Vitamin D: pharmacology and clinical challenges in oral health care

Vitamin D is a hormone, produced endogenously through cutaneous transformation of 7-dehydrocholesterol by UVB-irradiation with skeletal and non-skeletal functions and could be involved in oral health conditions especially periodontitis. Vitamin D main mechanism of action occurs through binding to its intracellular receptor. In this article, we aim to review the beneficial role of vitamin D in dentistry. Articles related to vitamin D and oral health were screened and reviewed with the main findings and clinical implications presented. Vitamin D deficiency prevalence is high especially among the elderly and is associated with oral health complications such as periodontitis with a possible role of vitamin D supplementation in oral health conditions’ management. The review discusses the main findings as although the majority of the literature demonstrates vitamin D essential role, some research suggest excess vitamin D supplementation could lead to other health issues. Thus, further research is needed to define vitamin D target levels and establish effective strategies for managing patients suffering from oral health conditions especially periodontitis. Improving the knowledge of dental practitioners, periodontologists and pharmacists regarding vitamin D deficiency implications in oral health conditions could guide the management of oral conditions especially periodontitis

Iloperidone - new second generation antipsychotic: Pharmacological aspects and schizophrenia clinical management

Iloperidone is a new atypical antipsychotic drug approved by FDA for the treatment of schizophrenia. In this article, we searched the published randomized controlled trials (RCT) and other literature to review the efficacy and safety of iloperidone using the following database (Science Direct, PubMed) and illustrate its role in the management of schizophrenia. Iloperidone showed efficacy by causing significant improvements in psychiatric scales such as Positive and Negative Syndrome scale (PANSS) and clinical global impressions (CGI). Iloperidone was associated with a number of common side effects such as metabolic and cardiovascular side effects. This review illustrated that iloperidone was well tolerated with significant improvements in disease severity and symptom intensity control in patients suffering with schizophrenia, however, iloperidone was associated with a significantly higher risk of metabolic and cardiovascular side effects with minimal extrapyramidal side effects. These findings would guide psychiatrists and pharmacists in their clinical role for supporting the care of psychiatric patients

ASENAPINE: PHARMACOLOGICAL ASPECTS AND ROLE IN PSYCHIATRIC DISORDERS

Schizophrenia and bipolar disorders are serious psychiatric disorders with substantial health risks. Asenapine is a new secondgeneration antipsychotic, available as a sublingual tablet, approved in Europe for the treatment of moderate-to-severe manic episodes in adults, and in US for manic or mixed episodes of bipolar I disorder in adults and adolescents. In this review, we searched the available literature to appreciate the role of asenapine in the management of psychiatric conditions such as bipolar disorders and schizophrenia and describe its mechanism of action, efficacy and tolerability. Asenapine has demonstrated efficacy in the management of bipolar disorders and schizophrenia, while a possible role in the management of borderline personality disorder and agitation needs further research. Asenapine has favourable side effects profile and combining with other pharmacological treatment in post-traumatic stress disorder has shown promising results. Asenapine fulfils important requirements of efficacy and tolerability as an anti-psychotic. These findings should support psychiatrists and pharmacists in the care of their patients while on asenapine

Pharmacological alternatives to Antipsychotics in the Management of BPSD

In this review, we will discuss the evidence and provide an update on the pharmacological treatments of Behavioural and Psychological symptoms of Dementia (BPSD) especially anti-psychotic medications. Non-pharmacological management of BPSD remains the initial treatment for BPSD; however, pharmacological management have a role in specific situations. This review should support the management of elderly inpatients suffering from Dementia and challenging behaviour in mental health units, general hospitals, community settings and care homes. It will help in raising awareness to the risk of complications such as stroke/death associated with first and second generation antipsychotic medications. It will also highlight some issues in relation to the current guidelines and licensing in the USA, UK and Europe. Good clinical practice used in the management of BPSD to reduce the risk of stroke and other complications is included

Rabbit syndrome: update on aetiology and management for pharmacists, psychiatrists and dentists

Rabbit syndrome (RS) is an involuntary movement disorder, characterized by fast and fine movements of oral and masticatory muscles along the mouth vertical axis in the absence of tongue involvement. RS prevalence varies between 2.3% to 4.4% and could result from the administration of antipsychotics and antidepressants. In case of second generation antipsychotics, there is a reduced risk of RS compared with first generation antipsychotics with mainly isolated literature case reports especially with the use of risperidone as antipsychotic. RS affects only the buccal region, with the possible involvement of the basal ganglia, in particular the substantia nigra. The management of RS include reduction or change of the psychotropic treatment and use of anticholinergic medications such as trihexyphenidyl. Although RS is rare and easily treatable, it is essential that dentists and psychiatrists could distinguish this syndrome from other movement disorders such as tardive dyskinesia

Lithium overdose and delayed severe neurotoxicity:timing for renal replacement therapy and restarting of lithium

This is a case report of a man in his 60s who presented to an English hospital following a significant lithium overdose. He was monitored for 24 hours, and then renal replacement therapy was initiated after assessment by the renal team. As soon as the lithium level returned to normal therapeutic levels (from 4.7 mEq/L to 0.67 mEq/L), lithium was restarted by the medical team. At this point, the patient developed new slurred speech and later catatonia. In this case report, we discuss the factors that could determine which patients are at risk of neurotoxicity following lithium overdose and the appropriate decision regarding when and how to consider initiation of renal replacement therapy and restarting of lithium

Pharmacological and non-pharmacological management of burning mouth syndrome: a systematic review

© 2020 The Authors. Published by Wroclaw Medical University Press. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: http://www.dmp.umed.wroc.pl/en/article/2020/57/3/295

Vitamin D has an aetiological role in dementias; myth or fact ?

