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Objective: There is a lack of studies on the natural history of the initial stages of schizophrenia in Colombia. This study aims to assess functionality in the first five years after the diagnosis of schizophrenia. Methods: Naturalistic longitudinal study of 50 patients with early schizophrenia evaluated between 2011 and 2014. Data about demographic background, symptoms, introspection, treatment and adverse reactions were collected in all patients every 3 months for at least 3-5 years. Functionality was measured with the Global Assessment of Functioning (GAF) and Personal and Social Performance (PSP) scales. Results: Patients were followed up for a mean of 174 ± 62.5 weeks and showed moderate difficulties in overall functioning. This functioning was modified by polypharmacy, degree of introspection, changes in antipsychotic regimens, and the number of episodes, relapses and hospitalisations. Conclusions: The results suggest that functional outcomes seem to be related to the use of polypharmacy, degree of insight, changes in antipsychotic regimens, and number of episodes, relapses and hospitalisations during the first years of schizophrenia. RESUMEN Objetivo: Existe una falta de estudios en la historia natural de los estadios iniciales de la esquizofrenia en Colombia. Este estudio apunta a evaluar la funcionalidad en los primeros cinco años después del diagnóstico de esquizofrenia. Método: Estudio longitudinal naturalístico de 50 pacientes con esquizofrenia temprana evaluados entre los anos 2011 y 2014. Loa datos demográficos, síntomas, introspección, tratamiento, y reacciones adversas fueron recolectados en todos los pacientes cada 3 meses por lo menos3a5anos. La funcionalidad se midió mediante la escala global de funcionamiento (GAF), y la escala de funcionamiento personal y social (PSP). Resultados: Los pacientes fueron seguidos por una media de 174 semanas (SD: 62.5) y mostraron dificultades moderadas en su funcionamiento global. Este funcionamiento fue modificado por la presencia de polifarmacia, grado de introspección, cambios en los esquemas antipsicóticos, y el número de episodios, recaídas, y hospitalizaciones. Conclusiones: Los resultados sugieren que los desenlaces en funcionalidad parecen estar relacionados con uso de polifarmacia, grado de introspección, cambios en esquemas antipsicóticos, y numero de episodios, recaídas, y hospitalizaciones durante los primeros años de esquizofrenia.

Anticholinergic medication abuse is common in patients with schizophrenia. The recreational use of anticholinergic plants for their euphoria inducing and hallucinogenic properties is a rising concern in America and Eastern Europe, but rare in Portugal. Anticholinergic misuse poses a challenge to Psychiatrists treating patients with dual pathology, for its addictive potential. In managing antipsychotic medication and its side effects in this population one must have in mind the potential for abuse of anticholinergics. We present a case report of a patient with schizophrenia and abuse of anticholinergic plants, after receiving biperiden to treat extrapyramidal symptoms. Later we discuss anticholinergic effects and potential for addiction and explore ways to prevent and treat drug misuse in this context.

Schizophrenia patients show very complex symptoms in several psychopathological domains. Some of these symptoms remain poorly treated. Therefore, continued effort is needed to find novel pharmacological strategies for improving schizophrenia symptoms. Recently, minocycline, a second-generation tetracycline, has been suggested as an adjunctive treatment for schizophrenia. The antipsychotic-like effect of doxycycline, a minocycline analog, was investigated here. We found that both minocycline and doxycycline prevented amphetamine-induced prepulse inhibition (PPI) disruption. However, neither of them blocked MK801-induced effects, albeit doxycycline had a modest impact against ketamine-induced effects. Neither c-Fos nor nNOS expression, which was evaluated in limbic regions, were modified after acute or sub-chronic treatment with doxycycline. Therefore, apomorphine inducing either PPI disruption and climbing behavior was not prevented by doxycycline. This result discards a direct blockade of D2-like receptors, also suggested by the lack of doxycycline cataleptic-induced effect. Contrasting, doxycycline prevented SKF 38393-induced effects, suggesting a preferential doxycycline action at D1-like rather than D2-like receptors. However, doxycycline did not bind to the orthosteric sites of D1, D2, D3, D4, 5-HT2A, 5-HT1A, and A2A receptors suggesting no direct modulation of these receptors. Our data corroborate the antipsychotic-like effect of doxycycline. However, these effects are probably not mediated by doxycycline direct interaction with classical receptors enrolled in the antipsychotic effect.

Introduction: Antipsychotic polypharmacy (APP) and high dose (APHD) remain a common practice in the treatment of severe mental illness, even though they are not supported by current international guidelines. Methods: We aimed to establish the prescribing patterns of antipsychotics in a community mental health service in a rural setting, to determine the prevalence of APP and APHD treatment and to identify associated factors. Results: We identified 284 patients. APP was present in 46.5% patients and was associated to younger age, single status, more previous psychiatric admissions, and anticholinergic prescription. Prescription of APHD was observed in 14.4% patients and was associated with previous inpatient admissions, being prescribed with a first generation long‑acting injectable antipsychotic and anticholinergics. We also found that APP and APHD were mutually associated. Conclusion: Despite current guidelines, we found prevalences of APP and APHD of 46.5% and 14.4%, respectively. Further studies are necessary to better evaluate the antipsychotic prescription patterns in Portugal.

In emergency rooms with large numbers of assigned population, we often see isolated conditions, such as severe dehydration, hypernatremia or hyponatremia, acute kidney injury, sensory disorder, among others. However, many of these conditions are part of a single disease and, if they are not gathered together as a medical unit at the right time, morbidity and mortality may drastically increase, especially in the event of diseases with a very rare or unusual frequency. Such is the case of the following disorder, which could worsen the critical condition of the patient if it is not detected on time or not treated appropriately. This clinical case addresses a 74-year-old female patient who reports a history of psychotic disorder with irregular treatment and, after the intake of carbamazepine and risperidone, presents the typical and infrequent symptoms of neuroleptic malignant syndrome (NMS).

Objective: To gain a better understanding of how long-acting injectable antipsychotic (LAI) therapy is perceived by patients. Methods: A search for qualitative studies has been carried out on PubMed, Google Scholar, PsycINFO and PsycArticles, yielding 11 studies suitable for a review of qualitative studies. The reporting approach chosen was meta-ethnography, following the ENTREQ statement recommendations. Key concepts common to the different studies were extrapolated and then analysed in a systematic and comparative way. Results: Some recurrent issues were associated with LAIs, such as fear of coercion, fear of needles and lack of knowledge about depot therapy. These topics are linked to each other and the patients most concerned about the disadvantages of LAIs are those who are less informed about them, or who have experienced coercion and trauma during hospitalisation. On the other hand, patients who had already received LAIs, and those who had a good therapeutic relationship with their healthcare providers expressed satisfaction with this form of treatment and its continuation. Conclusion: Long-acting injectable antipsychotics are a tool in the management of mental disorders, and a viable alternative to oral medication. Patients show curiosity towards this method of administration, but lack of knowledge is a common finding. Shared decision making about the use of LAIs antipsychotics requires that patients receive accurate information and support for their decision regarding medication. RESUMO Objetivo: Compreender melhor de que forma a terapia com antipsicóticos injetáveis de ação prolongada (IAP) é percebida pelos pacientes. Métodos: Uma pesquisa por estudos qualitativos foi conduzida em PubMed, Google Scholar, PsycINFO e PsyArticles, resultando em 11 estudos adequados para desenvolver uma revisão de estudos qualitativos. A abordagem escolhida foi a metaetnografia, seguindo as recomendações da diretriz ENTREQ. Conceitos-chave comuns aos diferentes estudos foram extrapolados e analisados de forma sistemática e comparativa. Resultados: Alguns problemas recorrentes foram associados aos IAPs, como medo de coerção, medo de agulhas e falta de conhecimento sobre a terapia com medicação depot. Esses tópicos se conectam uns aos outros: os pacientes mais preocupados com as desvantagens dos IAPs são os menos informados a seu respeito ou aqueles que passaram por coação e traumas durante a hospitalização. Por outro lado, os pacientes que já receberam IAPs e aqueles que apresentam boa relação terapêutica com seus prestadores de assistência médica demonstraram satisfação com essa forma de tratamento e sua continuidade. Conclusão: Os antipsicóticos injetáveis de ação prolongada são um instrumento para a gestão de transtornos mentais e uma alternativa viável à medicação oral. Pacientes demonstram curiosidade em relação a esse método de administração, mas a falta de conhecimento é um fator comumente encontrado. A tomada de decisão compartilhada sobre o uso de antipsicóticos IAPs requer que os pacientes recebam informações precisas e apoio em suas decisões em relação à medicação.

