efetividade incremental em dólares/QALY da olanzapina/risperidona foi de 2.470,24, e de 352.671,90 para risperidona/ziprasidona, em comparação com a primeira opção. Todas as outras combinações terapêuticas foram dominadas. A avaliação do impacto orçamentário indicou que a escolha mais econômica geraria economia de US$ 1.555,00 em média, por paciente, ao longo de cinco anos. Conclusão: A proposta terapêutica de menor custo por paciente foi a risperidona associada à olanzapina, estratégia de menor impacto orçamentário e melhor custo-efetividade.


Subject(s)
Schizophrenia , Technology Assessment, Biomedical , Antipsychotic Agents , Cost-Benefit Analysis , Analysis of the Budgetary Impact of Therapeutic Advances
14.
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1121615

ABSTRACT

Tecnologia: Aripiprazol, medicamento antipsicótico de segunda geração. Indicação: tratamento da esquizofrenia. Objetivos: Apresentar evidências de análise econômicas em saúde, no cenário do SUS e contextos internacionais, do tratamento com Aripiprazol para esquizofrenia, comparado a outros antipsicóticos de uso oral de primeira e segunda geração utilizados no SUS. Realizar uma análise de impacto orçamentário para o contexto do SUS em Goiás e estimar uma projeção de gastos diretos com aquisição de Aripiprazol pela Secretaria de Saúde de Goiás, em cenário de incorporação do Aripiprazol para tratamento de esquizofrenia, no período de 2021 a 2025. Materiais e Métodos: Levantamentos bibliográficos nas bases de dados PUBMED e Biblioteca Virtual em Saúde, no mês de junho de 2020. Realizada avaliação da qualidade metodológica das revisões sistemáticas e dos estudos econômicos com as ferramentas Assessing the Methodological Quality of Systematic Reviews (AMSTAR), e Quality of Health Economic Studies (QHES) checklist, respectivamente. Foi calculado o impacto orçamentário, seguindo diretrizes do Ministério da Saúde, e projeção de gastos para a Secretaria de Saúde de Goiás. Resultados: Foram selecionadas e incluídas 1 revisão sistemática e 1 estudo econômico brasileiro no estudo de revisão rápida de evidências. Conclusão: No contexto brasileiro, o Aripiprazol é custo-efetivo, quando comparado a Clorpromazina, Haloperidol, Quetiapina e Ziprasidona. Porém, é menos custo-efetivo que Risperidona e Olanzapina. Caso seja padronizado pela Secretaria de Saúde de Goiás, promoverá economia anual para o SUS de R$ 250.042,05 a R$ 407.418,41, em sua máxima difusão. A projeção de gastos diretos é estimada em R$1.582.115,24 a R$27.960.108,08


Technology: Aripiprazole, second generation antipsychotic medication. Indication: treatment of schizophrenia. Objectives: To show evidence of health economic analysis in the scenario of Brazilian Public Health System (BPHS) and international contexts, for schizophrenia treatment with Aripiprazole, compared to other oral antipsychotics used in BPHS. To make a budget impact analysis for the Goias Public Health System perspective and estimate direct expenditures for the acquisition of Aripiprazole by State Department of Health of Goias, in a scenario of technology incorporation of Aripiprazole for the treatment of schizophrenia, in the period from 2021 to 2025. Materials and Methods: Bibliographical searches were done in the PUBMED and Virtual Health Library databases, in 2020 June. An evaluation of the methodological quality of systematic reviews and economic studies was done using the tools AMSTAR (Assessing the Methodological Quality of Systematic Reviews), and QHES (Quality of Health Economic Studies) checklist, respectively. Calculation of budget impact, following guidelines of the Brazilian Health Ministry, and projection of expenditures for the State Department of Health of Goias. Results: 1 systematic review and 1 Brazilian economic study were selected and included in the study of rapid evidence review. Conclusion: In the Brazilian context, Aripiprazole is cost-effective when compared to Chlorpromazine, Haloperidol, Quetiapine and Ziprasidone. However, it is less cost-effective than Risperidone and Olanzapine. If it is standardized by State Department of Health of Goias, it will promote anual savings for BPHS from R$ 250,042.05 to R$ 407,418.41, in its maximum dissemination. The direct expenses are estimated at R$ 1,582,115.24 to R $ 27,960,108.08