This is an accepted manuscript of an article published in the International Journal of Development Research on 30/05/2020. The accepted version of the publication may differ from the final published version, accessible at https://www.journalijdr.com/vitamin-d-has-aetiological-role-dementias-myth-or-factVitamin D is produced through the cutaneous transformation of 7-dehydrocholesterol by UVB-irradiation with multiple neurotrophic and neuroprotective functions, while regulating calcium-mediated neuronal excitotoxicity. Vitamin D acts mainly through binding to intracellular Vitamin D receptor (VDR) with a possible involvement of vitamin D receptor (VDR) and vitamin D-binding protein (VDBP). This is a review of evidence for the aetiological role of vitamin D in dementias and other neurological disorders. There is contradictory evidence regarding vitamin D supplementation in the prevention of dementia progression. Adding vitamin D to the standard medications used in dementia may have a future role in dementia management. Key words: Vitamin D; Dementia; Aetiology; Memantine; Dementia Medications; Neurodegenerative Disorders; Vitamin D Receptor; Neurological Disorder

Efficacy and safety of brexpiprazole in acute management of psychiatric disorders: a meta-analysis of randomized controlled trials

This is an accepted manuscript of an article published by Wolters Kluwer in International Clinical Psychopharmacology on 01/05/2020, available online: https://www.ingentaconnect.com/content/wk/incps/2020/00000035/00000003/art00001;jsessionid=11okj7rqu47a4.x-ic-live-01 The accepted version of the publication may differ from the final published version.Brexpiprazole is a new atypical antipsychotic for schizophrenia management and as adjunct in major depressive disorder (MDD). We searched randomized controlled-trials (RCT) to review brexpiprazole efficacy and tolerability in acute management of schizophrenia and MDD using PubMed, EUDRACT, ClinicalTrials.gov and Cochrane Central Register of Controlled-Trials. A meta-analysis was conducted using the identified 14 RCT to assess its efficacy using positive and negative syndrome scale (PANSS), clinical global impressions – severity of Illness (CGI-S), Personal and Social Performance scale (PSP), Montgomery–Åsberg Depression Rating Scale (MADRS), Sheehan Disability Scale (SDS) and Hamilton Depression Rating Scale (HDRS17). The mean difference (MD) comparing brexpiprazole and placebo were PANSS -4.48, CGI-S -0.23 and PSP 3.24 favoring brexpiprazole. Compared to aripiprazole and quetiapine, brexpiprazole showed similar efficacy. In MDD, brexpiprazole showed efficacy compared to placebo demonstrated by MADRS -1.25, SDS -0.37 and HDRS17 -1.28. Brexpiprazole was associated with side effects including akathisia RR=1.72; weight increase RR=2.74 and somnolence RR=1.87. Compared to 4mg, brexpiprazole 2mg was associated with less risk of akathisia and Somnolence. Brexpiprazole demonstrated significant improvements in schizophrenia and MDD and is well-tolerated; however, associated with akathisia and somnolence. These findings will guide psychiatrists and pharmacists in their clinical role for supporting psychiatric patients care

Brexpiprazole in the acute management of schizophrenia

© 2020 The Authors. Published by International Journal of Current Medical and Pharmaceutical Research. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://journalcmpr.com/issues/brexpiprazole-acute-management-schizophreniaBrexpiprazole is a new atypical antipsychotic used for the management of psychiatric conditions including schizophrenia and is associated with fewer extrapyramidal side effects compared to traditional antipsychotics due to its additional serotonergic effect, which may improve cognitive symptoms associated with social function decline in schizophrenia. We searched for randomized controlled-trials (RCT) to review the efficacy and tolerability of brexpiprazole in acute management of schizophrenia using different resources including PubMed, Google Scholar, ClinicalTrials.gov and Cochrane Central Register of Controlled-Trials. Data were extracted for adverse effects, positive and negative syndrome scale (PANSS), Personal and Social Performance scale (PSP), PANSS Excited Component (PEC) and Response Rate >30%. 5 RCT were identified and showed that brexpiprazole was favorable compared to placebo in improving PANSS with a mean difference (MD) -5.40 [confidence interval (CI) -6.98, -3.82] and PSP 3.2 [CI 2.09, 4.32] (P<0.00001). Improvement in PANSS positive, PANSS negative subscales and response rate were significant (P<0.00001). Brexpiprazole led to reduced treatment discontinuation due to adverse effects (risk ratio (RR) 0.58), however an increased risk of akathisia was observed (RR= 1.31) especially at higher doses but did not reach statistical significance. In summary, brexpiprazole improved significantly the symptoms of schizophrenia and is well-tolerated, while long-term research is still required to establish its role, particularly in patients with co-morbidities. These findings will guide clinical teams in supporting patients suffering from schizophrenia