La pandemia por el nuevo coronavirus denominado SARS-CoV-2 plantea retos sin precedentes en la atención de la salud. Entre ellos se cuenta el aumento en los casos de delirium. La enfermedad grave por SARS-CoV-2, COVID-19, tiene vulnerabilidades comunes con el delirium y produce alteraciones en órganos como el pulmón o el cerebro, entre otros, que tienen potencial para precipitar el trastorno mental; de hecho, este puede ser la primera manifestación de la infección, antes de la fiebre, el malestar general, la tos o las alteraciones respiratorias. Está ampliamente sustentado que el delirium incrementa la morbilidad y la mortalidad de quienes lo padecen durante una hospitalización, por lo que se debe buscar activamente para realizar las intervenciones pertinentes. Ante la ausencia de evidencia sobre el abordaje del delirium en el contexto de la COVID-19, se elaboró este consenso sobre tres aspectos fundamentales: diagnóstico, tratamiento no farmacológico y tratamiento farmacológico, en pacientes ingresados en el hospital general. El documento contiene recomendaciones sobre uso sistemático de herramientas diagnósticas, cuándo hospitalizar al paciente con delirium, la aplicación de acciones no farmacológicas dentro de las restricciones que impone la COVID-19 y la utilización de antipsicóticos teniendo en cuenta los efectos secundarios más relevantes y las interacciones farmacológicas. The pandemic caused by the new coronavirus named SARS-CoV-2 poses unprecedented challenges in the health care. Among them is the increase in cases of delirium. The severe SARS-CoV-2 disease, COVID-19, has common vulnerabilities with delirium and produces alterations in organs such as the lungs or the brain, among others, which have the potential to trigger the mental disorder. In fact, delirium may be the first manifestation of the infection, before fever, general malaise, cough or respiratory disturbances. It is widely supported that delirium increases the morbidity and mortality in those who suffer from it during hospitalization, so it should be actively sought to carry out the relevant interventions. In the absence of evidence on the approach to delirium in the context of COVID-19, this consensus was developed on three fundamental aspects: diagnosis, non-pharmacological treatment and pharmacological treatment, in patients admitted to the general hospital. The document contains recommendations on the systematic use of diagnostic tools, when to hospitalize the patient with delirium, the application of non-pharmacological actions within the restrictions imposed by COVID-19, and the use of antipsychotics, taking into account the most relevant side effects and pharmacological interactions.

Resumen Los agentes antipsicóticos son considerados como el principal tratamiento farmacológico para el manejo de mantenimiento y el tratamiento de casos agudos de la esquizofrenia y otros trastornos mentales. Estos medicamentos están clasificados en dos grupos: los antipsicóticos de primera generación o antipsicóticos típicos (AT) y los antipsicóticos de segunda generación o antipsicóticos atípicos (AA). En relación con el uso de los antipsicóticos típicos (AT), se han descrito importantes efectos adversos, sobre todo síntomas extrapiramidales (EPS), lo cual ha relegado su uso y fomenta el mayor empleo en la práctica clínica de los antipsicóticos atípicos (AA) gracias a la adecuada efectividad clínica demostrada hasta el momento. Sin embargo, estos medicamentos están asociados con diferentes alteraciones metabólicas, entre las cuales se encuentra un mayor riesgo de diabetes; para lo cual se han propuesto varios mecanismos etiopatogénicos. En esta revisión narrativa, se presenta un resumen actualizado de la literatura de los últimos 5 años sobre el uso de antipsicóticos atípicos y la diabetes mellitus tipo 2, haciendo énfasis en las diferentes hipótesis reportadas hasta el momento que involucran el aumento de peso y diferentes efectos mediados por hormonas, receptores de neurotransmisores y neuropéptidos que impactan en la génesis de los estados hiperglucémicos y de insulinorresistencia. Abstract Antipsychotic agents are currently considered as the main pharmacological treatment that helps the maintenance management of acute schizophrenia and other mental disorders. These drugs are classified into two groups: First-generation antipsychotics (FGAs) or typical antipsychotics, and Second-generation antipsychotics (SGAs) also known as atypical antipsychotics (AAP). In relation to the use of typical antipsychotics, some relevant adverse effects have been described, especially in terms of extrapyramidal side effects (EPS), which has downgraded their use and encourages the treatment of atypical antipsychotics (AAP) due to the adequate clinical effectiveness demonstrated so far in the practice. However, these drugs have been associated with different metabolic alterations such as the increased risk of suffering from diabetes; thus, several etiopathogenic mechanisms have been proposed. In this narrative review, we seek to present an updated summary of the literature of the last five years about the use of atypical antipsychotics and type 2 diabetes mellitus. Here it has been emphasized the different hypotheses reported so far that involve weight gain and different effects mediated by hormones, neurotransmitter receptors, and neuropeptides that impact on the genesis of hyperglycemia and insulin resistance states

La esquizofrenia es parte de un grupo de trastornos mentales graves, que no tiene sintomas caracteristicos. El tratamiento farmacologico de esta enfermedad consiste en el uso de antipsicoticos de primera generacion (tipicos), contemplados en atencion primaria, y antipsicoticos de segunda generacion (atipicos), que se incluyen en el Componente de Asistencia Farmaceutica Especializada (CEAF). El estudio tiene como objetivo analizar los aspectos clinicos y farmacoepidemiologicos de pacientes con esquizofrenia asistidos por CEAF en Teresina, Piaui. Este es un estudio descriptivo, observacional, transversal con un enfoque cuantitativo sobre el tema. Las investigaciones que informan los aspectos clinicos relacionados con los trastornos mentales graves se convierten en una referencia en el tema, proporcionan datos epidemiologicos sobre la enfermedad y son utiles para dirigir la implementacion de servicios de salud para estos pacientes. Los datos se recopilaron a traves de entrevistas usando un cuestionario. En relacion con los primeros sintomas presentados por los pacientes, los mas frecuentes fueron las alucinaciones y la agresion, los hombres sufren mas del trastorno, el medicamento Olanzapina es el mas dispensado, seguido de la quetiapina. La alucinacion es generalmente el primer signo presentado por el paciente, los tratamientos convencionales que usan medicamentos antipsicoticos son efectivos, pero estan sujetos a efectos adversos graves. Los pacientes que tienen esta enfermedad tienen una vida social deteriorada, que requieren atencion continua, el uso de medicamentos para controlar la enfermedad y el monitoreo del farmaceutico, que es crucial para optimizar la farmacoterapia, con el objetivo de una mejor calidad de vida.

Marco Solmi,1,2 Andrea Murru,3 Isabella Pacchiarotti,3 Juan Undurraga,4,5 Nicola Veronese,2,6 Michele Fornaro,7,8 Brendon Stubbs,2,9–11 Francesco Monaco,2 Eduard Vieta,3 Mary V Seeman,12 Christoph U Correll,13,14 André F Carvalho2,15 1Neuroscience Department, University of Padua, 2Institute for Clinical Research and Education in Medicine, Padua, Italy; 3Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; 4Department of Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, 5Early Intervention Program, J. Horwitz Psychiatric Institute, Santiago, Chile; 6National Research Council, Ageing Section, Padua, 7Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, School of Medicine, University “Federico II”, Naples, Italy; 8New York State Psychiatric Institute, Columbia University, New York, NY, USA; 9Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 10Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, 11Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK; 12Institute of Medical Science, Toronto, ON, Canada; 13Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, 14Department of Psychiatry and Molecular Medicine Hempstead, Hofstra Northwell School of Medicine, Hempstead, NY, USA; 15Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil Abstract: Since the discovery of chlorpromazine (CPZ) in 1952, first-generation antipsychotics (FGAs) have revolutionized psychiatric care in terms of facilitating discharge from hospital and enabling large numbers of patients with severe mental illness (SMI) to be treated in the community. Second-generation antipsychotics (SGAs) ushered in a progressive shift from the paternalistic management of SMI symptoms to a patient-centered approach, which emphasized targets important to patients – psychosocial functioning, quality of life, and recovery. These drugs are no longer limited to specific Diagnostic and Statistical Manual of Mental Disorders (DSM) categories. Evidence indicates that SGAs show an improved safety and tolerability profile compared with FGAs. The incidence of treatment-emergent extrapyramidal side effects is lower, and there is less impairment of cognitive function and treatment-related negative symptoms. However, treatment with SGAs has been associated with a wide range of untoward effects, among which treatment-emergent weight gain and metabolic abnormalities are of notable concern. The present clinical review aims to summarize the safety and tolerability profile of selected FGAs and SGAs and to link treatment-related adverse effects to the pharmacodynamic profile of each drug. Evidence, predominantly derived from systematic reviews, meta-analyses, and clinical trials of the drugs amisulpride, aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole,ziprasidone, CPZ, haloperidol, loxapine, and perphenazine, is summarized. In addition, the safety and tolerability profiles of antipsychotics are discussed in the context of the “behavioral toxicity” conceptual framework, which considers the longitudinal course and the clinical and therapeutic consequences of treatment-emergent side effects. In SMI, SGAs with safer metabolic profiles should ideally be prescribed first. However, alongside with safety, efficacy should also be considered on a patient-tailored basis. Keywords: antipsychotics, side effects, tolerability, safety, psychosis, psychiatry

