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Precision Psychiatry Approach to Treat Depression and Anxiety Targeting the Stress Hormone System - V1b-antagonists as a Case in Point. 针对应激激素系统治疗抑郁症和焦虑症的精准精神病学方法--以 V1b-拮抗剂为例。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-08-19 DOI: 10.1055/a-2372-3549
Florian Holsboer, Marcus Ising

The future of depression pharmacotherapy lies in a precision medicine approach that recognizes that depression is a disease where different causalities drive symptoms. That approach calls for a departure from current diagnostic categories, which are broad enough to allow adherence to the "one-size-fits-all" paradigm, which is complementary to the routine use of "broad-spectrum" mono-amine antidepressants. Similar to oncology, narrowing the overinclusive diagnostic window by implementing laboratory tests, which guide specifically targeted treatments, will be a major step forward in overcoming the present drug discovery crisis.A substantial subgroup of patients presents with signs and symptoms of hypothalamic-pituitary-adrenocortical (HPA) overactivity. Therefore, this stress hormone system was considered to offer worthwhile targets. Some promising results emerged, but in sum, the results achieved by targeting corticosteroid receptors were mixed.More specific are non-peptidergic drugs that block stress-responsive neuropeptides, corticotropin-releasing hormone (CRH), and arginine vasopressin (AVP) in the brain by antagonizing their cognate CRHR1-and V1b-receptors. If a patient's depressive symptomatology is driven by overactive V1b-signaling then a V1b-receptor antagonist should be first-line treatment. To identify the patient having this V1b-receptor overactivity, a neuroendocrine test, the so-called dex/CRH-test, was developed, which indicates central AVP release but is too complicated to be routinely used. Therefore, this test was transformed into a gene-based "near-patient" test that allows immediate identification if a depressed patient's symptomatology is driven by overactive V1b-receptor signaling. We believe that this precision medicine approach will be the next major innovation in the pharmacotherapy of depression.

抑郁症药物治疗的未来在于精准医疗方法,即认识到抑郁症是一种由不同病因导致症状的疾病。这种方法要求摒弃当前的诊断类别,因为当前的诊断类别过于宽泛,足以让人们遵循 "一刀切 "的范式,这与常规使用 "广谱 "单胺抗抑郁药是相辅相成的。与肿瘤学类似,通过实施实验室检测来缩小过度包容的诊断窗口,从而指导有针对性的治疗,将是克服当前药物研发危机的重要一步。因此,这一应激激素系统被认为是值得研究的目标。通过拮抗同源的 CRHR1 和 V1b 受体,阻断脑内应激反应神经肽、促肾上腺皮质激素释放激素(CRH)和精氨酸加压素(AVP)的非肽能药物更具针对性。如果患者的抑郁症状是由 V1b 信号过度活跃引起的,那么 V1b 受体拮抗剂应作为一线治疗药物。为了识别 V1b 受体过度活跃的患者,人们开发了一种神经内分泌测试,即所谓的 dex/CRH 测试,它可以显示中枢 AVP 的释放,但由于过于复杂而无法常规使用。因此,我们将这种检测方法转化为一种基于基因的 "近似患者 "检测方法,可以立即确定抑郁症患者的症状是否是由过度活跃的 V1b 受体信号传导引起的。我们相信,这种精准医疗方法将成为抑郁症药物疗法的下一个重大创新。
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引用次数: 0
Electroconvulsive Therapy Versus Aripiprazole Addition to Clozapine in Patients with Clozapine-Resistant Symptoms (EMECLO): A Protocol of a Single-Blind, Multicenter, Randomized-Controlled Feasibility Trial. 电休克疗法与在氯氮平基础上加用阿立哌唑治疗氯氮平耐药症状患者(EMECLO):单盲、多中心、随机对照可行性试验方案》。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-08-26 DOI: 10.1055/a-2364-4357
Manouk den Toom, Laura Blanken, Inge Horn, Selene Veerman, Joris J B van der Vlugt-Molenaar, Mariken B de Koning, Jan Bogers, John Enterman, Martin de Jonge, Daniela Cianci, Gerardus W J Frederix, Hans J de Haas, Bram W Storosum, Mike Veereschild, Martin Javadzadeh, Peter F J Schulte, Dan Cohen, Jim van Os, Wiepke Cahn, Lieuwe de Haan, Jasper B Zantvoord, Jurjen J Luykx

Background: Currently, guidance on the most effective treatment for patients with clozapine-resistant schizophrenia-spectrum disorders (SSD) is lacking. While augmentation strategies to clozapine with aripiprazole and electroconvulsive therapy (ECT) have been demonstrated to be effective in patients with clozapine-resistant schizophrenia spectrum disorders (CRS), head-to-head comparisons between these addition strategies are unavailable. We therefore aim to examine the feasibility of a larger randomized, single-blind trial comparing the effectiveness, cost-effectiveness, and safety of aripiprazole addition vs. ECT addition in CRS.