Subject(s)
Humans , Schizophrenia/drug therapy , Antipsychotic Agents/therapeutic use , Aripiprazole/therapeutic use , Analysis of the Budgetary Impact of Therapeutic Advances , Antipsychotic Agents/economics , Unified Health System/economics , Aripiprazole/economics
15.
Washington; Organización Panamericana de la Salud; ago 25, 2020. 28 p.
Non-conventional in Spanish | LILACS | ID: biblio-1117908

ABSTRACT

En el transcurso de la pandemia de COVID-19, numerosos países, de ingresos bajos, medianos y alto, han visto agotadas sus reservas de medicamentos esenciales necesarios para el manejo de los pacientes con COVID-19 en las unidades de cuidados intensivos (UCI). El plan de preparación para emergencias sanitarias de los países requiere incluir una lista de medicamentos esenciales y otros dispositivos médicos necesarios en las UCI para afrontar emergencias sanitarias. La lista de medicamentos esenciales para el manejo de pacientes que ingresan a unidades de cuidados intensivos con sospecha o diagnóstico confirmado de COVID-19 es un documento de orientación fundamental que ayuda a los sistemas de salud de los países a priorizar los medicamentos esenciales que deben estar ampliamente disponibles y ser asequibles para manejar los pacientes en las UCI durante las situaciones de emergencia sanitaria, en este caso con sospecha o diagnóstico confirmado de COVID-19. Está dirigida a las autoridades sanitaras y a los encargados del manejo del sistema de salud de los países. Esta lista incluye fundamentalmente los medicamentos considerados esenciales para el manejo de los cuadros clínicos que con se observan con mayor frecuencia en pacientes hospitalizados en UCI a causa de una infección por SARS-CoV-2. No se incluyen la mayoría de los medicamentos que comúnmente se encuentran en las UCI para el manejo de otras patologías, comorbilidades o la estabilización del paciente (p. ej., insulina o antihipertensivos), salvo aquellos que pueden requerirse para el tratamiento o apoyo (p. ej., bloqueantes neuromusculares o anestésicos) de las dolencias generadas por la infección. Tampoco se incluyen medicamentos específicos para el tratamiento de la infección por SARS-CoV-2, puesto que no existe, por el momento, evidencia científica de alta calidad que avale su uso, salvo en el contexto de ensayos clínicos controlados. Un equipo de expertos en el tema realizó una búsqueda de información sobre la atención de pacientes en UCI durante la pandemia de COVID-19, en Medline (a través de PubMed), Cochrane, Tripdatabase, Epistemonikos y en buscadores generales de internet (Google). Se identificaron también revisiones o guías generadas por ministerios de Salud de varios países de la Región de las Américas, la Organización Mundial de la Salud (OMS), la Organización Panamericana de la Salud (OPS), el Instituto Nacional de Salud y Excelencia Clínica (NICE) de Reino Unido, los Centros para el Control y la Prevención de Enfermedades (CDC) de Estados Unidos y los Institutos Nacionales de Salud (NIH) de Estados Unidos.


