Clinical Neuropharmacology最新文献

Background: Bipolar disorder is a complex psychiatric disorder where long-term treatment is crucial to maintain stabilization. Although largely well tolerated, lithium has a wide spectrum of adverse effects in different organs and seems to also cause taste and smell disorders, which remain rare and not largely described. We aim to present a rare case of hyposmia and dysgeusia secondary to lithium treatment in a bipolar patient and also conduct a review on these rare lithium adverse effects.

Case presentation: The case is a 43-year-old woman with type I bipolar disorder who became stabilized and fully functional with lithium therapy. After 4 months of treatment, she began to notice progressive hyposmia and dysgeusia. After multiple diagnostic and screening tests, lithium was implicated as the cause of the symptoms, which led to a switch to valproic acid. After 3 months, she was not compensated with valproic acid treatment, returned to lithium therapy despite its adverse effects, and became stabilized again.

Conclusions: There are few data on lithium therapy taste and smell adverse effects. Most studies on this topic are likely to be case reports. Lithium therapy may cause dysgeusia and hyposmia, although mechanisms are not fully understood. These adverse effects can interfere negatively in patient's treatment adherence. Therefore, physicians who prescribe lithium should be aware of them. Further structured studies are needed to better understand these lithium rare adverse effects and the appropriate way to assess and monitoring them.

Introduction: Chloroquine supplementation may show some potential in improving the efficacy for glioblastoma, and this meta-analysis aimed to identify the efficacy of chloroquine supplementation for patients with glioblastoma.

Methods: Several databases including PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases have been systematically searched through August 2022, and we included randomized controlled trials assessing the efficacy of chloroquine supplementation for glioblastoma. This meta-analysis was performed using the random-effect model or fixed-effect model based on the heterogeneity.

Results: Four randomized controlled trials were finally included in this meta-analysis. In comparison with control group for glioblastoma, chloroquine supplementation was associated with substantially decreased mortality (odd ratio [OR], 0.17; 95% confidence interval [CI], 0.06-0.53; P = 0.002), improved survival time (mean difference, 15.63; 95% CI, 2.27-28.99; P = 0.02), and remission (OR, 15.63; 95% CI, 2.27-28.99; P = 0.02), but unraveled no obvious impact on the incidence of adverse events (OR, 3.27; 95% CI, 0.29-36.44; P = 0.34) or seizure (OR, 2.57; 95% CI, 0.05-127.68; P = 0.64).

Conclusions: Chloroquine supplementation may be effective to improve the treatment efficacy for glioblastoma.

Objective: The aim of this study was to assess the efficacy of different dosage regimens of tanezumab among individuals living with chronic low back pain (CLBP).

Methods: PubMed, Embase, The Cochrane Library, and other databases were searched from inception until August 2021. Randomized controlled trials investigating the efficacy and safety of tanezumab in individuals with CLBP were included. Data were extracted independently by 2 investigators and assessed the study quality by the Cochrane risk-of-bias tool. The measurements include low back pain intensity and Roland-Morris Disability Questionnaire. The incidence of adverse events and serious adverse events was set to assess the safety of tanezumab for CLBP.

Results and discussion: Three high-quality randomized controlled trials with 3414 patients were finally included in our analysis. Tanezumab, respectively, led to a notable decrease compared with placebo in low back pain intensity (mean difference, -0.62; 95% confidence interval [CI], -0.77 to -0.46; P < 0.01) and Roland-Morris Disability Questionnaire (mean difference, -0.64; 95% CI, -0.80 to -0.47; P = 0.01). In addition, no significant difference existed between tanezumab and placebo groups (risk ratio, 1.10; 95% CI, 0.81-1.49; P = 0.55) in the adverse events and (risk ratio, 1.06; 95% CI, 0.34-3.27; P = 0.93) serious adverse events.

Conclusions: Intravenous and subcutaneous tanezumab injections as treatment for improving CLBP have promising clinical application as its great improvement on all efficacy and its controllable safety issues. Furthermore, intravenous and subcutaneous tanezumab injections were proved to achieve excellent and long-term curative effect on CLBP through our subgroup analysis and comparison.

Objective: Oxidative stress (OS) has a role in the pathogenesis and progression of multiple sclerosis. The effects of disease-modifying therapies (DMTs) on OS are unclear. We aimed to explore the association between DMTs and OS in patients with relapsing-remitting multiple sclerosis (RRMS).

