Survey on schizophrenia treatment in Mexico: perception and antipsychotic prescription patterns

BACKGROUND: Since the introduction of antipsychotics, especially the so called atypicals, the treatment of schizophrenia has shown important improvements. At the present time, it is preferred to label clozapine and other antipsychotics sharing similar profiles as second-generation antipsychotics (SGAs). These medications have been proposed by some experts as a first line treatment for schizophrenia. It is critical to have reliable data about antipsychotic prescription in Mexico and to create management guidelines based on expert meetings and not only on studies carried out by the pharmaceutical industry. Only this approach will help to make the right decisions for the treatment of schizophrenia. METHODS: A translated version of Rabinowitz's survey was used to evaluate antipsychotic prescription preferences and patterns in Mexican psychiatrists. The survey questionnaire was sent by mail to 200 psychiatrists from public institutions and private practice in Mexico City and Guadalajara, Mexico. RESULTS: Recommendations for antipsychotics daily doses at different stages of the treatment of schizophrenia varied widely. Haloperidol was considered as the first choice for the treatment of positive symptoms. On the contrary, risperidone was the first option for negative symptoms. For a patient with a high susceptibility for developing extrapyramidal symptoms (EPS), risperidone was the first choice. It was also considered that SGAs had advantages over typical antipsychotics in the management of negative symptoms, cognitive impairment and fewer EPS. Besides, there was a clear tendency for prescribing typical antipsychotics at higher doses than recommended and inadequate doses for the atypical ones. CONCLUSIONS: Some of the obstacles for the prescription of SGAs include their high cost, deficient knowledge about their indications and dosage, the perception of their being less efficient for the treatment of positive symptoms and the resistance of some Mexican physicians to change their prescription pattern. It is necessary to reach a consensus, in order to establish and standardize the treatment of schizophrenia, based on the information reported in clinical trials and prevailing economic conditions in Mexico

What Do We Know About Neuropsychological Aspects Of Schizophrenia?

Application of a neuropsychological perspective to the study of schizophrenia has established a number of important facts about this disorder. Some of the key findings from the existing literature are that, while neurocognitive impairment is present in most, if not all, persons with schizophrenia, there is both substantial interpatient heterogeneity and remarkable within-patient stability of cognitive function over the long-term course of the illness. Such findings have contributed to the firm establishment of neurobiologic models of schizophrenia, and thereby help to reduce the social stigma that was sometimes associated with purely psychogenic models popular during parts of the 20th century. Neuropsychological studies in recent decades have established the primacy of cognitive functions over psychopathologic symptoms as determinants of functional capacity and independence in everyday functioning. Although the cognitive benefits of both conventional and even second generation antipsychotic medications appear marginal at best, recognition of the primacy of cognitive deficits as determinants of functional disability in schizophrenia has catalyzed recent efforts to develop targeted treatments for the cognitive deficits of this disorder. Despite these accomplishments, however, some issues remain to be resolved. Efforts to firmly establish the specific neurocognitive/neuropathologic systems responsible for schizophrenia remain elusive, as do efforts to definitively demonstrate the specific cognitive deficits underlying specific forms of functional impairment. Further progress may be fostered by recent initiatives to integrate neuropsychological studies with experimental neuroscience, perhaps leading to measures of deficits in cognitive processes more clearly associated with specific, identifiable brain systems

A multi-property fluorescent probe for the investigation of polymer dynamics near the glass transition

In addition to the commonly observed single molecule fluorescence intensity fluctuations due to molecular reorientation dynamics, a perylene bisimide-calixarene compound (1) shows additional on-off fluctuations due to its ability to undergo intramolecular excited state electron transfer (PET). This quenching process is turned on rather sharply when a film of poly(vinylacetate) containing 1 is heated above its glass transition temperature (T (g)), which indicates that the electron transfer process depends on the availability of sufficient free volume. Spatial heterogeneities cause different individual molecules to reach the electron transfer regime at different temperatures, but these heterogeneities also fluctuate in time: in the matrix above T (g) molecules that are mostly nonfluorescent due to PET can become fluorescent again on timescales of seconds to minutes. The two different mechanisms for intensity fluctuation, rotation and PET, thus far only observed in compound 1, make it a unique probe for the dynamics of supercooled liquids