Methods: In this multi-center, randomized, single-blind feasibility study, the feasibility of recruiting 20 participants with CRS who will be randomized to either aripiprazole or bilateral ECT addition will be assessed. The main endpoint is the number of patients willing to be randomized. The number of screened individuals and reasons to decline participation will be recorded. Effects will be estimated for the benefit of the foreseen larger trial. To that end, differences between both arms in symptom severity will be assessed using blinded video assessments. In addition, tolerability (e. g., cognitive functioning), safety, quality of life, recovery, and all-cause discontinuation will be compared. The follow-up period is 16 weeks, after which non-responders will be given the option to switch to the other treatment.

Discussion: Strengths of this feasibility trial include maintaining blinding with video assessment, a possibility to switch groups in case of non-response, and a broad set of outcome measures. Identification of factors contributing to non-participation and drop-out will generate valuable information on trial feasibility and may enhance recruitment strategies in a follow-up RCT.

Trial registration: The study has been approved by the Medical Research Ethics Committee of the Amsterdam University Medical Center, location AMC, and was registered on 1 May 2022 in the EU Clinical Trials Register (EudraCT) under the trial name 'EMECLO' (2021-006333-19).

背景:目前,对于氯氮平耐药精神分裂症谱系障碍(SSD)患者最有效的治疗方法还缺乏指导。阿立哌唑和电休克疗法(ECT)作为氯氮平的辅助治疗策略已被证实对氯氮平耐药的精神分裂症谱系障碍(CRS)患者有效,但这些辅助治疗策略之间的正面比较尚不存在。因此,我们旨在研究一项更大规模的随机、单盲试验的可行性,比较阿立哌唑加用与ECT加用在CRS中的有效性、成本效益和安全性:在这项多中心、随机、单盲可行性研究中,将评估招募20名CRS患者的可行性,这些患者将随机接受阿立哌唑或双侧ECT治疗。主要终点是愿意接受随机治疗的患者人数。将记录接受筛选的人数和拒绝参与的原因。将对效果进行估计,以利于预期的更大规模试验。为此,将使用盲法视频评估两种方法在症状严重程度上的差异。此外,还将比较耐受性(如认知功能)、安全性、生活质量、恢复情况和全因停药情况。随访期为 16 周,随访期结束后,无应答者可选择转用其他疗法:讨论:这项可行性试验的优点包括通过视频评估保持盲目性、在无应答的情况下可以换组以及广泛的结果测量。确定导致不参与和退出的因素将为试验的可行性提供有价值的信息,并可加强后续 RCT 的招募策略:该研究已获得阿姆斯特丹大学医学中心(AMC)医学研究伦理委员会的批准,并于2022年5月1日在欧盟临床试验注册中心(EudraCT)注册,试验名称为 "EMECLO"(2021-006333-19)。
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引用次数: 0
Association Study Between DRD2, DRD3 Genetic Polymorphisms and Adverse Reactions in Chinese Patients on Amisulpride Treatment. 中国阿米舒必利患者DRD2、DRD3基因多态性与不良反应的关联研究
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-08-26 DOI: 10.1055/a-2375-3859
Kankan Qu, Yanan He, Zhongdong Zhang, Yeli Cao, Qiyun Qin, Zhenhe Zhou, Lili Zhen

Objective: To determine if the cardiac function and "endocrinium" of Chinese patients are associated with dopamine D2 (DRD2) (rs6276) and DRD3 (rs6280, rs963468) genetic polymorphisms when treated with amisulpride.

Methods: This study enrolled 148 patients with schizophrenia who took amisulpride orally for 8 weeks. DRD2 (rs6276) and DRD3 (rs6280, rs963468) genetic polymorphisms were detected with TaqMan-MGB allelic discrimination.

Results: Analysis by multivariate covariance analysis (MANCOVA) showed that after adjusting for age, gender, and the baseline level, the increase in the level of aspartate aminotransferase (AST) and creatine kinase (CK) in the rs6276 AG group was higher than that in the AA and GG groups. Similarly, the changed estradiol (E2) level in rs6276 GG and rs963468 GG groups was higher than that in the other two groups. Adjusting for covariates, the increased triglyceride (TG) level in rs6276 GG and rs963468 GG groups was the highest among their different genotype groups. The increase in the level of "AST" in the rs6280 TT group was higher than that in the CC and CT groups upon adjusting for covariates. Similarly, MANCOVA showed that the increase in the level of "CK" in the rs6280 CT group was higher than that in the CC and CT groups. Besides, the increased level of "PRL" in the rs6280 CC group and rs963468 GG group was higher than that in their other two genotypes groups.

Conclusion: DRD2 (rs6276) and DRD3 (rs6280, rs963468) polymorphisms can affect amisulpride tolerability since they are associated with the observed adverse reactions, including cardiac dysfunction and endocrine disorders in Chinese patients with schizophrenia.