Methods: The study conducted in 167 patients (102 received and 65 not received the DMTs). The DMTs included interferon beta-1a (n = 15), interferon beta-1b (n = 20), glatiramer acetate (n = 10), and sphingosine-1-phosphate receptor modulators (n = 57). Oxidative stress assessed by total antioxidant status (TAS) and total oxidant status (TOS) (determined by spectrophotometric method), oxidative index (OSI was calculated), and urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG/creatinine was determined by high-performance liquid chromatography and tandem mass spectrometry). Patients were classified by Multiple Sclerosis Severity Score (MSSS) to mild/moderate (MSSS, <6.7) and severe (MSSS, >6.7).

Results: Disease-modifying therapies are associated with increased TAS, decreased TOS, OSI, and 8-oxodG/creatinine. Regardless of therapy, women had a less favorable redox status (lower TAS, higher TOS and OSI). Patients with MSSS>6.7 and without DMTs had higher OSI than patients who received DMTs. Women with MSSS>6.7 without DMTs had lower TAS than women with DMTs, whereas in the same stage of MS, men without DMTs had higher TOS than patients with DMTs. Women with MSSS<6.7 and with DMTs had lower 8-oxodG/creatinine compared with those without DMT therapy.

Conclusions: The antioxidant effects of DMTs were evidenced in this study. The gender-related effects of DMTs on the OS imply the personalized antioxidant pharmacotherapy, especially for the women. The OS biomarkers have a potential as the prognostic for the assessment of DMTs outcomes in patients with RRMS.

Objectives: Risperidone is an effective drug used for the treatment of irritability in children with autism spectrum disorder (ASD). Atomoxetine (ATX) is a well-tolerated drug used in first-line therapy in children with attention-deficit/hyperactivity disorder (ADHD). However, uncommon adverse effects of risperidone and ATX are a concern among mental health professionals. To our knowledge, this is the first case report of priapism after addition of ATX upon existing treatment with risperidone.

Methods: Written informed consent for publication was obtained from the patient and his parents, and their identities were concealed for ethical reasons.

Results: Here, we report a case of priapism as an adverse effect of ATX and risperidone treatment in a 7-year-old boy with ASD and comorbid ADHD. In this case, priapism was not observed with risperidone until ATX was added.

Conclusions: Priapism is a condition viewed as a medical emergency. Although risperidone-induced priapism is a rare phenomenon, it is advised for clinicians to consider the drug interactions in treatment of ASD and ADHD in terms of early diagnosis and intervention.

Objective: This study aimed to evaluate the effect of genetic variants in glutamate ionotropic receptor N-methyl- d -aspartate type subunit 2B ( GRIN2B ), glutamate ionotropic receptor α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid type subunit 1 ( GRIA1 ), and brain-derived neurotrophic factor ( BDNF ) genes on therapeutic response, remission, and total Montgomery-Åsberg Depression Rating Scale scores after treatment with ketamine or esketamine in treatment-resistant depression (TRD) patients.

Methods: Participants (N = 60) are from a double-blind, randomized, noninferiority clinical trial comparing single-dose intravenous ketamine (0.5 mg/kg) to esketamine (0.25 mg/kg) for TRD. Montgomery-Åsberg Depression Rating Scale was applied at baseline, 24 hours, 72 hours, and 7 days postinfusion to assess depressive symptoms. Blood samples were collected to evaluate single nucleotide polymorphisms rs1805502 ( GRIN2B ), rs1994862 ( GRIA1 ), and rs6265 ( BDNF ).

Results: There was no association between rs1805502, rs1994862, or rs6265 polymorphisms and antidepressant response ( P = 0.909, P = 0.776, and P = 0.482, respectively), remission P = 0.790, P = 0.086, and P = 0.669), or Montgomery-Åsberg Depression Rating Scale scores at each time point ( P = 0.907, P = 0.552, and P = 0.778).

Conclusions: We found no association between the studied single nucleotide polymorphisms (rs6265, rs1805502, and rs1994862) and ketamine's therapeutic action in TRD patients. Further studies with larger samples are needed to clarify the utility of these genes of interest as predictors for antidepressant treatment.

