Medizinische Monatsschrift fur Pharmazeuten最新文献

Despite unmet meeds regarding efficacy, tolerability and time of onset and the high importance of mental disorders very few new psychotropics have been introduced in Germany recently. Lurasidon and the new multimodal antidepressant vortioxetine demonstrating clinical efficacy in the improvement of cognition have been withdrawn from the German market due to economic reasons based on an official committee judgement „missing additional benefit“. Among new substances introduced are the selective opioid modulator nalmefene for reduction of alcohol consumption, the selective alpha-2-receptor agonist guanfacine for ADHS treatment in child and youth psychiatry, the older antidepressant milnacipran and the glucagon-like-peptide-1-receptor agonist liraglutide for treatment of adipositas. In the USA the atypical antipsychotics cariprazine and brexpiprazole have been released. The introduction of the long acting depot antipsychotics aripiprazole (1 month) and paliperidone (3 months) can be seen as major progress in the treatment of schizophrenia. Loxapine is available as inhalative antipsychotic for rapid treatment of agitation in schizophrenia and mania. Atypical antipsychotics like quetiapine are recommended now as add-on treatment for therapy-resistant depressions. Ketamine and botulinum toxin are in experimental use as antidepressants. The development of psychotropics is long lasting and costly and made even more difficult by negative medial attitudes additionally. Constructive resolving attempts are needed urgently to avoid a standstill in the development of psychotropic drugs.

Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, unrefreshing sleep and mental/physical fatigue. Most patients report additional somatic and psychological symptoms. Fibromyalgia is a heterogeneous condition. The definite aetiology of this syndrome remains unknown. A model of interacting biological and psychosocial variables in the predisposition, triggering, and development of the chronicity of fibromyalgia symptoms has been suggested. Depression, genetics, obesity combined with physical inactivity, physical and sexual abuse in childhood, sleep problems, and smoking predict future development of fibromyalgia. Psychosocial stress (working place and family conflicts) and physical stress (infections, surgery, accidents) might trigger the onset of chronic widespread pain and fatigue. Mental disorders have a negative impact on the clinical outcome. Several factors are associated with the pathophysiology such as alteration of sensory processing in the brain, reduced reactivity of the hypothalamus-pituitary-adrenal axis to stress, increased pro-inflammatory and reduced anti-inflammatory cytokine profiles, disturbances in neurotransmitters such as dopamine and serotonin, and small fiber pathology. Prolonged exposure to stress, as outlined above, may contribute to these functional changes in predisposed individuals. The prevalence in the general German population is about 2 %. The clinical diagnosis is established by the history of the key symptoms and the exclusion of somatic diseases sufficiently explaining chronic widespread pain. For management, the German evidence and consensus based guideline recommends a stepwise approach according to the severity of FMS. All patients should receive adequate education about the disorder and its management. Non-pharmacological therapies such as low intensity aerobic exercise and meditative movement therapies such as Qi-Gong and Yoga are highly recommended for long-term self-management. Drug therapy is not mandatory. Recommended drugs are the antidepressants amitriptyline and duloxetine and the anticonvulsant pregabalin which act as pain modulators.

Endothelial dysfunction, characterized by a disturbed vascular NO metabolism, represents a key point in atherogenesis. Modern antiatherogenic therapies improve NO availability within the endothelium. As L-arginine acts as the substrate of endothelial nitric oxide synthase (eNOS), arginine supplementation can enhance NO formation. Actually, L-arginine at appropriate dosage (6–8 g/day) improves endothelial function and lowers blood pressure. However, beneficial effects can only be expected in individuals with pronounced endothelial dysfunction and/or individuals with an absolute (patients with hemodialysis) or relative (patients with elevated ADMA levels) arginine deficiency. Whether L-arginine delays progression of atherosclerotic lesions and lowers cardiovascular morbidity and mortality is unknown.