ABSTRACT
Clozapine presents immunoregulatory properties not well understood. To address this issue, we performed this systematic review to evaluate the immune alterations induced by clozapine and its relationship with the drug's clinical response and compare it with other antipsychotics. Our systematic review has selected nineteen studies meeting the inclusion criteria, from which eleven were included in the meta-analysis, totalizing 689 subjects distributed over three different comparisons. The results revealed that clozapine treatment activates the compensatory immune-regulatory system (CIRS) (Hedges's g = +1.049; CI +0.62 - +1.47, p < 0.001) but has no effects on the immune-Inflammatory Response System (IRS) (Hedges's g= -0.27; CI -1.76 - +1.22, p = 0.71), M1 macrophage (Hedges's g= -0.32; CI -1.78 - +1.14, p = 0.65) and Th1 (Hedge's g = 0.86; CI -0.93 - +1.814, p = 0.07) profiles. Comparing clozapine-treated patients with other anti-psychotics-treated, plasma levels of interleukin (IL)-6 were greater in the clozapine group (Hedge's g = 0.75; CI 0.35 - 1.15, p<0.001). In addition, higher IL-6 plasma levels after four weeks of clozapine treatment were related to the development of clozapine-induced fever; however, IL-6 levels recovered to baseline in 6-10 weeks due to an unexplained compensatory mechanism. In conclusion, our results show that clozapine treatment causes a time-dependent mixed immune profile characterized by increased IL-6 levels and CIRS activation, which may contribute to this drug mechanism of action and adverse effects. Future studies must be designed to investigate the relationship between clozapine-induced immune alterations and symptom remission, treatment resistance, and adverse effects, given the importance of this drug for treating resistant schizophrenia.
Subject(s)
Antipsychotic Agents , Clozapine , Schizophrenia , Humans , Clozapine/adverse effects , Schizophrenia/drug therapy , Interleukin-6 , Antipsychotic Agents/adverse effects , Oxidative StressABSTRACT
Objetctive: Realize a systematic review on articles about cannabidiol (CBD) as an anxiolytic and antidepressant drug. Methodology: A systematic review in PubMed, Science Direct and PsycINFO databases taking into consideration articles published in English and Portuguese from 2008 to 2018 with animal experimentation. Results: Eleven articles with experimental studies on animals were included. All studies exhibited anxiolytic and antidepressant activities after CBD use. Conclusion: It was proven by several experiments the anxiolytic and antidepressant activity of CBD, however there is still a need of more preclinicals and clinicals studies to elucidate its mechanisms.
Objetivo: Realizar uma revisão sistemática de artigos sobre o canabidiol (CBD) como ansiolítico e antidepressivo. Metodos: Revisão sistemática nas bases de dados PubMed, Science Direct e PsycINFO considerando artigos publicados em inglês e português de 2008 a 2018 com experimentação animal. Resultados: Onze artigos com estudos experimentais em animais foram incluídos. Todos os estudos exibiram atividades ansiolíticas e antidepressivas após o uso de CBD. Conclusão: Foi comprovada por diversos experimentos a atividade ansiolítica e antidepressiva do CBD, porém ainda há necessidade de mais estudos pré-clínicos e clínicos para elucidar seus mecanismos.
Subject(s)
Cannabidiol , Cannabis , Anti-Anxiety Agents , Antidepressive AgentsABSTRACT
Abstract Objective To evaluate the satisfaction of family caregivers with a mental health inpatient service in Brazil. Methods This was a cross-sectional study with a quantitative approach. A sample of 80 caretaking family members answered the abbreviated version of the Brazilian Mental Health Services' Family Satisfaction scale (SATIS-BR) and a sociodemographic questionnaire. Categorical variables were expressed as frequencies and percentages and quantitative variables as means and standard deviations. Interactions among variables and indexes of the scale were analyzed using the Student's t test, Pearson correlation coefficient and analysis of variance. Results The results showed a high mean overall satisfaction score when considering the categorization of the items of the scale, with higher satisfaction indexes in the 'Treatment results' subscale and lower ones in the 'Reception and competence of staff' and 'Privacy and confidentiality' subscales. In the comparison of the samples studied, greater scores were observed in general satisfaction and in factors in the medical residency care model than in the attending psychiatrist model. There were no significant differences in terms of family member satisfaction in relation to sociodemographic variables. Conclusion Family member satisfaction was high. The need for improvement in aspects related to the infrastructure of services was evident. This paper underlines the importance of continuous and regular evaluations of the services provided, focusing on the satisfaction of users and family members in order to better understand the factors that contribute towards the quality of care provided.
