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Introduction: This review article develops the basic principles for the use and action mechanisms of neuromodulators applied in clinical practice and their role in treating different disorders of gutbrain interaction (DGBI), particularly, esophageal disorders in part I. Materials and methods: The working group reviewed the most frequent pathologies and medications used according to the most recent literature and presented those with the best clinical evidence in each case. Results: Due to the diversity of disorders, types of studies, and therapeutic options, we decided to present the evidence with the best results for each case. We determined the doses used, their results, and the side effects of each one. Conclusions: The basic principles of the use and mechanisms of action of the main neuromodulators were reviewed, including their use in this section in the main esophageal gastrointestinal functional disorders. Given that the available evidence is not definitive, more controlled clinical trials are needed for each condition to confirm the effectiveness and safety of neuromodulators. [ABSTRACT FROM AUTHOR]

Copyright of Dilemas Contemporáneos: Educación, Política y Valores is the property of Dilemas Contemporaneos: Educacion, Politica y Valores and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Psicoterapia y Psicosomática is the property of Instituto de Estudios Psicosomaticos & Psicoterapia Medica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Colombiana de Psiquiatria is the property of Asociacion Colombiana de Psiquiatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Colombiana de Psiquiatria is the property of Asociacion Colombiana de Psiquiatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Kranion is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Colombiana de Psiquiatria is the property of Asociacion Colombiana de Psiquiatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: To present a descriptive analysis carried out at the Toxicological Center of the Angeles Lomas Hospital, Mexico. PATIENTS AND METHODS: A descriptive study of patients treated at the Toxicological Center of the Angeles Lomas Hospital, Mexico, from 2012 to 2019. Patients with intoxication secondary to a suicide attempt were identified. A database was analyzed to validate that they met the established inclusion criteria and the information was collected in a database designed for this purpose. RESULTS: Two-hundred twenty-nine patients with suicide attempt were treated, which represented 20% of the total of intoxicated patients treated in the study period. The xenobiotics involved in each intake were distributed as follows: cyclic antidepressants: 10, benzodiazepines: 101, serotonin reuptake inhibitors: 2, antipsychotics: 16, paracetamol: 13, metals: 3, drugs of abuse: 51, phosphides: 1, antibiotics/antivirals: 58, opioids: 9, plants and herbal preparations: 6, others (anticoagulants, hypoglycemic agents, anticonvulsants): 159, gas (butane): 1. CONCLUSIONS: The approach to the suicidal patient involves a multidisciplinary team, which must be made up of toxicologists, emergency physicians, psychiatrists and psychotherapists, as well as other specialists who are required depending on the xenobiotic involved and the patient's clinical situation (internists, intensivists, gastroenterologists, neurologists, cardiologists and surgeons). [ABSTRACT FROM AUTHOR]

Introduction. Patients with psychotic disorders often have substance use disorders and other addictions. The objective of this study was to know the current treatment situation of these patients focusing on clozapine, which was proposed in most consensus as antipsychotic of first choice in this indication. Material and methods. A survey with 14 questions on aspects related to the treatment and management of the dual disorders was developed, emphasizing the role of clozapine in this disease. Results. The survey was answered by 199 experts in mental illnesses (90.5% physicians and 9.5% psychologists). A total of 88.4% of experts were able to prescribe clozapine, but the majority (89.4%) administered the drug to patients with resistant schizophrenia without considering a dual disorder. Only 30.8% considered the use of clozapine in patients with dual psychosis. The underutilization of clozapine in these patients was mainly attributed to controls of the pharmacovigilance plan, including frequent leukocyte count (57.1%), and lack of drug education (35.6%). The main measures proposed to increase its use are fewer blood tests (29.3%), more training (27.8%), and fewer administrative problems (25.1%). Conclusions. In order to improve the treatment of patients with dual psychosis, it is necessary to simplify the therapy and increase the training of professionals in the use of atypical antipsychotics, especially clozapine, designed to be the drug of choice in the main expert consensus. [ABSTRACT FROM AUTHOR]