Subject(s)
Humans , Child , Adult , Pneumonia, Viral/drug therapy , Succinylcholine/therapeutic use , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Patient Care Management/organization & administration , Dexamethasone/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Coronavirus Infections/drug therapy , Drugs, Essential/supply & distribution , Dexmedetomidine/therapeutic use , Severe Acute Respiratory Syndrome/drug therapy , Antipyretics/therapeutic use , Pandemics/prevention & control , Betacoronavirus/drug effects , Haloperidol/therapeutic use , Analgesics, Opioid/therapeutic use , Intensive Care Units/organization & administration , Anti-Infective Agents/therapeutic use , Pneumonia, Viral/prevention & control , Respiration, Artificial/nursing , Shock, Septic/prevention & control , Thromboembolism/prevention & control , Coronavirus Infections/prevention & control , Evidence-Based Medicine , Intubation/nursing , Hypoxia/drug therapy
16.
Rev. chil. neuro-psiquiatr ; 58(1): 61-65, mar. 2020. tab
Article in Spanish | LILACS | ID: biblio-1115471

ABSTRACT

Resumen Se han descrito una serie de reacciones adversas asociadas a antipsicóticos, entre las que destacan las reacciones adversas hematológicas propias de algunos antipsicóticos atípicos. Las más renombradas han sido clásicamente las discrasias sanguíneas asociadas al uso de olanzapina. En este trabajo nos enfocamos en una reacción adversa poco común: eosinofilia en un paciente esquizofrénico paranoide usuario de olanzapina, situación documentada en contadas publicaciones a lo largo de la historia de uso de este medicamento. Se trata de una reacción adversa infrecuente, y por lo mismo poco conocida y estudiada.


Many adverse effects of antipsychotic drugs have been described, among which hematologic adverse effects stand out. Classically, blood discrasias have been associated to the use of olanzapine. On this paper we will focus on an uncommon adverse reaction: eosinophilia in a patient diagnosed with a paranoid schitzophrenia, who had been using olanzapine. There have been just a few reported cases of eosinophilia secondary to the use of olanzapine, which makes this an infrequent, rarely known and even less studied adverse reaction.


Subject(s)
Humans , Male , Adult , Schizophrenia , Antipsychotic Agents , Eosinophilia , Olanzapine
17.
Medwave ; 20(2): e7853, 31-03-2020.
Article in English, Spanish | LILACS | ID: biblio-1095856

ABSTRACT

INTRODUCCIÓN: La Unidad de Corta Estadía Infanto-juvenil del Hospital Psiquiátrico del Salvador (Valparaíso, Chile) y sus pacientes poseen características clínicas y sociales diferentes a las reportadas por la escasa literatura nacional al respecto. OBJETIVOS: Describir el funcionamiento la unidad, las características sociofamiliares y clínicas de sus pacientes y analizar los factores asociados a su evolución clínica. MÉTODOS: Estudio transversal que describió el universo de pacientes hospitalizados durante tres años. Las variables se recogieron desde una base de datos anonimizada. Se evaluó la evolución clínica dentro del año posterior al egreso hospitalario. RESULTADOS: El modelo de atención de la unidad presenta los componentes biomédico, psicodinámico y ecológico. Se analizaron 98 pacientes, 70,4% hombres, con edad promedio de 11,5 ± 2,3 años. Un 82,6% perteneció al nivel socioeconómico bajo y 35,7% estaba desescolarizado; 98,9% presentó disfunción familiar y 91,8% de los padres portaba alguna psicopatología. Los motivos de ingreso más frecuente fueron riesgo de hetero y autoagresión. Los diagnósticos de egreso más frecuente fueron trastornos de conducta, depresivos y del desarrollo de la personalidad. El tiempo de estadía promedio fue de 41,8 ± 31,1 días. Los fármacos más utilizados fueron antipsicóticos y estabilizadores del ánimo. Un 47% tuvo una buena evolución clínica, 27% regular y 26% insatisfactoria. El único factor que se asoció a esta última fue haber tenido prescrito un antidepresivo durante la hospitalización. El factor que consistentemente se vinculó al reingreso a lo largo de un año, fue el haber presentado trastorno por consumo de sustancias. El abandono a tratamiento se relacionó con haber presentado un trastorno de conducta al egreso hospitalario y a tener padres con antecedente de suicidio o suicidio consumado. CONCLUSIONES: El perfil de pacientes de esta unidad corresponde a pacientes de nivel socioeconómico bajo, psicopatología severa, conducta desadaptativa, disfunción familiar y frecuente psicopatología parental. El trastorno por consumo de sustancias es un factor significativamente asociado al reingreso hospitalario.