Objectives We explored levonorgestrel (LNG) concentrations, bleeding patterns and endometrial thickness in women with epilepsy (WWE) initiating an LNG-intrauterine device (IUD) co-administered with antiepileptic drugs (AEDs). Study design This pilot study included 20 WWE ages 18 to 45 years with well-controlled seizures and stable AED regimens initiating a 52-mg LNG-IUD (20 mcg/d initial release). We collected blood and measured endometrial thickness before IUD placement and 21 days, 3 months and 6 months thereafter. Participants recorded bleeding/spotting daily. We measured total LNG (radioimmunoassay), serum hormone binding globulin (SHBG, immunoassay) and calculated the free LNG index. We compared total LNG, free LNG index, SHBG and endometrial thickness over time using a linear mixed-effects model. Results Total LNG, free LNG index and SBHG levels remained stable from day 21 throughout. Endometrial thickness decreased from a median of 5.9 mm [interquartile range (IQR) 4.6–7.5] at day 21 to 3.3mm (2.8–4.9) by month 6 (p=0.02). Bleeding and spotting days decreased from a median of 16 (IQR 13–23) in month 1 to 6.5 (IQR 4–8.5) in month 6 regardless of AED regimen. Conclusion Like women without epilepsy, WWE initiating the LNG-IUD experience stable total LNG concentrations and decreasing endometrial thickness and bleeding over the first 6 months of use. Implications Like women without epilepsy, WWE using antiepileptic drugs can expect a stable LNG concentration and decreasing bleeding during the first 6 months of LNG-IUD use. Our data can be useful for guidance of WWE considering use the LNG-IUD.

Los antipsicóticos son un componente esencial del tratamiento de la esquizofrenia. Las formulaciones inyectables de liberación prolongada (ILP) surgen para mejorar la adherencia con el potencial asociado de reducir el riesgo de recaídas. El objetivo de este artículo es analizar el uso de antipsicóticos ILP en España –que es similar al de otros países europeos pero con un predominio de la utilización de ILP de segunda generación–, discutir las posibles causas de las diferencias de prescripción respecto a otros países de nuestro entorno (entre otras, aspectos organizativos, actitudes de psiquiatras, pacientes y familiares, guías de práctica clínica), y discutir su utilización en unidades de agudos, primeros episodios, y en niños y adolescentes. A nuestro juicio, aunque es necesario aumentar las pruebas existentes respecto a las ventajas de los antipsicóticos ILP y la diferenciación entre aquellos disponibles actualmente, su utilización seguirá probablemente creciendo impulsada por la experiencia clínica. post-print 1,08 MB

Resumo: Introdução: Avaliar a adesão ao tratamento com agentes antipsicóticos em doentes com esquizofrenia é um desafio para qualquer médico psiquiatra, dada a subjetividade inerente ao tema. Apesar disso, a falta de adesão à terapêutica é prejudicial para o curso clínico da doença, resultando num risco aumentado de agudizações da doença e de internamentos hospitalares. O objetivo do presente estudo é rever a literatura corrente relativa aos fatores que influenciam a adesão ao tratamento antipsicótico em doentes com esquizofrenia. Métodos: Foi revista a literatura escrita em inglês entre 2006 e 2016 integralmente disponível no PubMed/MEDLINE que avaliasse potenciais fatores de risco para a adesão ao tratamento em doentes adultos (com mais de 18 anos) com esquizofrenia, através das palavras-chave: adherence, nonadherence, compliance, noncompliance, schizophrenia, psychosis, antipsychotic, neuroleptic. Resultados: Foram incluídos 39 estudos na revisão final. A média dos níveis de adesão ao tratamento foi de 32%. Foram identificados os seguintes fatores de risco para a falta de adesão ao tratamento: idade jovem, abuso de substâncias, psicopatologia psicótica presente, ausência de insight sobre a doença e a necessidade de tratamento, atitudes negativas perante o tratamento, relação médico-doente de má qualidade ou falta de apoio social e familiar. Conclusões: As intervenções direcionadas para melhorar a adesão à terapêutica devem ser individualizadas para cada doente, baseadas numa história clínica completa, para que todos os aspetos individuais que contribuam para esta variável possam ser convenientemente avaliados.

Objective To describe the case of a patient with schizophrenia on clozapine treatment who had an episode of heat stroke. Case description During a heat wave in January and February 2014, a patient with schizophrenia who was on treatment with clozapine was initially referred for differential diagnose between systemic infection and neuroleptic malignant syndrome, but was finally diagnosed with heat stroke and treated with control of body temperature and hydration. Comments This report aims to alert clinicians take this condition into consideration among other differential diagnoses, especially nowadays with the rise in global temperatures, and to highlight the need for accurate diagnosis of clinical events during pharmacological intervention, in order to improve treatment decisions and outcomes.

Objetivo: Caracterizar o perfil socioeconômico, nutricional e os fatores de risco cardiometabólico de pacientes com esquizofrenia em uso de antipsicóticos atendidos em um hospital público de Fortaleza/CE. Métodos: Estudo transversal, descritivo, com abordagem quantitativa, envolvendo 146 indivíduos com esquizofrenia em uso de antipsicóticos, acompanhados numa unidade de saúde terciária em Fortaleza/CE. A coleta dos dados foi realizada nos meses de agosto e setembro de 2012. Realizou-se entrevista contendo aspectos sociodemográficos, avaliação dos antipsicóticos, fatores de risco, exame clínico e medidas antropométricas (peso, altura, circunferências da cintura, do quadril e abdominal). Resultados: Dentre os entrevistados, 44,52% (n=65) eram mulheres e 55,48% (n=81) homens. A idade prevalente foi de 20 a 39 anos, 32,19% brancos (n=47), 117 solteiros (80,14%), que tiveram de 1 a 9 anos de estudo (n=51; 34,93%), sem ocupação (n=110; 75,34%) e com renda de até 1 salário (n=72; 49,32%). Pela classificação do IMC, 25,34% (n=37) apresentavam sobrepeso e 28,08% (n=41) obesidade. Dos homens, 78,32% (n=65) apresentavam risco muito alto de doença cardiovascular e 92,06% das mulheres (n=58). Da amostra, 42 homens (51,22%) e 43 (67,19%) mulheres apresentaram risco de desenvolver doenças metabólicas. Conclusão: O estudo demonstrou que os pacientes se encontravam, em sua maior parte, na fase produtiva da vida, não tinham ocupação e apresentavam baixa renda. Pode-se inferir que a maioria estava com excesso de peso e apresentava maior probabilidade de desenvolver distúrbios metabólicos.

Objective The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive–compulsive disorder (OCD). Methods Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. Results The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. Conclusions The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended., Author V. B. would like to acknowledge all the staff at the numerous research centres throughout the world and their participants who contributed valuable data to this large data base. V. B. would also like toacknowledge Prof. Naomi Fineberg and the International College of Obsessive‐Compulsive Spectrum Disorders (ICOCS) who supportedthis project by circulating his invitation to participate in the surveyto its members.This study was sponsored by Nepean Medical Research Founda-tion Grant, Pfizer Neuroscience Grant, National Natural Science Foun-dation of China (Grant 81371340), and Spanish MINECO GrantPSI2013‐44733‐R.