Introduction. Despite the high prevalence of sexual dysfunction in patients with schizophrenia, its origins are still unclear. The aim of this study: to determine the prevalence and causal factors of sexual dysfunction in a group of outpatients with schizophrenia. Methods. The study was designed to be cross-sectional and naturalistic, including outpatients with schizophrenia undergoing second generation antipsychotic monotherapy. Patients receiving antidepressants and/or mood stabilisers were excluded. The following data were recorded: sexual functionality, sociodemographic information, sexual history, psychotic and depressive psychopathology, metabolic syndrome and BMI. Psychotropic-Related Sexual Dysfunction Questionnaire (PR SexDQ-Salsex); Positive and Negative Syndrome Scale; Hamilton Depression Rating Scale; Plasma concentrations of prolactin, testosterone, estradiol, progesterone and the International Diabetes Federation diagnostic criteria for metabolic syndrome, were used to complete the study. Results. Of the 57 patients included in the study, 80% exhibited sexual dysfunction, one-third of which suffered severe levels of dysfunction. However, only 30% of patients spontaneously reported this problem. Although there were significant differences in the prevalence of hyperprolactinemia and metabolic syndrome according to the antipsychotic received, multivariant regression analysis did not show a correlation between sexual dysfunction and prolactin, sexual hormones, type of antipsychotic received, psychotic psychopathology or metabolic syndrome. Sexual dysfunction was only associated with age, civil status and depressive psychopathology. Conclusions. There is a high prevalence of sexual dysfunction in the patients with schizophrenia who participated in the study, but it was only associated with higher age, being single or divorced or having depressive psychopathology; this suggests a multifactorial etiology for sexual dysfunction in schizophrenia. [ABSTRACT FROM AUTHOR]

The case report of a newly-delivered woman that went spontaneously to the Gynecology Service in the Teaching Municipal Polyclinic in Santiago de Cuba 37 days after the childbirth is presented, referring that she felt a lot of fear and sensation of intense cold in the head, besides that she could not sleep well. The presumptive diagnosis was postpartum psychosis that was confirmed in the Department of Psychology consultation. The patient was treated with floral therapy and antipsychotics in an ambulatory way, and she maintained follow up until she was discharged. Age over 30 years, and the personal and family history of marital break-up and psychiatric disease respectively were identified as risk factors. [ABSTRACT FROM AUTHOR]

Background: Sleep disorders affect between 70% and 90% of patients with posttraumatic stress disorder (PTSD). Traumatic events that can developing PTSD are often reactivated by nightmares or flashbacks which are considered core symptoms of PTSD. These nightmares in patients who are suffering from PTSD are stressful, and efficacy treatments are necessary. So far, neuropsychologic scientific findings about PTSD-related nightmares are inconclusive but in terms of pharmacologic treatments there are many drugs which have been proposed for reducing PTSD-related nightmares such as antidepressants, anxiolytics antipsychotics, and antihypertensives. These agents are promising agents for the treatment of PTSD-related nightmares. This review examines the efficacy of pharmacotherapy in the reduction of nightmares on patients with PTSD. Material and methods: This is a literature review of the psychopharmacological treatment of PTSD-related nightmares by searching electronic databases in MEDLINE, EMBASE, Cochrane Central, Psych Info database and gray literature from 1980 onwards. Studies investigating the efficacy of psychopharmacological treatment on PTSD-related nightmares were eligible for inclusion in the review. Results: There is an extensive literature regarding treatment of PTSDrelated nightmares. Most of the articles focuses on a general treatment that includes several PTSD symptoms in addition to sleep disorders in which nightmares is included. Such general treatment are antidepressants (Selective Serotonin Reuptake Inhibitors). On the other hand, some clinical trials have demonstrated to be effective on PTSD-related nightmares by blocking a1-adrenoreceptor which include atypical antipsychotics and prazosin. Conclusions: This literature review provides a scientific knowledge of the evidence of the usefulness of a set of drugs. However, it becomes clear that only a few antipsychotics and one antihypertensive (prazosin) are drugs that have proven to be effective in treating PTSD-relate nightmares. It therefore requires a systematic review of both antipsychotics as prazosin to show that such evidence exist about its efficacy. [ABSTRACT FROM AUTHOR]

Introduction. Scientific evidence focused on the treatment response in delusional disorder (DD) patients is scarce, and the findings are controversial. Our goal was to compare the antipsychotic response at the 12-week follow-up between patients diagnosed with DD and patients diagnosed with schizophrenia and to identify potential response dimensions. Methods. A prospective, observational, cohort study with 12-week follow-up was conducted with DD and schizophrenia patients matched for sex, age and cumulative years of disease. The following scales were assessed: Positive and Negative Syndrome Scale (PANSS; 5-factors), Personal and Social Performance Scale (PSP), Clinical Global Impression Scale (CGI), and Columbia-Suicide Severity Rating Scale (C-SSRS). Treatment response was defined as a ≥30% reduction in the total PANSS score. Linear and logistic regression models were used to investigate the potential predictive value of psychopathological variables for the antipsychotic response. Results. Response percentages in DD and schizophrenia were 61.5% and 69.2%, respectively. The duration of untreated psychosis, antipsychotic dosage, and diagnosis did not predict antipsychotic response. In the whole sample, improvement in positive symptoms was significantly associated with the clinical global improvement (p=0.006), explaining almost 20% of the variance in the model. Within the DD group, improvement in cognitive symptoms explained 30% of the variance in clinical global improvement. Conclusions. Both response percentages and required antipsychotic doses were similar between DD and schizophrenia. Changes in positive symptoms were associated with clinical global improvement in the entire sample, and improvement in cognitive symptoms was correlated with global improvement exclusively in DD. [ABSTRACT FROM AUTHOR]