INTRODUCTION: Patients of the Short-stay Child and Adolescent Unit of the Del Salvador Psychiatric Hospital (Valparaíso, Chile) exhibit different clinical and social characteristics compared to literature reports of other national centers, although published data are scarce. OBJECTIVES: To describe the operation of the Unit, the socio-familial and clinical characteristics of its patients and analyze factors associated with their clinical evolution. METHODS: We performed a cross-sectional study to describe the patients hospitalized over a three-year period. Variables were registered in an anonymized database. Clinical evolution was evaluated over the year following hospital discharge. RESULTS: The Unit's model of care can be described as involving biomedical, psychodynamic, and ecological components. We included 98 patients, of which 70.4% were male, and the average age was 11.5 ± 2.3 years. 82.6% were of low socioeconomic status, and 35.7% did not attend school; 98.9% presented family dysfunction, and 91.8% of parents had a history of psychopathology. The most frequent reason for admission was the risk of harm to self or others. The most frequent discharge diagnoses were behavioral, depressive, and personality development disorders. The average length of stay was 41.8 ± 31.1 days. The most commonly used pharmacological agents were antipsychotics and mood stabilizers. Regarding clinical evolution in the first year post-discharge, 47% were evaluated as positive, 27% regular, and 26% unsatisfactory. The factor associated with an unsatisfactory clinical course was having had in-patient antidepressants. Re-admission during the first year post-discharge was associated with comorbid substance use disorder. Treatment noncompliance was associated with a history of behavioral disorder at hospital discharge and having parents with a history of suicide or consummated suicide. CONCLUSIONS: The patient profile is one of low socioeconomic status, severe psychopathology, maladaptive behavior, family dysfunction, and parental psychopathology. Substance use disorder is also associated with readmission.


Subject(s)
Humans , Male , Female , Child , Adolescent , Substance-Related Disorders/complications , Hospitalization , Mental Disorders/complications , Mental Disorders/psychology , Mental Disorders/therapy , Patient Readmission , Suicide , Antipsychotic Agents , Family , Chile , Cross-Sectional Studies , Hospitals, Psychiatric
20.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(1): 27-32, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1055350

ABSTRACT

Objective: Patients with schizophrenia have visual processing impairments. The main findings from the literature indicate that these deficits may be related to differences in paradigms, medications, and illness duration. This study is part of a large-scale study investigating visual sensitivity in schizophrenia. Here we aimed to investigate the combined effects of illness duration and antipsychotic use on contrast sensitivity function. Methods: Data were collected from 50 healthy controls and 50 outpatients with schizophrenia (classified according to illness duration and medication type) aged 20-45 years old. The contrast sensitivity function was measured for spatial frequencies ranging from 0.2 to 20 cycles per degree using linear sine-wave gratings. Results: Patients with an illness duration > 5 years had more pronounced deficits. Differences in the combined effects of illness duration and antipsychotic use were marked in patients on typical antipsychotics who had been ill > 10 years. No significant differences were found between typical and atypical antipsychotics in patients with an illness duration < 5 years. Conclusion: Visual impairment was related to both long illness duration and medication type. These results should be tested in further studies to investigate pharmacological mechanisms.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Schizophrenia/drug therapy , Antipsychotic Agents/adverse effects , Vision Disorders/chemically induced , Psychiatric Status Rating Scales , Schizophrenia/complications , Time Factors , Vision, Ocular/drug effects , Contrast Sensitivity/drug effects , Case-Control Studies , Chlorpromazine/adverse effects , Treatment Outcome , Middle Aged
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