Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Background Despite of its global underuse, clozapine is still the golden standard antipsychotic for patients with treatment-resistant schizophrenia (TRS). Objective To evaluate the patterns of clozapine and other antipsychotic drugs prescription in TRS in community mental health centers in São Paulo, Brazil. Methods A multiple-choice questionnaire was applied to fifteen psychiatrists at five centers inquiring about patients’ clinical condition, adherence to oral treatment and current antipsychotic treatment. History of previous and current antipsychotic treatment was collected through medical chart review. Results Out of 442 schizophrenia patients, 103 (23.3%) fulfilled the criteria for TRS. Fifty-eight patients (56.3%) were receiving polypharmacy; 30 (29.1%) were on atypical antipsychotic monotherapy, 14 (13.6%) were on typical antipsychotic monotherapy, 25 (24.3%) were taking depot antipsychotic medication and only 22 (21.4%) were receiving clozapine. Discussion As well as in other parts of the world, many TRS patients (78.6%) receive other drugs instead of clozapine in São Paulo, the best evidence-based medication for patients with TRS. The government should make every effort to provide medical training and the equipment and logistic support to adequately serve those who could benefit from clozapine treatment at the community health centers

Perfil sociodemográfico do adulto quilombola com distúrbios hiperglicêmicos/ Sociodemographic profile of adult quilombola with hyperglycemic disorders

Os Distúrbios Hiperglicêmicos são responsáveis por crescente utilização dos serviços, com impacto no aumento dos gastos em saúde pública. A prevalência elevada de doenças crônicas e metabólicas isoladas em populações específicas instituem graves problemas de saúde. Neste sentido, este estudo objetiva analisar o perfil sociodemográfico do adulto quilombola com distúrbios hiperglicêmicos. A coleta de dados foi realizada por meio de entrevistas e coleta sanguínea. Os dados foram armazenados e analisados em planilha do programa Statisitical Package for the Social Sciences (SPSS), versão 22.0. A prevalência dos DHG foi de 21,8% (IC95%: 19,03: 24,60), 86,5% se autorreferiram negros. A idade variou de 18 a 92 anos, amostra prevalente por mulheres (61,1%, IC: 95%, 57,9: 64,5) e 76,7% relataram possuir cônjuge. A análise bruta indicou associação com situação conjugal, grupo etário, escolarização e situação laboral. Após análise ajustada permaneceram independentemente associadas grupo etário e escolarização. No mesmo sentido, ter > 4 anos de estudo diminui em 63% a probabilidade para DHG diante daqueles com < anos de estudo. A prevalência dos DHG foi identificada aproximadamente em 2 a cada 10 quilombolas. Desta maneira, torna-se imprescindível a consolidação de planos e metas que atendam a realidade dessas comunidades

Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates

Objectives: To determine the prevalence and correlates of treatment-resistant schizophrenia (TRS) through a systematic review and meta-analysis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, an electronic search was performed in PubMed and Embase through May 17, 2022. All study designs that assessed a minimum of 20 schizophrenia-spectrum patients and provided data on TRS prevalence or allowed its calculation were included. Estimates were produced using a random-effects model meta-analysis. Results: The TRS prevalence across 50 studies (n = 29,390) was 36.7% (95%CI 33.1-40.5, p < 0.0001). The prevalence ranged from 22% (95%CI 18.4-25.8) in first-episode to 39.5% (95%CI 32.2-47.0) in multiple-episode samples (Q = 18.27, p < 0.0001). Primary treatment resistance, defined as no response from the first episode, was 23.6% (95%CI 20.5-26.8) vs. 9.3% (95%CI 6.8-12.2) for later-onset/secondary (≥ 6 months after initial treatment response). Longer illness duration and recruitment from long-term hospitals or clozapine clinics were associated with higher prevalence estimates. In meta-regression analyses, older age and poor functioning predicted greater TRS. When including only studies with lower bias risk, the TRS prevalence was 28.4%. Conclusion: Different study designs and recruitment strategies accounted for most of the observed heterogeneity in TRS prevalence rates. The results point to early-onset and later-onset TRS as two separate disease pathways requiring clinical attention. Registration number: PROSPERO CRD42018092033

Trematodos del ganado vacuno lechero al pastoreo en Cajamarca, Perú: Fasciola hepatica y Calicophoron microbothrioides

