Clinical Neuropharmacology最新文献

Objective: The aim of the study was to assess the characteristics and outcomes of adults with attention-deficit/hyperactivity disorder (ADHD) and a previous history of restrictive eating disorder symptoms.

Method: We retrospectively reviewed the health records of patients with ADHD and a history of disordered eating who were treated at our institution with medications that have potential anorexiant properties from October 1, 2022, through March 31, 2024.

Results: We initially identified 159 patients who were referred to an ADHD program at our institution during the study period. Of 72 patients who met criteria for an ADHD diagnosis, 18 had SCOFF questionnaire scores of 2 or higher, which suggests symptoms of a restrictive eating disorder. Of these 18 patients, 3 had a previous diagnosis of an eating disorder documented in their health records. Each patient was treated with medications chosen to manage their reported ADHD symptoms, regardless of eating disorder concerns. All patients had improvements in ADHD symptoms without reporting adverse effects on disordered eating behaviors. Body weight and body mass index values did not significantly change after treatment with atomoxetine, dextroamphetamine/amphetamine, or methylphenidate (all P ≥ 0.14).

Conclusions: Our findings are consistent with those of previous reports and suggest that ADHD treatment, including treatment with stimulant medications, is safe and tolerable for patients with a history of restrictive eating disorder symptoms.

Objectives: Animal studies have suggested that valproic acid (VPA) is neuroprotective in aneurysmal subarachnoid hemorrhage (SAH). However, the effect of VPA on SAH outcomes in humans has not been investigated.

Methods: We conducted a retrospective analysis of 123 patients with nontraumatic SAH. Eighty-seven patients had an aneurysmal source and 36 patients had no culprit lesion identified. We used stepwise logistic regression to determine the association between VPA and delayed cerebral ischemia (DCI), radiographic vasospasm, and discharge modified Rankin Scale (mRS) score >3.

Results: All 18 patients who received VPA underwent coil embolization of their aneurysm. VPA use did not have a significant association with DCI on adjusted analysis (odds ratio [OR] = 1.07, 95% confidence interval [CI]: 0.20-5.80). The association between VPA use and vasospasm was OR = 0.64 (0.19-1.98) and discharge mRS > 3 was OR = 0.45 (0.10-1.64). Increased age (OR = 1.04, 1.01-1.07) and Hunt and Hess grade >3 (OR = 14.5, 4.31-48.6) were associated with poor discharge outcome (mRS > 3). Younger age (OR = 0.96, 0.93-0.99), modified Fisher Scale (mFS) score = 4 (OR = 4.14, 1.81-9.45), and Hunt and Hess grade >3 (OR = 2.92, 1.11-7.69) were all associated with development of radiographic vasospasm. There were no complications associated with VPA administration.

Conclusions: We did not observe an association between VPA and the rate of DCI. We found that VPA use was safe in SAH patients who have undergone endovascular treatment of their aneurysm.

Objectives: People with diabetes are 1.5 times more likely to experience stroke than those without diabetes, underlining the urgent need to address this issue. Metformin is often the initial medication chosen to manage diabetes mellitus (DM). The purpose of our systematic review and meta-analysis is to explore the potential neuroprotective effects of metformin in individuals who have received it prior to stroke.

Method: Our study encompassed cohort studies that drew a comparison between the severity and diverse outcomes of stroke among individuals with DM who were administered metformin prior to the stroke event and those with DM who did not receive the treatment.

Results: Ten studies met the eligibility criteria. Prestroke metformin use was associated with a significantly lower National Institutes of Health Stroke Scale score (mean difference = -1.29, 95% confidence interval: -2.11 to -0.47) in ischemic stroke. Metformin pretreatment in ischemic stroke was associated with increased odds of favorable outcome (mRS < 2) at 90 days (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.06 to 1.99), but it was not significant at discharge. Metformin was found to be associated with reduced mortality (OR = 0.52, 95% CI: 0.42 to 0.64) in ischemic stroke. In hemorrhagic stroke, the results showed a significantly lower intracranial hemorrhage volume in prestroke metformin use (mean difference = -4.77, 95% CI: -6.56 to -2.98).

Conclusions: We found that prestroke metformin use in diabetic patients yielded neuroprotective effects. In ischemic strokes, metformin reduces stroke severity and 90-day mortality; it also improves 90-day functional outcomes. In hemorrhagic strokes, prestroke metformin use can also cause less intracranial hemorrhage volume. Further clinical trials are needed to confirm its efficacy and verify its benefits in stroke management.

Objectives: Impulsivity is thought to be a core feature of gambling disorder, yet little is known as to whether trait impulsivity predicts treatment response.

Methods: Data were pooled from 2 previous randomized controlled pharmacological trials using naltrexone and N-acetyl cysteine.

Results: Trait impulsivity statistically explained variation in medication treatment response ( P = 0.0260, R2 = 0.26). Higher baseline motor impulsiveness was associated with greater treatment response ( P = 0.009).

Conclusions: Measures of impulsivity may thus be important to include in future large-scale datasets, in trial settings but also routine clinical gambling clinic practice, toward building predictive algorithms that may ultimately help to inform optimal treatment choices and improve outcomes.

Objectives: This study reviews literature on the psychiatric effects of delta-8-THC, particularly psychosis and severe mental health outcomes, to highlight the need for further research and regulation.

Background: Marijuana, the most widely used illicit drug in the United States, sees increasing use due to legalization. Although moderate use is generally safe, adverse effects can occur, especially in those with preexisting conditions. Delta-9-THC is known for its psychoactive effects and potential to induce psychosis. Delta-8-THC, another cannabinoid, is gaining popularity and has been linked to severe adverse events but remains under-researched.

