Analysis of the management of antipsychotics in a group of prisons.

Objective: To assess the use of prescribed antipsychotic treatments in the Spanish prison population in order to determine whether there are differences in efficacy and cost between the different long-acting antipsychotic injectables (LAIs). Material and method: An observational, retrospective study was carried out in twelve prisons and in two prison psychiatric hospitals. To assess efficacy, all the clinical histories of patients with some kind of LAI were reviewed and only those who were in a situation of therapeutic stability were selected, defined as those treatments that had not undergone any change in the three last months, both in doses and in the association of another antipsychotic. Results: Of the 11,953 inmates included in the study, 1,851 (15.5%) received prescriptions for an antipsychotic, 415 in penitentiary psychiatric hospitals (87%) and 1,436 in prisons (12%), which is a much higher prevalence than that found in the population. Regarding the prescription pattern of LAIs, paliperidone is the most widely prescribed in prison psychiatric hospitals and prisons, followed by aripiprazole, zuclopenthixol and risperidone. Finally flufenazine, olanzapine and paliperidone quarterly, which are scarcely represented. Of the 292 patients with LAI, 41% (121 patients) are with monotherapy and 59% (171 patients) are with polytherapy, which is similar to the data found in the bibliography. Discussion: The use of prescribed LAIs amongst inmates is widespread. Polytherapy is also a common phenomenon, although there is a downward trend due to the use of more recently marketed drugs. Since the use of LAI is long-term, with numerous side effects and a wide range of prices, it is essential to consider the patient's risk factors and the cost of treatment alongside the therapeutic efficacy.

Análisis del manejo de antipsicóticos inyectables de larga duración en varios centros penitenciarios / Analysis of the management of antipsychotics in a group of prisons

Objetivos: Evaluar el uso de los tratamientos antipsicóticos prescritos en la población reclusa española y determinar si hay diferencias, en cuanto a eficacia y coste, entre los diferentes antipsicóticos inyectables de larga duración (ALD). Material y método: Estudio observacional, retrospectivo, efectuado en doce centros penitenciarios (CCPP) y en dos hospitales psiquiátricos penitenciarios. Para evaluar la eficacia, se revisaron todas las historias clínicas de pacientes con algún ALD y se seleccionaron los que estaban en situación de estabilidad terapéutica, definida como aquellos tratamientos que no habían experimentado ningún cambio en los tres últimos meses, tanto en dosis como en la asociación de otro antipsicótico. Resultados: De 11.953 internos incluidos, 1.851 (el 15,5%) tenían prescrito algún antipsicótico; 415 (el 87%) en los hospitales psiquiátricos penitenciarios y 1.436 (el 12%) en los CCPP. La paliperidona es el ALD más prescrito en hospitales psiquiátricos penitenciarios y en CCPP, seguido del aripiprazol, el zuclopentixol y la risperidona. La flufenazina, la olanzapina y la paliperidona trimestral están poco prescritos. El 41% de los pacientes eran tratados con monoterapia y el 59% con politerapia. Con los ALD de más reciente incorporación, se ha observado una tendencia a la disminución de la politerapia. Discusión: La prevalencia de prescripción de ALD en población reclusa es muy superior a la de la población no presa. La politerapia está muy extendida, aunque muestra una tendencia descendente con el uso de los fármacos más recientemente comercializados. Se recomienda que además de la eficacia terapéutica se valore a la hora de prescribir el riesgo de interacciones farmacológicas y el coste del tratamiento

Objective: To assess the use of prescribed antipsychotic treatments in the Spanish prison population in order to determine whether there are differences in efficacy and cost between the different long-acting antipsychotic injectables (LAIs). Material and method: An observational, retrospective study was carried out in twelve prisons and in two prison psychiatric hospitals. To assess efficacy, all the clinical histories of patients with some kind of LAI were reviewed and only those who were in a situation of therapeutic stability were selected, defined as those treatments that had not undergone any change in the three last months, both in doses and in the association of another antipsychotic. Results: Of the 11,953 inmates included in the study, 1,851 (15.5%) received prescriptions for an antipsychotic, 415 in penitentiary psychiatric hospitals (87%) and 1,436 in prisons (12%), which is a much higher prevalence than that found in the population. Regarding the prescription pattern of LAIs, paliperidone is the most widely prescribed in prison psychiatric hospitals and prisons, followed by aripiprazole, zuclopenthixol and risperidone. Finally flufenazine, olanzapine and paliperidone quarterly, which are scarcely represented. Of the 292 patients with LAI, 41% (121 patients) are with monotherapy and 59% (171 patients) are with polytherapy, which is similar to the data found in the bibliography. Discussion: The use of prescribed LAIs amongst inmates is widespread. Polytherapy is also a common phenomenon, although there is a downward trend due to the use of more recently marketed drugs. Since the use of LAI is long-term, with numerous side effects and a wide range of prices, it is essential to consider the patient's risk factors and the cost of treatment alongside the therapeutic efficacy

Reduced to oxidized glutathione ratios and oxygen sensing in calf and rabbit carotid body chemoreceptor cells.

1. The aim of this work was to test the redox hypotheses of O(2) chemoreception in the carotid body (CB). They postulate that hypoxia alters the levels of reactive oxygen species (ROS) and the ratio of reduced to oxidized glutathione (GSH/GSSG), causing modifications to the sulfhydryl groups/disulfide bonds of K+ channel proteins, which leads to the activation of chemoreceptor cells. 2. We found that the GSH/GSSG ratio in normoxic calf CB (30.14 +/- 4.67; n = 12) and hypoxic organs (33.03 +/- 6.88; n = 10), and the absolute levels of total glutathione (0.71 +/- 0.07 nmol (mg tissue)(-1), normoxia vs. 0.76 +/- 0.07 nmol (mg tissue)(-1), hypoxia) were not statistically different. 3. N-Acetylcysteine (2 mM; NAC), a precursor of glutathione and ROS scavenger, increased normoxic glutathione levels to 1.03 +/- 0.06 nmol (mg tissue)(-1) (P < 0.02) and GSH/GSSG ratios to 59.05 +/- 5.05 (P < 0.001). 4. NAC (20 microM-10 mM) did not activate or inhibit chemoreceptor cells as it did not alter the normoxic or the hypoxic release of (3)H-catecholamines ((3)H-CAs) from rabbit and calf CBs whose CA deposits had been labelled by prior incubation with the natural CA precursor (3)H-tyrosine. 5. NAC (2 mM) was equally ineffective in altering the release of (3)H-CAs induced by stimuli (high external K+ and ionomycin) that bypass the initial steps of the hypoxic cascade of activation of chemoreceptor cells, thereby excluding the possibility that the lack of effect of NAC on normoxic and hypoxic release of (3)H-CAs results from a concomitant alteration of Ca(2+) channels or of the exocytotic machinery. 6. The present findings do not support the contention that O(2) chemoreception in the CB is linked to variations in the GSH/GSSG quotient as the redox models propose.