Eficácia, segurança e efetividade comparada de palmitato de paliperidona e outros antipsicóticos injetáveis de efeito prolongado para tratamento de esquizofrenia: revisão rápida de evidências / Efficacy, safety and effectiveness in the real world for paliperidone palmitate compared to the others long acting injectable antipsychotics for schizophrenia treatment: rapid review of evidence

Tecnologia: Palmitato de Paliperidona (PP) é um antipsicótico injetáveis de efeito prolongado (AIEP). Indicação: Tratamento sintomático da esquizofrenia. Objetivo: Comparar a eficácia, segurança e efetividade terapêutica entre PP e outros AIEP para o tratamento de esquizofrenia em adultos. Pergunta: O PP é mais eficaz e seguro que os outros AIEP (Decanoato de Haloperidol, Enantato de Flufenazina, Decanoato de Zuclopentixol, Risperidona-IEP) para o tratamento sintomático de esquizofrenia em adultos? Métodos: Levantamento bibliográfico, com estratégias estruturadas de busca, na base de dados PUBMED. Foi feita avaliação da qualidade metodológica das revisões sistemáticas (RS), ensaios clínicos randomizados (ECR) e dos estudos observacionais de efetividade no mundo real (EOEMR) com as ferramentas Assessing the Methodological Quality of Systematic Reviews (AMSTAR), Delphi List e Newcastle-Ottawa Scale (NOS), respectivamente. Resultados: Foram selecionadas 3 RS, 1 ECR e 3 EOEMR. Conclusão: PP (de aplicação mensal) tem similar eficácia e segurança com a Risperidona-IEP para o tratamento de esquizofrenia, exceto que provoca menor incidência de sintomas extrapiramidais. PP e Decanoato de Haloperidol são similares na eficácia e segurança para o tratamento de esquizofrenia, inclusive no risco de sintomas extrapiramidais (discinesias tardias e parkinsonismo), exceto que PP tem menor incidência de acatisia. PP é similar aos outros AIEP nos vários desfechos de eficácia e segurança terapêutica, inclusive mortalidade

Technology: Paliperidone palmitate (PP) is a long-acting injectable (LAI) antipsychotics. Indication: Symptomatic treatment of schizophrenia. Objective: To compare the therapeutic efficacy, safety and effectiveness in the real world between PP and other LAI antipsychotics for the treatment of schizophrenia in adults. Question: Is PP more effective and safer than other LAI antipsychotics (Haloperidol Decanoate, Fluphenazine Enanthate, Zuclopentixol Decanoate, Risperidone-LAI), for the symptomatic treatment of schizophrenia? Methods: Bibliographic survey, with structured search strategies, in the PUBMED database. Na evaluation was made of the methodological quality of systematic reviews (SR), randomized clinical trials (RCT) and observational studies (OS) of effectiveness in the real world with Assessing the Methodological Quality of Systematic Reviews (AMSTAR), Delphi List and Newcastle-Ottawa Scale (NOS) tools, respectively. Results: 3 SR, 1 RCT and 3 OE were included. Conclusion: PP (monthly dose presentation) has similar efficacy and safety with Risperidone-LAI for the treatment of schizophrenia, except that it causes a lower incidence of extrapyramidal symptoms. PP and Haloperidol Decanoate are similar in efficacy and safety for the treatment of schizophrenia, including the risk of extra-pyramidal symptoms (tardive dyskinesias and parkinsonism), except that PP has a lower incidence of akathisia. PP has similar outcomes of efficacy and safety to the other LAI antipsychotics, including mortality risk

A Systemic Review and Experts' Consensus for Long-acting Injectable Antipsychotics in Bipolar Disorder