目的确定中国患者在接受氨磺必利治疗时,其心脏功能和 "内分泌 "是否与多巴胺D2(DRD2)(rs6276)和DRD3(rs6280,rs963468)基因多态性有关:本研究招募了 148 名精神分裂症患者,这些患者口服阿米舒必利 8 周。采用TaqMan-MGB等位基因辨别法检测DRD2(rs6276)和DRD3(rs6280、rs963468)基因多态性:多变量协方差分析(MANCOVA)显示,在调整年龄、性别和基线水平后,rs6276 AG 组天门冬氨酸氨基转移酶(AST)和肌酸激酶(CK)水平的升高幅度高于 AA 组和 GG 组。同样,rs6276 GG 组和 rs963468 GG 组的雌二醇(E2)水平变化也高于其他两组。调整协变量后,rs6276 GG 组和 rs963468 GG 组甘油三酯(TG)水平的升高在不同基因型组中最高。在调整协变量后,rs6280 TT 组 "谷草转氨酶 "水平的升高幅度高于 CC 组和 CT 组。同样,MANCOVA 显示,rs6280 CT 组 "肌酸激酶 "水平的升高也高于 CC 组和 CT 组。此外,rs6280 CC 组和 rs963468 GG 组 "PRL "水平的升高也高于其他两个基因型组:结论:DRD2(rs6276)和DRD3(rs6280、rs963468)多态性可能影响阿米舒必利的耐受性,因为它们与观察到的不良反应有关,包括中国精神分裂症患者的心功能障碍和内分泌紊乱。
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引用次数: 0
Correction: Electroconvulsive Therapy Versus Aripiprazole Addition to Clozapine in Patients with Clozapine-Resistant Symptoms (EMECLO): A Protocol of a Single-Blind, Multicenter, Randomized-Controlled Feasibility Trial. 更正:电休克疗法与在氯氮平基础上加用阿立哌唑治疗氯氮平耐药症状患者(EMECLO):单盲、多中心、随机对照可行性试验方案》。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-09-06 DOI: 10.1055/a-2406-6396
Manouk den Toom, Laura Blanken, Inge Horn, Selene Veerman, Joris J B van der Vlugt-Molenaar, Mariken B de Koning, Jan Bogers, John Enterman, Martin de Jonge, Daniela Cianci, Gerardus W J Frederix, Hans J de Haas, Bram W Storosum, Mike Veereschild, Martin Javadzadeh, Peter F J Schulte, Dan Cohen, Jim van Os, Wiepke Cahn, Lieuwe de Haan, Jasper B Zantvoord, Jurjen J Luykx
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引用次数: 0
A Trajectory of Long-Term Antipsychotic Medication Dosage in Inpatients with Severe Behavioral and Psychological Symptoms of Dementia: A Retrospective Study. 有严重行为和心理症状的痴呆住院患者长期服用抗精神病药物的剂量轨迹:一项回顾性研究
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-06-25 DOI: 10.1055/a-2336-3317
Teruo Tada, Takefumi Suzuki, Yusuke Iwata, Masaharu Kubota, Koichiro Watanabe, Hitoshi Sakurai

Introduction: While antipsychotics are often prescribed for behavioral and psychological symptoms of dementia (BPSD), typically on an off-label basis, these medications have serious adverse effects. This study investigated the long-term use of antipsychotics among inpatients with dementia displaying severe BPSD, focusing on how prescriptions change over time.

Methods: Medical charts at Kusakabe Memorial Hospital were retrospectively reviewed from October 2012 to September 2021. The study included patients diagnosed with dementia, admitted for BPSD, and were continuing antipsychotics at 3 months of their admission. Antipsychotic dosages were categorized as high (≥300 mg/d), medium (100-300 mg/d), and low (<100 mg/d) based on chlorpromazine equivalents and tracked until 15 months during hospitalization. Binary logistic regression was used to identify factors associated with dosage reductions between months 3 and 6.

Results: This study involved 188 patients, with an average age of 81.2 years, 67% of whom were diagnosed with Alzheimer's dementia. At 3 months, 15.4% were taking high, 44.1% on medium, and 40.4% on low dosages of antipsychotics. The highest average dosage was observed at 3 months, with a subsequent decrease over time. By the 12th month, 20-30% of patients in all dosage categories had stopped their antipsychotic medication. Significant factors for dosage reduction included higher initial doses (OR 1.003, 95%Cl: 1.001-1.006, P=0.01) and male gender (OR 2.481, 95%Cl: 1.251-4.918, P=0.009).

Discussion: A trajectory of antipsychotic dosage in inpatients with severe BPSD has rarely been reported. This research emphasizes the need for personalized strategies in managing long-term pharmacotherapy for this vulnerable group of patients.