Recently, we found a rapid and long-lasting improvement of symptoms in schizophrenic patients on antipsychotics after a single four-hour infusion of sodium nitroprusside (SNP), a nitric oxide (NO) donor with a short half-life. This improvement persisted for up to 4 weeks. Because these patients remained on antipsychotics after infusion of SNP was finished, the question arises about whether this improvement was due to SNP itself. We have now investigated whether SNP, alone, can produce preventive antipsychotic effects in rats treated with ketamine (KET). 56 adult rats divided into 7 groups were infused with SNP 4 mg/kg, KET 25 mg/kg, or saline as follows: group1 — saline, group2 — SNP, group3 — KET, group4 — KET 12 h after SNP, group5 — KET 1 day after SNP, group6 — KET 2 days after SNP, and group7 — KET 1 week after SNP. The animals were filmed in an open field arena for 30 min and the videos were later analyzed by ANY-Maze software to measure activity and stereotypy. SNP significantly prevented the emergence of hyperactivity induced by KET when it was administered for up to 1 week before KET, and prevented the emergence of stereotypies when it was administered for up to 1 day before KET. These findings in rats, which have an even faster metabolic rate than humans, suggest that the long-lasting effects observed in our clinical trial with SNP in humans could have been due to SNP itself, and indicate for the first time that SNP may present preventive antipsychotic effects.

Objective: Identify drug interactions of old antiepileptic drugs with antidepressants and antipsychotics and its impact on the patient with epilepsy at the Hospital de San Jose in outpatient appointment from June 1 st, 2015 to the april 30th, 2016.Material and methods: A descriptive study was conducted to identify drugs interactions in patients diagnosed with epilepsy. The study involved patients over 18 years old with a diagnosis of epilepsy according to the International League Against Epilepsy criteria in therapy with first line antiepileptic drugs associated with antipsychotic drugs or/and antidepressants, excluded pregnant women, patients with hepatic and renal impairment. The statistic analysis of qualitative variables was performed using absolute and relative frequencies. Quantitative variables were analysed using medians and interquartile ranges.Results: We included 26 patients with a median age of 49 years (IQR: 33-57), 14 were women (53.8%). The most relevant conditions on past medical history were perinatal hypoxia and brain trauma, both diagnosed on 5 patients (19.2%). The most frequently anticonvulsant monotherapy used was carbamazepine, which was prescribed on 8 patients (30.8%). Only two patients receiving carbamazepine presented leucopenia. None of the patients presented elevated liver enzymes. Anticonvulsant serum levels in most therapies were within the therapeutic range. Discussion and conclusions: We described multiple combinations of anticonvulsants with antipsychotics and/or antidepressants. No liver toxicity or serious hematologic abnormalities that could suggest a change on the therapy was documented. Furthermore, most anticonvulsants serum concentration remained within the therapeutic range.

Summary Objective: Determine whether there is an association between the risk of cardiovascular adverse events and the use of antipsychotic agents. Method: Analysis of original articles retrieved from the following databases: LILACS, PubMed, Cochrane Controlled Trials Clinical Data Bank (CENTRAL) and PsycINFO, without language restriction, dated until November 2015. After screening of 2,812 studies, three cohort original articles were selected for quality analysis. Results: 403,083 patients with schizophrenia and 119,015 participants in the control group data were analyzed. The occurrence of cardiovascular events observed in the articles was: 63.5% (article 1), 13.1% (article 2) and 24.95% (article 3) in the group of treated schizophrenic patients, and 46.2%, 86.9% and 24.9%, respectively, in the control groups. Conclusion: Clinical heterogeneity among the studies led to a provisional response and made it impossible to perform the meta-analysis, although the articles demonstrate an association between cardiovascular adverse events and the use of antipsychotics. More quality clinical trials are needed to support this evidence. Resumo Objetivo: Determinar se existe associação entre o risco de eventos adversos cardiovasculares e o uso de agentes antipsicóticos. Método: Análise de artigos originais identificados pelas bases de dados: Lilacs, PubMed, Cochrane Controlled Trials Banco de Dados Clínicos (CENTRAL) e PsycINFO, sem restrição de idiomas, foi realizada até novembro de 2015. Depois da triagem de 2.812 estudos, três artigos originais tipo coorte foram selecionados para análise de qualidade. Resultados: Foram analisados dados de 403.083 pacientes com esquizofrenia e 119.015 participantes do grupo controle. A ocorrência de eventos cardiovasculares observados nos artigos foi: 63,5% (artigo 1), 13,1% (artigo 2), 24,95% (artigo 3) nos grupos de esquizofrênicos tratados e, respectivamente, 46,2%, 86,9% e 24,9%, nos grupos controle. Conclusão: A heterogeneidade clínica entre os estudos levou a uma resposta provisória e impossibilitou a execução da metanálise, apesar de os artigos demonstrarem associação entre eventos adversos cardiovasculares e uso de antipsicóticos. São necessários mais ensaios clínicos de qualidade para sustentar essa evidência.

Background There is accumulating evidence that progressive changes in brain structure and function take place as schizophrenia unfolds. Among many possible candidates, oxidative stress may be one of the mediators of neuroprogression, grey matter loss and subsequent cognitive and functional impairment. Antioxidants are exogenous or endogenous molecules that mitigate any form of oxidative stress or its consequences. They may act from directly scavenging free radicals to increasing anti-oxidative defences. There is evidence that current treatments impact oxidative pathways and may to some extent reverse pro-oxidative states in schizophrenia. The existing literature, however, indicates that these treatments do not fully restore the deficits in antioxidant levels or restore levels of oxidants in schizophrenia. As such, there has been interest in developing interventions aimed at restoring this oxidative balance beyond the benefits of antipsychotics in this direction. If antioxidants are to have a place in the treatment of this serious condition, the relevant and up-to-date information should be available to clinicians and investigators. Objectives To evaluate the effect of antioxidants as add-on treatments to standard antipsychotic medication for improving acute psychotic episodes and core symptoms, and preventing relapse in people with schizophrenia. Search methods We searched the Cochrane Schizophrenia Group’s Study-Based Register of Trials which is based on regular searches of CINAHL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. There are no language, time, document type, or publication status limitations for inclusion of records in the register. We ran this search in November 2010, and again on 8 January 2015. We also inspected references of all identified studies for further trials and contacted authors of trials for additional information. Selection criteria We included reports if they were randomised controlled trials (RCTs) involving people with schizophrenia who had been allocated to either a substance with antioxidant potential or to a placebo as an adjunct to standard antipsychotic treatment. Data collection and analysis We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE. Main results The review includes 22 RCTs of varying quality and sample size studying Ginkgo biloba, N-acetyl cysteine (NAC), allopurinol, dehydroepiandrosterone (DHEA), vitamin C, vitamin E or selegiline. Median follow-up was eight weeks. Only three studies including a minority of the participants reported our a priori selected primary outcome of clinically important response. Short-term data for this outcome (measured as at least 20% improvement in scores on Positive and Negative Syndrome Scale (PANSS)) were similar (3 RCTs, n = 229, RR 0.77, 95% CI 0.53 to 1.12, low quality evidence). Studies usually reported only endpoint psychopathology rating scale scores. Psychotic symptoms were lower in those using an adjunctive antioxidant according to the PANSS ( 7 RCTS, n = 584, MD -6.00, 95% CI -10.35 to -1.65, very low quality evidence) and the Brief Psychiatric Rating Scale (BPRS) (8 RCTS, n = 843, MD -3.20, 95% CI -5.63 to -0.78, low quality evidence). There was no overall short-term difference in leaving the study early (16 RCTs, n = 1584, RR 0.73, 95% CI 0.48 to 1.11, moderate quality evidence), or in general functioning (2 RCTs, n = 52, MD -1.11, 95% CI -8.07 to 5.86, low quality evidence). Adverse events were generally poorly reported. Three studies reported useable data for 'any serious adverse effect', results were equivocal (3 RCTs, n = 234, RR 0.65, 95% CI 0.19 to 2.27, low quality evidence). No evidence was available for relapse, quality of life or service use. Authors' conclusions Although 22 trials could be included in this review, the evidence provided is limited and mostly not relevant to clinicians or consumers. Overall, although there was low risk of attrition and selective data reporting bias within the trials, the trials themselves were not adequately powered and need more substantial follow-up periods. There is a need for larger trials with longer periods of follow-up to be conducted. Outcomes should be meaningful for those with schizophrenia, and include measures of improvement and relapse (not just rating scale scores), functioning and quality of life and acceptability and, importantly, safety data.

