Psychopharmacology bulletin最新文献

The atypical antipsychotic, quetiapine has been on market for years now with long track record. In child and adolescent psychiatry, it is FDA-approved for childhood-onset schizophrenia and juvenile bipolar mood disorder. Its attractive pharmacological portfolio speaks to the idea of a versatile pluripotent broad-spectrum psychotropic agent expanding its therapeutic potential on clinical grounds. In this focussed review, authors brief these clinical indications whilst examining the extant evidence.

Akinetic mutism is a rare but important clinical syndrome characterised by a profound decrease in goal-directed behaviour and speech output, yet with preservation of consciousness. This report describes the case of a 58-year-old male with a background of hypertension, alcohol use disorder, smoking, and MTHFR C677T homozygosity who experienced two ischaemic strokes within weeks of each other. The initial infarct involved the right thalamus, posterior putamen, external capsule, and subcortical anterior frontal lobe. Approximately five weeks later, he developed a second stroke in the left hemisphere, eventually leading to the identification of a mitral valve mass consistent with a papillary fibroelastoma. Following surgical resection of this mass, the patient demonstrated severe reductions in spontaneous movement and speech in a pattern consistent with akinetic mutism. He ultimately improved with rehabilitative measures and the initiation of a stimulant medication. This case highlights the intricate relationship between bilateral frontal-subcortical network injuries and the development of akinetic mutism.

In this case report, we present a patient with treatment-resistant depression (TRD) and comorbid generalized anxiety disorder, eating disorder, post-traumatic stress disorder, and borderline personality disorder. Over a 10-year period, our case transitioned from adolescence to adulthood and received antidepressant monotherapy, adjunctive therapy with antipsychotics, lithium, or lamotrigine, several series of electroconvulsive therapy (ECT), ketamine infusion (KET-IFU), compounded ketamine intranasal spray (COM-KET), and intranasal esketamine (ESK). She had seventeen documented hospitalizations, five self-reported hospitalizations, three intensive outpatient program treatments, two partial hospitalization program treatments, and three residential treatments. She attempted suicide seven times. She received five acute ECT series, one series of KET-IFU, one series of acute ESK with weekly ECT, a series of COM-KET treatment for more than two years, and a series of ESK for more than two years. The patient had some short-term benefit from ECT and KET-IFU. However, she had two-years stability with COM-KET or ESK at two different times. She has been relatively stable without hospitalization or suicide attempt with ESK for more than two years, suggesting that patients with TRD with complex representations may benefit from ketamine treatment at different times of life development.

The exploration of GLP-1 receptor agonists as pleiotropic agents in the treatment of neuropsychiatric disorders and substance use disorders is a rapidly evolving field. While early studies have shown promising results, much of the research is still nascent, and larger clinical trials are definitely needed to confirm the safety and efficacy of these agents on real grounds.

Background: Methadone is frequently used for chronic pain management due to its long half-life and NMDA receptor activity, making it an effective option for opioid-tolerant patients. Buprenorphine-naloxone is increasingly explored as an alternative for chronic pain and opioid use disorder, offering partial opioid agonism with a ceiling effect on respiratory depression. The transition from methadone to buprenorphine-naloxone remains clinically challenging, requiring careful management to prevent withdrawal and ensure adequate pain control.

Case descriptions: Two patients with chronic pain were transitioned from methadone to buprenorphine-naloxone. The first patient, a mid-40s female, was abruptly switched from methadone 10 mg twice daily dosing to buprenorphine-naloxone 4 mg-1 mg twice daily dosing without a taper, resulting in severe withdrawal requiring hospitalization. The second patient, a late-50s male, underwent a two-month methadone taper before initiating buprenorphine-naloxone 4 mg-1 mg twice daily dosing, but reported persistent uncontrolled pain despite dose escalation to 4 mg-1 mg three times a day. Both patients reported significant dissatisfaction with buprenorphine-naloxone therapy, citing inadequate pain relief. Both patients eventually left the practice and were lost to follow up.

