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Comparative analysis of third-generation antipsychotics in first-episode schizophrenia: efficacy, safety, and cognitive impacts. A narrative review. 第三代抗精神病药物对首发精神分裂症的比较分析:疗效、安全性和认知影响。叙述性综述。
IF 2.1 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-06-14 DOI: 10.1097/YIC.0000000000000559
Valerio Ricci, Alessandro Sarni, Giovanni Martinotti, Giuseppe Maina

Background and objectives: Schizophrenia is a chronic, complex mental health disorder requiring effective management to mitigate its broad personal and societal impacts. This narrative review assesses the efficacy, effectiveness, and side effects of third-generation antipsychotics (TGAs) like aripiprazole, brexpiprazole, and cariprazine, focusing on their use in first-episode schizophrenia. These drugs aim to reduce side effects typical of earlier antipsychotics while more effectively addressing positive and cognitive symptoms.

Methods: Our extensive literature review, using PubMed and Scopus, includes randomized controlled trials and observational studies, showing TGAs may match older antipsychotics in efficacy with fewer side effects, notably in reducing extrapyramidal symptoms and enhancing cognitive outcomes.

Results: Aripiprazole appears effective in both acute and maintenance phases of schizophrenia, while brexpiprazole and cariprazine show potential in managing negative symptoms and improving social functioning, essential for patient recovery.

Conclusions: This review emphasizes the need for personalized treatment and further research to fully determine the long-term benefits and safety of TGAs. These findings can inform clinical decisions and underline the ongoing need for innovation in schizophrenia pharmacotherapy.

背景和目标:精神分裂症是一种慢性、复杂的精神疾病,需要有效的治疗以减轻其对个人和社会的广泛影响。这篇叙述性综述评估了阿立哌唑、布雷哌唑和卡哌嗪等第三代抗精神病药物(TGAs)的疗效、有效性和副作用,重点关注它们在首发精神分裂症中的应用。这些药物旨在减少早期抗精神病药物的典型副作用,同时更有效地解决阳性症状和认知症状:我们利用PubMed和Scopus进行了广泛的文献综述,其中包括随机对照试验和观察性研究,结果表明TGAs的疗效可与较早的抗精神病药物媲美,但副作用较少,尤其是在减少锥体外系症状和增强认知功能方面:结果:阿立哌唑似乎对精神分裂症的急性期和维持期均有效,而布拉克哌唑和卡哌嗪则在控制阴性症状和改善社会功能方面显示出潜力,这对患者的康复至关重要:本综述强调了个性化治疗和进一步研究的必要性,以充分确定 TGAs 的长期益处和安全性。这些研究结果可为临床决策提供依据,并强调精神分裂症药物治疗需要不断创新。
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引用次数: 0
Antidepressants in the acute treatment of post-traumatic stress disorder in adults: a systematic review and meta-analysis. 抗抑郁药在成人创伤后应激障碍急性期治疗中的应用:系统回顾和荟萃分析。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-06-14 DOI: 10.1097/YIC.0000000000000554
Clotilde Guidetti, Anna Feeney, Rebecca S Hock, Nadia Iovieno, Jesús M Hernández Ortiz, Maurizio Fava, George I Papakostas

Currently, there are few pharmacotherapy options for clinicians treating post-traumatic stress disorder (PTSD), and antidepressants are usually the medication of choice. This meta-analysis aimed to review the efficacy of antidepressants in the acute treatment of PTSD in adults while investigating the contribution of study design and placebo response to the findings of these studies. Randomized, double-blind, placebo-controlled clinical trials that compared antidepressants with placebo for acute treatment of PTSD were selected. Standardized mean difference (SMD) in change in Clinician-Administered PTSD Scale scores were pooled after examining for heterogeneity. A random-effects meta-analysis was performed. Twenty-nine antidepressant-placebo comparisons, involving 4575 subjects, were analyzed. The SMD among all studies was 0.25, a small to medium effect size, lower than that in studies of antidepressants in adult major depressive disorder. The SMDs for low and high mean placebo responses, were 0.27 and 0.22, respectively. The overall SMD for paroxetine studies was in the moderate range (0.43) and that for sertraline studies was in the small range (0.12). Our findings suggest that antidepressants have modest efficacy in alleviating PTSD symptoms. Patient-level meta-analyses are required to further explore the potential clinical relevance of sertraline for PTSD.