Background: Ischemic colitis (IC) is an uncommon adverse event associated with antipsychotic agents, more commonly found with phenothiazine drugs and atypical neuroleptics such as clozapine. The risk of developing ischemic colitis increases when anticholinergic drugs are associated. Case report: We report the case of a 38-year-old woman with a history of schizoaffective disorder who had been on chronic quetiapine for 3 years, and presented to the ER because of diarrhea for 5 days. Four months previously, olanzapine had been added to her psychiatric drug regimen. Physical examination revealed abdominal distension with abdominal tympanic sounds and tenderness. Emergency laboratory tests were notable for increased acute phase reagents. Tomography revealed a concentric thickening of the colonic wall in the transverse, descending and sigmoid segments, with no signs of intestinal perforation. Colonoscopy demonstrated severe mucosal involvement from the sigmoid to the hepatic flexure, with ulcerations and fibrinoid exudate. Biopsies confirmed the diagnosis of ischemic colitis. The only relevant finding in her history was the newly added drug to her baseline regimen. An adverse effect was suspected because of its anticholinergic action at the intestinal level, and the drug was withdrawn. After 6 months of follow-up clinical, laboratory and endoscopic recovery was achieved. Discussion: Antipsychotic medication should be considered as a potential cause of ischemic colitis, particularly atypical antipsychotics such as clozapine and olanzapine; despite being uncommon, this adverse event may result in high morbidity and mortality.

Aunque algunos antipsicóticos de segunda generación reducen el riesgo de efectos adversos extrapiramidales frente a los de primera generación, su uso se ha asociado a la aparición de síndrome metabólico. Esta es una entidad caracterizada por resistencia a la insulina, obesidad abdominal, dislipidemia aterogénica (hipertrigliceridemia, disminución del colesterol- HDL y aumento del colesterol-LDL), hipertensión arterial y un estado protrombótico y proinflamatorio. El síndrome metabólico puede aumentar significativamente el riesgo de enfermedad cardiovascular y muerte prematura por lo que su abordaje multidisciplinar podría incidir sustancialmente en el estado de salud general de los pacientes que lo desarrollen. Se presenta en este trabajo una revisión de la asociación del síndrome metabólico y los antipsicóticos de segunda generación. Se revisan hipótesis y hallazgos actuales en la fisiopatología, el aumento de riesgo con la politerapia (con antipsicóticos de segunda generación y con combinaciones de fármacos), los criterios diagnósticos actuales y el seguimiento de pacientes con riesgo de desarrollarlo. Pretendemos contribuir a una detección temprana de este síndrome que facilite implementar intervenciones multidisciplinarias farmacológicas y no farmacológicas.

Introducción: La catatonia es un sÍndrome neuropsiquiátrico con posturas anormales, mutismo y estupor. Tiene una prevalencia en Colombia del 11.4% de pacientes psiquiátricos. Objetivo: Discutir el curso clÍnico de una mujer de 34 años con antecedente de trastorno depresivo mayor que llega de urgencias con delirios nihilistas y sÍntomas catatónicos. Presentación del caso: Se reportó el caso de una adulta joven con trastorno depresivo mayor y sÍntomas psicóticos previamente hospitalizada hace nueve meses, egresó con tratamiento farmacológico que no recordaba. Llegó al servicio de urgencias del Hospital Universitario de Santander por tres dÍas de comportamiento extraño, mutismo y negativismo. ParaclÍnicos y tomografÍa de cráneo normales. Se inició tratamiento con una benzodiacepina lográndose remisión de los sÍntomas catatónicos. Posteriormente refirió anhedonia, tristeza e ideas delirantes nihilistas; se consideró que correspondÍa a una recidiva del episodio depresivo que inició hace nueve meses ligado a sÍndrome de Cotard. Se adicionó sertralina con incremento gradual hasta 150.0 mg y olanzapina 5.0 mg lográndose remisión de los sÍntomas afectivos y psicóticos. Discusión: El trastorno afectivo es la causa más frecuente de catatonia. Existen reportes similares, pero pocos donde coexistan las tres entidades; este es el primer caso reportado en el Hospital Universitario de Santander, con previo consentimiento informado. Conclusiones: Es inusual que un paciente deprimido presente delirios de negación y sÍntomas catatónicos simultáneamente, por lo cual este reporte es único y genera aporte a la literatura. Los sÍntomas catatónicos dificultan la exploración de otras esferas mentales y pueden ser secundarios a una condición médica, por lo cual es indispensable descartar organicidad, darles tratamiento oportunamente y asÍ aclarar la psicopatologÍa de base. [Torrado-Arenas DM, Santos-Gutiérrez KE, Ruiz-Higuera SM, Zabala-Arias LM, Niño-GarcÍa JA. SÍndrome de Cotard asociado a Trastorno Depresivo Mayor con sÍntomas catatónicos. Informe de caso. MedUNAB 2016;18(1): 76-80]. Introduction: Catatonia is a neuropsychiatric syndrome with abnormal postures, mutism and stupor. Colombia has a prevalence of 11.4% of psychiatric patients. Objective: To discuss the clinical curse of a 34-year-old woman with major depressive disorder that presents to emergency department with nihilistic delirium and catatonic symptoms. Case presentation: A young woman with history of unipolar major depression with psychotic features was hospitalized nine months ago. She was medicated with a nonspecific medical treatment. At the admission the patient had three days of bizarre behavior, mutism and negativism. Paraclinics and brain computer tomography didn’t report any abnormality or changes. Treatment began with benzodiazepine, which achieved full remission of catatonic symptoms. After this, she developed anhedonia, sadness and nihilistic delusions and was considered as a relapse of a previous depressive episode from nine months ago, associated with Cotard’s syndrome. Sertraline was added with gradual increase to 100mg and 5mg of olanzapine, getting a complete remission of psychotic and mood symptoms. Discussion: Affective disorders are most common cause of catatonia. There has already been a history of similar reports, but in few times this three entities were associated; this is the first case reported in Hospital Universitario de Santander, with informed consent. Conclusions: It is unusual for a depressed patient to present denial delusions and catatonic symptoms simultaneously; therefore this case is unusual and may contribute to literature. The catatonic symptoms make it difficult to explore other mental spheres, though they may be secondary to a medical condition, therefore, it is essential to dismiss organic pathologies and give initial treatment, so we can discover the underlying etiopsychopathology. [Torrado-Arenas DM, Santos-Gutiérrez KE, Ruiz-Higuera SM, Zabala-Arias LM, Niño-GarcÍa JA. Cotard’s syndrome associated to major depressive disorder with catatonic symptoms. Case report. MedUNAB 2016;18(1):76-80].

ResumenLas enfermedades mentales presentan una baja mortalidad pero son altamente discapacitantes, lo que ha hecho que su diagnóstico y tratamiento ocupen un papel cada vez más relevante en la terapia actual y en las políticas sanitarias.En este escenario se planteó este estudio, que pretende analizar los factores que pueden haber influido en la utilización de antidepresivos y antipsicóticos en España durante el período 1997-2004.Los antidepresivos tricíclicos son los fármacos de referencia para tratar la depresión, pero a su perfil de efectos adversos se ha atribuido una falta de adherencia. La búsqueda de una mejor tolerancia, en un mercado en auge, ha favorecido la síntesis de nuevos antidepresivos y la investigación de nuevas indicaciones. Esto explicaría en buena parte el crecimiento del consumo de este grupo, tanto en unidades como en ventas, que ha pasado de 14,14 a 26,79 millones de envases y de 168,61 a 447,11 millones de euros en valor.En el caso de los antipsicóticos su utilización se ha mantenido más o menos estable, pasando de 11,74 a 12,65 millones de envases, pero el aumento de facturación ha sido espectacular: ha pasado de 61,84 a 317,46 millones de euros; la risperidona y la olanzapina son las principales causantes de este incremento. Muchos pacientes tratados con antipsicóticos de primera generación han pasado a ser tratados con estos nuevos antipsicóticos.Algunos factores que han contribuido a la situación actual son el mayor número de depresiones diagnosticadas, así como de otras enfermedades mentales, el aumento del número de indicaciones aprobadas y el crecimiento de la población anciana tratada con los nuevos antipsicóticos. Todo ello, junto con el marketing promocional, ha disparado la utilización de los principios activos de más reciente comercialización.AbstractMental disorders mortality rates are low but they are extremely disabling so that the diagnosis and treatment of mental illness is an important task for public health and it is central in current therapy strategies and sanitary policy.The aim of this study is to analyse conditions influencing antidepressants and antipsychotics use in Spain from 1997 to 2004.Tryciclic antidepressants have been of first-choice in depression treatment for many years but their side effects profile are related to a lack of treatment adherence. Trying to increase tolerance, new antidepressants have been developed and research into new therapeutic uses is being done. These are some of the reasons causing an increase in medical utilization and costs. Medical boxes sold have increased from 14,14 million in 1997 to 26,76 million in 2004, meaning 168,61 and 447,11 million euros respectively.Antipsychotic use has been maintained, 11,74 million boxes in 1997 and 12,65 in 2004; however, there has been a rise in price from 61,84 to 317,46 million euros due to second generation antipsychotics prescription (mainly risperidone and olanzapine)Some conditions have contributed to current situation: increased number of diagnosed patients with depression and other mental disorders, new approved therapeutic uses and a rise in elderly people receiving new antipsychotic agents. Moreover, promotional marketing is causing an increase in new recently commercialised drugs use.