Objectives: To carry out pharmacovigilance (PhV) in a community pharmacy, recording the adverse reactions (ADR) and to refer patients to their doctor if necessary. Methodology: Transversal observational study. In an ad hoc questionnaire, patients' demographic information is collected, along with details about their use of medication, and perceptions about the effectiveness and safety of drugs being studied. Four drugs were selected: duloxetine, venlafaxine, quetiapine and olanzapine, all of which were frequently dispensed in the pharmacy and recently came onto the market. Results: 47 patients used one of the antidepressants studied. 34 (72.3%) women and 13 (27.7%) men. 21 (55.3%) were taking venlafaxine and 26 (44.7%) duloxetine. Mean age 52.9 (SD = 13.7) years (21-80). 36 were undergoing treatment using two of the antipsychotics in the study. 21 (58.3%) used olanzapine and 15 (41.8 %) quetiapine. mean age 41.6 (SD=13.4) years (27-70). 174 ADR in the antidepressants and 120 in the antipsychotics. Dry mouth, tremors, excessive sweating, flatulence and anxiety were the most common ADR in the two antidepressants and dry mouth, decreased libido and weight gain were the most common in the two antipsychotics. One case was reported to the Galician Pharmacovigilance Center. Two patients were referred to their doctors for drug related problems (DRPs). Conclusions: PhV activity in a community pharmacy in A Coruña detected a large number of ADR, contributing to safer pharmacotherapy outcomes for patients. [ABSTRACT FROM AUTHOR]

Due to the frequency of mental diseases as a health problem, the importance of antipsychotics drugs in its treatment, and to the need to identify and prevent some of the undesirable effects wich may result; it was decided to make a literature review of the greater relevant pharmacological characteristics such drugs. This is aimed at providing a knowledge base for all healthcare professionals in order to improve medical care in the health services. [ABSTRACT FROM AUTHOR]

Schizophrenia is one of the most severe psychiatric disorders. It is a chronic mental disease that may include psychotic and cognitive symptoms as well as social withdrawal. The onset of this disorder often occurs in adolescents or young adults. Several theories intend to explain the origin of schizophrenia including alterations in central nervous system development due to stress or infectious agents, as well as genetic predisposition. Whatever the case, dysfunction of several neurotransmitter systems has been associated with this disease including dopamine, glutamate and nitric oxide. Studies about those topics may help to elucidate the pathophysiology of a disease that we know better and, maybe, understand worse. [ABSTRACT FROM AUTHOR]

Copyright of Revista Colombiana de Psiquiatria is the property of Asociacion Colombiana de Psiquiatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. In spite of the historic, clinical and therapeutic importance of cycloid psychosis, no controlled studies have been performed as yet on its treatment. Electroconvulsive therapy has classically been the treatment of choice and the first generation antipsychotics have not been indicated. This study has aimed to analyze the acute treatment (and response to it) of cycloid psychoses. Methodology. In a sample of 75 hospitalized medication- naive patients treated for a First Psychotic Episode (FPE), possible cases of cycloid psychoses were detected using the Perris and Brockington operative diagnostic criteria. The sample was divided into “cycloids" and “non-cycloids" and both groups were compared based on clinical and therapeutic variables. Results. All the patients were treated with second generation antipsychotics. No significant differences (p=0.17; t-1.39) were found in the antipsychotic dose prescribed (equivalents of chlorpromazine). However, significant differences were observed in the improvement on hospital discharge (clinical global impression severity: CGI-S), with better response in the “cycloid" group" (p=0.002; u=162). Significant differences were also observed in the dose of benzodiazepines, there being significantly greater improvement for the “cycloid" group (p>0.001; u=28). Conclusions. Without contradicting the classical idea of the treatment of cycloid psychoses, the present study contributes to the opening of a new therapeutic prospect. Thus, the use of second generation antipsychotics could have a particularly beneficial effect, especially if combined with high doses of benzodiazepines in the acute treatment of cycloid psychoses. However, controlled studies need to be carried out to confirm this. [ABSTRACT FROM AUTHOR]

