Search

OBJECTIVES This study aimed to determine the prevalence of metabolic syndrome in schizophrenic patients in a tertiary care hospital. METHODOLOGY This descriptive cross-sectional study was conducted at the Department of Psychiatry, PGMI Lady Reading Hospital Peshawar, Pakistan, from March 2023 to February 2024. A total of 196 schizophrenic patients were studied. After obtaining permission from the hospital's ethical committee and consent from patients included in the study, metabolic syndrome was diagnosed based on the American Association of Clinical Endocrinology criteria (2003). All the data, like age, gender, height, weight, BMI, smoking status, and metabolic syndrome, were recorded in a pre-designed proforma. All the data were analyzed in SPSS version 20. Mean and standard deviation were calculated for numerical variables, and frequencies and percentages for qualitative variables. The Chi-square test for categorical variables was applied with a p-value of < 0.05 as significant. Results were presented in the form of tables and charts. RESULTS The mean and standard deviation of age, height, weight, and BMI were 35.72±13.28, 164.80±11.50, 71.87±13.60 and 27.00±6.96, respectively. Out of 196 schizophrenic patients, 59 patients had metabolic syndrome, making up 31.1%, while 69.9% of patients had no metabolic syndrome. Of 196 schizophrenic patients, 106 were female, and 90 were male, making 54.1% and 45.9%, respectively, of all schizophrenic patients. Among 196 patients, 28 were from the BMI group < 18kg/m2, 71 from the BMI group 18-24kg/m2, 51 from the BMI group 25-30kg/m2, and 46 from the BMI group> 30kg/m2 making 14.3%, 36.2%, 26.0% and 23.5% respectively. Metabolic syndrome was statistically significant in age and BMI groups using the chi-square test with a p-value < 0.05 as significant. CONCLUSION The metabolic syndrome affects individuals with schizophrenia, particularly among older patients and those with a high BMI. Significant associations were observed with age and BMI, but gender and smoking status did not show significant differences.

Objectives: Anxiety disorder is present in approximately half of all bipolar disorder (BD) patients. There are neurologic bases for the comorbidity of balance (vestibular) disorders and anxiety. Our objective is to use electrovestibulography (EVestG), which is predominantly a measure of vestibular neural activity to not only quantitatively detect and measure comorbid anxiety disorder but also to quantitatively measure the impacts of anti-depressant, anti-psychotic, and mood stabilizer medication groups on anxiety measures in BD patients. Methods: In a population of 50 (24 with anxiety disorder) depressive phase BD patients, EVestG signals were measured. Participants were labeled depression-wise as anxious or non-anxious using standard questionnaires. Analyses were conducted on the whole dataset as well as on matched (age/gender/MADRS) and “modeled medication-free” subsets. Modulations of the low-frequency EVestG firing pattern data were measured. Findings: For BD, the main anxious minus non-anxious dierence was the presence of an increase in spectral power proximal to 8–9 Hz, which was best attenuated by mood stabilizers. Novelty: This is the first study to use an oto-acoustic physiological measure to quantify anxiety disorder in BD wherein it appears to manifest as a peak proximal to 8–9 Hz which we hypothesize as likely linked to hippocampal theta. [ABSTRACT FROM AUTHOR]

Background: The study evaluated the effect of various psychotropics on pulmonary function to identify the psychotropic drug class most commonly associated with risk of respiratory disorders. Since psychotropic medications have safety concerns for usage in general population, their use in people with Coronavirus Disease (COVID-19) is considered challenging. The study may also serve to draw evidence-based practical recommendations for the treatment of people with COVID-19. Materials and Methods: A 10-item containing questionnaire was designed to capture clinical information regarding psychotropic use and respiratory disorders. Internal consistency and reproducibility were determined using Cronbach's alpha and intra-class correlation coefficient respectively. A validated questionnaire was administered to patients or caregivers at a community pharmacy setup and data was collected through electronic data capture. All captured data were summarized descriptively and statistically analyzed using R Studio 4.0. Results: Cronbach's alpha and intra-class correlation coefficient values were found to be 0.92 and 0.85 respectively. In a sample of 198 patients, benzodiazepines were the commonly used medication (43.9%) followed by selective serotonin reuptake inhibitors (21.2%), anti-psychotics (15.1%), mood stabilizers (7.6%) and others (12.2%). A statistically significant association was observed between benzodiazepine, second-generation antipsychotics, and respiratory disorders (OR 1.56 [1.1 - 2.3, p<0.1]). However, the use of first-generation antipsychotics was found to be less associated with respiratory infections. Conclusion: Benzodiazepine and second-generation antipsychotics were found to be significantly associated with respiratory disorders. Hence patients on psychotropics should be monitored for respiratory symptoms and the choice of anti-psychotic medications should be on existing clinical evidence. The psychotropics which were found to be safer through the study can be chosen to improve the quality of psychiatric care in COVID-19 patients, also promoting an optimal management of psychiatric conditions without worsening the medical condition due to COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Drug-induced QT prolongation is the most common cause of acquired QT prolongation. Risk factors for QTc prolongation and TdP are recorded as the following: female sex, old age, cardiac disease, electrolyte abnormalities, diabetes mellitus type II, thyroid disease, and bradycardia. Hence the present study was conducted to find out the changes in QTc readings after taking predefined subset of drugs among patients. Materials and Methodology: This study is adopted as a prospective observational study and was planned to be conducted at L.N. Medical College & Research centre and associated J.K Hospital Bhopal.. The study group was formed based on the fulfilment of the inclusion and exclusion criteria. There are certain biochemical tests to be done in order to exclude the acquired cause. The primary test to be followed is ECG in which the QTc was calculated, measured and analysed. Baseline ECG was recorded at the time of inclusion then follow up ECG was recorded within 24 hours of completion of antibiotic treatment, and 7 days of antidepressant and antipsychotic treatment. Results: Theoverall distribution of study subjects according to level of QTc change according to drug class results revealed that maximum 64 subjects those were on antibiotics, 49 subjects were on antidepressants and 40 subjects were on anti-psychotics where QTc level change 1-5ms. There were significant (p<0.01) association of various drugs class with according to level of QTc change. Conclusion: Acquired QTc prolongation due to drugs is the most common cause for QTc prolongation observed in clinical practice. Though antipsychotics, antidepressant and antibiotics could cause significant QTc prolongation, ventricular tachycardia or Torsade De Pointes is more common with simultaneous use of two or more other QT prolonging drugs. [ABSTRACT FROM AUTHOR]

ObjectivesAnxiety disorder is present in approximately half of all bipolar disorder (BD) patients. There are neurologic bases for the comorbidity of balance (vestibular) disorders and anxiety. Our objective is to use electrovestibulography (EVestG), which is predominantly a measure of vestibular neural activity to not only quantitatively detect and measure comorbid anxiety disorder but also to quantitatively measure the impacts of anti-depressant, anti-psychotic, and mood stabilizer medication groups on anxiety measures in BD patients.MethodsIn a population of 50 (24 with anxiety disorder) depressive phase BD patients, EVestG signals were measured. Participants were labeled depression-wise as anxious or non-anxious using standard questionnaires. Analyses were conducted on the whole dataset as well as on matched (age/gender/MADRS) and “modeled medication-free” subsets. Modulations of the low-frequency EVestG firing pattern data were measured.FindingsFor BD, the main anxious minus non-anxious difference was the presence of an increase in spectral power proximal to 8–9 Hz, which was best attenuated by mood stabilizers.NoveltyThis is the first study to use an oto-acoustic physiological measure to quantify anxiety disorder in BD wherein it appears to manifest as a peak proximal to 8–9 Hz which we hypothesize as likely linked to hippocampal theta.