La obesidad se ha convertido en un importante problema de salud pública, no sólo por su creciente prevalencia sino por las patologías asociadas. En efecto, hay un gran número de enfermedades cuyo riesgo de padecerlas se ve aumentado en aquellos sujetos que presentan exceso de peso: Diabetes Mellitus tipo 2, dislipemias, tumores (endometrio, colon, mama, etc), trastornos del aparato locomotor, alteraciones digestivas, enfermedades cardiovasculares, alteraciones respiratorias, problemas psicológicos, alteraciones obstétricas y ginecológicas.En España, el consumo de psicofármacos es importante y en los últimos años se ha incrementado. Muchos de los medicamentos utilizados en el tratamiento de la ansiedad, la depresión, el trastorno bipolar, la esquizofrenia, la epilepsia, pueden producir un aumento o disminución de peso. Estos efectos secundarios podrían agravar una situación previa de obesidad e incluso provocar una ganancia ponderal en pacientes que al comenzar el tratamiento presentan peso normal, con el riesgo y complicaciones asociadas. Esta acumulación de grasa inducida puede contribuir también a la falta de adherencia a la medicación y, por tanto, a posibles recaídas de estos enfermos.En esta revisión se trata de precisar la relación entre psicofármacos y obesidad, así como los mecanismos potencialmente implicados.

Objetivo: Se pretende estudiar la prevalencia de TMG (trastorno mental grave) en los internos recluidos en las tres prisiones de Cadiz (Espana) que solicitaron asistencia psiquiatrica. Material y metodo: Estudio transversal que analiza la demanda asistencial psiquiatrica en los centros penitenciarios de Puerto I, II y III del Puerto de Santa Maria (Cadiz) durante un ano. Resultados: Se estudian 128 pacientes. Los diagnosticos psiquiatricos mas prevalentes fueron los trastornos de personalidad (F60-69) (35.2%), el grupo de esquizofrenia, trastorno esquizotipico y trastorno de ideas delirantes (F20-29) (25.8%) y los trastornos mentales y del comportamiento debidos al consumo de sustancias psicotropas (F10-19) (16.4%). El 46.1% corresponden a trastornos mentales graves (TMG). Discusion: Se confirma que hay una alta prevalencia de TMG en los presos de Cadiz, por lo que se precisa una elevada asignacion de recursos para atender este grupo de enfermedades. Palabras Clave: prisiones; trastornos mentales; esquizofrenia; salud mental; antipsicoticos; trastornos relacionados con sustancias; distancia social; servicios comunitarios de salud mental.

Obsessive-compulsive disorder patients who do not improve sufficiently after treatment with a selective serotonin reuptake inhibitor might improve further if other drugs were added to the treatment regimen. The authors present a double-blind, placebo-controlled trial comparing the efficacy of adding quetiapine or clomipramine to a treatment regimen consisting of fluoxetine. Between May 2007 and March 2010, a total of 54 patients with a primary diagnosis of obsessive-compulsive disorder, as defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and a current Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of at least 16, the score having dropped by less than 35% after fluoxetine monotherapy, were allocated to 1 of 3 arms (n = 18 per arm): quetiapine + fluoxetine (≤200 and ≤40 mg/d, respectively), clomipramine + fluoxetine (≤75 and ≤40 mg/d, respectively), or placebo + fluoxetine (≤80 mg/d of fluoxetine). Follow-up was 12 weeks. The Y-BOCS scores were the main outcome measure. No severe adverse events occurred during the trial, and 40 patients (74%) completed the 12-week protocol. The Y-BOCS scores (mean [SD]) were significantly better in the placebo + fluoxetine and clomipramine + fluoxetine groups than in the quetiapine + fluoxetine group (final: 18 [7] and 18 [7], respectively, vs 25 [6], P < 0.001) (reduction from baseline: -6.7 [confidence interval {CI}, -9.6 to -3.8; and -6.5 [CI, -9.0 to -3.9], respectively, vs -0.1 [CI, -2.9 to 2.7], P < 0.001; number needed to treat = 2.4). The clomipramine-fluoxetine combination is a safe and effective treatment for fluoxetine nonresponders, especially those who cannot tolerate high doses of fluoxetine. However, the period of monotherapy with the maximum dose of fluoxetine should be extended before a combination treatment strategy is applied.

INTRODUÇÃO: Pacientes com esquizofrenia têm maior prevalência de obesidade em comparação à população geral. Esse fato está relacionado a uma alimentação inadequada, ao sedentarismo e ao uso de antipsicóticos. O aumento da obesidade associa-se a diversos distúrbios metabólicos, como o diabetes melito. As intervenções para prevenção e controle do ganho de peso são necessárias nessa população, em especial as intervenções não farmacológicas. OBJETIVO: Revisar os estudos sobre intervenções não farmacológicas para prevenção e controle do ganho de peso em pacientes com esquizofrenia. MÉTODOS: Foram encontrados oito estudos controlados e quatro não controlados sobre intervenções não farmacológicas. Foi feita uma revisãosobre a metodologia e os fatores positivos e limitações dos estudos. CONCLUSÕES: As intervenções não farmacológicas parecem ter um efeito importante em termos de prevenção e controle do ganho de peso e, portanto, devem ser incentivadas e adaptadas à realidade dos pacientes e serviços de saúde. INTRODUCTION: Schizophrenic patients have a higher prevalence of obesity than the general population. There are several factors implicated in weight gain, including poor dietary conditions, sedentary lifestyle and antipsychotic drugs use. Obesity is also associated with metabolic disturbances such as diabetes mellitus. Weight gain interventions are necessary in this population, especially non-pharmacological interventions. OBJECTIVE: To review the non-pharmacological interventions for weight gain management in patients with schizophrenia. METHODS: Eight clinical trials and four open-label studies using these interventions were found. The methodology, strength and limitations of the studies were reviewed. CONCLUSIONS: Non-pharmacological interventions seem to have an important effect on weight gain prevention and control, and should be encouraged and adapted to patients and in mental health institution's reality.