简介:虽然抗精神病药物通常被用于治疗痴呆症的行为和心理症状(BPSD),但这些药物具有严重的不良反应。本研究调查了表现出严重BPSD的痴呆住院患者长期使用抗精神病药物的情况,重点关注处方随时间的变化:方法:对草壁纪念医院 2012 年 10 月至 2021 年 9 月期间的病历进行回顾性审查。研究对象包括确诊为痴呆症、因BPSD入院、入院3个月后仍在服用抗精神病药物的患者。抗精神病药物剂量分为高剂量(≥300 毫克/天)、中剂量(100-300 毫克/天)和低剂量(结果:高剂量(≥300 毫克/天)患者的抗精神病药物剂量为 100 毫克/天,中剂量(100-300 毫克/天)患者的抗精神病药物剂量为 100 毫克/天):这项研究涉及 188 名患者,平均年龄为 81.2 岁,其中 67% 被诊断为阿尔茨海默型痴呆。3 个月时,15.4% 的患者服用大剂量抗精神病药物,44.1% 的患者服用中剂量,40.4% 的患者服用小剂量。3个月时的平均剂量最高,随后随着时间的推移逐渐降低。到第 12 个月时,所有剂量类别中都有 20%-30% 的患者停止了抗精神病药物治疗。导致剂量减少的重要因素包括初始剂量较高(OR 1.003,95%Cl:1.001-1.006,P=0.01)和男性(OR 2.481,95%Cl:1.251-4.918,P=0.009):讨论:很少有关于重度BPSD住院患者抗精神病药物剂量轨迹的报道。这项研究强调,需要为这一易感人群制定个性化的长期药物治疗管理策略。
{"title":"A Trajectory of Long-Term Antipsychotic Medication Dosage in Inpatients with Severe Behavioral and Psychological Symptoms of Dementia: A Retrospective Study.","authors":"Teruo Tada, Takefumi Suzuki, Yusuke Iwata, Masaharu Kubota, Koichiro Watanabe, Hitoshi Sakurai","doi":"10.1055/a-2336-3317","DOIUrl":"10.1055/a-2336-3317","url":null,"abstract":"<p><strong>Introduction: </strong>While antipsychotics are often prescribed for behavioral and psychological symptoms of dementia (BPSD), typically on an off-label basis, these medications have serious adverse effects. This study investigated the long-term use of antipsychotics among inpatients with dementia displaying severe BPSD, focusing on how prescriptions change over time.</p><p><strong>Methods: </strong>Medical charts at Kusakabe Memorial Hospital were retrospectively reviewed from October 2012 to September 2021. The study included patients diagnosed with dementia, admitted for BPSD, and were continuing antipsychotics at 3 months of their admission. Antipsychotic dosages were categorized as high (≥300 mg/d), medium (100-300 mg/d), and low (<100 mg/d) based on chlorpromazine equivalents and tracked until 15 months during hospitalization. Binary logistic regression was used to identify factors associated with dosage reductions between months 3 and 6.</p><p><strong>Results: </strong>This study involved 188 patients, with an average age of 81.2 years, 67% of whom were diagnosed with Alzheimer&apos;s dementia. At 3 months, 15.4% were taking high, 44.1% on medium, and 40.4% on low dosages of antipsychotics. The highest average dosage was observed at 3 months, with a subsequent decrease over time. By the 12th month, 20-30% of patients in all dosage categories had stopped their antipsychotic medication. Significant factors for dosage reduction included higher initial doses (OR 1.003, 95%Cl: 1.001-1.006, P=0.01) and male gender (OR 2.481, 95%Cl: 1.251-4.918, P=0.009).</p><p><strong>Discussion: </strong>A trajectory of antipsychotic dosage in inpatients with severe BPSD has rarely been reported. This research emphasizes the need for personalized strategies in managing long-term pharmacotherapy for this vulnerable group of patients.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":"275-282"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451120","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
Twenty-Three Years of Declining Lithium Use: Analysis of a Pharmacoepidemiological Dataset from German-Speaking Countries. 二十三年来锂的使用量不断下降:德语国家药物流行病学数据集分析》。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-08-22 DOI: 10.1055/a-2374-2386
Waldemar Greil, Mateo de Bardeci, Nadja Nievergelt, Sermin Toto, Renate Grohmann, Johanna Seifert, Georgios Schoretsanitis

Introduction: Pharmacoepidemiological data suggest that lithium prescriptions for bipolar disorder are gradually decreasing, with less attention having been paid to other indications.

Methods: We examined lithium prescriptions between 1994 and 2017 in data provided by the Drug Safety in Psychiatry Program AMSP, including psychiatric hospitals in Germany, Austria and Switzerland. We compared lithium use for different diagnoses before and after 2001 and in three periods (T1: 1994-2001, T2: 2002-2009, and T3: 2010-2017).