Background: Schizophrenic patients' adherence to medication regimens can determine clinical outcome success. This study focuses on medication adherence and its correlation with the efficacy of anti-psychotics. The study's goal is to (1) assess the efficacy of anti-psychotics and adherence using the Self-evaluation of Negative Symptoms (SNS) tool and Medication Adherence Rating Scale (MARS), and (2) examine the demographic and clinical factors that could impact both outcomes (SNS and MARS). Materials and Methods: Between November 2021 and February 2022, a cross-sectional study was carried out. Only 45 of 100 schizophrenia patients screened were included in the sample. MARS and SNS self-assessment questionnaires that took approximately 15 min to complete were administered to patients in a scheduled clinic interview. Other patients' demographic, physical, and clinical information was gathered from their electronic medical records via a Redcap designed data collection sheet. Results: Almost 53.3% of the current schizophrenic patients had perceived mild negative symptoms (scored 1 to <20 out of 40 on SNS). Surprisingly, 64.4% were either poor adherent (n=13 scored 5 to 6) or non-adherent (n=16 scored <5). There was a notable negative correlation between the total MARS score and both total SNS (r = -0.325, p=0.03) and social withdrawal scores (r = -0.436, p=0.003). Non-adherence was significantly associated with lower education levels (p=0.028) and unemployment (p=0.008), whereas SNS total score and anhedonia were both markedly associated with different marital status (p=0.046, and p=0.016, respectively). Conclusion: According to the study, medication schizophrenia nonadherence correlates negatively with the efficacy of anti-psychotics as perceived by patients, which reflects patient quality and perception of life. These findings strongly emphasize the importance of developing adherence interventions to enhance compliance with anti-psychotic regimens and improve patients' perceived self-evaluation of negative symptoms. [ABSTRACT FROM AUTHOR]

Mental health and neurodevelopmental disorders are extremely common across the lifespan and are characterized by a complicated range of symptoms that affect wellbeing. There are relatively few drugs available that target disease mechanisms for any of these disorders. Instead, therapeutics are focused on symptoms and syndromes, largely driven by neurotransmitter hypotheses, such as serotonin or dopamine hypotheses of depression. Emerging evidence suggests that maternal inflammation during pregnancy plays a key role in neurodevelopmental disorders, and inflammation can influence mental health expression across the lifespan. It is now recognized that commonly used psychiatric drugs (anti-depressants, anti-psychotics, and mood stabilizers) have anti-inflammatory properties. In this review, we bring together the human evidence regarding the anti-inflammatory mechanisms for these main classes of psychiatric drugs across a broad range of mental health disorders. All three classes of drugs showed evidence of decreasing levels of pro-inflammatory cytokines, particularly IL-6 and TNF-a, while increasing the levels of the anti-inflammatory cytokine, IL-10. Some studies also showed evidence of reduced inflammatory signaling via nuclear factor- (NF-)kB and signal transducer and activator of transcription (STAT) pathways. As researchers, clinicians, and patients become increasingly aware of the role of inflammation in brain health, it is reassuring that these psychiatric drugs may also abrogate this inflammation, in addition to their effects on neurotransmission. Further studies are required to determine whether inflammation is a driver of disease pathogenesis, and therefore should be a therapeutic target in future clinical trials. [ABSTRACT FROM AUTHOR]

Background: The side effects of antipsychotics (APs), related to weight gain and metabolic disturbances, can contribute to the health burden of psychotic people. Objective: To explore a) the level of adherence to the Mediterranean Diet (MedDiet) and consumption of fermented foods by first episode of psychosis (FEPs) patients taking APs, in comparison to matched -for age and BMI- healthy controls (HCs), and b) the effect of this dietary pattern on the biochemical and metabolic profile of FEPs. Method: The study population consisted of 33 FEPs treated with APs for less than 5 years, with no history of other chronic diseases, and an equal number of HCs. The FEPs were classified into two subgroups, according to their AP medication, depending on the documented risk of weight gain. A validated questionnaire for the adherence to Mediterranean diet and a food frequency questionnaire for selected fermented foods were completed by FEPs and HC. Anthropometric data and blood measurements were recorded for all participants. Results and conclusions: The FEPs showed a relevant lower overall adherence to the MedDiet, but no differences in consumption of fermented foods. Type of antipsychotic therapy uncovered differences in platelet count, vitamin B12, HDL and glucose (p < 0.05) between the subgroups of FEPs and HCs, although no values were abnormal. The MedDiet score was found to act as a prognostic factor for abnormal glucose levels in FEPs treated with APs associated with weight gain (p = 0.04). These results need to be confirmed by observations after long term adherence to MedDiet.

Mental health and neurodevelopmental disorders are extremely common across the lifespan and are characterized by a complicated range of symptoms that affect wellbeing. There are relatively few drugs available that target disease mechanisms for any of these disorders. Instead, therapeutics are focused on symptoms and syndromes, largely driven by neurotransmitter hypotheses, such as serotonin or dopamine hypotheses of depression. Emerging evidence suggests that maternal inflammation during pregnancy plays a key role in neurodevelopmental disorders, and inflammation can influence mental health expression across the lifespan. It is now recognized that commonly used psychiatric drugs (anti-depressants, anti-psychotics, and mood stabilizers) have anti-inflammatory properties. In this review, we bring together the human evidence regarding the anti-inflammatory mechanisms for these main classes of psychiatric drugs across a broad range of mental health disorders. All three classes of drugs showed evidence of decreasing levels of pro-inflammatory cytokines, particularly IL-6 and TNF-α, while increasing the levels of the anti-inflammatory cytokine, IL-10. Some studies also showed evidence of reduced inflammatory signaling via nuclear factor- (NF-)κB and signal transducer and activator of transcription (STAT) pathways. As researchers, clinicians, and patients become increasingly aware of the role of inflammation in brain health, it is reassuring that these psychiatric drugs may also abrogate this inflammation, in addition to their effects on neurotransmission. Further studies are required to determine whether inflammation is a driver of disease pathogenesis, and therefore should be a therapeutic target in future clinical trials.

Background: Metabolic syndrome (MetS) is a complex illness with interconnected physiological, clinical, and metabolic factors. MetS is more prevalent in patients with mental illness than in the general population and contributes to greater morbidity and mortality. Thus we, studied the prevalence and correlates of MetS in psychiatric inpatients. Materials and Methods: The study is an observational cross-sectional study conducted at a tertiary care center. All consecutive patients (n = 185) admitted to the department of Psychiatry were enrolled after informed consent. Sociodemographic data, clinical data, and treatment details were collected. The WHO Global Physical Activity Questionnaire was administered to assess the level of physical activity; MetS was diagnosed as per the International Diabetes Federation criteria. Results: The prevalence of MetS was 22.7% among the study participants. The prevalence of MetS was significantly associated with higher age, urban domicile status, and middle and upper socioeconomic classes. Clinical characteristics such as longer duration of illness, comorbid substance use disorders, and treatment regimens with only antipsychotics medications were associated with higher likelihood of MetS. There was a higher prevalence of MetS among subjects with lower level of physical activity. Conclusion: One-fourth of the psychiatric inpatients had MetS. Guidelines specific to the Indian context need to be developed for the screening and monitoring of psychiatric patients with reference to MetS. Promotion of physical well-being and physical activity among patients with mental disorders is likely to contribute to a better overall outcome.