CONTEXTO: A disfunção sexual é frequente entre pacientes com esquizofrenia, sendo relatada como um dos mais incômodos efeitos adversos dos antipsicóticos, e está diretamente relacionada com adesão ao tratamento. OBJETIVOS: a) avaliar a acurácia da Escala de Experiência Sexual do Arizona (ASEX) para identificar a disfunção sexual; b) avaliar a frequência da disfunção sexual em uma amostra de pacientes do espectro da esquizofrenia em tratamento com antipsicóticos; e c) investigar o efeito dos diferentes antipsicóticos na função sexual. MÉTODO: Pacientes ambulatoriais com esquizofrenia ou transtorno esquizoafetivo foram entrevistados por meio de questionários: ASEX e escala Dickson-Glazer (DGSFi) para avaliação do funcionamento sexual, em uma única entrevista. RESULTADOS: Cento e trinta e sete pacientes foram entrevistados. A sensibilidade e a especificidade da ASEX em relação à DGSFi foram: 80,8% (95% IC = 70,0%-88,5%) e 88,1% (95% IC = 76,5%-94,7%), e a taxa de classificação incorreta foi 9,5%. A curva ROC comparando a pontuação da ASEX e da DGSFi revelou valor de 0,93 (IC = 0,879-0,970) com o ponto de corte da ASEX encontrado sendo 14/15. A disfunção sexual foi mais alta entre as mulheres (79,2%) que nos homens (33,3%) (χ2 = 27,41, gl = 1, p < 0,001). CONCLUSÃO: Os pacientes em tratamento com antipsicóticos mostraram alta frequência de queixas sexuais e a ASEX provou ser um instrumento eficaz para identificar disfunção sexual em amostra de pacientes ambulatoriais do espectro da esquizofrenia. As mulheres apresentaram frequência mais alta de disfunção, e desejo sexual e habilidade para alcançar orgasmo foram as áreas mais afetadas. O uso de antipsicóticos, principalmente o uso de combinações, foi associado com piora do funcionamento sexual. BACKGROUND: Sexual dysfunction is frequent in patients with schizophrenia, it is reported as one of the most distressing antipsychotic's adverse effects and it is directly related to treatment compliance. OBJECTIVES: a) to evaluate the accuracy of the Arizona Sexual Experience Scale (ASEX) to identify sexual dysfunction; b) to assess the frequency of sexual dysfunction in a sample of outpatients with schizophrenia and schizoaffective disorder under antipsychotic therapy; and c) to investigate the effect of different antipsychotics on sexual function. METHOD: Outpatients with schizophrenia or schizoaffective disorder were asked to fulfill both the ASEX and the Dickson Glazer Scale for the Assessment of Sexual Functioning Inventory (DGSFi) at a single interview. RESULTS: 137 patients were interwied. The sensitivity and specificity of the ASEX in relation to DGSFi were: 80.8%, (95% CI = 70.0%-88.5%) and 88.1% (95% CI = 76.5%-94.7%), and the misclassification rate was 9.5%. The ROC curve comparing the ASEX and the DGSFi scores revealed a value of 0.93 (CI = 0.879-0.970), with the optimum cut-off point of ASEX being 14/15. Sexual dysfunction measured was higher in females (79.2%) than in males (33.3%) (χ2 = 27.41, d.f. = 1, p < 0.001). DISCUSSION: Patients under antipsychotic treatment showed a high level of sexual complaints, and the ASEX proved to be an accurate instrument to identify sexual dysfunction in an outpatient sample of patients with schizophrenia spectrum. Females showed a higher frequency of sexual dysfunctions and sexual drive and ability to reach orgasm were the most affected areas. The use of antipsychotics, especially the combinations, was more likely to impair sexual functioning.

Resumen Introduccion: En los ultimos anos se han incorporado al medio nacional diversosantipsicoticos de nueva generacion, pero el modo de utilizacion practica por los clinicos hasido poco documentada. El objetivo de este estudio es caracterizar el patron de prescripcion delos antipsicoticos en pacientes hospitalizados en una institucion psiquiatrica nacional. Meto-dos: Se estudio retrospectivamente las historias clinicas de los pacientes hospitalizados en laClinica Psiquiatrica Universitaria entre Marzo y Septiembre de 2005. Se registraron los diver-sos antipsicoticos empleados y sus dosis para cada diagnostico, tanto como indicacion de usopermanente o esporadico. Resultados: En el periodo estudiado hubo 246 egresos y se empleoalgun antipsicotico en el 80% de los casos. Su principal indicacion fue en esquizofrenia,psicosis exogena y trastorno bipolar, pero tambien fueron utilizados con frecuencia en otroscuadros como en trastornos de la alimentacion, de la personalidad y en depresion monopolar.Los mas empleados fueron los antipsicoticos atipicos, solos o asociados con un neurolepticode uso esporadico. Los antipsicoticos atipicos mas prescritos fueron risperidona (41%) yquetiapina (34%). Las dosis utilizadas variaron ampliamente segun los diversos diagnosti-cos. Conclusiones: Los antipsicoticos, en especial los atipicos, son ampliamente utilizados enel tratamiento de diversas patologias psiquiatricas en pacientes hospitalizados.Palabras clave: Antipsicoticos, risperidona, quetiapina, olanzapina, clozapina, atipicos,prescripcion.

Objective: This pilot, twelve-week, open-label study examined the effect of clozapine orally disintegrating tablet or ODT in patients with schizophrenia and schizoaffective disorder utilizing Positive and Negative Syndrome Scale (PANSS) as a long-term outcome measurement tool. Methods: The final study sample consisted of nineteen subjects who were residents a long-term care psychiatric facility in Pomona, California. Subjects were using clozapine ODT (FazaClo®) at the most clinically effective dosage depending on their symptoms and at the discretion of the psychiatrist and psychopharm consultant. PANSS were administered at baseline, week-4, week-8 and week-12. Paired sample t-tests were used to calculate the statistical significance of the mean differences for scores at baseline and week-12. Results: Mean differences from baseline indicated significant improvement on total score, as well as positive, negative, cognitive and general psychopathology subscales after twelve weeks of treatment. The greater average reduction in the negative syndrome subscale across the twelve weeks possibly illustrates the ability of clozapine ODT in improving negative symptoms, including cognitive function which is their ability to participate in their personal care and creative expressions in dance, arts, games, poetry to a greater extent their overall, quality of life and living along with the effect on positive symptoms. Conclusion: Overall, clozapine proved to affect a broad range of psychopathology including cognitive functions in this schizophrenic sample. Objetivo: Este estudio piloto de 12 semanas examinó el efecto de comprimidos oralmente dispersables (OD) de clozapina en pacientes con esquizofrenia o desordenes esquizo-afectivos utilizando la escala Positive and Negative Syndrome Scale (PANSS) como herramienta de medida de resultados. Métodos: La muestra final de estudio consistió en 19 individuos que residían en una clínica siquiátrica de larga estancia en Pomona, California. Los individuos estaban utilizando clozapina OD (FazaClo®) a la dosis más efectiva clínicamente dependiendo de sus síntomas y a discreción del psiquiatra y el consultor psicofarmacéutico. Se administró el PANS Sal inicio, en las emana 4, semana 8 y semana 12. Se utilizaron t-test apareados para calcular la significación estadística de las diferencias de las medias para las puntuaciones basales y en la semana 12. Resultados: Las diferencias medias del valor inicial indicaron mejora significativa en la puntuación total, así como en las subescalas positiva, negativa y de psicopatología general después de 12 semanas de tratamiento. La mayor media de reducción en la subescala negativa tras las 12 semanas posiblemente ilustra la capacidad de la clozapina OD para mejorar los síntomas negativos, incluyendo la función cognitiva que es la capacidad de participare n su cuidado personal y las expresiones creativa sen baile, arte, juegos, poesía y en mayor escalas u calidad de vida general ye l sobrellevar los efectos en los síntomas positivos. Conclusión: En general, la clozapina demostró afectar un amplio margen del a psicopatología, que incluye las funciones cognitiva sen esta muestra de esquizofrénicos.

INTRODUÇÃO: Um aumento na incidência de obesidade e diabetes melito entre pacientes psiquiátricos foi observado ainda na década de 60, como resultado indesejável do uso de antipsicóticos. Nos anos 80 e 90, a reabilitação da clozapina, a síntese dos demais antipsicóticos atípicos e a disseminação do uso do lítio e do ácido valpróico chamaram novamente a atenção para os efeitos metabólicos desses medicamentos. Este estudo tem por objetivo revisar a literatura médica a respeito dos efeitos adversos metabólicos associados ao uso de antipsicóticos e estabilizadores de humor. MÉTODO: Foi realizada uma extensa pesquisa nas bases de dados MEDLINE e LILACS até outubro de 2005. CONCLUSÃO: Os efeitos adversos metabólicos permanecem como problemas importantes da psicofarmacologia. Ganho de peso clinicamente relevante ocorre com freqüência em pacientes em uso de antipsicóticos e estabilizadores de humor, principalmente naqueles em uso de clozapina, olanzapina, lítio e ácido valpróico. A clozapina e a olanzapina associam-se também a uma maior incidência de diabetes melito e dislipidemias, seja devido ao ganho de peso, seja por ação deletéria direta sobre o metabolismo da glicose. A incidência de obesidade e outros distúrbios metabólicos é menor com a risperidona, se comparada à olanzapina ou à clozapina. Carbamazepina associa-se a menor ganho de peso, se comparada ao lítio ou ao ácido valpróico. Drogas como o haloperidol, a ziprasidona, o aripiprazol e a lamotrigina não estão associadas a ganho importante de peso ou a maior incidência de diabetes melito e são alternativas para pacientes mais propensos a desenvolver tais efeitos adversos. BACKGROUND: An increase in the incidence of obesity and diabetes mellitus in psychiatric patients using antipsychotic drugs was observed as early as the 1960's. In the 1980's and 1990's, rehabilitation of clozapine, synthesis of other atypical antipsychotics, and spread of the use of lithium and valproic acid once again directed the attention to their metabolic effects. This study aims to review the medical literature with regard to metabolic side effects associated with the use of antipsychotics and mood stabilizers. METHOD: Research was carried out at MEDLINE and LILACS through October 2005. CONCLUSION: Metabolic side effects remain a major concern for psychopharmacology. Clinically relevant weight gain occurs frequently in patients taking antipsychotics and mood stabilizers, particularly clozapine, olanzapine, lithium, and valproic acid. Clozapine and olanzapine are also associated with higher incidence of diabetes mellitus and dyslipidemias, either due to weight gain or because of a direct deleterious action on glucose metabolism. Incidence of obesity and other metabolic disorders is lower with risperidone when compared to olanzapine or clozapine. Carbamazepine is associated with lower weight gain when compared to lithium or valproic acid. Drugs such as haloperidol, ziprasidone, aripiprazole and lamotrigine are not associated with significant weight gain or with higher incidence of diabetes mellitus. They are alternatives for patients more likely to develop these adverse effects.

