Clinical Psychopharmacology and Neuroscience最新文献

Objective: Schizophrenia is a severe and chronic mental disorder that significantly impacts cognitive, social, and occupational functions, leading to substantial economic burdens. Long-acting injectable (LAI) antipsychotics have been introduced to improve treatment adherence and outcomes, yet their economic impact remains debated. We aim to analyze the impact of LAIs on the medical costs of Korean schizophrenia patients.

Methods: A retrospective analysis of 164 schizophrenia patients treated with LAI antipsychotics, paliperidone palmitate, and aripiprazole monohydrate at Korea University Guro Hospital between January 2017 and July 2022 was performed. Comparisons of inpatient department (IPD) and outpatient department (OPD) healthcare expenditures one year before and after LAI initiation were conducted.

Results: LAIs led to an increase in annual OPD costs (1,437.44 ± 1,127.60 to 4,015.42 ± 1,204.59; units: 1,000 KRW) but significantly reduced IPD admission associated costs (3,826.06 ± 5,500.63 to 698.06 ± 3,619.38; units: 1,000 KRW). After LAI administration, there was an overall reduction in total annual healthcare costs (5,263.49 ± 5,333.11 to 4,713.48 ± 3,625.89; units: 1,000 KRW), but it was not statistically significant.

Conclusion: Although the use of LAIs did not significantly lower the first-year medical costs of schizophrenia patients, they offer beneficial economic impacts over time by reducing hospitalization-associated costs. Future research should focus on long-term cost analyses and the impacts of newer LAI formulations.

Objective: : This study aimed to analyze the effect of the intensified transcranial direct-current stimulation (tDCS) targeting bilateral dorsolateral prefrontal cortex (DLPFC) on craving reduction in patients with opioid use disorder.

Methods: : This quasi-experimental study was conducted on 30 individuals who participated voluntarily at Baharan Camp of Shahid Mahalati. The participants had already completed the detoxification phase and stayed at the camp to resolve their craving and gain occupational skills to reintegrate into the community. The participants were selected using convenience and purposive sampling methods and were then assigned to an experimental group (n = 15) and a control group (n = 15). The experimental group received ten 20-minute tDCS sessions twice a day for 5 consecutive days. There was a 20-minute break between the two stimulations. The DLPFC was stimulated with a current intensity of 2 mA (anode: F3 and cathode: F4). The control group received a sham stimulation. Both groups completed Franken's Desires for Drug Questionnaire at baseline and after the stimulation sessions. Additionally, they completed the questionnaires once again three months after the end of the treatment to assess treatment retention.

Results: : At the posttest stage, the intensified tDCS had significant effects on momentary opioid craving reduction in all measured factors, e.g., desire and intention, negative reinforcement, and control (p ＜ 0.001). However, the results concerning treatment retention at the 3-month follow-up stage were insignificant for all factors (p ＜ 0.001).

Conclusion: : Apparently, tDCS can be used as a tool to reduce craving. However, its application as an independent and sustainable treatment remains debatable.

Objective: Comprehensive evaluation of lisedexamfetamine dimesylate (LDX) alone and in combination with topiramate (TPM) was done for treatment of binge eating disorder (BED) in adults aged 18-55 years.

Methods: In the present randomized clinical trial study, 93 patients were selected by convenience sampling method and were allocated to two groups of 48 and 45 using the permuted block randomization method. This study was conducted from January to September 2022 in Shiraz, Iran. Patients received LDX (n = 48) or LDX plus TPM. Average dose of LDX was 37.5 mg/day and 38 mg/day in the first and second group respectively. The second group (n = 45) also received TPM with average dose of 77.7 mg/day.

Results: Twelve weeks treatment caused significant higher mean reduction in level of triglyceride (73.68 vs. 58.97 respectively, p = 0.024), low density lipo-protein (LDL) (9.66 vs. 5.16 respectively, p < 0.001) and body mass index (5.48 vs. 3.41 respectively, p < 0.001) with TPM plus LDX and also greater significant improvement (p < 0.001) in binge eating scale compared to use of LDX alone. Combination therapy with TPM and LDX had better tolerability and lower adverse events such as insomnia (p < 0.001), paresthesia (p = 0.001), confusion (p = 0.035) and ataxia (p = 0.009) compared to monotherapy in BED.