Valentin Petre Matei,1 Alexandra Ioana Mihăilescu,1,2 Iuliana Raluca Gheorghe,3 Ruxandra Grigoraş,4 Andrei Crasan,5 Alina Roșca,1,6 Ovidiu Popa-Velea2 1Clinical Hospital of Psychiatry “Alexandru Obregia”, Bucharest, Romania; 2Department of Medical Psychology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 3Department of Marketing and Medical Technology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 4Voila Psychiatric Hospital, Câmpina, Romania; 5The City Hospital of Curtea De Argeş, Curtea De Argeș, Romania; 6Department of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, RomaniaCorrespondence: Iuliana Raluca Gheorghe Email raluca.gheorghe@umfcd.roPurpose: This study examined the validity of subjective clinical prognosis (SCP), a commonly used clinical tool, in first episode psychosis patients included in the European First Episode Schizophrenia Trial (EUFEST) study.Patients and Methods: The study comprised 455 patients from the EUFEST trial (mean age 25.92, SD=5.45; 188 (41.31%) women, 267 (58.69%) men). SCP was classified into three mutually exclusive groups: “good prognosis” (GP) (n=265), “average prognosis” (AP) (n=131), and “poor prognosis” (PP) (n=59). The validity of the SCP was assessed by investigating the differences between the SCP groups and completer or responder status of the patients, during 1 year of the trial.Results: The proportion of completers was significantly higher in the GP group (64.4%) compared to the AP group (25.6%) (OR=1.62, 95% CI=1.062– 2.476, p< 0.031) and the PP group (10%) (OR=2.17, 95% CI=1.226– 3.853, p< 0.009) throughout the whole duration of the trial. In what concerns responsiveness, a significantly higher number of responders were registered in the GP group compared to the AP and the PP groups in the first three months of treatment, but this outcome did not persist afterwards.Conclusion: In terms of its predictive value at first episode schizophrenic patients, SCP seems to be reliable for treatment completion, but has a limited utility in what concerns responsiveness to treatment. This finding suggests the necessity of creating a prediction model potentially including, besides SCP, other measurement-based variables.Keywords: anti-psychotics, first episode psychosis, prognosis, schizophrenia

Genetic and metabolic disorders present unique challenges in understanding the pathophysiology and outcomes of specific symptoms and presentations due to their broad spectrum of manifestations and etiologies. In this case report, we have studied a 26-year-old who was diagnosed with omodysplasia, a rare form of skeletal dysplasia. She exhibits atypical symptoms of psychosis and was diagnosed with schizophreniform disorder at an early age. Various antipsychotic medications were administered; however, minimal to no improvement was noted in the symptoms. On the contrary, she reported adverse effects to some antipsychotics. She continued to exhibit delusions and hallucinations and showed clinical improvement after treatment with olanzapine. Her clinical course was further complicated by the presence of borderline personality traits, which went unnoticed earlier. Here, we would like to highlight the course of her symptoms, the different treatments administered, and the possible link between omodysplasia and treatment-resistant schizophrenia., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Das et al.)

Evidence to support the use of antipsychotic medications for the management of delirium symptoms remains limited. The primary objective of this study was to compare the effect of antipsychotic and non-antipsychotic treatments for delirium symptoms among palliative care inpatients. Secondary outcomes were use of midazolam and overall survival. This involved retrospective analysis of medical records (November 2018 to April 2019) for adult palliative care patients diagnosed with delirium at an Australian tertiary hospital. NuDESC was used to assess symptoms daily from baseline to Day 3. All 65 patients (mean age 73.5 ± 13.7 years, 48% female, 59% with cancer) included received standard care which included management of underlying causes of delirium symptoms, of which 17 received additional treatment using antipsychotic medications. Forty-eight did not receive any antipsychotic medication. An absolute reduction in NuDESC score was observed in the group that did not receive additional treatment using antipsychotics (by 1.37 units, 95% CI 0.79–1.95, p < 0.0001). A significantly higher proportion of midazolam use (n = 9, 53% versus n = 2, 4%, p < 0.001) and shorter median survival (13 days versus 26 days, p = 0.03) was observed in the group of patients that received antipsychotics. The use of antipsychotic medications in addition to standard treatments targeting underlying precipitants did not lead to a significant improvement in delirium symptoms and was associated with a greater midazolam use and lower median duration of survival. Individualized treatment of underlying causes still appears to be essential in the management of delirium in patients receiving palliative care. [ABSTRACT FROM AUTHOR]

Background: Delirium is common in hospitalised patients but its epidemiology remains poorly characterised. Aims: To test the hypothesis that patient demographics, clinical phenotype, management and outcomes of patient with delirium in hospital ward patients differ from intensive care unit (ICU) patients. Methods: Retrospective cohort of patients admitted to an Australian university‐affiliated hospital between March 2013 and April 2017 and coded for delirium at discharge using the International Classification of Diseases System, 10th revision, criteria. Results: Among 61 032 hospitalised patients, 2864 (4.7%) were coded for delirium. From these, we studied a random sample of 100 ward patients and 100 ICU patients. Ward patients were older (median age: 84 vs 65 years; P < 0.0001), more likely to have dementia (38% vs 2% for ICU patients; P < 0.0001) and less likely to have had surgery (24% vs 62%; P < 0.0001). Of ward patients, 74% had hypoactive delirium, while 64% of ICU patients had agitated delirium (P < 0.0001). Persistent delirium at hospital discharge was more common among ward patients (66% vs 17%, P < 0.0001). On multivariable analysis, age and dementia predicted persistent delirium, while surgery predicted recovery. Conclusions: Delirium in ward patients is profoundly different from delirium in ICU patients. It has a dominant hypoactive clinical phenotype, is preceded by dementia and is less likely to recover at hospital discharge. Therefore, delirium prevention, detection and goals of care should be adapted to the environment in which it occurs. [ABSTRACT FROM AUTHOR]