Hyponatremia is a known adverse effect of antidepressants. A review of the literature was performed in relation to one case treated in our hospital to identify risk factors and possible psychopharmacologic alternatives. A 57-year old woman with HIV and HCV suffered 4 episodes of severe hyponatremia within 5 months of treatment involving the following drugs: thiazide diuretic, venlafaxine, citalopram, olanzapine, haloperidol, enalapril and escitalopram. Risk of hyponatremia is higher in patients treated with antidepressants, especially selective serotonin reuptake inhibitors. Advance age, female gender, thiazidic diuretics, sodium levels in the lower limits and low weight increase the risk. All the SSRIs can produce hyponatremia. In most of the cases, this effect appears in the first month. It is not dose dependent and the patient recovers when treatment is interrupted. Early detection as well as the evaluation of concomitant risk factors in all patients starting antidepressant are important. It seems necessary to control ions periodically and to choose safe drugs. [ABSTRACT FROM AUTHOR]

The cognitive deficits in schizophrenia is measured by neuropsychological tests. It is believed that poor performance of patients is due to certain brain differences found in these patients by neuroimaging studies. Proponents of this theory argue that schizophrenia is a biological disease genetically determined, and defend, the thesis that the cognitive deficits and brain differences in schizophrenia are signs of the disease and are independent of treatment with antipsychotics. This paper argues the opposite perspective. Showing data supporting the idea that antipsiychotic drugs cause brain changes that correspond to the differences found in schizophrenics. Also argues that cognitive deficits can not be independent of treatment with these drugs. The data provided to argue this thesis still remain relevant have not been into account by theorists of cognitive deficits in schizophrenia. [ABSTRACT FROM AUTHOR]

Schizophrenia is a severe and chronic disorder affecting children, adolescents and adults. The international recommendations for the treatment of pediatric patients with this disorder point to a comprehensive management which includes early detection programs, pharmacological and psychosocial treatment. A review of current information regarding the efficacy and safety of antipsychotics in children and adolescents, as well as the effect of psychosocial interventions on the academic and social functioning of patients with early onset schizophrenia is presented. The pharmacological treatment's goal is to achieve optimal outcome with the lowest effective dose and the fewest side effects. It should be started with an antipsychotic that has been evaluated on its efficacy and safety in this age group. Risperidone, olanzapine and aripiprazole have been approved for the treatment of schizophrenia in adolescents, clozapine has shown greater efficacy for the treatment resistant condition. The side effects of these drugs must be monitored during treatment. The psychosocial treatment objectives are to provide information, to promote the patient's adaptation, to reduce comorbidity and to prevent relapses through psychoeducation, psychotherapy and rehabilitation programs. The psychoeducation programs include information about the characteristics and causes of the illness, the available treatment choices and the factors associated to recovery or relapse. Psychotherapy in schizophrenia has been examined in individual, group and family modalities, the cognitive behavioral therapy has demonstrated efficacy on cognition, social adjustment and quality of life. The rehabilitation programs include the training on social skills, cognitive remediation therapy and exercise programs, which would increase the wellbeing of patients and reduce metabolic alterations associated to the use of antipsychotics. In conclusion, the treatment of patients with early onset schizophrenia must be multimodal and directed to improve their long term outcome.s [ABSTRACT FROM AUTHOR]

Schizophrenia is a chronic disease of body and mind that affects 1% of the population. The existence of the person with schizophrenia should be understood, at least, with two perspectives: one considering the integration of the individual into the social community, another which includes the understanding that there is a patient with a medical problem treatable with medications and psychotherapies. There is a large group of patients with 'treatment-resistant schizophrenia," that is, cases in which a minimum degree of remission with conventional treatments is not obtained. These cases have pointed to the fact that even today we still lack an integrative treatment model obtained through the assembling of specific interventions with verifiable effectiveness. The concept of treatment-resistant schizophrenia should have evolved in accordance with the advancing of the currently available knowledge and therapeutic resources. Why hasn't this happened? This article reviews the history of the concept of "resistance" to account for such failure and proposes a methodological approach to overcome this stagnation. [ABSTRACT FROM AUTHOR]

In the article a brief nosographic revision is realised on the epistemic and clinical situation of praxis psychiatric, to raise a critical reflection on the justification or not of iatrogenia psychogenic caused in some psychotics patients and on the matter to remember the directives of the Universal Declaration on Bioethics and Human rights of UNESCO (2005). [ABSTRACT FROM AUTHOR]

