Search

Intramuscular formulations of antipsychotics can be sub-divided into two groups on the basis of their pharmacokinetic features: short-acting preparations and long-acting or depot preparations. Short-acting intramuscular formulations are used to manage acute psychotic episodes. On the other hand, long-acting compounds, also called 'depot', are administered as antipsychotic maintenance treatment to ensure compliance and to eliminate bioavailability problems related to absorption and first pass metabolism. Adverse effects of antipsychotics have been studied with particular respect to oral versus short- and long-acting intramuscular formulations of the different compounds. For short-term intramuscular preparations the main risk with classical compounds are hypotension and extrapyramidal side effects (EPS). Data on the incidence of EPS with depot formulations are controversial: some studies point out that the incidence of EPS is significantly higher in patients receiving depot preparations, whereas others show no difference between oral and depot antipsychotics. Studies on the strategies for switching patients from oral to depot treatment suggest that this procedure is reasonably well tolerated, so that in clinical practice depot antipsychotic therapy is usually begun while the oral treatment is still being administered, with gradual tapering of the oral dose. Efficacy, pharmacodynamics and clinical pharmacokinetics of haloperidol decanoate, fluphenazine enanthate and decanoate, clopenthixol decanoate, zuclopenthixol decanoate and acutard, flupenthixol decanoate, perphenazine enanthate, pipothiazine palmitate and undecylenate, and fluspirilene are reviewed. In addition, the intramuscular preparations of atypical antipsychotics and clinical uses are reviewed. Olanzapine and ziprasidone are available only as short-acting preparations, while risperidone is to date the only novel antipsychotic available as depot formulation. To date, acutely ill, agitated psychotic... [ABSTRACT FROM AUTHOR]

Purpose: Uterine arteriovenous malformations (UAVM) are rare vascular lesions characterized by an abnormal arteriovenous communication between the branches of uterine artery and the myometrial venous plexus. UAVM can be a serious cause of massive post-partum hemorrhage (PPH) leading to potentially life-threatening anemic shock. This review aims to summarize main experiences on clinical presentation and management of UAVM in the setting of unexplained PPH., Methods: A systematic review of the literature in Scopus, PubMed and MEDLINE was conducted. A case report of a PPH UAVM-related in a patient managed at the authors' center is also provided., Results: Eleven studies met the inclusion criteria. The mean age of cases was 30. In 3/11 cases, previous uterine surgeries were reported and 72.7% cases gave birth by cesarean section. Nine cases had a secondary PPH (24 h up to 12 week post-partum), whereas only one case had a primary PPH. Our case report had both a primary and a secondary PPH. Reported vaginal bleedings were profuse and blood loss entity ranged from 1000 to 2000 ml. In all cases a color Doppler ultrasound was performed first to suspect UAVM and in 10/11 cases a subsequent pelvic angiography confirmed the diagnosis of UAVM as leading cause of the unexplained PPH. In 81.8% cases a conservative management by uterine artery embolization (UAE) was adopted: bilateral UAE was always successful; in 1 out of 2 cases treated by unilateral UEA, emergency total hysterectomy was performed for a sudden hemodynamic instability., Conclusion: Maternal mortality pregnancy-correlated is a major health concern worldwide, mostly due by PPH. UAVM should be considered in clinical practice among possible causes of unexplained PPH., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Dysregulation of the inflammatory response system has been linked to the pathophysiology of schizophrenia. Abnormal levels of proinflammatory cytokines and their receptors have been found in peripheral blood and cerebrospinal fluid of schizophrenic patients, suggesting the presence of immune activation. Monocyte chemoattractant protein 1 (MCP-1) influences the expression of cytokines related to T helper responses. MCP-1 also exerts several effects on monocytes, including the expression of several proinflammatory genes. The A-2518G polymorphism of the MCP-1 gene (SCYA2) appears to affect the transcriptional activity and monocyte MCP-1 production. The aim of this case-control study was to investigate the potential role of SCYA2 (A-2518G polymorphism) in conferring susceptibility to schizophrenia and to the resistance to antipsychotic treatment. The sample studied consisted of 191 DSM-IV schizophrenia or schizoaffective disorder (depressive subtype) patients and 161 matched healthy controls. No significant genotypic (chi(2) = 0.278, df = 2, P = 0.986) or allelic (chi(2) = 0.021, df = 1, P = 0.884) association was found between the A-2518G variant of the SCYA2 and the diagnosis. No differences in the age at onset of schizophrenia were found between the three genotype groups identified. Significant genotypic association was found between the A-2518G variant of the SCYA2 and the resistance to antipsychotic treatment (chi(2) = 6.26, df = 2, P = 0.04), with resistant patients more frequently carrying the G allele. The odds ratio associated to the presence of the G allele was 2.39 (95% CI = 1.14-4.98). These data suggest that the A-2518G variant of the SCYA2 has not a major role in the pathogenesis of schizophrenia, while it could be implicated in the resistance to antipsychotic treatment., (Copyright 2004 Wiley-Liss, Inc.)

The aim of this study was to evaluate the effects of comorbid subthreshold anxiety on the course and the treatment of Depressive Disorders. The sample studied comprised four groups defined by the DSM-IV Axis I diagnosis: (1) Patients with a Major Depressive Disorder (MDD) and an Anxiety Disorder (DA); (2) patients with MDD and a subthreshold Anxiety Disorder (Da); (3) patients with subthreshold depression and an Anxiety Disorder (dA); (4) patients with subthreshold depression and subthreshold anxiety (da). HAMD, HAMA and CGI rating scales were administered monthly for 12 months while patients were treated with different antidepressants. Significant differences were found among the four groups with respect to the baseline depressive symptoms: Da presented more frequently suicidal ideation (chi2=9.568, d.f.=3, p=0.023), psychomotor retardation (chi2=12.568, d.f.=3, p=0.006), sexual dysfunctions (chi2=7.761, d.f.=3, p=0.05), hypochondriacal ideation (chi2=13.633, d.f.=3, p=0.003), weight loss (chi2=9.520, d.f.=3, p=0.023), and diurnal variation of symptoms (chi2=13.258, d.f.=3, p=0.004). With respect to the treatment response Da patients showed an overall worse response to antidepressants, having a longer latency and a lower reduction of symptoms. These results suggest that patients with Major Depression and subthreshold anxiety present with a more severe baseline clinical picture and seem to have a less efficient response to antidepressants.