Summary: Epigenetic effects of anti‐psychotic medications are poorly understood. We have appropriated a model whereby heterochromatin is established through 24‐ or 48‐h lipopolysaccharide (LPS) treatment, and tested the epigenetic effects of risperidone along the adenylyl cyclase/protein kinase A (AC/PKA) pathway in human liposarcoma cells that express the LPS‐sensitive Toll‐like receptor (TLR)‐4. Human SW872 cells were cultured with LPS and mRNA expression levels and epigenetic modifications of dimethylated lysine 9 of histone 2 (H3K9me2), geterochromatin protein 1γ (HP1γ) and phospho‐H3S10 at promoters of interleukin (IL)‐6, tumor necrosis factor (TNF)‐α and IL1β were measured. Pharmacological manipulation of the AC/PKA pathway was achieved through treatment with a PKA inhibitor (H89), mitogen‐ and stress‐activated kinase 1 (MSK1) inhibitor (SB‐747651A) or forskolin. Twenty‐four and 48‐h LPS treatment establishes heterochromatin at selected promoters, corresponding to decreased mRNA expression. Concurrent risperidone treatment with LPS treatment can both 'block' and 'reverse' heterochromatin formation. Forskolin treatment resulted in a similar disassembling effect on heterochromatin. Conversely, inhibition of PKA by H89 or MSK1 both blocked 'normalizing' effects of risperidone on LPS‐induced heterochromatin. Our results demonstrate that risperidone can disassemble heterochromatin, exerting this effect along the G‐protein/AC/PKA pathway. This approach can also be utilized to investigate functional outcomes of single or combined pharmacological treatments on chromatin assemblies in human cells. We have appropriated a model whereby heterochromatin is established through 24‐ or 48‐hour lipopolysaccharide (LPS) treatment, and tested epigenetic effects of the anti‐psychotic risperidone along the adenylyl cyclase (AC)/PKA pathway in human liposarcoma cells that express the LPS‐sensitive receptor TLR‐4. LPS treatment establishes heterochromatin at IL‐6, TNF‐α and IL‐1β promoters, corresponding to decreased mRNA expression, but concurrent risperidone treatment can both 'block' and 'reverse' heterochromatin formation, an effect also seen with forskolin treatment. Conversely, inhibition of PKA by H89 or MSK1 both blocked 'normalizing' effects of risperidone on LPS‐induced heterochromatin, demonstrating that risperidone can disassemble heterochromatin, exerting this effect along the G‐protein/AC/PKA pathway. [ABSTRACT FROM AUTHOR]

Vasanth Kattalai Kailasam,1 Victoria Chima,2,* Uchechukwu Nnamdi,3,* Kavita Sharma,4,* Kairav Shah5 1College of Medicine, University of Illinois, Chicago, IL, USA; 2Mount Sinai Beth Israel Medical Center, New York, NY, USA; 3Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA; 4Harlem Hospital Center, New York, NY, USA; 5Department of Psychiatry & Behavioral Sciences, The University of Texas McGovern Medical School, Houston, TX, USA *These authors contributed equally to this work Abstract: This case report presents a 44-year-old man with a history of schizophrenia who developed neutropenia on risperidone therapy. The patient’s laboratory reports showed a gradual decline of leukocytes and neutrophils after resolution and rechallenging. This was reversed with the discontinuation of risperidone and by switching to olanzapine. In this case report, we also discuss the updated evidence base for management of risperidone-induced neutropenia. Keywords: risperidone, antipsychotics, neutropenia, blood dyscrasias

Objectives The study aimed to evaluate the prevalence of insomnia in patients with first episode psychosis (FEP) and to explore the relationship between insomnia and socio-demographic and clinical variables as well as quality of life (QOL) and functioning in Singapore. Methods Data on sleep, smoking, alcohol habits, QOL and socio-demographics were collected from 280 FEP patients who were enrolled in the Early Psychosis Intervention Programme (EPIP) within 3 months of joining the programme. Multiple logistic regression analyses were performed to determine the socio-demographic and clinical correlates of insomnia. The association of insomnia with QOL as well as functioning was examined using multiple linear regression analyses. Results The prevalence of clinical insomnia was 22.6%. Older age and higher dosage of antipsychotic medication were significantly associated with a lower risk of insomnia while hazardous alcohol use, current smoking and a longer duration of untreated psychosis were significantly associated with a higher risk of insomnia. Insomnia was associated with significant decreases in all QOL domains assessed in the study even after adjusting for confounders. Conclusions FEP patients with insomnia must be screened for hazardous alcohol use and smoking. Patients must be referred concurrently for treatment of insomnia, smoking cessation as well as brief intervention for hazardous alcohol use when needed. [ABSTRACT FROM AUTHOR]

This article reports on the outcome and evaluation of the focused intervention training and support (FITS) into practice programme, a training and support programme for care home staff aimed at reducing inappropriate anti-psychotic prescribing for people living with dementia by implementing alternative psychosocial interventions. This programme was adapted from an original randomised-controlled trial that successfully reduced the prescribing of antipsychotic medications in care homes. The aim of the new programme was to replicate the impact of the original trial, but using a less resource-intense model, so that it could be implemented across care homes in the UK within existing resource conditions. The programme successfully reduced anti-psychotic prescribing and improved staff knowledge and attitudes. Barriers and facilitators of implementation were identified at four key levels: the dementia care coach; the care home; the organisation; and external relationships. Crucial to success was the provision of dedicated time for dementia care coaches to implement, the ongoing support provided by the expert-practitioner role, and the quality of relationships with prescribers. The implications of these for the FITS into practice programme, other similar interventions, and the work of prescribers with care homes are discussed. [ABSTRACT FROM AUTHOR]

In recent years, evidence supporting a link between inflammation and neuropsychiatric disorders has been mounting. Autism spectrum disorders (ASD) and schizophrenia share some clinical similarities which we hypothesize might reflect the same biological basis, namely, in terms of inflammation. However, the diagnosis of ASD and schizophrenia relies solely on clinical symptoms, and to date, there is no clinically useful biomarker to diagnose or monitor the course of such illnesses.The focus of this review is the central role that inflammation plays in ASD and schizophrenia. It spans from pre-clinical animal models to clinical research and excludes in vitro studies. Four major areas are covered: (1) microglia, the inflammatory brain resident myeloid cells, (2) biomarkers, including circulating cytokines, oxidative stress markers, and microRNA players, known to influence cellular processes at brain and immune levels, (3) effect of anti-psychotics on biomarkers and other predictors of response, and (4) impact of gender on response to immune activation, biomarkers, and response to anti-psychotic treatments. [ABSTRACT FROM AUTHOR]

Idiopathic granulomatous lesion is a rare entity of the breast seen in young-middle aged women. Diagnosis and management of granulomatous lesions with known aetiology does not impose major clinical problems. However, most often these lesions are undetected or unnoticed due to lack of timely diagnosis and inappropriate management, as primarily it is idiopathic. Hyperprolactinemia have been proposed as one of the mechanisms underlying the development of granulomatous lesions of the breast. We report a case of hyperprolactinemia due to risperidone therapy for bipolar mood disorder in a woman who eventually developed granulomatous mastitis. Histologically, the diagnosis was confirmed by the presence of granulomatous lesion and by ruling out other potential causes. In this case, raised prolactin was possibly an important factor which was secondary to risperidone therapy. However, idiopathic granulomatous mastitis could not be completely ruled out.

Tardive dyskinesia (TD) is a potentially serious and irreversible side effect of anti-psychotic medications. It is characterized by choreiform movements, or rhythmic abnormal involuntary movements of the face, mouth, tongue, trunk, and limbs. Although no reliable treatment for TD exists, atypical anti-psychotics are associated with a significantly lower incidence of TD than typical anti-psychotics. Recent reports suggest that atypical anti-psychotics may have a beneficial effect on TD remission. We present a case of severe oro-bucco-lingual TD, which was effectively managed with aripiprazole.