Conclusion: The combinative treatment was more effective than single drug in terms of higher tolerability, safety and causing lesser adverse events for BED patients. However, more studies with larger samples are needed.

Objective: This study provides histological evidence of the combined effects of L-Carnitine, and Coenzyme Q10 on gliosis and anhedonia in a rat model of multiple sclerosis (MS).

Methods: Fifty male Sprague Dawley rats were randomly divided into 5 groups of 10 rats each. Group 1 was the control group. The rest of the groups were disease models and were given 0.2% cuprizone w/w to induce MS. After 4 weeks, Group 3 started receiving L-Carnitine, Group 4 was given Coenzyme Q10, and Group 5 received both, while cuprizone poisoning continued. After 12 weeks sucrose preference test and tail suspension test were performed for anhedonia. Rats were euthanized and brains were dissected, and assessed for astrocytes, oligodendrocytes, and microglial count.

Results: A significant increase in oligodendrocyte count, while a reduction in astrocyte and microglial count was seen in the synergistic group (p < 0.05). Synergism could not be proved in anhedonia.

Conclusion: The combination of Coenzyme Q10 and L-Carnitine has a synergistic effect in controlling gliosis in a rat model of MS, but synergism could not be demonstrated on anhedonia.

Objective: This study determined the threshold for recurrent depressive episodes that predicted conversion from major depressive disorder (MDD) to bipolar disorder (BD).

Methods: We retrospectively reviewed the medical records of 296 patients diagnosed with MDD for a minimum of 5 years in two university hospitals. We examined their the Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnoses and detailed clinical information at the initial admission and yearly assessments after discharge to establish the threshold for recurrent depressive episodes indicating a risk of diagnostic conversion from MDD to BD. Optimal cut-offs were derived using receiver operating characteristic (ROC) curves.

Results: ROC curve analysis revealed that more than four recurrent depressive episodes was indicative of potential diagnostic conversion from MDD to BD (area under the curve, 0.604; sensitivity, 0.353; specificity, 0.855; positive predictive value, 0.421; negative predictive value, 0.816).

Conclusion: These findings suggest that the best predictor of conversion from MDD to BD is more than four recurrent depressive episodes. Our findings have the potential to enhance diagnostic accuracy and treatment efficiency. To validate our results, longitudinal prospective studies are necessary.

Clozapine is the only approved drug for treatment-resistant schizophrenia, but the response to the drug is often inadequate. Augmentation with other antipsychotics, anticonvulsants, and antidepressants is recommended for such patients, but there is a lack of evidence regarding the most effective therapy. This network meta-analysis was conducted to evaluate the efficacy of pharmacological agents used in the augmentation strategies in patients who were partial/ non-responders to clozapine. Relevant data were extracted from 30 randomized controlled trials through searches of electronic databases (MEDLINE/PubMed, Embase, Cochrane, clinical trial registries). PRISMA guidelines were followed for the extraction, management, analysis, and reporting of the data. The outcome measure in this study was a reduction in symptom severity according to total PANSS/BPRS and was reported as the standardized mean difference with a 95% credible interval. Bayesian network meta-analysis with random effects model and uninformative priors was conducted, and the ranking probability of each intervention was done. Meta-regression was done to assess the effect of duration on the reduction in symptom severity scores. Mirtazapine (-5.2 [95%CrI: -7.7, -2.7]) and memantine (-2.1 [95%CrI: -4.0, -0.19]] were more efficacious than placebo for augmentation of clozapine in partial/non-responders and were the most effective adjunctive agents as per SUCRA scores. Both drugs did not cause a significant increase in frequency of adverse events compared to placebo. There was a significant effect of duration on the reduction in symptom severity. There was no evident publication bias. Mirtazapine and memantine may prove beneficial for augmentation of clozapine in non/partial responders to monotherapy.