Results: In a total of 158,384 adult inpatients (54% female, mean age 47.4±17.0 years), we observed a statistically significant decrease in lithium prescriptions between 1994-2000 and 2001-2017 in patients with schizophrenia spectrum disorder from 7.7% to 5.1% and in patients with affective disorders from 16.8% to 9.6%. Decreases in use were also observed for diagnostic subgroups: schizoaffective disorder (ICD-10 F25: 27.8% to 17.4%), bipolar disorder (F31: 41.3% to 31%), depressive episode (F32: 8.1% to 3.4%), recurrent depression (F33: 17.9% to 7.5%, all: p<0.001) and emotionally unstable (borderline) personality disorder (6.3% to 3.9%, p=0.01). The results in T1 vs. T2 vs. T3 were for F25: 26.7% vs. 18.2% vs. 16.2%, F32: 7.7% vs. 4.2% vs. 2.7%, F33: 17.2% vs. 8.6% vs. 6.6% and for F31: 40.8% vs. 31.7% vs 30.0%, i. e. there was no further decrease for lithium use in bipolar disorder after 2002. Lithium's main psychotropic co-medications were quetiapine (21.1%), lorazepam (20.6%), and olanzapine (15.2%).

Discussion: In inpatients, the use of lithium has decreased in patients with bipolar disorder and also with various other psychiatric diagnoses.

引言药物流行病学数据表明,用于治疗双相情感障碍的锂处方正在逐渐减少,而对其他适应症的关注则较少:我们根据精神病学药物安全项目 AMSP(包括德国、奥地利和瑞士的精神病院)提供的数据,研究了 1994 年至 2017 年期间的锂处方。我们比较了 2001 年前后三个时期(T1:1994-2001 年;T2:2002-2009 年;T3:2010-2017 年)不同诊断的锂使用情况:在总共 158384 名成年住院患者(54% 为女性,平均年龄为 47.4±17.0 岁)中,我们观察到在 1994-2000 年和 2001-2017 年间,精神分裂症谱系障碍患者的锂处方从 7.7% 降至 5.1%,情感障碍患者的锂处方从 16.8% 降至 9.6%,降幅具有统计学意义。在以下诊断亚组中也观察到了使用量的减少:分裂情感障碍(ICD-10 F25:27.8%降至17.4%)、双相情感障碍(F31:41.3%降至31%)、抑郁发作(F32:8.1%降至3.4%)、复发性抑郁(F33:17.9%降至7.5%,均为 "讨论":在住院病人中,双相情感障碍和其他各种精神疾病患者使用锂的情况有所减少。
{"title":"Twenty-Three Years of Declining Lithium Use: Analysis of a Pharmacoepidemiological Dataset from German-Speaking Countries.","authors":"Waldemar Greil, Mateo de Bardeci, Nadja Nievergelt, Sermin Toto, Renate Grohmann, Johanna Seifert, Georgios Schoretsanitis","doi":"10.1055/a-2374-2386","DOIUrl":"10.1055/a-2374-2386","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacoepidemiological data suggest that lithium prescriptions for bipolar disorder are gradually decreasing, with less attention having been paid to other indications.</p><p><strong>Methods: </strong>We examined lithium prescriptions between 1994 and 2017 in data provided by the Drug Safety in Psychiatry Program AMSP, including psychiatric hospitals in Germany, Austria and Switzerland. We compared lithium use for different diagnoses before and after 2001 and in three periods (T1: 1994-2001, T2: 2002-2009, and T3: 2010-2017).</p><p><strong>Results: </strong>In a total of 158,384 adult inpatients (54% female, mean age 47.4±17.0 years), we observed a statistically significant decrease in lithium prescriptions between 1994-2000 and 2001-2017 in patients with schizophrenia spectrum disorder from 7.7% to 5.1% and in patients with affective disorders from 16.8% to 9.6%. Decreases in use were also observed for diagnostic subgroups: schizoaffective disorder (ICD-10 F25: 27.8% to 17.4%), bipolar disorder (F31: 41.3% to 31%), depressive episode (F32: 8.1% to 3.4%), recurrent depression (F33: 17.9% to 7.5%, all: p<0.001) and emotionally unstable (borderline) personality disorder (6.3% to 3.9%, p=0.01). The results in T1 vs. T2 vs. T3 were for F25: 26.7% vs. 18.2% vs. 16.2%, F32: 7.7% vs. 4.2% vs. 2.7%, F33: 17.2% vs. 8.6% vs. 6.6% and for F31: 40.8% vs. 31.7% vs 30.0%, i. e. there was no further decrease for lithium use in bipolar disorder after 2002. Lithium's main psychotropic co-medications were quetiapine (21.1%), lorazepam (20.6%), and olanzapine (15.2%).</p><p><strong>Discussion: </strong>In inpatients, the use of lithium has decreased in patients with bipolar disorder and also with various other psychiatric diagnoses.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":"296-303"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11543241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluation of E-Cigarette Use in Opioid-Dependent Patients in Maintenance Treatment. 评估阿片类药物依赖患者在维持治疗中使用电子烟的情况。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-30 DOI: 10.1055/a-2414-5867
Josef Rabl, Michael Specka, Udo Bonnet, Özge Irtürk, Fabrizio Schifano, Norbert Scherbaum

Introduction: As tobacco smoking decreases, the use of e-cigarettes is on the rise. There is a debate whether switching from smoking to the use of e-cigarettes might represent a harm reduction strategy for those who smoke tobacco heavily, a habit often observed in individuals with opioid dependence. The present study investigated the prevalence and patterns of tobacco smoking and e-cigarette use in patients in opioid maintenance treatment (OMT) and whether e-cigarette use contributed to the cessation of smoking tobacco.