Polymer glass transitions switch electron transfer in individual molecules

Essentially complete photoinduced electron transfer quenching of the fluorescence of a perylene−calixarene compound occurs in poly(methyl acrylate) and poly(vinyl acetate) above their glass transition temperatures (T-g), but the fluorescence is completely recovered upon cooling the polymer matrix to a few degrees below the T-g. The switching can be observed in an on/off fashion at the level of individual molecules

Excited state interactions in calix[4]arene-perylene bisimide dye conjugates: Global and target analysis of supramolecular building blocks

The photophysical properties of two supramolecular building blocks oc and oc2 consisting of a perylene bisimide chromophore substituted with either one or two calix[4]arene units in the N-imide position as well as those of the reference compound oref without calix[4]arene substituents were investigated. A complete picture of the processes taking place after photoexcitation in toluene, CH2Cl2, and benzonitrile was obtained by means of UV/vis absorption, steady state and time-resolved emission, and femtosecond transient absorption spectroscopy

Sequential FRET processes in calix[4]arene-linked orange-red-green perylene bisimide dye zigzag arrays

Perylene bisimide-calix[4]arene arrays composed of up to three different types of perylene bisimide chromophores (orange, red, and green PBIs) have been synthesized. Within these arrays, the individual chromophoric building blocks are positioned in defined spatial orientation and are easily replaceable by each other without influencing the overall geometric arrangement of the supramolecular system. The specific optical properties of the individual chromophore facilitated the investigation of photoinduced processes very accurately by time-resolved emission and femtosecond transient absorption spectroscopy. A quantitative analysis of the photophysical processes as well as their rate constants have been obtained by employing UV/vis absorption, steady state and time-resolved emission, femtosecond transient absorption spectroscopy, and spectrotemporal analysis of the femtosecond transient absorption data. These studies reveal very efficient energy transfer processes from the orange to the red PBI chromophoric unit (k(ET) = 6.4 x 10(11) s(-1) for array or), from the red to the green PBI (k(ET) = 4.0 x 10(11) s(-1) for array rg), and slightly less efficient from the orange to the green PBI (k(ET) = 1.5 x 10(11) s(-1) for array og) within these perylene bisimide-calix[4]arene arrays. The experimentally obtained rate constants for the energy transfer processes are in very good agreement with those calculated according to the Forster theory

Adverse effects associated with the short-term treatment of panic disorder with imipramine, alprazolam or placebo

Side effects play a significant role in the selection of drugs to be used in panic disorder/agoraphobia whose polyphobic symptomatology often includes a suspiciousness about taking drugs and a fear of undesired side effects which may lead to the refusal of treatment.The safety, side effects and patients' acceptance of alprazolam and imipramine versus placebo were evaluated in 1168 subjects with panic disorder/agoraphobia who had been enrolled in the second phase of the Upjohn World Wide Panic Study. Side effects that worsened over baseline to a greater extent with alprazolam than with imipramine and placebo were sedation, fatigue/weakness, memory problems, ataxia and slurred speech. In the imipramine group blurred vision, tachycardia/palpitations, insomnia, sleep disturbance, excitement/nervousness, malaise, dizziness/faintness, headache, nausea/vomiting and decrease in appetite were worse than in the other groups. In the placebo group the anxious symptoms were most prominent. The highest level of compliance was shown in the alprazolam-treated group and the lowest in the placebo-treated group. Strong predictors of side effects were not observed.If a side effect profile is known, it will be easier for a clinician to choose the right drug and the appropriate management by taking into account compliance, safety and efficacy in each patient under treatment. Further information about side effects in long-term maintenance treatment would be of great clinical pertinence in ensuring safety and enhancing patients' quality of life.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31721/1/0000659.pd