Bipolar disorder (BD) is a major psychiatric disorder that is easily misdiagnosed. Patient adherence to a treatment regimen is of utmost importance for successful outcomes in BD. Several trials of antipsychotics suggested that depot antipsychotics, including long-acting first- and second-generation agents, are effective in preventing non-adherence, partial adherence, and in reducing relapse in BD. Various long-acting injectable (LAI) antipsychotics are available, including fluphenazine decanoate, haloperidol decanoate, olanzapine pamoate, risperidone microspheres, paliperidone palmitate, and aripiprazole monohydrate. Due to the increasing number of BD patients receiving LAI antipsychotics, treatment guidelines have been developed. However, the clinical applicability of LAI antipsychotics remains a global cause for concern, particularly in Asian countries. Expert physicians from Taiwan participated in a consensus meeting, which was held to review key areas based on both current literature and clinical practice. The purpose of this meeting was to generate a practical and implementable set of recommendations for LAI antipsychotic use to treat BD; target patient groups, dosage, administration, and adverse effects were considered. Experts recommended using LAI antipsychotics in patients with schizophrenia, rapid cycling BD, BD I, and bipolar-type schizoaffective disorder. LAI antipsychotic use was recommended in BD patients with the following characteristics: multiple episodes and low adherence; seldom yet serious episodes; low adherence potential per a physician's clinical judgment; preference for injectable agents over oral agents; and multiple oral agent users still experiencing residual symptoms.

La intoxicación con cobre disminuye la sobrevida e induce alteraciones neurológicas en Drosophila melanogaster / Copper intoxication decreases lifespan and induces neurologic alterations in Drosophila melanogaster

La enfermedad de Wilson, es un trastorno hereditario autosómico recesivo causado por mutaciones del gen de la trifosfatasa de adenosina (ATP7B). Dicha mutación ocasiona intoxicación con cobre, generando manifestaciones clínicas por los efectos tóxicos del metal, principalmente a nivel del hígado y el encéfalo. Recientemente se han desarrollado modelos genéticos de la enfermedad para su estudio clínico. Sin embargo, la utilidad de los mismos es limitada por el hecho de que en tales modelos no se observan manifestaciones neurológicas. El presente estudio tuvo como objetivo desarrollar un modelo de la enfermedad de Wilson en Drosophila melanogaster. Inicialmente se evaluó el efecto de la suplementación con concentraciones de 31 µM y 47 µM de cobre en la sobrevida. Posteriormente se realizaron estudios de conducta para determinar si existían alteraciones en el desempeño motor asociadas al tratamiento con la dosis de 47 µM de cobre. Los resultados obtenidos sugieren que el tratamiento con cobre disminuye la viabilidad de la Drosophila. La disminución de la sobrevida estuvo asociada a un aumento y una disminución de los registros de actividad motora en las etapas tempranas y tardías de la intoxicación respectivamente. Por último, se evaluó el papel del sistema de neurotransmisión dopaminérgico sobre las alteraciones conductuales inducidas por el cobre. El tratamiento con el precursor de la dopamina, L-dopa, indujo un aumento de la actividad motora similar al inducido por el cobre. Por el contrario, el tratamiento con Flufenazina, un antagonista de los receptores dopaminérgicos D2, fue capaz de impedir las alteraciones conductuales en todas las edades evaluadas. Estos resultados sugieren que la Drosophila melanogaster podría ser empleada como modelo para el estudio de posibles intervenciones con potencial terapéutico en la enfermedad de Wilson.

Wilson disease is a hereditary disorder caused by mutations of the ATP7B gene, which leads to intoxication with copper as a result of an unbalance of copper homeostasis. The clinical manifestations resulting from this intoxication are related to the affectation of liver and the encephalon in most cases. Several animal models are currently available for the study of the malady. However, in such models no neurological symptoms are observed, which limits their use for the study of pathogenic effects of this disease on the central nervous system. The aim of the present study was to evaluate if copper feeding could induce a disease state in Drosophila melanogaster to model Wilson disease. The effect of the feeding of copper at the doses of 31 µM and 47 µM on the survival was initially evaluated. Next, behavioral experiments were conducted to determine whether the motor performance was altered by the 47 µM concentration. The results suggest that copper treatment decreases the viability of the flies. In addition, the decrease of viability was associated to an increase and decrease of spontaneous motor activity at early and late stages of the intoxication, respectively. Finally, the role of the dopaminergic neurotransmission system on the observed motor alterations was evaluated. The dopamine precursor L-dopa increased motor activity. In contrast, D2 receptor antagonist, Fluphenazine, was able to block both the increase and decrease of motor activity scores induced by copper. These results suggest that Drosophila melanogaster could be used as a model organism for the study of possible interventions with potential neuroprotective effects in Wilson disease.

