Psychopharmacology bulletin最新文献

Psychotropic-induced pancreatitis is rare and even rarer in pediatric population. Here, authors report on an interesting case of risperidone-induced pancreatitis in a child with ADHD comorbid with conduct disorder. Clinicians should be mindful of this remote, yet serious, side effect.

Background: CYP2D6 subfamily isoenzymes play an important role in the biotransformation of haloperidol, and their activity may influence the efficacy and safety of haloperidol. The use of haloperidol is often associated with the occurrence of adverse drug reactions (ADRs), such as dyskinesia, acute dystonia, and orthostatic hypotension. Previous studies have demonstrated the relationship between the CYP2D6*4 genetic polymorphism and CYP2D6 activity, as well as haloperidol efficacy and safety rates.

Purpose: To evaluate the association of CYP2D6*4 genetic polymorphism with the steady-state concentration of haloperidol in patients with acute alcohol-induced psychotic disorders (AIPDs).

Material and methods: The study involved 100 male patients with AIPD (average age 41.4 ± 14.4 years) who received haloperidol by injections in a dose of 5-10 mg/day. The efficacy profile was assessed using a validated psychometric PANSS scale (Positive and Negative Syndrome Scale). Therapy safety was assessed using the internationally validated UKU (Side-Effect Rating Scale) and SAS (Simpson-Angus Scale for Extrapyramidal Symptoms) scales. Genotyping was performed with the real-time polymerase chain reaction.

Results: We revealed the statistically significant results in terms of therapy safety evaluation (dynamics of the UKU scores: (GG) 8.00 [7.00; 10.00], (GA) 15.0 [9.25; 18.0], p < 0.001; dynamics of the SAS scores: (GG) 11.0 [9.0; 14.0], (GA) 14.50 [12.0; 18.0], p < 0.001. Pharmacokinetic study showed a statistically significant difference across the groups with different genotypes: (GG) 3.13 [2.32; 3.95], (GA) 3.89 [2.92; 5.26], p = 0.010.

Conclusion: It can be concluded that patients with the GA genotype have a higher risk of ADRs compared to patients who carry the GG genotype. It was shown that CYP2D6*4 genetic polymorphism has a statistically significant effect on the steady-state concentration of haloperidol.

Objective: In a phase 2 study, pimavanserin demonstrated efficacy as adjunctive treatment for major depressive disorder (MDD). Subsequently, two phase 3 studies (NCT03968159 in the US; NCT03999918 in Europe) were initiated to examine the efficacy and safety of adjunctive pimavanserin in subjects with MDD and inadequate response to antidepressant treatment. Studies were combined with a prespecified statistical analysis plan owing to recruitment challenges related to the COVID-19 pandemic.

Experimental design: The randomized, double-blind studies enrolled 298 patients with MDD and inadequate response to current antidepressants. Patients were randomly assigned 1:1 to pimavanserin or placebo added to current antidepressant for 6 weeks. Primary endpoint was change from baseline to week 5 in the Hamilton Rating Scale for Depression, 17-item version (HAM-D-17).

Principal observations: There was no effect of pimavanserin in change from baseline to week 5 in the HAM-D-17 (pimavanserin [n = 138]: least-squares mean [LSM] [standard error {SE}], -9.0 [0.58]; placebo [n = 135]: -8.1 [0.58]; mixed-effects model for repeated measures LSM [SE] difference, -0.9 [0.82], P = 0.2956). Nominal improvement with pimavanserin was observed on 2 secondary endpoints: Clinical Global Impressions-Severity scale, Karolinska Sleepiness Scale. Treatment-emergent adverse events occurred in 58.1% of pimavanserin-treated and 54.7% of placebo-treated patients.

Conclusions: Adjunctive pimavanserin did not significantly improve depressive symptoms, although pimavanserin was well tolerated.

Objectives: Pharmacophilia and pharmacophobia have positive and negative effects on treatment outcomes. There exist lacune of information on these phenomena in middle east countries. Therefore the current study aimed to determine the pattern and predictors of Pharmacophilia and pharmacophobia in Saudi Arabia. The study further explored the impact of these phenomena on the perception of medication use and self-medication behaviours.

Experimental design: An online questionnaire-based cross-sectional study was conducted during March-May 2021. Saudi residents aged 15 years or older were eligible for this study. Individuals' attitude towards medication was assessed using the Drug attitude inventory classification questionnaire, and the general belief of medication was assessed using the Beliefs about Medicine Questionnaire.

Observation: One-fifth (n = 101; 20%) and two-third (n = 338; 65%) participants were categorized as pharmacophobic and pharmacophilic, respectively. The mean BMQ score was not statistically significant between the pharmacophobic and pharmacophilic groups (mean difference = 0.314; p-value = 0.176). Males were more likely pharmacophilic than females [AOR: 0.34 (95% CI 0.17-0.69)]. Both groups showed nearly a similar pattern of self-medication behaviours.

Conclusion: There exist a good number of pharmacophobic and pharmacophilic among the Saudi population. A detailed understanding of the attitudes towards treatment among these groups is essential for enhancing treatment outcomes.

ASD is commonly associated with a host of challenging behaviours. Pharmacotherapy is indicated if psycho-social and educational interventions fail. Atypical antipsychotics have the strongest evidence-base so far, with both risperidone and aripiprazole are FDA-approved. Unfortunately, their use is fraught with metabolic and neuro-hormonal side effects. Here, authors report on a case of ASD/mild ID with behavioural dyscontrol that failed multiple psychotropic trials and ultimately responded favourably to agomelatine monotherapy. This was achieved with excellent tolerability. This might open new venues in such complicated cases.