Conclusion: These cases underscore the challenges of transitioning chronic pain patients from methadone to buprenorphine-naloxone formulations. Transitioning patients between these medications may lead to issues regarding withdrawal symptoms, inadequate pain control, and patient attrition.

Background: It is widely agreed that the mentally ill constitute a sizeable chunk of the disabled population not only for those afflicted but also for their caregivers alike.

Objective: To assess the degree of disability with subsequent medico-legal ramifications, clinicians largely rely on generic clinical impressions and short brief interviews that are by no means bias-free lacking in standardization and objectivity.

Methods: To this end, authors, herein, draft, the K-MIDS or the Kuwait-Mental Illness Disability Scale.

Results: Baseline Requirements and Scoring System of K-MIDS are devised largely drawing on authors' vast clinical expertise in this area.

Conclusions: The assessment of functional disability related to serious mental illness remains an unmet need in the Gulf region where disability allowance is currently based on generic clinical impressions, brief interviews and collateral input. K-MIDS is intended to be a step moving forward. Psychometric properties are due second.

Recent mental health research has highlighted the critical role of inflammation in conditions like depression and bipolar disorder, examining correlations with markers such as calcium levels, thyroid function, and inflammatory markers. The study aims to compare unipolar and bipolar depression samples in terms of socio-demographic and clinical features. Patients were prospectively enrolled during their hospitalization at the University of Insubria Psychiatric Unit. Patients were administered psychometric questionnaires (Beck Depression Inventory-II, Mental Pain Questionnaire, Beck Anxiety Inventory, Clinical Global Impressions Severity scale, and Brief Reasons for Living Inventory). Thirty-six patients (17 males, 19 females) were enrolled. A statistically significant association emerged between calcium levels and bipolar depression (Pearson Chi square = 0.050) and between CRP and bipolar depression (Pearson Chi-square = 0.017). Additionally, a statistically significant association was observed between the unipolar and bipolar depression subgroups and current substance abuse (p = 0.0275) A statistically significant difference between the BRLF scores and UD (unipolar depression) subgroup emerged (p = 0.0126). The results of the pilot study revealed significant associations between calcium/CRP levels with depressive symptoms, particularly in bipolar depression. Further research on inflammatory markers is needed to refine diagnostic subtypes and therapeutic strategies.

Fibromyalgia is a complex clinical entity characterized by a broad range of symptoms including chronic widespread musculoskeletal pain, profound fatigue, impaired cognition, and mood disturbances. Current understanding of disease pathogenesis assumes neurotransmitter dysregulation and central pain sensitization play a key role resulting in heightened pain sensitivity. Genetic predisposition as well as alterations in endocrine and immune function have been implicated. Accurate diagnosis requires a comprehensive evaluation, and a personalized treatment approach is needed to address the biopsychosocial components of the disease process. Among pharmacologic treatment options, serotonin norepinephrine reuptake inhibitors (SNRIs) have demonstrated analgesic effects in addition to mood stabilizing properties. Currently, duloxetine and milnacipran are approved by the Food and Drug Administration although other agents in this drug class including venlafaxine and desvenlafaxine have been studied in the management of fibromyalgia. In addition, selective norepinephrine reuptake inhibitors, esreboxetine and reboxetine, as well as tramadol, a weak opioid mu-receptor agonist with SNRI activity have shown potential utility. Although some studies have demonstrated SNRIs to be effective and well tolerated in patients with fibromyalgia, individual response may vary. There remains a continued need for large scale clinical trials to establish the safety and clinical effectiveness of these agents in this patient population. Further information is needed to optimize patient selection and dosing regimens as well as elucidate the clinical factors associated with poor response. Moreover, pharmacologic agents may be combined with lifestyle changes and non-drug-based treatments to address the complex interactions of biological and psychosocial factors that facilitate disease development and persistence of symptoms.