Chemical and toxicological studies on some phenothiazines

Phenothiazines are widely used in the treatment of certain psychiatric disorders. Overdoses of these drugs are common and are potentially lives threatening of patients. This work aims to study the chromatographic and spectrophotometric behavior of some of commonly used phenothiazines [chlorpromazine hydrochloride and fluphenazine decanoate]. And estimation of the drugs to determine their distribution among different tissues, hair and body fluids of albino rats by using quick, sensitive and reliable method of analysis. The present study was conducted on ninety albino rats. The study divided into two parts [A and B] each involved 45 rats; A: The chemical and toxicological studies on chlorpromazine hydrochloride in toxic, lethal and chronic toxic doses. B: The chemical and toxicological studies on fluphenazine decanoate in toxic, lethal and chronic toxic doses. After extraction of chlorpromazine and fluphenazine from brain, liver, kidney, muscle, hair and plasma with ammonium sulphate, identification of the drugs was done using color tests and thin layer chromatography. UV spectrophotomeric and HPLC analysis of the samples was done. The results revealed that thin-layer chromatography gave positive results with tissue extracts of all organs and in all doses. It was obvious from the obtained results that the method used for spectrophotometric analysis offers the advantages of simplicity, specificity without the need of further extraction or heating, besides having higher sensitivity range than most of the existing spectrophotometric methods. The highest concentration of chlorpromazine was found in the kidney in all doses, followed by serum in toxic dose and liver in both lethal and chronic toxicity. Then the distribution varies in the other organs according to the different doses. The mean concentration of chlorpromazine was higher with HPLC than that with spectrophotometric method with significant difference in all organs. The order of distribution of fluphenazine in various organs of animals receiving the toxic dose by both HPLC and spectrophotometric methods was; [kidney, muscles, serum, liver, lung, hair, brain and heart] While the order of distributions of fluphenazine in various organs of animals received the lethal dose by the two methods was; [kidney, liver, serum, muscle, brain, hair, heart and lung] and that for animals receiving the chronic toxic dose was,[kidney, liver, serum, muscle, hair, brain, lung and heart]. It was clear that the order of distributions of chlorpromazine and fluphenazine in various organs in all doses was the same either by spectrophotometric or by HPLC methods, but the concentration of the drug was higher by HPLC than that by spectrophotometer and this difference was significant in all organs

influence of different storage conditions on the stability of amitriptyline and fluphenazine in biological specimens