Objective: Major depressive disorder (MDD) which comes to transcranial magnetic stimulation (TMS) is prone to relapse. Cluster maintenance (CM) TMS is courses of 5 treatments delivered over 2.5-5 days, separated by monthly or greater non-treatment periods. Our aim was to characterize the outcomes of 100 courses of CM TMS.

Method: This was a Quality Assurance/Clinical Audit study. We studied consecutive CM TMS courses provided to private hospital inpatients. Mood was rated (on admission and discharge) using the six-item Hamilton depression rating (HAMD6) and the Clinical Global Impression - Severity (CGI-S) scales. We also applied recent STAR*D criteria which are designed to measure the 'clinical change' expected to impact patient function [16].

Results: For the total sample, using the HAMD6, 83% of courses featured relapse or partial relapse on admission, and 81% featured remission on discharge. Of 46 courses featuring HAMD6 relapse on admission, 74% featured remission on discharge. For the 100 courses the HAMD6 discharge scores were significantly lower than the admission scores (p = 2.0 × 10^-24), as were the CGI-S scores (p = 1.8 × 10^-25). Using STAR*D criteria for people in relapse or partial relapse on admission, CM TMS provided least a 'clinically meaningful' outcome in 82% of the cases.

Conclusion: For courses featuring relapse or partial relapse on admission, CM TMS converted greater than 70% to remission at discharge. It produced statistically significant reductions in HAMD6 and CGI-S scores, and using STAR*D criteria, at least 'clinically meaningful' change was extensively demonstrated. This evidence indicates CM TMS should be readily available to people living with relapsing MDD.

Objectives: The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (FAs) and inositol alone and in combination for the treatment of pediatric bipolar (BP) spectrum disorder in young children.

Methods: Participants were male and female children ages 5-12 meeting DSM-IV diagnostic criteria for a BP spectrum disorder and displaying mixed, manic, or hypomanic symptoms without psychotic features at the time of evaluation.

Results: Participants concomitantly taking psychotropic medication were excluded from efficacy analyses. There were significant reductions in YMRS and HDRS mean scores in the inositol and combination treatment groups (all p < 0.05) and in CDRS mean scores in the combination treatment group (p < 0.001), with the largest changes seen in the combination group. Those receiving the combination treatment had the highest rates of antimanic and antidepressant response. The odds ratios for the combination group compared to the omega-3 FAs and inositol groups were clinically meaningful (ORs ≥2) for 50% improvement on the YMRS, normalization of the YMRS (score <12) (vs. inositol group only), 50% improvement on the HDRS, 50% improvement on CDRS (vs. omega-3 FAs group only), and CGI-I Mania, CGI-I MDD, and CGI-I Anxiety scores <2.

Conclusion: The antimanic and antidepressant effects of the combination treatment of omega-3 FAs and inositol were consistently superior to either treatment used alone. This combination may offer a safe and effective alternative or augmenting treatment for youth with BP spectrum disorder, but more work is needed to confirm the statistical significance of this finding.

Introduction: Depression is a common disease worldwide but still, the role of combined treatment (pharmacological and psychological interventions) needs to be clarified. The study aims to compare the effectiveness of integrated treatment versus exclusive pharmacological intervention of depression.

Materials and methods: The observational prospective study provided the collection of data relating to outpatients evaluated through the administration of the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), and the Clinical Global Impression Scale (CGI) both at T0 and at a 3-month follow up visit (T1).

Results: A statically significant association between sex (female) and psychotherapy utilization emerged. A statistically significant association between education (graduated patients) and psychotherapy use was observed. The other qualitative variables showed no statistically significance associations. No significant association between drop out and type of treatment emerged.

Discussion: Clinical research has not yet conclusively demonstrated the superiority of combined therapy over single treatments. As regards sex, the result is in line with the professional literature and provides support in describing how men have more stigmatizing beliefs about treatment of mental health. As regards education, graduated people present higher rates of adherence probably because they may have major introspective capacity and predisposition to communication.

Conclusions: Limitations consist in small sample and short duration of the follow-up (3 months). The strengths, in the type of setting and the respect for routine clinical practice. Future perspective of the research could focus on application of rating instruments to highlight the variables involved in depressive disorder.

Patients with severe mental illness (SMI) who do not adhere to treatment have a lower quality of life, with more hospitalizations, interpersonal relationship conflict, homelessness, substance use problems, and incarceration compared to patients who adhere to treatment. Nonadherence to psychiatric medications has been studied for over a decade in patients diagnosed with bipolar, schizoaffective, and schizophrenia disorders with long-acting injectable antipsychotics (LAI) becoming a mainstay of adherence-focused treatment. Previous studies have shown that LAI treatment can be further optimized with the inclusion of the behavioral intervention, Customized Adherence Enhancement (CAE). It was unclear if outcomes improved similarly across the studies that varied by demographics, diagnoses, and CAE + LAI protocols. We aimed to evaluate CAE + LAI adherence outcomes in SMI by pooling three studies to better understand response to treatment in the setting of varied circumstances. Our findings show that adherence improved similarly across studies despite these differences. Furthermore, it was demonstrated that CAE + LAI improved adherence to a similar degree when primary mood and psychotic disorder cohorts were compared. As the use of LAI expands, our findings show the versatility and effectiveness of including CAE to further optimize adherence and improve other outcomes.

Nearly forty percent of women with PMDD remain impaired and resistant to first-line agents. This reflects complexity and heterogeneity of etiopathogenesis at the core of PMDD. Some agents, in the pipeline, sound promising that might usher in a new sparkle in the psychopharmacology of PMDD.