Based on present knowledge, in this work we review the importance of the pharmacogenetic tests in the treatment with antipsychotic drugs. Many associations have been reported between different genetic markers and response to treatment as well as to the appearance of adverse reactions. However, up to now, no "prime" biomarker capable of unequivocally predicting the clinical benefits of a specific treatment or its toxicity has been identified. The use of individual pharmacogenetic markers has been demonstrated to have little clinical utility, and therefore the combination of information obtained from the analysis of different genes seems to be a more promising strategy. Inclusion of pharmacogenetic tests in clinical trials conducted prospectively and that include a large number of cases could, undoubtedly, significantly contribute to the development of individualized medicine protocols. [ABSTRACT FROM AUTHOR]

Introduction. The importance of the glial cells in the function of the nervous system and in its pathology has been the object of multiple studies in the last years. Specifically, their role in the action of the antipsychotics is debated. Our study has analyzed glial reactivity in rats treated with antipsychotics. Methodology. In a first ultrastructural study of the arcuate nucleus of the hypothalamus, the animals were treated with chlorpromazine for 40 days, and were sacrificed at the end of the treatment, after 20 days of rest without treatment. In another series of studies, with the light microscope and immunohistochemistry we evaluated the immunoreactivity of the glial fibrillary acidic protein (GFAP) in six regions of the central nervous system of rats treated with typical and atypical antipsychotics. Results. With the electron microscope, the animals treated with chlorpromazine showed a significant reduction of the axosomatic synapses on the neurons of the hypothalamic arcuate nucleus and an increase of glial presence, as noted by the greater amount of astrocyte processes. The mentioned modifications were reversible, tending to normalize in a group of animals sacrificed 20 days after completion of the treatment. In the immunohistochemical study, the glial reaction was important in the territory of the nucleus accumbens with all the antipsychotics, moderate in the cingulate cortex, although only with atypical antipsychotics, and scarcely significant in the rest of the regions. Conclusions. Our results confirm that the glial cells are targets of the antipsychotic action, and this will allow us to better understand the action of these drugs and the role of the glial cells in the normal function of the nervous system and in the mental disease. [ABSTRACT FROM AUTHOR]

Schizophrenic treatment was developed during the second half of the last century, mainly within the context of the development of antipsychotic drugs. Even though there has been significant progress due to the availability and use of multiple drugs, these can still be classified into three basic groups of antipsychotic drugs (atypical antipsychotics, typical antipsychotics and dopamine partial agonist antipsychotics). Their primary antipsychotic mechanism is still the action on the dopamine systems. Many of the second-generation antipsychotics are believed to offer advantages over first-generation agents in the treatment for schizophrenia. However, the drug properties that provide the different therapeutic effects from those of the first generation are not clear and some adverse effects may still affect the patient's health and quality of life. Furthermore, the efficacy of the antipsychotics is limited. This has led to the use of adjuvant medications to strengthen the treatment effects. On the other hand, work is being done on the development of new research lines to develop new non-dopaminergic antipsychotic drugs, with not very successful results. The aim of this paper is to make a brief review on the current therapeutic armamentarium for schizophrenia, the strategies to develop drugs, and theories of mechanisms of action of antipsychotics. Emphasis is placed on the new therapeutic targets for the development of future treatments. [ABSTRACT FROM AUTHOR]

Aripiprazole is a dopamine partial agonist antipsychotic drug that has just been approved in Europe for its use in the treatment of acute mania and for the prevention of manic episodes in bipolar disorder. Its efficacy in mania is superior to that of placebo, both as monotherapy and as adjunctive therapy, and comparable to that of haloperidol and lithium. From the safety perspective it is remarkable that it is not highly sedative and does not impair the metabolic parameters. The advantages of a non-sedative and metabolically neutral antimanic drug are particularly relevant in the long-term, due to their impact on cognition and quality of life. The experience on its use in routine clinical practice indicates that in order to avoid phenomena such as activation, abrupt worsening or akathisia, it is recommendable to start treatment with low doses and to increase them progressively, especially in those patients who are already receiving other drugs; moreover, it is advisable not to stop abruptly any ongoing treatment, unless there is an emergency, to transiently prescribe a concomitant benzodiazepine, and to maintain the dose that proved efficacious during the short term treatment during maintenance therapy. [ABSTRACT FROM AUTHOR]

