RESUMO
BACKGROUND: Atypical antipsychotics effectively reduce maladaptive behavior in individuals with mental retardation, yet bring significant weight gain and metabolic anomalies. Ziprasidone, a weight-neutral antipsychotic in patients with schizophrenia or schizoaffective disorder, has not been studied in a population with mental retardation and maladaptive behaviors. METHOD: Forty patients with mental retardation and maladaptive behaviors who had gained excessive weight or were inadequately responsive to other agents were switched to ziprasidone. Weight, total cholesterol, HDL, LDL, triglycerides, and frequency of maladaptive behavior were recorded at baseline and after 6 months of ziprasidone treatment. RESULTS: Ziprasidone treatment was associated with a significant weight loss of 8.1 lb (3.6 kg) as well as a significant reduction in total cholesterol and triglycerides (p < or =.05). The monthly frequency of the maladaptive behavior remained unchanged or improved in 72% (18/25) of the patients in whom maladaptive behavior was assessed. CONCLUSION: Ziprasidone effectively reduces the frequency of maladaptive behavior in a patient group with mental retardation without causing weight gain or metabolic disturbances.
Assuntos
Antipsicóticos/uso terapêutico , Glicemia/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Deficiência Intelectual/reabilitação , Lipídeos/sangue , Transtornos Mentais/tratamento farmacológico , Piperazinas/uso terapêutico , Tiazóis/uso terapêutico , Antipsicóticos/administração & dosagem , Colesterol/sangue , Esquema de Medicação , Feminino , Seguimentos , Humanos , Deficiência Intelectual/sangue , Deficiência Intelectual/psicologia , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Piperazinas/administração & dosagem , Escalas de Graduação Psiquiátrica , Tiazóis/administração & dosagem , Resultado do Tratamento , Triglicerídeos/sangueRESUMO
Intravenous access cannot always be promptly obtained when treating status epilepticus outside the hospital. We compared the efficacy and safety of diazepam rectal gel to IV lorazepam in our long-term care facility for adults with developmental disabilities. Diazepam rectal gel was given more quickly and reliably, reducing total seizure time, potential neuronal injury and other complications. A treatment protocol for treating status epilepticus with diazepam rectal gel is given.
Assuntos
Anticonvulsivantes/administração & dosagem , Diazepam/administração & dosagem , Estado Epiléptico/tratamento farmacológico , Administração Retal , Adulto , Anticonvulsivantes/uso terapêutico , Moradias Assistidas/estatística & dados numéricos , Diazepam/uso terapêutico , Serviços Médicos de Emergência , Feminino , Humanos , Injeções Intravenosas , Lorazepam/administração & dosagem , Lorazepam/uso terapêutico , Masculino , Pessoas com Deficiência Mental/estatística & dados numéricos , Estado Epiléptico/enfermagem , Fatores de Tempo , Resultado do TratamentoRESUMO
A 52-year-old woman and a 56-year-old man who were receiving carbamazepine experienced markedly elevated levels of its active metabolite, carbamazepine-10,11-epoxide (CBZ-E), after starting quetiapine therapy. The CBZ-E:carbamazepine ratio increased 3-4-fold in each patient. Levels of CBZ-E returned to baseline after discontinuing this drug combination. The metabolite can accumulate and cause neurotoxicity. The woman experienced ataxia and agitation while receiving quetiapine, which resolved after carbamazepine was switched to oxcarbazepine. The man was asymptomatic. To our knowledge, these are the first two case reports describing this interaction. Quetiapine may inhibit epoxide hydrolase and/or glucuronidation of carbamazepine-10,11-trans-diol in the same way as valproate and possibly lamotrigine do. If carbamazepine and quetiapine are administered concurrently, clinicians should consider monitoring CBZ-E concentrations.