目前,临床医生在治疗创伤后应激障碍(PTSD)时可供选择的药物疗法很少,而抗抑郁药通常是首选药物。本荟萃分析旨在回顾抗抑郁药对成人创伤后应激障碍急性期治疗的疗效,同时探讨研究设计和安慰剂反应对这些研究结果的影响。研究选取了比较抗抑郁药与安慰剂对创伤后应激障碍急性期治疗效果的随机、双盲、安慰剂对照临床试验。在检查异质性后,对临床医师自编创伤后应激障碍量表评分变化的标准化平均差(SMD)进行了汇总。进行了随机效应荟萃分析。分析了 29 项抗抑郁药与安慰剂的比较,涉及 4575 名受试者。所有研究的SMD为0.25,属于中小型效应,低于成人重度抑郁障碍抗抑郁药研究的SMD。低平均安慰剂反应和高平均安慰剂反应的SMD分别为0.27和0.22。帕罗西汀研究的总体SMD处于中等范围(0.43),舍曲林研究的总体SMD处于小范围(0.12)。我们的研究结果表明,抗抑郁药在缓解创伤后应激障碍症状方面疗效一般。要进一步探讨舍曲林对创伤后应激障碍的潜在临床意义,还需要进行患者层面的荟萃分析。
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引用次数: 0
Treatment adherence rates across different psychiatric disorders and settings: findings from a large patient cohort. 不同精神疾病和环境下的治疗依从率:一个大型患者队列的研究结果。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-05-30 DOI: 10.1097/YIC.0000000000000557
Nicolaja Girone, Maddalena Cocchi, Francesco Achilli, Edoardo Grechi, Chiara Vicentini, Beatrice Benatti, Matteo Vismara, Alberto Priori, Bernardo Dell'Osso

Approximately 50% of patients with psychiatric disorders do not fully adhere to the prescribed psychopharmacological therapy, significantly impacting the progression of the disorder and the patient's quality of life. The present study aimed to assess potential differences in terms of rates and clinical features of treatment adherence in a large cohort of psychiatric patients with different diagnoses attending various psychiatric services. The study included 307 psychiatric patients diagnosed with a primary major depressive disorder, bipolar disorder, anxiety disorder, schizophrenic spectrum disorder, or personality disorder. Patient's adherence to treatment was evaluated using the Clinician Rating Scale, with a cutoff of at least five defining adherence subgroups. One-third of the sample reported poor medication adherence. A lower rate of adherence emerged among patients with schizophrenic spectrum disorder and bipolar disorder. Subjects with poor adherence were more frequently inpatients and showed higher current substance use, a greater number of previous hospitalizations, and more severe scores at psychopathological assessment compared with patients with positive adherence. Poor adherence was associated with symptom severity and increased rates of relapses and rehospitalizations. In addition, substance use appears to be an unfavorable transdiagnostic factor for treatment adherence.

约有 50%的精神病患者不能完全遵照处方接受精神药物治疗,这严重影响了病情的发展和患者的生活质量。本研究旨在评估一大批接受各种精神科服务的不同诊断的精神病患者在坚持治疗的比例和临床特征方面的潜在差异。研究对象包括 307 名被诊断为原发性重度抑郁障碍、双相情感障碍、焦虑障碍、精神分裂症谱系障碍或人格障碍的精神病患者。患者的治疗依从性采用临床医师评分量表进行评估,以至少5分为分界点划分依从性亚组。样本中有三分之一的患者表示服药依从性较差。精神分裂症谱系障碍和双相情感障碍患者的依从性较低。与依从性良好的患者相比,依从性差的患者更经常住院,目前使用药物的比例更高,以前住院的次数更多,精神病理学评估的评分更严重。依从性差与症状严重程度、复发率和再住院率增加有关。此外,药物使用似乎是影响治疗依从性的一个不利的跨诊断因素。
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引用次数: 0
Systematic review and network meta-analysis of agomelatine for the treatment of generalized anxiety disorder in adult patients. 阿戈美拉汀治疗成人广泛性焦虑症的系统综述和网络荟萃分析。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-05-20 DOI: 10.1097/YIC.0000000000000551
Sean D Hood, Olatunji Odufowora-Sita, Jean-Baptiste Briere, Marco Lucchino, Fatma Khrouf, Elzbieta Olewinska, Paulina Pierzchala, Marwa Mezghani, Mateusz Nikodem, Pierre Lévy