Introdução: O uso de antipsicóticos tem sido fundamental no tratamento de portadores de esquizofrenia. Entretanto, tanto a clozapina quanto a maior parte dos antipsicóticos atípicos podem induzir um maior ganho de peso corporal e alterações metabólicas. Objetivo: Comparar a freqüência de sobrepeso e obesidade em pacientes esquizofrênicos expostos à clozapina com a dos expostos a demais antipsicóticos. Método: Foram estudados 121 pacientes esquizofrênicos, com idade de 18 anos ou mais, de ambos os sexos, atendidos no Ambulatório de Esquizofrenia e Demências do Hospital de Clínicas de Porto Alegre, encaminhados de forma consecutiva. Foram avaliadas medidas antropométricas de 53 pacientes em uso de clozapina e de 68 usando outros antipsicóticos, e todos preencheram os critérios diagnósticos de esquizofrenia do DSM-IV e CID-10. Resultados: Não houve diferença significativa na freqüência do IMC entre os esquizofrênicos em uso de clozapina, quando comparado com o dos que usam os demais antipsicóticos. As análises mostraram uma elevada prevalência de pacientes (72,7%) com excesso de peso (sobrepeso + obesidade). Discussão: Devido à maior freqüência de excesso de peso na população esquizofrênica, pode-se evidenciar na amostra um indicativo de maior risco para transtornos vasculares e metabólicos. A ausência de diferença significativa em relação ao uso de clozapina, comparada com os demais antipsicóticos, demonstra a necessidade da montagem de estudos prospectivos determinando a magnitude de ganho de peso e o aumento de risco relativo à exposição específica de cada antipsicótico. Background: The use of antipsychotics has been crucial in the treatment of schizophrenic patients. However, clozapine, as well as most atypical antipsychotics, may lead to higher weight gain and metabolic changes. Objective: To compare the frequency of overweight and obesity between schizophrenic patients exposed to clozapine to the prevalence of patients exposed to other antipsychotics. Method: This study assessed 121 schizophrenic outpatients aged 18 years or older, both genders, consecutively referred to an outpatient clinic for schizophrenia and dementia at Hospital de Clínicas de Porto Alegre, a public hospital in Porto Alegre, Brazil. Anthropometric measures of 53 patients taking clozapine and of 68 taking other antipsychotics were assessed. All patients met DSM-IV and ICD-10 diagnostic criteria for schizophrenia. Results: There was no significant difference in body mass index between schizophrenic patients taking clozapine and patients taking other antipsychotics. Analyses showed high frequency of overweight and obesity (72.7%). Discussion: Due to higher frequency of overweight in the schizophrenic population, it was possible to confirm a higher risk of vascular and metabolic disorders in the sample. Absence of a significant difference with regard to the use of clozapine, compared to other antipsychotics, provides evidence for the need of prospective studies in order to determine the magnitude of weight gain and risk increase related to specific exposure to each antipsychotic drug.

Estas diretrizes para o tratamento biológico da esquizofrenia foram desenvolvidas pela Força-Tarefa da Federação Mundial das Sociedades de Psiquiatria Biológica (World Federation of Societies of Biological Psychiatry, WFSBP). A meta fixada durante o desenvolvimento destas diretrizes foi rever sistematicamente todas as evidências disponíveis referentes ao tratamento da esquizofrenia, tanto no âmbito clínico como científico, e chegar a um consenso sobre as principais recomendações para a prática psiquiátrica. Estas diretrizes são destinadas a todos os médicos que atendem e tratam de pacientes portadores de esquizofrenia. Os dados usados para desenvolver estas diretrizes foram extraídos primariamente de vários painéis e diretrizes nacionais de tratamento para esquizofrenia, assim como de metanálises, revisões e estudos clínicos randomizados sobre a eficácia do tratamento farmacológico e de outras intervenções terapêuticas biológicas, identificadas por uma busca nas bases de dados MedLine e Biblioteca Cochrane. A literatura identificada foi avaliada no que diz respeito à solidez das evidências a favor da eficácia de uma dada intervenção e, então, categorizada em quatro níveis de evidências (de A a D). A primeira parte das diretrizes abrange a definição da doença, sua classificação, a epidemiologia e o curso da esquizofrenia, assim como o manejo terapêutico de fase aguda. Estas diretrizes são primariamente relacionadas ao tratamento biológico de adultos esquizofrênicos, incluindo medicação antipsicótica, outras opções de tratamento farmacológico, terapia eletroconvulsiva, estratégias terapêuticas recentes e complementares. These guidelines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating people with schizophrenia. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for schizophrenia, as well as from meta-analyses, reviews and randomised clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into four levels of evidence (A/D). This first part of the guidelines covers disease definition, classification, epidemiology and course of schizophrenia, as well as the management of the acute phase treatment. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication, other pharmacological treatment options, electroconvulsive therapy, adjunctive and novel therapeutic strategies) of adults suffering from schizophrenia.

La prévalence du tabagisme chez les individus souffrant de schizophrénie est élevée. Ceux-ci sont plus susceptibles d’être de gros fumeurs et de présenter une dépendance à la nicotine. Chez les schizophrènes, la nicotine corrige certaines anomalies neurophysiologiques comme les déficits de filtrage sensoriel. La normalisation de ces paramètres est liée à la stimulation d’un récepteur nicotinique particulier, le récepteur alpha-7. La prise d’antipsychotiques peut à la fois influencer le profil tabagique des personnes souffrant de schizophrénie et être influencée par le tabagisme. En effet, la fumée générée par la combustion du tabac induit le métabolisme de plusieurs antipsychotiques. La nicotine peut également atténuer certains effets indésirables liés à la prise de cette classe de médicaments. Tous ces éléments font foi des liens particuliers qui unissent la schizophrénie et son traitement au tabagisme., The prevalence of tobacco use among individuals suffering from schizophrenia is high. They tend to be heavy smokers and suffer from nicotine dependence. In schizophrenics, nicotine corrects certain neurophysiological anomalies such as sensory gating deficits. Normalization of these parameters is related to the stimulation of a specific nicotinic receptor, alpha-7. Antipsychotic drugs may have an influence on the tobacco use profile of persons suffering from schizophrenia and be influenced by its use. The smoke created by the combustion of tobacco affects the metabolism of several antipsychotic drugs. Nicotine may also attenuate certain undesirable effects related to taking this class of medication. All these elements indicate special links uniting schizophrenia and its treatment with tobacco use., La prevalencia del tabaquismo en individuos que sufren de esquizofrenia es elevada. Estas personas son más susceptibles de ser grandes fumadores y de presentar una dependencia a la nicotina. En los esquizofrénicos, la nicotina corrige ciertas anomalías neurofisiológicas, como los déficits de filtrado sensorial. La normalización de estos parámetros está ligada a la estimulación de un receptor nicotínico particular, el receptor alfa-7. La toma de antipsicóticos puede influir en el perfil tabáquico de las personas que sufren esquizofrenia y ser, al mismo tiempo, influenciada por el tabaquismo. En efecto, el humo generado por la combustión del tabaco induce el metabolismo de numerosos antipsicóticos. La nicotina puede, asimismo, atenuar ciertos efectos indeseables relacionados con la toma de esta clase de medicamentos. Todos estos elementos dan fe de las relaciones particulares que unen la esquizofrenia y su tratamiento con el tabaquismo.