Background: Neuropsychiatric Symptoms (NPS) are ubiquitous in dementia and are often treated pharmacologically. The objectives of this study were to describe the use of psychotropic, anti-cholinergic, and deliriogenic medications and to identify the prevalence of polypharmacy and psychotropic polypharmacy, among older hospitalized patients in Ireland, with and without dementia.Methods: All older patients (≥ 70 years old) that had elective or emergency admissions to six Irish study hospitals were eligible for inclusion in a longitudinal observational study. Of 676 eligible patients, 598 patients were recruited and diagnosed as having dementia, or not, by medical experts. These 598 patients were assessed for delirium, medication use, co-morbidity, functional ability, and nutritional status. We conducted a retrospective cross-sectional analysis of medication data on admission for 583/598 patients with complete medication data, and controlled for age, sex, and co-morbidity.Results: Of 149 patients diagnosed with dementia, only 53 had a previous diagnosis. At hospital admission, 458/583 patients experienced polypharmacy (≥ 5 medications). People with dementia (PwD) were significantly more likely to be prescribed at least one psychotropic medication than patients without dementia (99/147 vs. 182/436; p < 0.001). PwD were also more likely to experience psychotropic polypharmacy (≥ two psychotropics) than those without dementia (54/147 vs. 61/436; p < 0.001). There were no significant differences in the prescribing patterns of anti-cholinergics (23/147 vs. 42/436; p = 0.18) or deliriogenics (79/147 vs. 235/436; p = 0.62).Conclusions: Polypharmacy and psychotropic drug use is highly prevalent in older Irish hospitalized patients, especially in PwD. Hospital admission presents an ideal time for medication reviews in PwD. [ABSTRACT FROM AUTHOR]

Coroners files and toxicological records of fatally-injured drivers in Victoria from 2000 to 2006 and from 2007 to 2013 were reviewed in separate studies to establish the role of prescribed drugs on crash risk. 2638 driver fatalities were included in the study, which represented over 97% of all driver fatalities in this period. The detection limits of the drugs were at the low end of those seen with common illicit drugs or prescribed drugs. Drugs of any type were found in 34.4% of the study group, medicinal drugs 21.2%, and alcohol (≥0.05 gram/100mL) was found in 24.8%. The prevalence of the most common drugs detected that are legally available by prescription were anti-depressants (7.9%), benzodiazepines (7.0%), opiates/opioids (6.6%), and sedating anti-histamines (1.1%). Each driver was assessed for responsibility using a previously published and validated method. The crash risk of drivers taking opioids, benzodiazepines, or anti-depressants (primarily the serotonin reuptake inhibitors), were not significantly over-represented compared to the drug-free control group, although there was a suggestion of increased crash risk for benzodiazepines. Crash risk was elevated for drivers using cannabis (by presence of THC in blood at>2ng/mL) and amphetamines. These data show that drivers using medicinal drugs alone are unlikely to show significant crash risk even if drugs are potentially impairing. [ABSTRACT FROM AUTHOR]

One of the major mental health problems with an increased rate of medication failures and treatment resistance arises with the combination of substance use and mood disorders. The purpose of this report is to discuss the off-label use of fluphenazine in managing bipolar disorder in patients with a history of substance abuse, its efficacy, and the importance of having community resources such as assertive community treatment in monitoring treatment progress and improving overall health outcomes. First-generation antipsychotics, like fluphenazine, should be used cautiously with the risks and benefits weighed against possible side effects. This report shows how fluphenazine can successfully be used as an off-label maintenance option in challenging cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Khan et al.)

Introduction: Mental disorders are very serious complicated disorders. Schizophrenia is one of the most baffling mental disorders. The new series 7-(2-(benzo[d]thiazol-2- ylamino)ethoxy)-4-methyl-2H-chromen-2- synthesized in search of newer compounds for Schizophrenia., Methods: Synthesis is done by refluxing in dry pyridine with various substituted 2-amino benzothiazoles derivatives (3a-3k) and 7-(2-Chloroethoxy)-4-methyl-2H-chromen-2-one (2). The molecular docking approach was used to screen these generated derivatives. Chem Bio Draw Ultra 12 was used to draw the compounds, which were then exposed to all potential conformations of compounds interacting with receptors. The Glide 7.6, Schrodinger 2017 Maestro 11.3 was used to achieve molecular docking. The Dopamine receptor 6CM4 serotonin 5TUD PDBs were acquired from the database of Brookhaven Protein. Using the OPLS 2005 force field, the ligand-protein hydrogen-bond network was acquired, along with the overall energy reduced. A glide score was used to rate the docking poses., Results: The produced compounds have been identified with the use of analytical and spectral data. All of the produced substances were tested and analyzed for serotonin 5HT2 antagonistic and dopamine D2 activity, which can be considered as a measure of typical antipsychotic properties., Conclusion: Compounds 4b, 4c, 4e, 4g & 4i have demonstrated promising pharmacological action in preliminary studies. According to the preceding findings, compounds with electronwithdrawing substitutions, such as 4e & 4b, have a good atypical profile of antipsychotics., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

In recent decades the understanding of the core physiology giving rise to schizophrenia has advanced markedly. Current pharmacological interventions fail to target the core problems in schizophrenia. Several important outcome studies call into question whether current medications actually make long-term outcomes worse. These new studies follow the recognized negative side effect of anti-psychotic drugs. The implication of these findings for social workers who work with the seriously mentally ill are discussed. Alternatives to current pharmacological treatments that are more targeted toward the core physiology of schizophrenia are reviewed. [ABSTRACT FROM AUTHOR]

Background: The pathways to care in a first onset psychosis are diverse and may influence the chances of early treatment and therefore the duration of untreated psychosis. We test which pathways to care are associated with a delay in receiving treament and a longer duration of untreated psychosis (DUP). Methods: In a population based survey, we interviewed 480 people with first episode psychosis aged 18 to 64 years over a 2-year period. Information from structured interview and case files provided DSM-IV diagnostic, clinical, and demographic information. Consecutive contacts in the care pathway were mapped using the World Health Organisation’s Encounter Form. Using information from all sources, DUP was defined as time from symptom onset to first treatment with antipsychotic medication. Results: The most common first contacts were primary care physicians (35.2%), emergency rooms in general hospital settings (21.3%), and criminal justice agencies (25.4%). In multivariate regression models, compared to DUP for those first in contact with primary care, DUP was shortest for first encounters with psychiatric emergency clinics (RR = 0.4, 95% CI: 0.23-0.71) and longest for first encounters with criminal justice agencies (RR = 1.61, 95% CI: 1–2.58). Older age was associated with a longer DUP (RR = 1.01 per year, 95% CI: 1–1.04). A shorter DUP was associated with a diagnosis of mania and affective psychoses-NOS compared with schizophrenia (RR = 0.22, 95% CI: 0.14-0.35; RR = 0.18, 95% CI: 0.06-0.54, respectively), for Black compared with White ethnicity (RR = 0.52, 95% CI: 0.34-0.82), and for each close person in the social network (RR = 0.9, 95% CI: 0.84-0.96). Conclusions: To further reduce DUP, better links are needed between primary care, emergency rooms, criminal justice and psychiatric services. [ABSTRACT FROM AUTHOR]