This systematic literature review aimed to assess the efficacy and tolerability of agomelatine versus approved medications for the treatment of generalized anxiety disorder (GAD) in adult patients. We selected randomized controlled trials on various medications used to treat GAD in adult patients. An existing systematic literature review (Kong et al., 2020) was used to identify relevant studies published before 2020. Outcomes of remission and discontinuation due to adverse events (AEs) were analyzed, following a random-effects network meta-analysis approach. Of 25 identified studies, 20 and 22 studies were included in the network meta-analysis for studying the remission and discontinuation (due to AEs) outcomes, respectively. A statistically significant difference in the remission rate was observed between agomelatine and pregabalin [odds ratio (OR), 2.22; 95% confidence interval (CI), 1.19-4.21]. For the other comparators, the results were nonsignificant; however, all the point estimates were in favor of agomelatine. Similarly, for discontinuation because of AEs, the point estimates leaned consistently toward agomelatine suggesting its higher tolerability. The probabilities of agomelatine having the highest remission rate and lowest discontinuation (due to AEs) rate were 67% and 68%, respectively. Based on its demonstrated effectiveness and tolerability, agomelatine can be considered as a drug of choice for the treatment of GAD.

本系统性文献综述旨在评估阿戈美拉汀与已获批准的药物相比,在治疗成人广泛性焦虑症(GAD)方面的疗效和耐受性。我们选择了用于治疗成年 GAD 患者的各种药物的随机对照试验。我们利用现有的系统性文献综述(Kong 等人,2020 年)来确定 2020 年之前发表的相关研究。采用随机效应网络荟萃分析法对缓解和因不良事件(AEs)而停药的结果进行了分析。在25项已确定的研究中,有20项和22项研究被纳入网络荟萃分析,分别研究缓解和停药(因不良反应)的结果。阿戈美拉汀和普瑞巴林的缓解率差异具有统计学意义[几率比(OR),2.22;95% 置信区间(CI),1.19-4.21]。对于其他比较者,结果并不显著;但是,所有的点估计值都有利于阿戈美拉汀。同样,对于因 AE 而停药的情况,点估计值也一致倾向于阿戈美拉汀,这表明阿戈美拉汀具有更高的耐受性。阿戈美拉汀具有最高缓解率和最低停药率(由于 AEs)的概率分别为 67% 和 68%。鉴于阿戈美拉汀的有效性和耐受性,可以考虑将其作为治疗 GAD 的首选药物。
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引用次数: 0
Risk of VMAT2 inhibitors on suicidality and parkinsonism: report utilizing the United States Food and Drug Administration adverse event reporting system. VMAT2 抑制剂对自杀和帕金森症的风险:利用美国食品和药物管理局不良事件报告系统进行的报告。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-05-11 DOI: 10.1097/YIC.0000000000000553
Sabrina Wong, Gia Han Le, Angela T H Kwan, Taeho Greg Rhee, Kayla M Teopiz, Roger C Ho, Bing Cao, Joshua D Rosenblat, Rodrigo Mansur, Roger S McIntyre

Prescription of vesicular monoamine transporter 2 (VMAT2) inhibitors, valbenazine, deutetrabenazine, and tetrabenazine, is becoming increasingly common in persons treated with antipsychotics. Reported suicidality and parkinsonism are safety concerns with VMAT2 inhibitors. Herein, we aim to evaluate the aforementioned safety outcomes using the FDA Adverse Event Reporting System. Reporting odds ratios (RORs) and lower limits of 95% confidence intervals of information components (IC025) were calculated to quantify VMAT2 inhibitor-associated adverse events. Acetaminophen was the reference agent. Suicidal ideation was significantly associated with VMAT2 inhibitors, with RORs ranging from 2.38 to 10.67 and IC025 ranging from 0.73 to 2.39. Increased odds of suicidal behavior was observed with tetrabenazine (ROR 3.011, IC025 0.0087), but not deutetrabenazine or valbenazine. Decreased odds of suicide attempts and completed suicide were observed with VMAT2 inhibitors, with RORs ranging from 0.011 to 0.10 (all IC025 < 0). Increased odds of parkinsonism were reported for all VMAT2 inhibitors, with RORs and IC025 ranging from 19.49 to 25.37 and 1.66 to 2.93, respectively. The mixed results with VMAT2 inhibitor-associated suicidality and parkinsonism do not establish causal relationships. The parameters of suicidality may be explained by underlying psychiatric disorders.