The aim of this research is to study the effect of different storage conditions [different temperatures and formalin preservation] on the stability of amitriptyline and fluphenazine in some biological samples. The LD[50] of amitriptyline and fluphenazine were administrated orally to rabbits which were sacrificed two hours after administration of the drugs. The tissues were stored at different conditions for six months. U.V. Spectrophotometer was used for estimation of the drugs at different periods. The results revealed that both amitriptyline and fluphenazine were rapidly declined in samples stored at room temperature [25 - 38°C]. It could not be detected in brain and liver samples at the end of three weeks, in the kidney at the end of four weeks and in plasma at the end of six weeks. While fluphenazine could not be detected in the brain at the end of three weeks, in the kidney and liver at the end of four weeks and in the plasma at the end of six weeks. At fridge temperature [5°C], amitriptyline could not be detected in brain and liver at the end of four weeks, in kidney samples at the end of six weeks. While fluphenazine could not be detected in brain at the end of four weeks, in kidney and liver at the end of six weeks, in plasma both of them couldn't be detected at the end of eight weeks. At freezer temperature [-20°C], amitriptyline could be detected up to the end of six months of the storage in the different samples with different relative recovery percent 80%, 75%, 69.57%, and 63.00% [for plasma, kidney, brain and liver samples respectively]. While fluphenazine could be detected up to the end four months of the storage in the plasma, kidney, and liver with different relative recovery percent [19.77%, 13.88%, and 11.56% respectively]. In brain fluphenazine could be detected up to the end of twelve weeks with a relative recovery percent of 15.76%. In samples preserved in 10% formalin solution, amitriptyline could be detected up to the end of six months of the storage in the different samples with high relative recovery percents [90.81%, 90.18%, 87.84% and 86.14%] for the kidney, plasma, brain, and liver respectively. While fluphenazine could not be detected in brain samples at the end of six weeks. It could not be detected in liver, kidney, and plasma at the end of eight weeks of the storage. In conclusion amitriptyline is stable in tissues stored at freezer [-20°C] and that preserved in formalin solution. While fluphenazine is stable in tissues stored at freezer [-20°C] for sometime, but it is not stable in the samples stored at room temperature, fridge temperature, and in samples preserved in formalin solution

Photo-oxidative damage to isolated rat liver mitochondria induced by phenothiazines

Photosensitization is a well-known side-effect of phenothiazines that could involve photochemically promoted oxidative damage to mitochondria, leading to the impairment of metabolic functions and apoptosis. In this work, for the first time, we investigated the effects of photoexcited thioridazine (TR), trifluoperazine (TFP) and fluphenazine (FP) on isolated rat liver mitochondria. Under UV irradiation, the presence of these phenothiazines led to a dose-dependent lack of the respiratory control ratio. These effects were not accompanied by significant swelling and oxidation of protein thiol groups but were accompanied by lipid peroxidation. Lycopene and sorbate, well-known quenchers of singlet oxygen and triplet species, respectively, were ineffective at protecting mitochondrial lipids against the damage promoted by the excited phenothiazines, suggesting that photochemically-produced cation radicals were the pro-oxidant species. Corroborating this proposal, butylated hydroxytoluene (BHT) completely inhibited the lipid peroxidation induced by UV irradiation in the presence of phenothiazines. These novel results make a significant contribution to the understanding of the photochemical properties of phenothiazines in biological systems

Chronic effect of antidopaminergic drugs or estrogen on male Wistar rat lactotrophs and somatotrophs

The aim of the present study was to evaluate the effect of antidopaminergic agents on the somatotrophs in the presence of hyperprolactinemia. Adult male Wistar rats were divided into 6 groups: a control group and five groups chronically treated (60 days) with haloperidol, fluphenazine, sulpiride, metoclopramide or estrogen. Somatotrophs and lactotrophs were identified by immunohistochemistry and the data are reported as percent of total anterior pituitary cells counted. The drugs significantly increased the percentage of lactotrophs: control (mean + or - SD) 21.3 + or - 4.4, haloperidol 27.8 + or - 2.2, fluphenazine 34.5 + or - 3.6, sulpiride 32.7 + or - 3.5, metoclopramide 33.4 + or - 5.5 and estrogen 42.4 + or - 2.8. A significant reduction in somatotrophs was observed in animals treated with haloperidol (23.1 + or - 3.0), fluphenazine (22.1 + or - 1.1) and metoclopramide (24.2 + or - 3.0) compared to control (27.3 + or - 3.8), whereas no difference was observed in the groups treated with sulpiride (25.0 + or - 2.2) and estrogen (27.1 + or - 2.8). In the groups in which a reduction occurred, this may have simply been due to dilution, secondary to lactotroph hyperplasia. In view of the duplication of the percentage of prolactin-secreting cells, when estrogen was applied, the absence of a reduction in the percent of somatotrophs suggests a replication effect on this cell population. These data provide additional information about the direct or indirect effect of drugs which, in addition to interfering with the dopaminergic system, may act on other pituitary cells as well as on the lactotrophs.