Abstract: The design, synthesis and structure activity relationship studies of a series of compounds from benzo[d]imidazo[5,1-b]thiazole scaffold as phosphodiesterase 10A (PDE10A) inhibitors are discussed. Several potent analogs with heteroaromatic substitutions (9a–d) were identified. The anticipated binding mode of these analogs was confirmed by performing the in silico docking experiments. Later, the heteroaromatics were substituted with saturated heteroalkyl groups which provided a tool compound 9e with excellent PDE10A activity, PDE selectivity, CNS penetrability and with favorable pharmacokinetic profile in rats. Furthermore, the compound 9e was shown to be efficacious in the MK-801 induced psychosis model and in the CAR model of psychosis. [Copyright &y& Elsevier]

Abstract: Adherence to antipsychotic medication was assessed monthly over a 6-month study period using patient-specific electronic monitoring (EM) of medication bottle opening in 23 outpatients with schizophrenia or schizoaffective disorder. Patient-specific EM adherence results were then shared with the seven participating prescribers, who were surveyed concerning the treatment changes, if any, that they would recommend based on the EM adherence results. Prescribers indicated that they would recommend adherence-related treatment plan changes in 61% of patients, all of whom were ≤80% adherent. The strength of this effect was significantly stronger for psychosocial intervention treatment plan change recommendations than for medication treatment plan change recommendations. Of the psychosocial intervention recommendations, an increase in case management intensity was most often recommended. Of the medication treatment plan recommendations, initiation of a long-acting injectable medication and an increase in dosage of current oral antipsychotic medication were each recommended in only one case. Prescriber recommendations of adherence interventions in this study were not necessarily consistent with major guideline recommendations. Findings suggest the need for further study and dissemination of findings regarding evidence-based adherence assessment and interventions. [Copyright &y& Elsevier]

Colpocephaly, a congenital anomaly in the ventricles, is usually discovered early in infancy and rarely during adulthood. Partial or complete agenesis of the corpus callosum or Chiari malformations (developmental arrest of white matter formation in early fetal development) can lead to abnormal asymmetrical ventricular enlargement. Minimal literature about colpocephaly is available for clinicians, making diagnosis and treatment very challenging. Colpocephaly in adults is an infrequent condition, mostly found as an incidental finding with no neurological or cognitive impairment. Symptoms usually represent the affected lobe in the brain as our patient's visual hallucination may be attributed to the lesioned occipital horn. Differentiating from normal pressure hydrocephalus, representing new-onset dementia, can help avoid unnecessary procedures. Neurological and psychiatric consultation should be practiced to exclude other causes of neurological and cognitive impairment. While there is no definitive treatment for this condition, seizure prophylaxis has been helpful. Cognitive behavioral therapy, psychotherapy, and social skills training are recommended in some literature. Typical and atypical antipsychotics can control symptoms with uncertain efficacy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Mahmoud et al.)

Objective: To explore, using a naturalistic design, the efficacy of typical and atypical antipsychotics in the management of behavioural disturbance in people with psychiatric disorders.Method: Prospective naturalistic study of 15,278 incidents of behavioural disturbance perpetrated by 1,059 patients, over a two year period.Results: Typical and atypical antipsychotics did not differ in terms of their efficacy, overall. In terms of specific agents, haloperidol and quetiapine tended to show equal efficacy, with olanzapine being somewhat less effective on two of three outcome measures.Conclusions: Overall, atypical antipsychotics were as effective as typical agents in the management of acute behavioural disturbance in a mental health setting. Further work is required to determine the relative side effect burden of those agents. [ABSTRACT FROM PUBLISHER]

This paper reviews melatonin as an overlooked factor in the developmental etiology and maintenance of schizophrenia; the neuroimmune and oxidative pathophysiology of schizophrenia; specific symptoms in schizophrenia, including sleep disturbance; circadian rhythms; and side effects of antipsychotics, including tardive dyskinesia and metabolic syndrome. Electronic databases, i.e. PUBMED, Scopus and Google Scholar were used as sources for this review using keywords: schizophrenia, psychosis, tardive dyskinesia, antipsychotics, metabolic syndrome, drug side effects and melatonin. Articles were selected on the basis of relevance to the etiology, course and treatment of schizophrenia. Melatonin levels and melatonin circadian rhythm are significantly decreased in schizophrenic patients. The adjunctive use of melatonin in schizophrenia may augment the efficacy of antipsychotics through its anti-inflammatory and antioxidative effects. Further, melatonin would be expected to improve sleep disorders in schizophrenia and side effects of anti-psychotics, such as tardive dyskinesia, metaboilic syndrome and hypertension. It is proposed that melatonin also impacts on the tryptophan catabolic pathway via its effect on stress response and cortisol secretion, thereby impacting on cortex associated cognition, amygdala associated affect and striatal motivational processing. The secretion of melatonin is decreased in schizophrenia, contributing to its etiology, pathophysiology and management. Melatonin is likely to have impacts on the metabolic side effects of anti-psychotics that contribute to subsequent decreases in life-expectancy. [ABSTRACT FROM AUTHOR]

The present study investigates the extrapyramidal effects of co-administration of enalapril (angiotensin-converting enzyme inhibitor) or losartan (angiotensin receptor blocker) with haloperidol in mice. Enalapril/losartan (as a suspension in 1% gum acacia) was administered by oral gavage and haloperidol was administered as an intraperitoneal injection to all the animals for seven days. Catalepsy was measured 30 min after the administration of haloperidol (1 mg/kg i.p.) on days 1 and 7. Observations on day 1 constituted the acute study (single dose administration) and observations on day 7, constituted the chronic study (repeated dose administration). Both acute and chronic administration of enalapril/losartan produced an increase in the duration of haloperidol induced catalepsy at the highest dose (20 mg/kg). Enalapril produced a more pronounced increase in the duration of catalepsy as compared to losartan on both acute and chronic administration. Results of our study suggest that co-administration of anti-psychotics and drugs affecting the angiotensin system can lead to an increase in motor side effects and therefore should be used with caution in patients with these co-morbid conditions. [ABSTRACT FROM AUTHOR]

Background: Anti-psychotics, prescribed to people with dementia, are associated with approximately 1,800 excess annual deaths in the UK. A key public health objective is to limit such prescribing of anti-psychotics. Methods: This project was conducted within primary care in Medway Primary Care Trust (PCT) in the UK. There were 2 stages for the intervention. First, primary care information systems including the dementia register were searched by a pharmacy technician to identify people with dementia prescribed anti-psychotics. Second, a trained specialist pharmacist conducted targeted clinical medication reviews in people with dementia initiated on anti-psychotics by primary care, identified by the data search. Results: Data were collected from 59 practices. One hundred and sixty-one (15.3%) of 1051 people on the dementia register were receiving low-dose anti-psychotics. People with dementia living in residential homes were nearly 3.5 times more likely to receive an anti-psychotic [25.5% of care home residents (118/462) vs. 7.3% of people living at home (43/589)] than people living in their own homes (p < 0.0001; Fisher's exact test). In 26 practices there was no-one on the dementia register receiving low-dose anti-psychotics. Of the 161 people with dementia prescribed low-dose anti-psychotics, 91 were receiving on-going treatment from local secondary care mental health services or Learning Disability Teams. Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review. Conclusions: In total 15.3% of people on the dementia register were receiving a low-dose anti-psychotic. However, such data, including the recent national audit may under-estimate the usage of anti-psychotics in people with dementia. Anti-psychotics were used more commonly within care home settings. The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia. [ABSTRACT FROM AUTHOR]