在接受抗精神病药物治疗的患者中,处方膀胱单胺转运体2(VMAT2)抑制剂(valbenazine、deutetrabenazine和tetrabenazine)越来越常见。据报道,自杀和帕金森症是 VMAT2 抑制剂的安全隐患。在此,我们旨在利用 FDA 不良事件报告系统对上述安全性结果进行评估。我们计算了报告几率比(ROR)和信息成分(IC025)的95%置信区间下限,以量化与VMAT2抑制剂相关的不良事件。对乙酰氨基酚为参照药物。自杀意念与 VMAT2 抑制剂明显相关,RORs 为 2.38 至 10.67,IC025 为 0.73 至 2.39。观察到四苯嗪(ROR 3.011,IC025 0.0087)会增加自杀行为的几率,但去甲四苯嗪或戊苯嗪不会增加自杀行为的几率。VMAT2 抑制剂可降低自杀未遂和自杀未遂的几率,ROR 从 0.011 到 0.10 不等(IC025 均为 0.0087)。
{"title":"Risk of VMAT2 inhibitors on suicidality and parkinsonism: report utilizing the United States Food and Drug Administration adverse event reporting system.","authors":"Sabrina Wong, Gia Han Le, Angela T H Kwan, Taeho Greg Rhee, Kayla M Teopiz, Roger C Ho, Bing Cao, Joshua D Rosenblat, Rodrigo Mansur, Roger S McIntyre","doi":"10.1097/YIC.0000000000000553","DOIUrl":"https://doi.org/10.1097/YIC.0000000000000553","url":null,"abstract":"<p><p>Prescription of vesicular monoamine transporter 2 (VMAT2) inhibitors, valbenazine, deutetrabenazine, and tetrabenazine, is becoming increasingly common in persons treated with antipsychotics. Reported suicidality and parkinsonism are safety concerns with VMAT2 inhibitors. Herein, we aim to evaluate the aforementioned safety outcomes using the FDA Adverse Event Reporting System. Reporting odds ratios (RORs) and lower limits of 95% confidence intervals of information components (IC025) were calculated to quantify VMAT2 inhibitor-associated adverse events. Acetaminophen was the reference agent. Suicidal ideation was significantly associated with VMAT2 inhibitors, with RORs ranging from 2.38 to 10.67 and IC025 ranging from 0.73 to 2.39. Increased odds of suicidal behavior was observed with tetrabenazine (ROR 3.011, IC025 0.0087), but not deutetrabenazine or valbenazine. Decreased odds of suicide attempts and completed suicide were observed with VMAT2 inhibitors, with RORs ranging from 0.011 to 0.10 (all IC025 < 0). Increased odds of parkinsonism were reported for all VMAT2 inhibitors, with RORs and IC025 ranging from 19.49 to 25.37 and 1.66 to 2.93, respectively. The mixed results with VMAT2 inhibitor-associated suicidality and parkinsonism do not establish causal relationships. The parameters of suicidality may be explained by underlying psychiatric disorders.</p>","PeriodicalId":13698,"journal":{"name":"International Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140898035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The potential use of daridorexant in eating disorders: beyond the treatment of insomnia? 达立酮在饮食失调症中的潜在用途:超越失眠治疗?
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-05-10 DOI: 10.1097/YIC.0000000000000552
Alice Caldiroli, Letizia M Affaticati, Enrico Capuzzi, Davide La Tegola, Fabrizia Colmegna, Massimo Clerici, Antonios Dakanalis, Massimiliano Buoli

A strong interplay exists between sleep and dietary habits, and sleep disturbances have been repeatedly documented in individuals with eating disorders (EDs). The orexin system - implicated in sleep regulation, energy homeostasis, and food reward - may represent a mechanist link between sleep alterations and disordered eating behaviors. Daridorexant is a dual orexin receptor antagonist (DORA) recently approved for the treatment of insomnia, with demonstrated efficacy and tolerability. Owing to its action on orexin neurons, the compound represents an intriguing option for addressing both sleep-related and core symptoms of EDs. By inhibiting motor hyperactivity, daridorexant may reduce excessive physical exercise in individuals with anorexia nervosa (AN) restricting type. Additionally, the compound may exert anti-binge effects, suggesting broad applicability in binge ED, bulimia nervosa, and binge/purging AN. In this framework, daridorexant emerges as a promising therapeutic option, offering a multifaceted approach to improving circadian rhythms, energy balance, and overall quality of life in individuals with diverse ED subtypes.