Determination of nortriptyline hydrochloride and fluphena-zine hydrochloride in motival tablets

Accurate and sensitive methods were proposed for the determination of nortriptyline hydrochloride and fluphenazine hydrochloride in mixture. The first method based on first derivative spectrophotometric procedure. Nortriptyline hydrochloride was determined by zero crossing measurements at 255.5 nm. The ordinate value at 262.5 nm was used to calculate the amount of fluphenazine hydrochloride in mixture. An alternative evaluation of both drugs in mixture involved the use of sodium 1,2-naphthoquine-4-sulfonate as a colorimetric reagent for the selective determination of nortriptyline hydrochloride and a fluorimetric method for the determination of fluphenazine hydrochloride alone. The presented methods were successfully applied on laboratory made mixtures and motival tablets. The described methods were compared with official methods for the determination of both drug [1,2]

attitude of the psychiatric patient about depot treatment, compulsion or help?

This study was carried out on 73 patients who were on injection treatment at the time of investigation [depot treatment with neuroleptics], they were asked about their experiences with the treatment and most of them [a little over 60%] seemed to be satisfied. No major differences with respect to the length of the treatment period could be found. A certain difference between the preparations was observed, but this was due to the variable age distribution in the preparation groups. Older patients seemed to have experienced more side effects

Effect of estrogen and neuroleptics on prolactin secretion and immunoreactive prolactin cells

The use of estrogen and dopamine receptor antagonists is associated with elevated prolactin levels and, in rats, chronic estrogen treatment is also associated with lactotroph proliferation. In this study, haloperidol, fluphenazine, sulpiride and metoclopramide, alone or combined with estradiol, were administered to Wistar rats. Pituitary weight, serum prolactin levels and percent of immunoreactive prolactin cells in the anterior pituitary glands were determined at the end of 60 days of treatment. The pituitary weight of rats treated with estrogen alone or in combination with other drugs was significantly higher than the control group. The serum prolactin level was higher than the upper confidence limit in all but three of the 90 treated rats. While in the control group the percent of immunoreactive prolactin cells was 20 per cent, administration of the neuroleptic drugs and metoclopramide increased this percent to approximately 30 per cent, and estrogen alone or in combination with one of the neuroleptic drugs increased it to approximately 40 per cent. The results presented here demonstrate the elationship between prolactin secretion and prolactin cell number when different neuroleptics and related drugs are used.

Nortriptyline-fluphenazine vs. carbamazepine in the symptomatic treatment of diabetic neuropathy

We compared the efficacy and tolerance of the combination of nortriptyline-fluphenazine (NF) vs. carbamazepine (CNZ) in the symptomatic therapy of patients with severe, distal, symmetrical, predominantly sensitive diabetic polyneuropathy (DPN). We followed a double blind, crossover, randomized and double placebo design. Sixteen patients with severe DPN participated in the study. Patients received either NF (1 tablet three times a day (tid)), for 2 weeks. After this, patients received placebos of both drugs (wash-out period), until symptoms returned to baseline levels (100 percent), then they were crossed over to receive the other comparing drug schedule. A visual analoque scale was used to evaluate the percent changes in pain and paresthesia. HBA1, fasting serum glucose, and safety tests were performed at 2- and 4-week intervals, respectively. Both therapies produced significant improvement of both pain and paresthesis. No statistically significant differences were observed between both therapies for either pain or paresthesia. No significant biochemical changes were observed with any of the two therapies. Side effects were mild and more frequent in the NF period. In this study no superiority of either drug schedule was demonstrated; therefore, the decision to use any of them should be made according to the associated pathology and potential side effects of each drug

Tensäo pré-menstrual: resultados clínicos com 5 tipos de tratamento / Premenstrual syndrome: clinical results with 5 types of treatment