Metabolic polymorphism can alter the efficiency of a treatment or influence the occurrence of adverse reactions. Cytochrome 450, includes CYP2D6 which metabolizes 20% of drugs such as antipsychotic and antidepressive. Several studies have shown significant racial differences in the prevalence of phenotypes of CYP2D6, but there is not enough information on this subject in pediatric populations. Polymorphism of cytochrome is of great importance in pediatric pharmacotherapy, because of its therapeutic limitations are due to the lack of knowledge of metabolic characterization as well as, the lack of monitoring of the treatment results. Pharmacogenetic techniques are important inasmuch as they help physicians to prescribe more adequate doses of antipsychotic drugs which are currently effective only in 30% of the patients. "Personalized medicine" is important in psychiatry in order to optimize the dose of psychoactive drugs, by means of the use of CYP2D6 phenotyping, which allows to classify patients as slow, fast, intermediate and ultrarapid metabolizers. Phenotyping is done with the use of dextromethorphan as an indicator of the metabolism of CYP2D6. After oral administration of a single 0.5 mg/kg dose of DM, its urinary concentration and that of its metabolite (dextrorphan) are measured with HPLC method for fluorescence detection. [ABSTRACT FROM AUTHOR]

Introduction. Psychotropic drugs are frequently used in the population and account for a big share of the Spanish health budget. This study aims to describe the patterns of use of psychotropic drugs in the Spanish general population and its relationship with mental health. Methods. A stratified, multistage, clustered area, probability sample design was used and 5,473 non-institutionalized individuals older than 18 were randomly selected among the Spanish population. They were administered the Spanish version of the World Health Organization-Composite International Diagnostic Interview (CIDI 3.0). Information on previous 12-months psychiatric symptoms and psychotropic drugs use was obtained. The proportion of individuals using psychotropic drugs was estimated and stratified according mental health diagnosis. Multivariate analyses were carried out in order to assess the influence of sociodemographic factors on use. Results. 16% of the sample had used some psychotropic drug. Benzodiacepines (11.4 %) and antidepressants (4.7%) were the most commonly used and the most common combination (1.8%). Women showed the highest use of any drug (odds ratio [OR]: 2.1; 95 confidence interval [CI]: 1.7-2.5), benzodiacepines (OR: 2.3; 95 CI: 1.9-2.8), antidepressants (OR: 2.2; 95 CI: 1.6-3.1) and antipsychotics (OR: 1.9; 95 CI: 1.2-3.0). The odds of use did increase with age, and was related with the presence and number of mental disorders. Conclusions. Use of psychotropic drugs in the Spanish general population is high, although many individuals with mental disorders remain untreated. Gender and age showed an association with psychotropic drug use independent of mental health. [ABSTRACT FROM AUTHOR]

Introduction. We describe the different diseases in which conventional and second generation antipsychotic (APS) prescriptions are made. Method. Observational, retrospective, multicenter study based on the review of 300 clinical records of public and private sites, hospital and out-patient clinics, located in Salamanca, Vigo, Bilbao, Barcelona, Valencia, Oviedo and Malaga. Results. The mean age of the population studied was 42 ± 17 years; 56.6% were men. Atypical drugs (67%) were used basically versus classical ones (33 %). Classical APS are basically prescribed in bipolar disorder with/without psychotic symptoms (20.6 %), schizophrenia (18.3%) and delusional disorder (11.5 %). Atypical APS are fundamentally prescribed in schizophrenia (31.5 %), bipolar disorders with/without psychotic symptoms (12.5 %) and other psychotic disorders (8.9 %). When the psychotic disorders are considered by groups (schizophrenia, bipolar disorder with psychotic symptoms, delusional disorder and other psychotic disorders), classical APS are used in 47.4% and atypical APS in 62.5%. APS were used «outside the indication » (off-label) in 32.8 %, including resistant depressions, serious obsessive-compulsive disorder and borderline personality disorder, with similar percentages for both conventional and atypical ones. In dementia, atypical APS were used in 5.1% versus 1.5% of the conventional ones. The most frequent reasons for prescription of classical APS were control of psychotic symptoms (33.6%), aggressivenessagitation (31.3 %), severe insomnia (16 %), impulsivity (6.9 %) and severe anxiety (6.1 %). Atypical APS were preferably used in the control of psychotic symptoms (58.8%) and aggressiveness-agitation (25.5%). Conclusions. The use of APS basically occurs within their authorized indications (67.2 %). The off-label use (32.8 %) occurs both for the classical as well as atypical APS and occurs in serious diseases in which there are no alternative treatments. [ABSTRACT FROM AUTHOR]