睡眠与饮食习惯之间存在着强烈的相互作用,睡眠障碍已多次被记录在饮食失调(ED)患者的病例中。奥曲肽系统与睡眠调节、能量平衡和食物奖赏有关,它可能是睡眠改变与饮食失调行为之间的机理联系。Daridorexant 是一种双重奥曲肽受体拮抗剂(DORA),最近被批准用于治疗失眠症,其疗效和耐受性均已得到证实。由于其对奥曲肽神经元的作用,该化合物是解决睡眠相关症状和肥胖症核心症状的一个令人感兴趣的选择。通过抑制运动亢进,daridorexant 可减少神经性厌食症(AN)限制型患者的过度运动。此外,该化合物还可能具有抗暴饮暴食的作用,这表明它广泛适用于暴饮暴食性厌食症、神经性贪食症和暴饮暴食/暴食性厌食症。在这一框架下,daridorexant 成为一种很有前景的治疗选择,它提供了一种多方面的方法来改善昼夜节律、能量平衡和不同 ED 亚型患者的整体生活质量。
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引用次数: 0
Efficacy and safety of agomelatine versus SSRIs/SNRIs for post-stroke depression: a systematic review and meta-analysis of randomized controlled trials. 阿戈美拉汀与SSRIs/SNRIs治疗脑卒中后抑郁症的疗效和安全性:随机对照试验的系统综述和荟萃分析。
IF 2.1 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-05-01 Epub Date: 2024-03-25 DOI: 10.1097/YIC.0000000000000509
Yicong Chen, Jianle Li, Mengshi Liao, Yinxin He, Chao Dang, Jian Yu, Shihui Xing, Jinsheng Zeng

Agomelatine is effective in the treatment of depression, but its effect for post-stroke depression (PSD) remains unclear. This study was conducted to compare the efficacy and safety of agomelatine versus SSRIs/SNRIs in treating PSD. We systematically searched Embase, PubMed, Cochrane Library, WanFang Data, China National Knowledge Infrastructure, and Cqvip databases for double-blind randomized controlled studies comparing the efficacy and safety of agomelatine versus SSRIs/SNRIs for PSD until December 2022. The primary efficacy endpoint was the Hamilton Depression Rating Scale (HAMD) score, and the primary safety endpoint was the incidence of overall adverse reactions. Nine studies comprising 857 patients with PSD were included. After 6-12 weeks of treatment, the HAMD score ( P  = 0.16) and the overall response rates ( P  = 0.20) in the agomelatine group were comparable to that in the SSRIs/SNRIs group. Participants treated with agomelatine achieved higher Barthel Index scores compared with the SSRIs/SNRIs group ( P  = 0.02). There was a significantly lower incidence of overall adverse reactions ( P  = 0.008) and neurological adverse reactions ( P  < 0.0001) in the agomelatine group. The efficacy of agomelatine for treating PSD is probably comparable to that of SSRIs/SNRIs, and it may improve stroke outcomes with better safety.

阿戈美拉汀对抑郁症有效,但其对脑卒中后抑郁症(PSD)的作用尚不清楚。本研究旨在比较阿戈美拉汀与SSRIs/SNRIs治疗PSD的疗效和安全性。我们系统地搜索了Embase、PubMed、Cochrane Library、万方数据、中国国家知识基础设施和Cqvip数据库,以进行双盲随机对照研究,比较阿戈美拉汀与SSRIs/SNRIs治疗PSD的疗效和安全性,直至2022年12月。主要疗效终点是汉密尔顿抑郁量表(HAMD)评分,主要安全性终点是总体不良反应的发生率。9项研究包括857名PSD患者。治疗6-12周后,HAMD评分(P = 0.16)和总体应答率(P = 0.20)与SSRIs/SNRIs组相当。与SSRIs/SNRIs组相比,接受阿戈美拉汀治疗的参与者获得了更高的Barthel指数得分(P = 总不良反应发生率显著降低(P = 0.008)和神经系统不良反应(P
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引用次数: 0
The effects of psychological flexibility and resilience on psychopharmacological treatment response in patients with obsessive-compulsive disorder. 心理灵活性和复原力对强迫症患者精神药物治疗反应的影响。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-05-01 Epub Date: 2023-08-07 DOI: 10.1097/YIC.0000000000000499
Nisa Deveci, Mustafa Uğurlu, Görkem Karakaş Uğurlu, Esra Kabadayi Şahin, Ezgi Çisil Erdoğan, Ali Çayköylü