Delirium is a common yet under-diagnosed syndrome of acute brain dysfunction, which is characterized by inattention, fluctuating mental status, altered level of consciousness, or disorganized thinking. Although our recognition of risk factors for delirium has progressed, our understanding of the underlying pathophysiologic mechanisms remains limited. Improvements in monitoring and assessment for delirium (particularly in the intensive care setting) have resulted in validated and reliable tools such as arousal scales and bedside delirium monitoring instruments. Once delirium is recognized and the modifiable risk factors are addressed, the next step in management (if delirium persists) is often pharmacological intervention. The sedatives, analgesics, and hypnotics most often used in the intensive care unit (ICU) to achieve patient comfort are all too frequently deliriogenic, resulting in a longer duration of ICU and hospital stay, and increased costs. Therefore, identification of safe and efficacious agents to reduce the incidence, duration, and severity of ICU delirium is a hot topic in critical care. Recognizing that there are no medications approved by the Food and Drug Administration (FDA) for the prevention or treatment of delirium, we chose anti-psychotics and alpha-2 agonists as the general pharmacological focus of this article because both were subjects of relatively recent data and ongoing clinical trials. Emerging pharmacological strategies for addressing delirium must be combined with nonpharmacological approaches (such as daily spontaneous awakening trials and spontaneous breathing trials) and early mobility (combined with the increasingly popular approach called: Awakening and Breathing Coordination, Delirium Monitoring, Early Mobility, and Exercise [ABCDE] of critical care) to develop evidence-based approaches that will ensure safer and faster recovery of the sickest patients in our healthcare system. [ABSTRACT FROM AUTHOR]

Idiopathic granulomatous lesion is a rare entity of the breast seen in young-middle aged women. Diagnosis and management of granulomatous lesions with known aetiology does not impose major clinical problems. However, most often these lesions are undetected or unnoticed due to lack of timely diagnosis and inappropriate management, as primarily it is idiopathic. Hyperprolactinemia have been proposed as one of the mechanisms underlying the development of granulomatous lesions of the breast. We report a case of hyperprolactinemia due to risperidone therapy for bipolar mood disorder in a woman who eventually developed granulomatous mastitis. Histologically, the diagnosis was confirmed by the presence of granulomatous lesion and by ruling out other potential causes. In this case, raised prolactin was possibly an important factor which was secondary to risperidone therapy. However, idiopathic granulomatous mastitis could not be completely ruled out. [ABSTRACT FROM AUTHOR]

The purpose of our study is to use Medicaid data to examine the relationship between race and (a) whether youth with schizophrenia or depression diagnoses receive anti-psychotic and antidepressant prescriptions and (b) adherence to anti-psychotics and antidepressants. The analysis is based on claims files from January 1, 2000 through June 30, 2001. To assess adherence, we used the Proportion of Days Covered (PDC) measure. Multivariable logistic regression was used to analyze the data. Black children with schizophrenia were significantly less likely to be adherent to anti-psychotics during a quarter than White children. White children with depression were significantly more likely to receive an antidepressant prescription and they were significantly more adherent during a quarter than Black children. Providers should make sure to investigate both youth and caregiver concerns, fears, and barriers to using these medications and work with the families to develop strategies to improve medication use among youth. [ABSTRACT FROM AUTHOR]

Anti-psychotic treatment appears to be associated with striatal volume increase, but how early this change occurs is still unknown. A single prospective cohort of 20 anti-psychotic-naïve patients, newly diagnosed with schizophrenia, underwent magnetic resonance imaging brain scan at baseline. This was repeated following up to 8 weeks of anti-psychotic treatment. Ten patients had repeat scan within only 3 weeks. The choice of anti-psychotic medication was naturalistic, i.e., clinician-led. Well-matched healthy individuals were also scanned to control for non-specific changes over a 3-week period. After 3 weeks of anti-psychotic treatment, significant grey matter volume increase in the right caudate, superior and inferior frontal gyrus, precentral gyrus, and left inferior parietal lobule was noted. However, after 8 weeks of anti-psychotic treatment, volume increase in the right thalamus and bilateral cerebellum was observed. Significant grey matter reduction was detected in the left medial frontal gyrus at both 3- and 8-week intervals. Early increase in striatal volume change occurs as early as 3 weeks after anti-psychotic treatment, whilst thalamic volume increase is apparent later, by 8 weeks of treatment. We speculate that drug-mediated neuroplasticity may provide a biomarker for clinical recovery. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the present work was to investigate possible differences in terms of efficacy and tolerability between different switching options to aripiprazole. 77 subjects were randomly assigned to (1) administration of aripiprazole (10 mg) with simultaneous discontinuation of current antipsychotic; (2) administration of aripiprazole (10 mg) and tapering off current antipsychotic over 4 weeks with half dose after the first 2 weeks; (3) administration of aripiprazole (10 mg) and tapering off current antipsychotic over 6 weeks with half dose after the first 2 weeks. Efficacy assessments included CGI-S, CGI-I, BPRS and SANS. Safety assessments included SAS, BAS and AIMS. Severity of symptoms significantly decreased from baseline over the 12 weeks of treatment. Patients switched to aripiprazole with immediate discontinuation of the previous antipsychotic showed an increase of symptoms'' severity at week 1. However, severity of side effects did not overall change significantly during the 12-weeks follow-up. Previous treatment''s tapering off strategy for switching patients to aripiprazole could be preferable as compared to abrupt discontinuation, in order to prevent early worsening of symptoms and premature discontinuation of treatment, though this results has to be considered with caution given the limitations of the study. [Copyright &y& Elsevier]

Anti-psychotic drugs, particularly the second generation, or 'atypical' agents, have been implicated in the development of metabolic dysfunction such as diabetes mellitus. There is a paucity of longitudinal data on the natural history of glucose homeostasis in anti-psychotic-treated patients, and there are no universally accepted strategies for managing worsening glycaemic control in this population. Notwithstanding, several guidelines recommend switching to a 'lower risk' agent if patients develop worsening glycaemic control during anti-psychotic treatment. We prospectively followed a cohort of 106 anti-psychotic-treated patients from across the diagnostic spectrum, and investigated changes in glycaemic status. Between baseline and follow-up assessment (mean follow-up time, 599.3 [SD ± 235.4] days glycaemic status was unchanged in 78 (86.7%) patients; 5 (5.6%) reverted from impaired fasting glucose (IFG) to normoglycaemia in the absence of any pharmacological or lifestyle intervention and all were taking a 'high risk' drug (clozapine or olanzapine). These preliminary data suggest that progression to overt diabetes mellitus is not inevitable in patients who develop IFG during anti-psychotic treatment. Switching to another agent simply on the basis of the development of IFG may not offer any advantage, especially if the mental state is stable. [ABSTRACT FROM AUTHOR]