Resumo Objetivo Avaliar a satisfação de familiares cuidadores com um serviço de internação em saúde mental no Brasil. Métodos Trata-se de um estudo transversal, com abordagem quantitativa. Uma amostra de 80 familiares cuidadores respondeu à Escala de Avaliação da Satisfação de Familiares com os Serviços de Saúde Mental (SATIS-BR), além de questionário sociodemográfico. As variáveis categóricas foram expressas como freqüências e porcentagens, e as variáveis quantitativas, como médias e desvios padrão. As interações entre variáveis e índices da escala foram analisadas utilizando o test t de Student, correlação de Pearson e análise de variância. Resultados Os resultados indicaram escore médio de satisfação geral elevado quando considerada a categorização dos itens da escala, tendo ocorrido maiores índices de satisfação no fator 'Resultados do tratamento' e menores índices nos fatores 'Acolhida e competência da equipe' e 'Privacidade e confidencialidade'. Na comparação das amostras estudadas, foram observados maiores escores de satisfação geral e por fator no modelo de atendimento residência médica em relação ao modelo psiquiatra assistente. Não houve diferenças significativas quanto à satisfação dos familiares em relação às variáveis sociodemográficas. Conclusão A satisfação dos familiares foi elevada. Foram evidenciadas necessidades de melhoria nos aspectos relacionados à infraestrutura dos serviços. Esta pesquisa aponta para a importância de serem realizadas avaliações contínuas e regulares dos serviços, tendo como foco a satisfação dos usuários e familiares para uma melhor compreensão dos fatores que contribuem para a qualidade do atendimento.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Family/psychology , Caregivers/psychology , Hospitalization , Mental Health Services , Cross-Sectional Studies , Patient Satisfaction , Hospitals, Psychiatric , Middle AgedABSTRACT
OBJECTIVE: To evaluate the satisfaction of family caregivers with a mental health inpatient service in Brazil. METHODS: This was a cross-sectional study with a quantitative approach. A sample of 80 caretaking family members answered the abbreviated version of the Brazilian Mental Health Services' Family Satisfaction scale (SATIS-BR) and a sociodemographic questionnaire. Categorical variables were expressed as frequencies and percentages and quantitative variables as means and standard deviations. Interactions among variables and indexes of the scale were analyzed using the Student's t test, Pearson correlation coefficient and analysis of variance. RESULTS: The results showed a high mean overall satisfaction score when considering the categorization of the items of the scale, with higher satisfaction indexes in the 'Treatment results' subscale and lower ones in the 'Reception and competence of staff' and 'Privacy and confidentiality' subscales. In the comparison of the samples studied, greater scores were observed in general satisfaction and in factors in the medical residency care model than in the attending psychiatrist model. There were no significant differences in terms of family member satisfaction in relation to sociodemographic variables. CONCLUSION: Family member satisfaction was high. The need for improvement in aspects related to the infrastructure of services was evident. This paper underlines the importance of continuous and regular evaluations of the services provided, focusing on the satisfaction of users and family members in order to better understand the factors that contribute towards the quality of care provided.
Subject(s)
Caregivers/psychology , Family/psychology , Hospitalization , Mental Health Services , Adolescent , Adult , Cross-Sectional Studies , Female , Hospitals, Psychiatric , Humans , Male , Middle Aged , Patient Satisfaction , Young AdultSubject(s)
Amantadine/therapeutic use , Catatonia/drug therapy , Psychotic Disorders/drug therapy , Schizophrenia/drug therapy , Adult , Catatonia/complications , Female , Humans , Male , Psychotic Disorders/complications , Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors , Schizophrenia/complicationsABSTRACT
We report the case of an adult male patient with Tourette syndrome, self-injurious behavior and depression, refractory to conventional treatment, and whose symptoms remitted after electroconvulsive therapy. Serial Technetium 99m-Ethyl-Cysteinate-Dimer single photon emission tomographies were applied, before, during, and after electroconvulsive therapy. The neural substrates of this treatment process were further analyzed by woxel-wise subtracted single photon emission tomography images.
Subject(s)
Brain/diagnostic imaging , Electroconvulsive Therapy , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Tomography, Emission-Computed, Single-Photon , Tourette Syndrome/diagnostic imaging , Tourette Syndrome/therapy , Adult , Brain/blood supply , Brain/physiopathology , Brain Mapping , Brief Psychiatric Rating Scale , Cerebral Cortex/blood supply , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/physiopathology , Combined Modality Therapy , Cysteine/analogs & derivatives , Depressive Disorder/diagnostic imaging , Depressive Disorder/physiopathology , Depressive Disorder/therapy , Humans , Male , Neurologic Examination , Organotechnetium Compounds , Psychotropic Drugs/administration & dosage , Regional Blood Flow/physiology , Self-Injurious Behavior/diagnostic imaging , Self-Injurious Behavior/physiopathology , Self-Injurious Behavior/therapy , Subtraction Technique , Tourette Syndrome/physiopathologyABSTRACT
The hypothesis that schizophrenia involves aberrant inter-hemispheric communication has a long pedigree, however its precise role remains unclear. We therefore report the case of a total agenesis of the corpus callosum in a 21-year-old man with childhood-onset schizophrenia. The presence of schizophrenia with very early onset on absence of corpus callosum offers an opportunity to examine neurodevelopmental model and theories regarding to interhemispheric communication in the pathogenesis of psychosis.
A hipótese que a esquizofrenia envolve comunicação inter-hemisférica aberrante possui longa tradição, entretanto seu papel permanece incerto. Nós relatamos um caso de agenesia total do corpo caloso em um homem de 21 anos portador de esquizofrenia de início na infância. A associação de esquizofrenia de início precoce na ausência de corpo caloso oferece uma oportunidade para exame do modelo neurodesenvolvimental e de teorias que envolvem a comunicação interemisférica na patogênese da psicose.
Subject(s)
Adult , Humans , Male , Corpus Callosum/abnormalities , Schizophrenia, Childhood/etiology , Electroencephalography , Magnetic Resonance Imaging , Schizophrenia, Childhood/pathologyABSTRACT
The hypothesis that schizophrenia involves aberrant inter-hemispheric communication has a long pedigree, however its precise role remains unclear. We therefore report the case of a total agenesis of the corpus callosum in a 21-year-old man with childhood-onset schizophrenia. The presence of schizophrenia with very early onset on absence of corpus callosum offers an opportunity to examine neurodevelopmental model and theories regarding to interhemispheric communication in the pathogenesis of psychosis.