Obsessive-compulsive disorder (OCD) is a challenging psychiatric condition to treat. Previous research has explored various aspects of treatment response, but limited attention has been given to the significance of psychological flexibility and resilience. This study aimed to investigate the correlation between psychological flexibility, resilience, and different dimensions of OCD, as well as their role in treatment response specifically concerning OCD symptom sub-dimensions. The study involved 50 OCD patients and 42 healthy individuals as controls. Participants completed the Dimensional Obsessive-Compulsive Scale (DOCS), Acceptance and Action Questionnaire (AAQ-2), and Resilience Scale for Adults (RS). Initial scale scores were compared to post-treatment scores obtained after a 3-month follow-up using pharmacotherapy. The patient group exhibited significantly higher AAQ-2 scores and lower RS scores compared to the control group. During the post-treatment follow-up, a reduction in DOCS and AAQ-2 scores was observed, along with an increase in RS scores. The impact of differences in AAQ-2 and RS scores on the change in DOCS total scores was analyzed using mixed model linear regression analysis. The results showed a statistically significant effect of changes in AAQ-2 and RS sub-dimension scores on the change in DOCS total scores. The findings highlight the importance of flexibility and resilience in influencing treatment response among patients with OCD. When conventional pharmacotherapy and psychotherapy approaches prove insufficient, interventions focused on enhancing flexibility and resilience may contribute to improved treatment outcomes.

强迫症(OCD)是一种极具挑战性的精神疾病。以往的研究对治疗反应的各个方面进行了探讨,但对心理灵活性和复原力的重要性关注有限。本研究旨在探讨心理灵活性、复原力与强迫症不同维度之间的相关性,以及它们在治疗反应中的作用,特别是在强迫症症状子维度方面。研究涉及 50 名强迫症患者和 42 名健康对照者。参与者填写了强迫症维度量表(DOCS)、接受与行动问卷(AAQ-2)和成人复原力量表(RS)。最初的量表得分与使用药物治疗 3 个月后获得的治疗后得分进行了比较。与对照组相比,患者组的 AAQ-2 分数明显较高,而 RS 分数较低。在治疗后的随访中,观察到 DOCS 和 AAQ-2 分数下降,RS 分数上升。采用混合模型线性回归分析法分析了 AAQ-2 和 RS 分数的差异对 DOCS 总分变化的影响。结果显示,AAQ-2 和 RS 子维度得分的变化对 DOCS 总分变化的影响具有统计学意义。研究结果凸显了灵活性和复原力对强迫症患者治疗反应的重要影响。当传统的药物治疗和心理治疗方法被证明效果不佳时,以提高灵活性和复原力为重点的干预措施可能有助于改善治疗效果。
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引用次数: 0
Treatment of high dose of intravenous midazolam abuse: a case report. 大剂量咪达唑仑静脉注射滥用的治疗:病例报告。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-05-01 Epub Date: 2023-08-09 DOI: 10.1097/YIC.0000000000000486
Yeganeh Ramazani, Ahmad Nemati, Mohammad Moshiri, Mahdi Talebi, Mohammad Dadkhah, Leila Etemad

This study reports a rare case of high-dose midazolam abuse and Munchausen Syndrome. A 48-year-old female physician was referred by a psychiatrist to the Toxicology Department of Imam Reza Hospital for abstaining from 300 mg/day of parenteral midazolam. She had mimicked the symptoms of Crohn's disease; therefore, she had undergone 15 colonoscopies and 40 times MRI or CT scan, all of which were normal. Six months earlier, she had switched oral methadone to 30 mg/day of intravenous midazolam. She also had several skin lesions on injection sites that she considered pyoderma gangrenosum. When the total daily dose of intravenous midazolam was switched to oral bioequivalence of clonazepam, she could not tolerate withdrawal (Clinical Institute Withdrawal Assessment Scale-Benzodiazepines = 68). Therefore, she received midazolam again as a continuous intravenous infusion. Within 7 days, the whole dose was replaced by the bioequivalence oral dose of clonazepam. She was also treated with carbamazepine and cognitive behavior therapy. Afterward, she was transferred to the psychiatric ward for further psychiatric treatment. Dependency on a high dose of midazolam could be treated by tapering off the long-acting benzodiazepine.