Introduction. Presence of disruptive behavioural and psychological symptoms in dementia (BPSD) is highly prevalent and, as a consequence, neuroleptics are frequently used in these patients to control BPSD. Several reviews have shown the clinical equivalence of different classes of neuroleptics in BPSD control, although that equivalence has been only indirectly assessed by comparing the combined results of different types of active drugs versus placebo. Thus, little is known on the comparative effectiveness, head to head, of different neuroleptics on BPSD. The aim of this study was to gather preliminary information on the effectiveness of typical (haloperidol, thioridazine) and atypical (olanzapine, risperidone) neuroleptics on BPSD. Methods. Multicenter, observational and retrospective study using chart reviews of patients with dementia to assess neuroleptic prescriptions and clinical outcomes at 12 weeks on treatment. Results. No significant differences on BPSD improvement were found by type of neuroleptic (n=78; Kruskal-Wallis exact test; p=0.47). There also were no differences by neuroleptics when the analysis was stratified by levels of cognitive decline (Kruskal-Wallis exact test; p=0.86 and 0.87 for moderate and severe levels of deterioration, respectively). Recorded side effects were worse in the haloperidol group (n=19) regarding rigidity (Fisher's exact; p=0.01), tremor (Fisher's exact p=0.03) and akathisia (Fisher's exact; p=0.03). Conclusions. Our findings support the equivalence in effectiveness of several classes of neuroleptics commonly used to treat BPSD. Nevertheless these results need to be confirmed by adequately powered randomized trials and further pharmacoepidemiological studies to assess their safety. [ABSTRACT FROM AUTHOR]

INTRODUCTION: New antipsychotics are associated with fewer adverse effects than classical ones. However, an increase in the patient's quality of life is not clear, given the complex relationship between quality of life and schizophrenia. OBJECTIVE: To show there are no real differences in adverse effects and quality of life of schizophrenic patients treated with atypical and typical neuroleptics. METHODS: Transversal study. The sample (78 male and female patients between 18 and 80 years old) was divided into three treatment groups: atypical, typical and both kinds of neuroleptics. Measurement instruments used were Udvalg Fur Kliniske Undersogesler (UKU) for adverse effects and Quality of Life Scale (QLS) for quality of life. RESULTS AND CONCLUSIONS: Treatment with atypical antipsychotic is significantly associated with fewer extrapyramidal adverse effects but not with a better quality of life in the scales applied. Probably quality of life does not only depend on treatment. It may also be affected by other several factors such as negative symptomatology and a long-term evolution of schizophrenia, which are not included in the quality of life scales used. However, this is a pilot study, in which we have used only a quality of life scale and a small sample chosen without previous sample calculus. Taking this into account, general conclusions on efficacy and global acceptance of antipsychotics cannot be deduced. [ABSTRACT FROM AUTHOR]

Reserpine, an alkaloid of the Rauwolfia serpentina plant isolated during the middle of the 20th Century, represented a highly important clinical advance in the treatment of schizophrenia whose pharmacological tools were limited to chlorpromazine that was introduced in the clinical area two years before. Both agents would come into the history as the drugs that made possible the beginning of the psychopharmacological era. In the present article, a revision is made of the complicated process leading to the isolation and synthesis of reserpine, by the Swiss pharmaceutical company Ciba (Schlittler and Muller) and how its pharmacological properties (Bein) were discovered and studied, in the animals laboratory, mainly, the "tranquillizers". The introduction of this antipsychotic in psychiatry, which was initiated in 1954 (half a century ago), and the results obtained in the first clinical studies, as well as the role played by researchers such as Kline, Delay, Noce, Hollister, Altschule, etc. are then described. In addition, and from a historical perspective, the discovery of the adverse effects of this drug, especially those of extrapyramidal nature (dyskinesia and akathisia), are studied, concluding with the reasons that produced its rapid clinical decline, among which the genesis of depressive pictures (phenomenon presently questioned) may be emphasized. Finally, the conclusion reached was that, although the clinical relevance of reserpine was not as evident and long lasting as chlorpromazine, its initial contribution to the treatment of schizophrenic patients was of maximum importance. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Due to the lack of scientific studies in the psychopharmacological treatment of psychosis, the references advise against the use of antipsychotic polypharmacy (AP). This study investigates the situation of this matter and its relationship with the introduction of atypical antipsychotics (AA) in our daily out-patient practice. METHODS: The study group included 160 patients, with ICD-10 diagnosis of non-affective psychosis and illness evolution of at least two years, whose ages ranged from 18 to 65 years, without mental retardation, who came to the out patient clinic at least once during the first semester of 2002 and, in order to make a comparison, at least one other time 9 to 12 months before. The retrospective study was done using the clinical records. RESULTS: In both moments studied, more than 50 % of the patients (65 % and 63.4 % respectively) had AA as their only treatment. AP was 25.6 % and 26.9 % respectively, 19.4 % of all patients were always in AP. At the end of the study, patients on AP were being prescribed a higher dose of chlorpromazine equivalents per day (p < 0.001) and more anticholinergics (p < 0.001). CONCLUSIONS: Our results show that in out patient settings AA have been consolidated as the first treatment option and that AP is a very common and stable phenomenon. [ABSTRACT FROM AUTHOR]

