Nota sobre l'obra paidopsiquiátrica de Joaquim Puig-Antich (1944-1989)

Joaquim Puig-Antich ha estat probablement el paidopsiquiatre català que ha fet una obra científica amb més repercussió internacional. La va fer als Estats Units, bàsicament en dues ciutats: New York i Pittsburgh. Primer va estar al Departament de Psiquiatria de nens i adolescents del 'New York State Psychiatric Institute' i fou professor associat de la Universitat de Columbis. A Pittsburgh fou cap del servei de Psiquiatria de nens i adolescents del 'Western Psychiatric Institute' i professor visitant de Psiquiatria Infantil de I'escola de medicina de la Universitat de Pittsburgh. Per tant no es va moure gaire de la zona est del pais. Va morir als quaranta-cinc anys, en plena creativitat científic

An evaluation of the dopaminergic systems\u27 response to a natural reinforcer: A comparison between cocaine pretreatment in adolescent and adult rats.

The long-term consequences of adolescent drug use in shaping a network primed for addiction is an issue of utmost importance. The use of cocaine during adolescent development could alter the normal growth of the reward system and affect the adult mesolimbic system, however, there is scant literature aimed at finding out if animals are more vulnerable to the adverse effects of drugs during adolescence. The present study investigated whether cocaine pretreatment in adolescent and adult rats produced differences in cocaine-induced neurochemical cross-sensitization to a naturally reinforcing substance in adulthood. To evaluate the responsivity of the mesolimbic system after repeated cocaine, sucrose was offered during the dialysis procedure and dialysate was collected. All saline pretreated rats had significant increases in DA levels compared to baseline levels and there were no difference in the age of pretreatment. Rats pretreated with cocaine as adults also had significant increases in DA levels after sucrose. Interestingly, sucrose intake significantly enhanced DA levels in cocaine pretreated adolescent rats. The results from this experiment clearly show that in rats pretreated with cocaine during adolescence there is an enhance response of the DAergic system in response to a naturally reinforcing substance therefore; cocaine exposure during adolescence results in persistent long term changes in the mesolimbic pathway. Future studies need to ascertain the underlying mechanisms and their role in the process of addiction

Precision pharmacotherapy of atomoxetine in children with ADHD: how to ensure the right dose for the right person?

Non-stimulant atomoxetine is recognized in various current clinical guidelines as an important alternative to stimulants for the pharmacological treatment of attention deficit/hyperactivity disorder (ADHD) in children. While its efficacy and tolerability for core symptoms are established, there is considerable inter-individual variability in response and exposure, highlighting the need for personalized dosing. In this review, we evaluated existing studies and summarized comprehensive evidence supporting the clinical implementation of therapeutic drug monitoring (TDM) and personalized dosing of atomoxetine, organized around a series of logically structured questions. Although there are notable gaps in achieving personalized dosing across multiple critical elements, the available evidence is helpful to endorse personalized dose adjustments based on TDM and CYP2D6 genotyping “whenever possible.” We advocate for ongoing improvement and enhancement in clinical practice. Future advancements will rely on a deeper understanding of ADHD, facilitating more precise diagnoses and personalized treatment strategies

Clinical pharmacokinetics of antipsychotics in pediatric populations:a scoping review focusing on dosing regimen

Introduction:Achieving optimal clinical responses and minimizing side effects through precision dosing of antipsychotics in children and adolescents with psychiatric disorders remains a challenge. Identifying patient characteristics (covariates) that affect pharmacokinetics can inform more effective dosing strategies and ultimately improve patient outcomes. This review aims to provide greater insight into the impact of covariates on the clinical pharmacokinetics of antipsychotics in pediatric populations. Areas covered: A comprehensive literature search was conducted, and the main findings regarding the effects of the covariates on the pharmacokinetics of antipsychotics in children and adolescents are presented. Expert opinion: Our study highlights significant covariates, including age, sex, weight, CYP2D6 phenotype, co-medication, and smoking habits, which affect the pharmacokinetics of antipsychotics. However, the findings were generally limited by the small sample sizes of naturalistic, open-label, observational studies, and the homogeneous subgroups. Dosing based on weight and preemptive genotyping could prove beneficial for optimizing the dosing regimen in pediatric populations. Future research is needed to refine dosing recommendations and establish therapeutic reference ranges critical for precision dosing and Therapeutic Drug Monitoring (TDM). The integration of individual patient characteristics with TDM can further optimize the efficacy and safety of antipsychotics for each patient.</p

Clinical Value of Emerging Bioanalytical Methods for Drug Measurements:A Scoping Review of Their Applicability for Medication Adherence and Therapeutic Drug Monitoring

INTRODUCTION: Direct quantification of drug concentrations allows for medication adherence monitoring (MAM) and therapeutic drug monitoring (TDM). Multiple less invasive methods have been developed in recent years: dried blood spots (DBS), saliva, and hair analyses. AIM: To provide an overview of emerging drug quantification methods for MAM and TDM, focusing on the clinical validation of methods in patients prescribed chronic drug therapies. METHODS: A scoping review was performed using a systematic search in three electronic databases covering the period 2000-2020. Screening and inclusion were performed by two independent reviewers in Rayyan. Data from the articles were aggregated in a REDCap database. The main outcome was clinical validity of methods based on study sample size, means of cross-validation, and method description. Outcomes were reported by matrix, therapeutic area and application (MAM and/or TDM). RESULTS: A total of 4590 studies were identified and 175 articles were finally included; 57 on DBS, 66 on saliva and 55 on hair analyses. Most reports were in the fields of neurological diseases (37%), infectious diseases (31%), and transplantation (14%). An overview of clinical validation was generated of all measured drugs. A total of 62 drugs assays were applied for MAM and 131 for TDM. CONCLUSION: MAM and TDM are increasingly possible without traditional invasive blood sampling: the strengths and limitations of DBS, saliva, and hair differ, but all have potential for valid and more convenient drug monitoring. To strengthen the quality and comparability of future evidence, standardisation of the clinical validation of the methods is recommended