The study determines the prevalence of trematodes through coproparasitology in grazing dairy cattle in six districts of the Cajamarca region. The analyzes and processing of the faecal samples were carried out by natural sedimentation. The proportion of parasitized animals was 50.4 ± 2.1% (1092/2169), only Fasciola hepatica 32.4 ± 2.0% (703/2169), Calicophoron microbothrioides 17.9 ± 1.6% (389/2169) and coinfection by both parasites was 7.51 ± 1.11% (163/2169). The prevalence by district in Cajamarca was 49.5±5.0% (188/380), Baños del Inca 61.2±5.6% (181/296), La Encañada 80.7±4.1% (284/352), Celendín 45.4±5.0% (171 /377), San Juan 50.0±5.0% (190/380) and Chota 20.3±4.0% (78/384). There was no statistical association in the presence of both trematodes in the animals (p&gt;0.95), nor was a correlation found between the altitude of each district and the presence of faecal eggs (r=0.19). It is concluded that the prevalence of trematodes in extensively reared dairy cattle in Cajamarca is high, with the greatest presence of F. hepatica, followed by C. microbothrioides and their coexistence.El estudio determina la prevalencia de trematodos mediante coproparasitología en ganado vacuno lechero de crianza al pastoreo en seis distritos de la región Cajamarca. Los análisis y procesamiento de las muestras fecales se realizaron mediante sedimentación natural. La proporción de animales parasitados fue de 50.4±2.1% (1092/2169), de Fasciola hepatica de 32.4±2.0% (703/2169) y Calicophoron microbothrioides de 17.9±1.6% (389/2169), en tanto que la coinfección por ambos parásitos fue de 7.51±1.11% (163/2169). Las prevalencias por distrito fueron en Cajamarca de 49.5±5.0% (188/380), Baños del Inca 61.2±5.6% (181/296), La Encañada 80.7±4.1% (284/352), Celendín 45.4±5.0% (171/377), San Juan 50.0±5.0% (190/380) y Chota 20.3±4.0% (78/384). No hubo asociación estadística en la presentación de ambos trematodos en los animales (p&gt;0.95), ni se encontró correlación entre la altitud de cada distrito y la presencia de huevos fecales (r=0.19). Se concluye que, la prevalencia de trematodos en ganado vacuno lechero de crianza extensiva en Cajamarca es alta, con mayor presencia de F. hepatica, seguido de C. microbothrioides y su coexistencia

Reduced dorso-lateral prefrontal cortex in treatment resistant schizophrenia

Background: Treatment resistance affects up to one third of patients with schizophrenia (SCZ). A better understanding of its biological underlying processes could improve treatment. the aim of this study was to compare cortical thickness between non-resistant SCZ (NR-SCZ), treatment-resistant SCZ (TR-SCZ) patients and healthy controls (HC).Methodology: Structural MRI scans were obtained from 3 groups of individuals: 61 treatment resistant SCZ individuals, 67 non-resistant SCZ and 80 healthy controls. Images were analyzed using cortical surface modelling (implemented in freesurfer package) to identify group differences in cortical thickness. Statistical significant differences were identified using Monte-Carlo simulation method with a corrected p-cluster < 0.01.Results: Patients in the TR-SCZ group showed a widespread reduction in cortical thickness in frontal, parietal, temporal and occipital regions bilaterally. NR-SCZ group had reduced cortex in two regions (left superior frontal cortex and left caudal middle frontal cortex). TR-SCZ group also showed decreased thickness in the left dorsolateral prefrontal cortex (DLPFC) when compared with patients from NR-SCZ group.Conclusions: the reduction in cortical thickness in DLPFC indicates a more severe form of the disease or a specific finding for this group. Alterations in this region should be explored as a putative marker for treatment resistance. Prospective studies, with individuals being followed from first episode psychosis until refractoriness is diagnosed, are needed to clarify these hypotheses. (C) 2013 Elsevier B. V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psychiat, Interdiciplinary Lab Clin Neurosci LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, PROESQ Schizophrenia Program, São Paulo, BrazilFed Univ ABC, Ctr Math Computat & Cognit, Santo Andre, BrazilUniversidade Federal de São Paulo, Dept Morphol & Genet, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdiciplinary Lab Clin Neurosci LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, PROESQ Schizophrenia Program, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Morphol & Genet, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilFAPESP: 2011/50740-5Web of Scienc