Methods: In 2014 (n=84) and in 2021 (n=128), patients from two OMT clinics of a psychiatric university hospital were interviewed RESULTS: In both surveys, patients presented with a comparable average age (45.6 vs. 46.9 years of age), gender distribution (mainly male 71.4 vs. 75.8%), and length of OMT history (median: 66 vs. 55 months). The lifetime prevalence of e-cigarette use (45.2% in 2014 and 38.3% in 2021) was much higher than the current prevalence (4.9% and 7.8%, respectively). Few patients reported either a complete switch from smoking to the use of e-cigarettes (2014, n=1 vs. 2021, n=2) or the achievement of abstinence from smoking after a temporary use of e-cigarettes (2014, n=2 vs. 2021, n=1).

Discussion: No increase in the use of e-cigarettes was observed in these groups of patients undergoing OMT. Presumably, harm reduction strategies relating to the use of e-cigarettes in this group need to be supported by motivational interventions. Given the high morbidity and mortality due to smoking, OMT clinics should offer professional help in reducing smoking.

导言:随着吸烟率的下降,电子烟的使用率也在上升。对于那些大量吸烟的人来说,从吸烟转为使用电子烟是否是一种减低危害的策略,这一点还存在争议。本研究调查了阿片类药物维持治疗(OMT)患者吸烟和使用电子烟的流行率和模式,以及使用电子烟是否有助于戒烟:结果:在两次调查中,患者的平均年龄(45.6岁对46.9岁)、性别分布(主要为男性,71.4%对75.8%)和OMT病史长度(中位数:66个月对55个月)具有可比性。终生使用电子烟的比例(2014 年为 45.2%,2021 年为 38.3%)远高于目前的比例(分别为 4.9% 和 7.8%)。很少有患者报告完全从吸烟转为使用电子烟(2014年,n=1;2021年,n=2)或在临时使用电子烟后实现戒烟(2014年,n=2;2021年,n=1):讨论:在这些接受OMT治疗的患者群体中,没有观察到使用电子烟的增加。据推测,在这一群体中使用电子烟的减害策略需要得到动机干预措施的支持。鉴于吸烟导致的高发病率和高死亡率,OMT 诊所应提供专业帮助以减少吸烟。
{"title":"Evaluation of E-Cigarette Use in Opioid-Dependent Patients in Maintenance Treatment.","authors":"Josef Rabl, Michael Specka, Udo Bonnet, Özge Irtürk, Fabrizio Schifano, Norbert Scherbaum","doi":"10.1055/a-2414-5867","DOIUrl":"https://doi.org/10.1055/a-2414-5867","url":null,"abstract":"<p><strong>Introduction: </strong>As tobacco smoking decreases, the use of e-cigarettes is on the rise. There is a debate whether switching from smoking to the use of e-cigarettes might represent a harm reduction strategy for those who smoke tobacco heavily, a habit often observed in individuals with opioid dependence. The present study investigated the prevalence and patterns of tobacco smoking and e-cigarette use in patients in opioid maintenance treatment (OMT) and whether e-cigarette use contributed to the cessation of smoking tobacco.</p><p><strong>Methods: </strong>In 2014 (n=84) and in 2021 (n=128), patients from two OMT clinics of a psychiatric university hospital were interviewed RESULTS: In both surveys, patients presented with a comparable average age (45.6 vs. 46.9 years of age), gender distribution (mainly male 71.4 vs. 75.8%), and length of OMT history (median: 66 vs. 55 months). The lifetime prevalence of e-cigarette use (45.2% in 2014 and 38.3% in 2021) was much higher than the current prevalence (4.9% and 7.8%, respectively). Few patients reported either a complete switch from smoking to the use of e-cigarettes (2014, n=1 vs. 2021, n=2) or the achievement of abstinence from smoking after a temporary use of e-cigarettes (2014, n=2 vs. 2021, n=1).</p><p><strong>Discussion: </strong>No increase in the use of e-cigarettes was observed in these groups of patients undergoing OMT. Presumably, harm reduction strategies relating to the use of e-cigarettes in this group need to be supported by motivational interventions. Given the high morbidity and mortality due to smoking, OMT clinics should offer professional help in reducing smoking.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546696","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
Recreational Cannabis Legalization: No Contribution to Rising Prescription Stimulants in the USA. 娱乐性大麻合法化:美国处方兴奋剂增加与大麻合法化无关。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-07-31 DOI: 10.1055/a-2334-6253
Garrett D Alexander, Luke R Cavanah, Jessica L Goldhirsh, Leighton Y Huey, Brian J Piper

Introduction: There have been substantial increases in the use of Schedule II stimulants in the United States. Schedule II stimulants are the gold standard treatment for attention-deficit hyperactivity disorder (ADHD), but also carry the risk of addiction. Since the neurocognitive deficits seen in ADHD resemble those of chronic cannabis use, and the rise in stimulant use is incompletely understood, this study sought to determine if recreational cannabis (RC) legalization increased distribution rates of Schedule II stimulants.