本研究报告了一例罕见的大剂量咪达唑仑滥用和孟乔森综合症病例。一名 48 岁的女医生因每天禁用 300 毫克肠外咪达唑仑而被精神科医生转介到伊玛目礼萨医院毒理学部。她曾模仿克罗恩病的症状,因此接受了 15 次结肠镜检查和 40 次核磁共振成像或 CT 扫描,结果均正常。六个月前,她将口服美沙酮改为每天 30 毫克的咪达唑仑静脉注射。她的注射部位也有几处皮肤损伤,她认为是脓皮病。当静脉注射咪达唑仑的每日总剂量改为口服氯硝西泮的生物等效剂量时,她无法耐受戒断(临床研究所戒断评估量表-苯二氮卓=68)。因此,她再次接受咪达唑仑持续静脉注射。在 7 天内,整个剂量被生物等效的氯硝西泮口服剂量所取代。她还接受了卡马西平和认知行为疗法的治疗。之后,她被转到精神科病房接受进一步的精神治疗。对大剂量咪达唑仑的依赖可以通过减少长效苯二氮卓类药物来治疗。
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引用次数: 0
The role of benzodiazepines in common conditions: a narrative review focusing on lormetazepam. 苯二氮卓类药物在常见疾病中的作用:以洛美西泮为重点的叙述性综述。
IF 2.1 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-05-01 Epub Date: 2024-02-13 DOI: 10.1097/YIC.0000000000000529
Stefano Pallanti

This review aimed to examine the place of benzodiazepines, specifically lormetazepam, in the treatment of insomnia, including during pregnancy or in patients with psychodermatoses. PubMed was searched for the term "lormetazepam" in association with MeSH terms encompassing anxiety, insomnia/sleep disorders, pregnancy/gestation, and psychodermatoses/skin disorders. English-language articles up to 31 July 2022 were identified. Ad hoc searches for relevant literature were performed at later stages of review development. Multiple randomized, placebo-controlled studies have demonstrated that lormetazepam dose-dependently increases total sleep time, decreases wakefulness over a dosing range of 0.5-2.0 mg, and improves subjective assessments of sleep quality. Lormetazepam is as effective as other benzodiazepines in improving sleep duration and quality, but is better tolerated than the long-acting agents with minimal next-day effects. Benzodiazepines can be used as short-term monotherapy at the lowest effective dose during the second or third trimesters of pregnancy; lormetazepam is also a reasonable choice due to its limited transplacental passage. Insomnia associated with skin disorders or pregnancy can be managed by effective symptom control (especially itching), sleep hygiene, treatment of anxiety/depression, and a short course of hypnotics.

本综述旨在研究苯二氮卓类药物(尤其是洛美西泮)在治疗失眠(包括妊娠期或患有精神皮肤病的患者)中的地位。在PubMed上搜索了 "洛美西泮 "和MeSH术语,其中MeSH术语包括焦虑、失眠/睡眠障碍、怀孕/妊娠和精神皮肤病/皮肤病。对截至 2022 年 7 月 31 日的英文文章进行了检索。在综述开发的后期阶段,对相关文献进行了特别搜索。多项随机安慰剂对照研究表明,在 0.5-2.0 毫克的剂量范围内,洛美西泮剂量依赖性地增加总睡眠时间、减少觉醒,并改善睡眠质量的主观评估。在改善睡眠时间和质量方面,洛美西泮与其他苯二氮卓类药物一样有效,但其耐受性优于长效药物,且对第二天的影响极小。苯二氮卓类药物可在妊娠期的第二或第三季度以最低有效剂量作为短期单一疗法使用;由于洛美西泮的胎盘通过能力有限,因此也是一种合理的选择。与皮肤病或妊娠有关的失眠可以通过有效控制症状(尤其是瘙痒)、保持睡眠卫生、治疗焦虑/抑郁以及短期服用催眠药来控制。
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International Clinical Psychopharmacology
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