A tensao pré-menstrual (TPM) é uma patologia muito comum em ginecologia, acometendo, em menor ou maior grau, uma em cada duas mulheres. Caracteriza-se por um conjunto de sintomas e sinais durante a fase lútea. Há várias etiologias propostas para explicar a síndrome, assim como várias opçoes terapêuticas. Neste trabalho foram tratadas 50 mulheres com cinco drogas diferentes, escolhidas aleatoriamente. Os sintomas mais freqüentes foram irritabilidade, mastalgia, cefaléia e depressao. O melhor efeito terapêutica foi obtido com cloridrato de piridoxina. Destaca-se que a utilizaçao do placebo reduziu a sintomatologia em 30 por cento, aproximadamente. Os autores enfatizaram que, muito possivelmente, a TPM é provocada pela associaçao de mais de um fator e evidenciaram a influência de aspectos emocionais na etiologia da sindrome.

Neurolépticos: os legítimos e verdadeiros antimanicomiais / Neuroleptic: the real antimanicomial drug

O autor analisa o advento dos neurolépticos e suas conseqüências. Faz ampla revisão do tema abordando a farmacologia destas substâncias, os aspectos clínicos, principais indicações e efeitos colaterais. Conclui mostrando o verdadeiro alcance antimanicomial dos neurolépticos

Late protective effects of the anticalmodulin drug fluphenazine on carbon tetrachloride-induced liver necrosis / 生物医学与环境科学（英文）

Fluphenazine (FP) treatment (50 mg/kg bw, ip in saline) 30 min before or 6 or 10 h after CCl4 administration (1 ml/kg ip in olive oil) significantly prevented the liver necrosis produced by the hepatotoxin at 24 h. FP had enhancing effects on the covalent binding of CCl4 reactive metabolites to cellular constituents and on CCl4 induced lipid peroxidation. FP lowered body temperature of the CCl4-poisoned animals during the 24 h observation period. The obtained results are compatible but do not prove the hypothesis that calmodulin (CaM) had participation in late occurring events preceding necrosis. FP lowering action on body temperature, however, might also play a role in the effects of this drug on the onset of CCl4 induced liver necrosis. FP levels in liver tissue as determined by gas chromatography-mass spectrometry evidenced the presence of the drug in amounts sufficient to inhibit CaM and that suggests that not all preventive effects of FP are due to its indirect actions on the central nervous system via decreased body temperature.

The treatment of fetishism and socially inappropriate sexual behavior in a young male with dull normal intelligence.

A young adult male with dull normal intelligence who had a fetish to female undergarments and was engaging in socially inappropriate sexual behavior was evaluated and treated in a multimodal treatment approach. Mild and diffuse encephalopathies were noted through EEG recordings. No definite epileptiform abnormalities or focal supratentorial lesions were seen and the pattern was consistent with patients with post-encephalitis. Treatment of this patient involved the use of anti-androgen and antianxiety pharmacotherapy along with counseling to provide basic sex education and specific education for socially accepted sexual behavior. Follow-up evaluation several yrs later indicated good treatment results. This case illustrates potential sources of sexually deviant behavior and treatment options. Promising new drug treatments are available which act as sexuoerotic tranquilizers as well as treatments for underlying or concomitant psychiatric disorders. In this case, however, family dynamics and poor sex education seemed to account for most of this patient's difficulties. Counseling and psychoeducation proved to be quite effective in resolving problematic behavior.

Herpes zoster, estudio de 96 pacientes: neuralgia postherpética y corticoides / Herpes zoster, study of 96 patients: postherpetic neuralgia and corticoids

96 pacientes con herpes zoster (HZ) registrados entre agosto de 1987 y febrero de 1989 fueron seguidos durante un año. En todos los casos fueron tratados con Aciclovir 1gr/día. 48 pacientes fueron además, tratados con prednisona oral 60 mg/día 1 semana, 40 mg/día la segunda semana y 20 mg diarios la tercera semana, a fin de evaluar la incidencia de neuralgia postherpética (NP). No se observó diferencia estadísticamente significativa entre el grupo tratado con corticoides y el grupo no tratado con corticoides (p=o.45). El promedio de edad de los pacientes con NP fue de 73 años y el de pacientes con HZ que no padecieron NP fue de 63 años (P=0.003). Los resultados sugieren la inutilidad de los corticoides para prevenir la NP y que la edad avanzada es un factor de riesgo de padecer NP. Se discute además la fisiopatología de la NP y sus distintas alternativas terapéuticas