Methods: The distribution of amphetamine, lisdexamfetamine, and methylphenidate were extracted from the ARCOS database of the Drug Enforcement Administration. The three-year population-corrected slopes of distribution before and after RC sales were evaluated.

Results: Total stimulant distribution rates were significantly higher in states with RC sales after (p=0.049), but not before (p=0.221), program implementation compared to states without RC. Significant effects of time (p<0.001) and RC sales status (p=0.045) were observed, while time x RC sales status interaction effects were not significant (p=0.406).

Discussion: RC legalization did not contribute to a more pronounced rise in Schedule II stimulant distribution in states. Future studies could explore the impact of illicit cannabis use on stimulant rates and the impact of cannabis sales on distribution rates of non-stimulant ADHD pharmacotherapies and ADHD diagnoses.

导言:在美国,二类兴奋剂的使用大幅增加。第二类兴奋剂是治疗注意力缺陷多动障碍(ADHD)的金标准,但也有成瘾的风险。由于注意力缺陷多动障碍(ADHD)的神经认知缺陷与长期吸食大麻相似,而且人们对兴奋剂使用的增加还不完全了解,因此本研究试图确定娱乐性大麻(RC)合法化是否会增加附表 II 兴奋剂的销售率:从缉毒署的 ARCOS 数据库中提取了苯丙胺、利眠宁和哌醋甲酯的分布情况。对 RC 销售前后三年的人口校正分布斜率进行了评估:与未实施 RC 的州相比,在实施 RC 计划后(p=0.049),而在实施 RC 计划前(p=0.221),有 RC 销售的州的兴奋剂总销售率明显较高。观察到时间的显著影响(pp=0.045),而时间 x RC 销售状况的交互影响不显著(p=0.406):讨论:RC 合法化并未导致各州附表 II 兴奋剂销售量的明显上升。今后的研究可以探讨非法使用大麻对兴奋剂使用率的影响,以及大麻销售对非兴奋剂多动症药物疗法和多动症诊断分布率的影响。
{"title":"Recreational Cannabis Legalization: No Contribution to Rising Prescription Stimulants in the USA.","authors":"Garrett D Alexander, Luke R Cavanah, Jessica L Goldhirsh, Leighton Y Huey, Brian J Piper","doi":"10.1055/a-2334-6253","DOIUrl":"10.1055/a-2334-6253","url":null,"abstract":"<p><strong>Introduction: </strong>There have been substantial increases in the use of Schedule II stimulants in the United States. Schedule II stimulants are the gold standard treatment for attention-deficit hyperactivity disorder (ADHD), but also carry the risk of addiction. Since the neurocognitive deficits seen in ADHD resemble those of chronic cannabis use, and the rise in stimulant use is incompletely understood, this study sought to determine if recreational cannabis (RC) legalization increased distribution rates of Schedule II stimulants.</p><p><strong>Methods: </strong>The distribution of amphetamine, lisdexamfetamine, and methylphenidate were extracted from the ARCOS database of the Drug Enforcement Administration. The three-year population-corrected slopes of distribution before and after RC sales were evaluated.</p><p><strong>Results: </strong>Total stimulant distribution rates were significantly higher in states with RC sales after (<i>p</i>=0.049), but not before (<i>p</i>=0.221), program implementation compared to states without RC. Significant effects of time (<i>p</i><0.001) and RC sales status (<i>p</i>=0.045) were observed, while time x RC sales status interaction effects were not significant (<i>p</i>=0.406).</p><p><strong>Discussion: </strong>RC legalization did not contribute to a more pronounced rise in Schedule II stimulant distribution in states. Future studies could explore the impact of illicit cannabis use on stimulant rates and the impact of cannabis sales on distribution rates of non-stimulant ADHD pharmacotherapies and ADHD diagnoses.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":"249-254"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860524","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
SARS-CoV-2-Infection in People Addicted to Illegal Drugs - Is There a Protective Effect of Opioid Maintenance Treatment? 非法药物成瘾者中的 SARS-CoV-2 感染--阿片类药物维持治疗是否有保护作用?
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-08-01 DOI: 10.1055/a-2345-7448
Simon Kurzhals, Martin Schäfer, Udo Bonnet, Katrin Isbruch, Stefan Kühnhold, Jörg Timm, Michael Specka, Norbert Scherbaum

Introduction: People addicted to illegal drugs were discussed as a risk group for SARS-CoV-2 infections, with increased susceptibility and a severe course of infection.

Methods: In this study, the frequency of SARS-CoV-2 infections of drug-dependent persons admitted to inpatient detoxification treatment in five psychiatric hospitals was determined by implementing routine polymerase chain reaction (PCR)-testing at admission (9/2020) up to one year. Main substance-related diagnosis, comorbid respiratory disease, housing situation, and current opioid maintenance treatment (OMT) were documented. An age-matched control group of psychiatric inpatients without dependence from illegal drugs was established.