Introducción. El objetivo de este trabajo fue estudiar posibles asociaciones entre la respuesta a la olanzapina y variaciones genotípicas (polimorfismos) en genes implicados en la transmisión serotoninérgica, en una muestra de pacientes esquizofrénicos en tratamiento con este fármaco estudiados prospectivamente. Metodología. Un total de 51 pacientes sin relación familiar, con un diagnóstico de esquizofrenia (DSM-IV) fueron tratados con olanzapina (dosis media: 12 mg/día, rango: 5-25) y seguidos durante un período de al menos tres meses. La respuesta a la olanzapina se midió mediante las diferencias entre las puntuaciones basales y post-tratamiento en la escala PANSS y GAS. Se estudiaron los siguientes polimorfismos: receptor de serotonina 5-HT2A (102-T/C, His452Tyr), receptor de serotonina 5-HT2C (Cys23Ser, -330-GT/-244-CT), y transportador de serotonina (VNTR, 5-HTTLPR). Resultados. Se observó una mejoría clínica global medida tanto con la escala GAS como con la PANSS. La distribución de frecuencias genotípicas y alélicas de cada polimorfismo al diferenciar los pacientes entre respondedores y no respondedores fue similar a la observada en estudios previos con clozapina. En los análisis de regresión, el polimorfismo ­330-GT/-244-CT de la 5-HT2C y el 5-HTTLPR del transportador de serotonina mostraron una tendencia hacia la asociación con la respuesta a la olanzapina. Conclusiones. En nuestro estudio, se observaron indicios para creer que las variaciones en los genes relacionados con la transmisión serotoninérgica pueden desempeñar un papel importante en la determinación de la respuesta clínica a la olanzapina. Considerando estudios previos, también podemos concluir que la olanzapina y la clozapina pueden tener afinidades similares por los receptores serotoninérgicos. [ABSTRACT FROM AUTHOR]

Objetivos: Analizar la incidencia de síntomas extrapiramidales (SEP) y el uso concomitante de fármacos anticolinérgicos en pacientes ambulatorios, diagnosticados de esquizofrenia, tratados con olanzapina (OLZ) en comparación con haloperidol (HAL) y risperidona (RIS), en las condiciones habituales de la práctica clínica. Material y métodos: El análisis se realizó a partir de la información obtenida en el estudio EFESO, un estudio observacional, prospectivo, realizado en pacientes ambulatorios diagnosticados de esquizofrenia tratados con olanzapina frente a otros antipsicóticos utilizados en la práctica clínica. En el presente trabajo, se analizó la incidencia de SEP del grupo tratado con OLZ frente a los grupos de tratamiento en los que se incluyeron más de 100 pacientes: haloperidol y risperidona. La duración del estudio fue de seis meses y los datos fueron recogidos por 293 psiquiatras de áreas de salud mental. Resultados: El porcentaje de pacientes que presentó al menos un acontecimiento adverso fue menor en el grupo de OLZ (47,8%) en comparación con los subgrupos de HAL (79,8%) y RIS (57,2%) (p¾ 0,001). Un porcentaje menor de pacientes tratados con OLZ (36,9%) presentó SEP en comparación a los subgrupos de RIS (49,6%) y HAL (76%) (p¾ 0,001). Un porcentaje menor de pacientes del grupo de OLZ (10,2%) recibió tratamientos anticolinérgicos respecto a los subgrupos de RIS (19,9%) y HAL (44%); (p < 0,001 en ambos casos). Conclusiones: Los pacientes tratados con OLZ presentaron menor incidencia de SEP y menor necesidad de tratamiento anticolinérgico que los pacientes tratados con HAL y RIS. Estos resultados, obtenidos en condiciones naturalistas, coinciden con las conclusiones de los ensayos clínicos realizados previamente a la comercialización de OLZ. [ABSTRACT FROM AUTHOR]

We assessed the efficacy and tolerance of switching to monotherapy with quetiapine fumarate (QF) in treatment-resistant schizophrenia with other antipsychotics, including atypical ones. QF treatment was maintained for 8 weeks. The PANSS scores improved at least 40% over this period. QF was well tolerated without the presence of serious adverse effects. Switching to QF in these patients may therefore be considered as optimal in response and tolerance. [ABSTRACT FROM AUTHOR]