The Effects of Acetazolamide and Fluphenazin on CSF Formation

The purpose of this study was to invstigate the effect of acetazolamide and fluphenazine on the formation of CSF. Studis were performed in 12 cats those were divided into 2 groups;A-F group included animals received initial acetazolamide infusion and additional infusion of fluphenazine to the initial infusion and the F-A group for vice versa. The rate of CSF formation was measured at 3cm above zero outflow pressure by force transducer which connected to personal computer. After obtaining steady value of CSF formation rate, the drugs were infused intravenously according to the protocol. Base line CSF formation rate, 18.87+/-6.52 microliter/min. is reduced to 6.67+/-2.45 microliter/min after acetazolamide infusion and further reduced to 3.48+/-4.06 microliter/min after additional fluphenazine. In fluphenazine group, the base line CSF formation rate, 16.34+/-4.58 microliter/min is reduced to 9.63+/-4.58 microliter/min after initial infusion of fluphenazine and further to 6.45+/-3.64 microliter/min. after additional infusion of acetazolamide. Mean reduction of CSF formation after initial intravenous infusion of acetazolamide and fluphenazine were 59% and 37% respectively. Although statistically insignificant, the CSF formation reduction in A-F group revealed more even and profound value comparing with that of F-A group. These date suggest that in addition to the effect of acetazolamide to reduce the formation of CSF, some other mechanism may exist in CSF formation that major tranquilizer exert the effect on CSF formation.

Embarazo en usuarias de decanoato de flufenazina: descripción de 22 casos / Pregnancy and flufenazine decanoate

Generalmente en las pacientes usuarias de neurolépticos de depósito se mantiene un estricto control de la fertilidad, en caso de ocurrencia de embarazo se recomienda la suspensión del fármaco de depósito puesto que nose ha establecido su inocuidad durante la gestación. Se presentan 22 pacientes usuarias de decanoato de flufenazina que presentaron 25 gestaciones. Se trata de pacientes en control en la Clínica de Psicofármacos del Servicio de Psiquiatría del Hospital de Valdivia entre 1979 y 1989. Se analizan la historia psiquiátrica, indicaciones farmacológicas, antecedentes, evolución de la gestación y parto, condición del recién nacido, reagudizaciones y evolución posterior de las pacientes. De acuerdo a las experiencias analizadas se sugieren medidas terapéuticas en caso de ocurrencia de gestación en pacientes usuarias de neuroléptico de depósito

Decanoato de flufenazina en el tratamiento de mantención de pacientes esquizofrénicos ambulatorios / Maintenance treatment of schizophrenic outpatients with fluphenazine decanoate

Se describen resultados de un estudio prospectivo acerca de los efectos del Decanoato de Flufenazina como tratamiento de mantención de 71 pacientes esquizofrénicos ambulatorios, realizado en el Servicio "A" del Hospital psiquiátrico "Dr. José Horwitz B.", entre los años 1976 y 1979. El 69,1% de los pacientes tuvo evolución satisfactoria. Los síntomas que más claramente mejoran fueron los desajustes conductuales, delirios y alucinaciones. Se modificaron menos los trastornos de la afectividad y el desgano. La evolución más favorable fue en esquizofrenias de tipo catatónico y paranoide. Las dosis terapéuticas oscilaron entre 12,5 y 52,5 mg. al mes. El efecto adverso más frecuente fue el temblor extrapiramidal. El 25,4% de pacientes abandonó el tratamiento y un 14% recayó a pesar de recibir tratamiento en forma regular