Results: Data from 1675 patients (male 79.5%; mean age 39.5 years; opioid dependence 81.5% homelessness; 2.4%; chronic respiratory disease 6.3%) were included. Out of 1365 patients dependent on opioids, 50.2% were currently in OMT. Six (3 female; mean age 40.3 years) patients tested positive for SARS-CoV-2 by PCR (0.36%), and none showed symptoms of COVID-19. All six were opioid dependent, 5 currently not in OMT. In the control group, 11 out of 1811 inpatients tested positive (0.61%).

Discussion: The rate of SARS-CoV-2-infections in persons with dependence on illegal drugs was not increased compared to a control group of psychiatric patients. OMT is presumably a protective factor, e. g. in the participating cities, OMT facilities offered an easy access to vaccination programs. In contrast, drug addicts in the USA were severely affected by the pandemic. Differences between countries might partially be explained by social factors such as the higher availability of OMT in Germany and a much lower frequency of homelessness.

引言方法:在本研究中,通过对五家精神病院中住院戒毒治疗的药物依赖者进行常规聚合酶链反应(PC)检测,确定了他们感染SARS-CoV-2的频率:本研究通过对五家精神病院住院戒毒治疗的药物依赖者进行入院时(2020 年 9 月)至一年的常规聚合酶链反应(PCR)检测,确定了他们感染 SARS-CoV-2 的频率。主要药物相关诊断、合并呼吸系统疾病、住房情况和当前阿片类药物维持治疗(OMT)情况均有记录。此外,还建立了一个年龄匹配的对照组,即无非法药物依赖的精神病住院患者:1675 名患者(男性占 79.5%;平均年龄 39.5 岁;阿片类药物依赖者占 81.5%;无家可归者占 2.4%;慢性呼吸道疾病患者占 6.3%)的数据被纳入其中。在 1365 名阿片类药物依赖患者中,50.2% 目前正在接受 OMT 治疗。6 名患者(3 名女性;平均年龄 40.3 岁)的 PCR 检测结果呈 SARS-CoV-2 阳性(0.36%),但无一人出现 COVID-19 症状。所有 6 名患者均为阿片类药物依赖者,其中 5 人目前未接受 OMT 治疗。在对照组中,1811 名住院病人中有 11 人检测结果呈阳性(0.61%):讨论:与对照组精神病患者相比,非法药物依赖者的 SARS-CoV-2 感染率并没有增加。OMT可能是一个保护因素,例如,在参与研究的城市中,OMT设施为疫苗接种计划提供了便利。相比之下,美国的吸毒者则受到了大流行病的严重影响。国与国之间的差异可以部分归因于社会因素,例如在德国,OMT的普及率较高,无家可归者的比例也低得多。
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引用次数: 0
Discontinuation Rate of Lurasidone and Quetiapine Extended Release in Bipolar Depression. 鲁拉西酮和喹硫平缓释剂在双相抑郁症中的停药率。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-06-19 DOI: 10.1055/a-2331-2300
Taro Kishi, Kenji Sakuma, Shun Hamanaka, Yasufumi Nishii, Nakao Iwata

Introduction: Lurasidone (LUR) was compared with quetiapine extended release (QUE-ER) regarding 1-year discontinuation in patients with bipolar depression (n=317).

Methods: This is a retrospective cohort study.

Results: Although the time to all-cause discontinuation was estimated using the Kaplan-Meier survival curve with log-rank tests to compare treatment groups, no difference was found (p=0.317). The Cox proportional hazard model revealed that only the presence of adverse events (AEs) is associated with increased treatment discontinuation (p<0.0001). The most common AEs were akathisia for LUR (17.7%) and somnolence for QUE-ER (34.7%). In other Cox models divided by LUR or QUE-ER, the presence of akathisia or somnolence was associated with increased LUR (p=0.0205) or QUE-ER (p<0.0001) discontinuation, respectively.

Discussion: The acceptability of both antipsychotics to bipolar depression in clinical practice may be similar. However, specific AEs for each antipsychotic (LUR: akathisia and QUE-ER: somnolence) were associated with high treatment discontinuation.

简介:研究比较了鲁拉西酮(LUR)与喹硫平缓释片(QUE-ER)对双相抑郁症患者(n=317)1年停药情况:方法:这是一项回顾性队列研究:这是一项回顾性队列研究:尽管使用卡普兰-梅耶生存曲线估算了全因停药时间,并用对数秩检验比较了治疗组,但没有发现差异(P=0.317)。考克斯比例危险模型显示,只有出现不良事件(AEs)才与治疗中断率增加有关(P=0.317):两种抗精神病药物在临床实践中对双相抑郁症的可接受性可能相似。然而,每种抗精神病药物的特定 AE(LUR:肌无力和 QUE-ER:嗜睡)都与治疗中断率高有关。
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引用次数: 0
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Pharmacopsychiatry
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