Background: Palliative cancer patients and family members in China may experience difficulties in expressing their feelings, concerns, and needs to each other because of the death-taboo culture and the strong desire to protect each other from being exposed to emotional distress.

Objectives: The aims of this study were to develop a nurse-led psychotherapeutic intervention aiming to facilitate meaningful conversations between palliative cancer patients and their family members, named family-based dignity therapy (FBDT), and preliminarily explore the anticipated benefits and challenges of the implementation of FBDT.

Methods: A convergent parallel mixed-methods design was used. The FBDT was designed based on the dignity therapy protocol and additionally inspired by the Chinese tradition of "4 important things in life." Ten palliative cancer patients, 10 family members, and 13 oncology and hospice nurses were surveyed to evaluate the FBDT protocol both quantitatively and qualitatively.

Results: The FBDT interview guide was endorsed by most palliative cancer patients and family members (>75.0%), as well as oncology and hospice nurses (>90.0%). Potential perceived benefits and challenges of FBDT were proposed by participants. The FBDT protocol was modified according to feedback from participants to make it more suitable to use in clinical practice in China.

Conclusion: The FBDT was perceived to be a potentially promising intervention to facilitate meaningful end-of-life conversations among palliative cancer patients and family members in China.

Implications for practice: The FBDT might provide a means for nurses to promote potentially enhanced end-of-life communications for palliative cancer patients and their families. Further studies are needed to examine the feasibility, acceptability, and efficacy of FBDT to confirm this in China.

Abstract: Alemtuzumab is a humanized anti-CD52 antibody that is registered for treatment of highly active relapsing-remitting multiple sclerosis. Disease activity after alemtuzumab treatment is infrequent. It may be a result of lack of lymphocyte depletion due to development of neutralizing autoantibodies. On the other hand, severe disease activity has been described after alemtuzumab, which is suggested to be caused by B-cell hyperpopulation. We present a case of a person with multiple sclerosis with severe disease activation after alemtuzumab administration that may represent paradoxical B cell-mediated disease activity. The patient was successfully treated with ocrelizumab.

Introduction: Few treatments exist for acute attacks of glossopharyngeal neuralgia (GPN). We investigated the efficacy of intravenous fosphenytoin therapy (IFT) during GPN crisis.

Case presentation: We evaluated records of 4 consecutive patients with GPN awaiting microvascular decompression (MVD) who received IFT (total, 750 mg). Pain severity was evaluated using a Numerical Rating Scale (NRS). The score was 10 (maximum pain) before treatment. Case 1 (a 52-year-old woman, left GPN): for 12 hours after IFT, pain was eliminated (NRS 0/10); however, severe pain recurred 2 days later. She received MVD 9 days after IFT. Case 2 (a 72-year-old woman, right GPN): pain score reduced to 0/10 immediately after IFT and remained so for 2 days. Severe pain recurred, and she underwent MVD 4 days after IFT. Case 3 (a 69-year-old woman, right GPN): pain was reduced (NRS, 5/10) immediately after IFT and nearly eliminated (1/10) 1 hour later. After 6 hours, severe pain recurred; she received a second IFT 3 days later, and pain score dropped to 1/10. She was pain-free for 24 hours but intermediate pain recurred in 2 days. Microvascular decompression was performed 9 days after the second IFT. Case 4 (a 32-year-old woman, right GPN): Pain score reduced to 0/10 immediately after IFT and remained so for 4 days. She underwent MVD 4 days after IFT. No evidence of recurrence was found throughout the 24-, 22-, 20-, and 5-month follow-ups.

Conclusions: These results provide new insights into the innovative therapeutic option of intravenous fosphenytoin and contribute to advancements in treating acute GPN crisis.

Objectives: Many psychiatrists, and other providers alike, find difficulty integrating a culture-centered approach to clinical practice and navigating the challenges when they arise. We call attention to the ongoing challenges of addressing the cultural barriers between patient and physician.

Methods: We present a case of an African patient with a rare case of Fahr's syndrome whose clinical diagnostic course was complicated by culture and language barriers.

Results: The patient's hospital course was challenged by cultural and language barriers that were difficult to integrate into her care, likely contributing to a prolonged diagnostic course and hospitalization.

Conclusions: Cultural considerations in medicine can enhance patient-physician relationships and ultimately strengthen clinical outcomes.