Schizophrenic patients reveal sexual dysfunctions at the onset of the disorder but more profound in chronicity, after long-term anti-psychotic treatment. Various aspects of the sexuality of chronic female schizophrenic patients and sexual side-effects of conventional and atypical anti-psychotics were evaluated. Fifty female chronic schizophrenic patients treated with conventional and atypical anti-psychotics, compared to 50 matched controls, were assessed with: PANSS, UKU sexual side-effects component, GAF, SDBQ-female version and the WHOQOL-BREF. Results showed that schizophrenic female patients were hyposexual, were dissatisfied with their sexual life, had experiences of sexual abuse, emphasizing a high sexual conservatism. The evolution of schizophrenia affected their professional and marital status, their general level of functioning and their quality of life; even novel anti-psychotics are responsible for sexual side-effects comparable to those produced by conventional anti-psychotics. Direct enquiry about sexuality in this group, along with information, symptom and side-effect management, could lead to long-term acceptance of, and adherence to, anti-psychotic medication of sexually active persons suffering from schizophrenia and a better functioning and enjoyment of life. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to compare the efficacy of atypical and typical anti-psychotics in treating behavioural disturbance in people with psychotic disorders, in a naturalistic setting. Method: This was a prospective naturalistic study of 303 incidents of behavioural disturbance at Royal Melbourne Hospital, Melbourne, Victoria, Australia. Results: There was no significant difference between atypicals and typicals on two efficacy measures and some evidence on a third measure, that typicals are more effective. Conclusions: In the pharmacological treatment of behavioural disturbance in psychosis, typical and atypical anti-psychotics have largely comparable efficacy. [ABSTRACT FROM AUTHOR]

Introduction: Hyperprolactinaemia is associated with the use of potent dopamine-2 receptor blocking anti-psychotic agents in schizophrenia and with bone loss in the general population. Significantly higher rates of reduced bone mineral density (BMD) have been identified in young pre-menopausal females with schizophrenia receiving prolactin-raising anti-psychotics compared to those receiving prolactin-sparing anti-psychotics. This prospective study compared BMD alterations over a period of 1 year in patients maintained on either prolactin-raising (e.g. risperidone, amisulpride or depot anti-psychotics) or prolactin-sparing (olanzapine) anti-psychotics. The effects of specific interventions to improve BMD were also examined in the context of whether patients were receiving either prolactin-raising or anti-psychotics or Olanzapine. Methods: Pre-menopausal females (n=38) with a diagnosis of schizophrenia, who had received exclusively either prolactin-raising (n=25) or prolactin-sparing (n=13) anti-psychotics during their treatment history, had clinical, endocrine and bone marker assessments performed at baseline and every 3 months for a period of 1 year. BMD was measured by DEXA scan at baseline and at 1-year follow-up. Patients from both groups either received specific interventions (n=16) or no interventions (n=16) to improve bone density. Results: There was an overall gain in lumbar BMD values in the prolactin-sparing subgroup, compared to an overall loss in the prolactin-raising subgroup (p=0.02), for the groups that received no specific interventions to improve BMD. Within the group that received specific interventions, the subgroup receiving prolactin-sparing anti-psychotics had a significant increase in lumbar (p=0.01) and hip (p=0.01) BMD over time, whereas alterations in the prolactin-raising subgroup were not significant. Discussion: Women taking prolactin-raising anti-psychotics and not receiving specific interventions to improve bone density had evidence of ongoing bone demineralisation over a year; whereas women taking prolactin-sparing anti-psychotics had a modest overall increase in BMD. Most clinical interventions appeared to be helpful, but were significantly more effective in those taking prolactin-sparing anti-psychotics. [ABSTRACT FROM AUTHOR]

Introduction The neural cell adhesion molecule (N-CAM) plays important roles in neural migration, synaptogenesis and CNS development. Change of N-CAM fragments in CSF of schizophrenic patients was reported previously, and we aimed to detect difference in circulating N-CAM in the serum of schizophrenic patients and healthy controls. Methods Samples were from 14 chronic schizophrenic patients including 3 drug naïve patients and 11 healthy controls. After removal of albumin and globulin, N-CAM fragments were measured by Western blot technique with monoclonal antibody. Results N-CAM immunoreactive bands were detected primarily at 180, 140, 120, 75, 68 and 52 kDa. Samples from patients and controls showed similar patterns of bands, but schizophrenic patients showed increases or decreases at some bands intensity compared to healthy controls. The 68 kDa/73–75 kDa bands intensity ratio was substantially elevated in schizophrenic patients (0.262 ± 0.14 in patients, 0.065 ± 0.04 in controls) especially, the three drug naïve patients had a higher value of this ratio compared to the medicated patients. One drug naïve patient showed a decrease in this ratio after one month of antipsychotic medication. Conclusions The results suggest elevated membrane turnover and/or abnormalities in the regulation of proteolysis of N-CAM in schizophrenia. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: It is estimated that 850,000 people are living with dementia in the UK (Ref 1) and 311,730 (39%) of people with dementia over the age of 65 are living in care homes. (Ref 2) These residents are often prescribed anti-psychotic medication for behavioural and psychological symptoms of dementia (BPSD). In care homes it is often unclear whether non-pharmacological interventions have been tried before usingmedication. Non-pharmacological interventions can deliver better outcomes for individuals, are safer and have a positive impact on their quality of life. Objectives: 1) To measure the number of people on anti-psychotics in care home residents with dementia. 2) To reduce the prescription of anti-psychotics in care home residents with dementia. Methods: 303 residents with dementia across 8 care homes was collected. The home with the highest number of residents on antipsychotics was selected to deliver the intervention. The intervention offered was care staff home training and medication reviews of people on anti-psychotics. Ani-psychotic prescriptions were reviewed post intervention. Results: Antipsychotic prescriptions across care home settings is variable. Reduction in anti-psychotic prescriptions by 30% was acheived in the care home where the intervention was delivered. Conclusions: 1) Staff training on managing behaviours in dementia using non-pharmacological interventions is useful in improving care in homes. 2) Reviews of patients on anti-psychotics in care homes are useful in reducing anti-psychotic prescriptions. Building strong relationships and collaborative working with home staff is vital for patient benefit, providing training to staff is a simple and effective measure that enables staff to provide person-centred care. [ABSTRACT FROM AUTHOR]

Retigabine activates inward potassium rectifying KCNQ channels. This stabilizes the membrane potential via hyperpolarization in vitro and retigabine has also been shown to inhibit convulsions in vivo. This study was carried out to determine whether retigabine inhibited haloperidol-dependent activation of neurons in the striatum as measured by expression of c-Fos. Groups of male rats were treated with retigabine (10 mg/kg i.p.), haloperidol (1 mg/kg i.p.), or the two in combination (at 15 min interval) and fixed 60 min after haloperidol treatment. Haloperidol produced a large increase in the number of c-Fos-positive nuclei in different degrees in all parts of the striatum. Pretreatment with retigabine completely blocked haloperidol-induced c-Fos in both the ventral and dorsal striatum suggesting that retigabine via activation of the KCNQ channel interacts with haloperidol and inhibits neuronal excitation in the striatum. [Copyright &y& Elsevier]