Methods: A comprehensive search of PubMed and Web of Science followed PRISMA guidelines to identify studies and case reports on delta-8-THC and psychosis. Articles on delta-9-THC or other cannabinoids were excluded. Relevant studies were screened, and duplicates removed. The included studies were evaluated using the Critical Appraisal Skills Programme Checklist for Case Reports.

Results: The search identified 201 studies, with 12 meeting the inclusion criteria for full-text analysis. Six case reports, involving 9 patients, were reviewed. Most patients were male and in their 20s, with varied psychiatric histories, including no prior psychiatric history, schizophrenia, posttraumatic stress disorder, and generalized anxiety disorder. Reported symptoms included psychosis, mood lability, and cannabinoid hyperemesis syndrome. Treatments varied, with different clinical outcomes.

Conclusions: Delta-8-THC poses significant psychiatric risks despite being less intoxicating than delta-9-THC. The lack of Food and Drug Administration regulation and the availability of delta-8-THC products heighten these risks. More rigorous studies are needed to understand delta-8-THC's impact on mental health and inform regulatory actions.

Objectives: Traditional antidepressant therapy is associated with an inadequate response and a low remission rate. Our aim was to synthesize published randomized controlled trials on the potential effects of minocycline in patients with depression.

Methods: PubMed, Web of Science, Embase, and Cochrane Library databases were searched for studies published. Randomized controlled trials published in English that evaluated the efficacy of minocycline in patients with depression were selected for inclusion. Changes from baseline in the Hamilton Depression Rating Scale (HDRS) or Montgomery-Åsberg Depression Rating Scale (MADRS) were pooled to determine the antidepressant effect of minocycline compared with placebo. The quality of the included studies was assessed using the Cochrane risk-of-bias tool.

Results: Eight trials with 567 participants were eligible and included in the analysis. The meta-analysis did not reveal a statistically significant effect of minocycline on depression based on HDRS or MADRS scores.

Conclusions: According to the HDRS and MADRS scores, minocycline did not demonstrate effectiveness in reducing depressive symptoms.

Introduction: Adjunctive therapies to treat OFF episodes resulting from long-term levodopa treatment in Parkinson disease (PD) are hampered by safety and tolerability issues. Istradefylline offers an alternative mechanism (adenosine A2A receptor antagonist) and therefore potentially improved tolerability.

Methods: A systematic review of PD adjuncts published in 2011 was updated to include randomized controlled trials published from January 1, 2010-April 15, 2019. Pairwise meta-analyses were updated, and Bucher indirect comparisons were used to generate estimates of relative safety, presented as odds ratio (OR) and 95% confidence interval (CI) for comparators versus istradefylline.

Results: Fifty-seven randomized controlled trials involving 11,517 patients were included in the meta-analysis. Relative to istradefylline, dopamine agonists and catechol-O-methyl transferase (COMT) inhibitors had statistically significant higher odds of dyskinesia and somnolence. Monoamine oxidase-B inhibitors had significantly higher odds of hypotension. Amantadine extended-release (ER) had statistically significant higher odds of hallucination, orthostatic hypotension, insomnia, and withdrawals due to adverse events. All interventions combined had significantly higher odds of dyskinesia versus istradefylline 20 mg and somnolence versus istradefylline 40 mg. Considering overall incidence of adverse events, COMT inhibitors and amantadine ER had statistically significant higher odds versus both istradefylline doses (COMT versus istradefylline 40 mg, OR: 1.33; 95% CI: 1.03, 1.75; versus istradefylline 20 mg, OR: 1.32; 95% CI: 1.01, 1.72; amantadine ER versus istradefylline 40 mg, OR: 3.45; 95% CI: 1.85, 6.25; versus istradefylline 20 mg, OR: 3.33; 95% CI: 1.82, 6.25).

Conclusion: Istradefylline was associated with a generally favorable safety profile relative to other adjunct medications in this study.

Objectives: This scoping review aimed to synthesize the existing data about psilocybin pharmacokinetics to learn what has been described regarding body disposition and safety when psilocybin was used in controlled research settings.

Methods: We performed a scoping literature review following the framework proposed by the JBI manual for evidence synthesis. Controlled clinical trials reporting pharmacokinetic data of psilocybin were considered appropriate for inclusion. We extracted the data on psilocybin pharmacokinetics and summarized it from the available literature on this topic. We also performed an exploratory-descriptive analysis using study level data to examine the relationship between dose of psilocybin and maximum serum concentrations (Cmax).

Results: We initially identified 850 articles, of which 5 were included. These trials included 112 healthy volunteers who received psilocybin in a controlled clinical setting. The peak concentration of psilocin in plasma (Cmax) ranged from 8.2 ng/mL to 37.2 ng/mL (median = 17, IQR = 11.9 to 23.5). The maximal concentrations (Cmax) of psilocin were reached (Tmax) around 2 hours, ranging from 1.7 hours to 2.2 hours (median = 2, IQR = 1.9 to 2.1) after psilocybin oral administration. Elimination half-life was between 1.2 hours and 3.3 hours (median = 2.0, IQR = 1.6 to 2.8). A strong positive relationship between dose and Cmax ( R2 = 0.95) was found. No serious adverse events were observed. We did not find studies reporting pharmacokinetic data from patients with depression or cancer patients transitioning to palliative care.

Conclusions: In summary, this review unveils oral psilocybin pharmacokinetics in healthy adults, revealing gaps in its application to target populations like those with depression or in palliative care.