95 research outputs found
Safety and tolerability of antipsychotics: focus on amisulpride
The introduction of the atypical antipsychotic drugs represents an important advance in the treatment of schizophrenia, because the therapeutic efficacy, tolerability, and safety profiles of these agents seem to be superior to that of the classical neuroleptics. As would be predicted from the pharmacologic profile of a pure D2/D3 receptor blocker, amisulpride is an atypical antipsychotic agent, effective for positive and negative symptoms, which can bring about additional improvement in the social functioning and quality of life of patients with schizophrenia. Amisulpride is effective in acute schizophrenia as determined by Clinical Global Impression scores. The major concern regarding the safety of the atypical antipsychotics is related to their propensity to induce weight gain and alter glucose and lipid metabolism. Amisulpride has one of the lowest potentials for weight gain of all the antipsychotic agents, and is associated with clearly lower use of antiparkinsonian medication and with fewer dropouts due to adverse events than conventional antipsychotics. Amisulpride is well tolerated with regard to anxiety and insomnia, and not notably different from placebo. Amisulpride has a pronounced prolactin-elevating effect which appears to be independent of dosage and duration of administration. Hyperprolactinemia rapidly reverses following amisulpride discontinuation. Amisulpride benefits patients with negative symptoms, and is the only antipsychotic to demonstrate efficacy in patients with predominantly negative symptoms. Amisulpride maintains its efficacy when used for medium/long-term treatment, as demonstrated in studies of up to 12 months. In terms of relevance of the effects, superiority is observed for quality of life, social adaptation, and functioning, as measured by the Quality of Life and Functional Status Questionnaire scales. In conclusion, amisulpride is an antipsychotic agent with proven efficacy and good tolerability. Moreover, this drug can help people with schizophrenia to attain social reinsertion
Childhood Sexual Abuse and Indicators of Immune Activity: A Systematic Review
Background: Childhood sexual abuse (CSA) is a prevalent subtype of early life stress associated with changes in immunological and neuroendocrine systems leading to inflammatory responses of the organism and increasing several inflammatory and immune markers. We aimed to conduct a systematic review concerning the association between CSA and indicators of immune activity.Methods: We conducted a search for articles in PubMed, Scopus, PsycINFO, and Web of Science, using the key words: (“Child sexual abuse” OR “childhood maltreatment” OR “sexual violence” OR “posttraumatic stress disorder” OR “rape”) AND (“cytokines” OR “inflammatory markers” OR “interleukin” OR “tumor necrosis factor” OR “C-reactive protein”). PRISMA guidelines were used in order to improve the quality of this research, and MeSH terms were used in PubMed.Results: A total of 3,583 studies were found and, after application of the exclusion criteria, 17 studies were included in this review. Most studies reported an increase of inflammatory activity associated with the presence of early abuse. IL-6, TNF- α, and C-reactive protein were the most frequently analyzed markers and some studies showed higher levels in individuals that suffered CSA compared with controls, although the results were heterogeneous, as was the assessment of CSA, repeated trauma, and time of occurrence. It was not possible to perform a meta-analysis because the results were diversified.Conclusion: CSA is associated with changes in inflammatory markers levels. Improving the assessment of subtypes of trauma is important to further understand the complex correlations of CSA and its biological consequences such as psychiatric and physical illness in later life
Analysis of the occurrence of early life stress in adult psychiatric patients:A systematic review
Bipolar disorder: a review of conceptual and clinical aspects
Esta revisĂŁo tem o objetivo de introduzir aspectos histĂłricos, epidemiolĂłgicos e etiolĂłgicos do transtorno bipolar, alĂ©m de apresentar a caracterização e curso da doença e algumas questões relativas ao diagnĂłstico, tratamento e prognĂłstico. O Transtorno Bipolar (TB) Ă© caracterizado por graves alterações de humor, que envolvem perĂodos de humor elevado e de depressĂŁo intercalados por perĂodos de remissĂŁo. O transtorno se diferencia em dois tipos principais: o Tipo I, em que ocorrem episĂłdios de mania, e o Tipo II, em que a elevação do humor Ă© mais branda e breve, caracterizando episĂłdios de hipomania. O conceito de espectro bipolar amplia a classificação do TB, incluindo padrões clĂnicos e genĂ©ticos. O TB Ă© uma doença comum, que atinge cerca de 30 milhões de pessoas no mundo, afetando homens e mulheres de modo diferente. As causas do TB incluem uma interação de fatores genĂ©ticos e ambientais, distinguindo-o como um transtorno complexo e multideterminado. O diagnĂłstico segundo os critĂ©rios do DSM-5 envolve a identificação de sintomas de mania ou hipomania e da avaliação do curso longitudinal da doença. A depressĂŁo Ă© geralmente o quadro mais comum e persistente entre os pacientes bipolares. Embora nĂŁo existam sintomas especĂficos que distinguem a depressĂŁo unipolar da depressĂŁo bipolar, foram encontradas caracterĂsticas clĂnicas tĂpicas de cada manifestação (e.g., perfil dos sintomas, histĂłria familiar, e curso da doença). O diagnĂłstico precoce e o tratamento dos episĂłdios agudos de humor melhoram significativamente o prognĂłstico. O tratamento de primeira escolha Ă© com medicamentos estabilizadores de humor, anticonvulsivantes e antipsicĂłticos atĂpicos. A combinação de medicamentos com intervenções psicossociais tem se mostrado efetiva. NĂŁo obstante, o uso de antidepressivos em monoterapia nĂŁo Ă© recomendadoThis review aims to introduce historical, epidemiological and etiological aspects of bipolar disorder, also to present the characterization and course of the disease, as well as some issues related to the diagnosis, treatment and prognosis. Bipolar disorder (BD) is characterized by severe mood disturbances, involving periods of elevated mood and depression intercalated with periods of remission. The disorder is distinguished into two main types: Type I, in which episodes of mania occur; and Type II, in which mood elevation is milder and briefer, characterizing episodes of hypomania. The concept of bipolar spectrum extends the classification of BD, including clinical and genetic patterns. BD is a common disease that strikes about 30 million people worldwide, affecting men and women differently. The causes of BD include the interaction of genetic and environmental factors, distinguishing it as a complex and multidimensional disorder. The diagnosis according to DSM-5 involves the identification of mania or hypomania symptoms and the longitudinal evaluation of the disease course. Depression is usually the most common and persistent condition among bipolar patients. Although there are no specific symptoms that distinguish unipolar depression from bipolar depression, typical clinical features of each manifestation were found (e.g., symptom profile, family history, and disease course). Early diagnosis and the treatment of acute mood episodes significantly improve the prognosis. The first choice treatment involves mood stabilizers, anticonvulsants and atypical antipsychotics. The combination of medication with psychosocial interventions has been proved effective. However, the use of antidepressant monotherapy is not recommende
Relationship Between Depression and Subtypes of Early Life Stress in Adult Psychiatric Patients
Numerous studies have researched the aggravating and maintainer effect of Early Life Stress in patients adults with psychiatric disorders. This study examined the relationship between depression and subtypes of early life stress among 81 psychiatric patients treated at the inpatient Day Hospital Unit of a University General Hospital. Psychiatric diagnosis was confirmed according to the MINI International Neuropsychiatric Interview (MINI). The Childhood Trauma Questionnaire (CTQ) was used for evaluating as retrospective assessment of the presence of ELS on these patients, and we also evaluated the severity of hopelessness with the Beck Hopelessness Scale (BHS). Our results suggested that the occurrence of depression in adulthood is related to situations of emotional abuse, sexual, and physical neglect during childhood. The analysis between depression and childhood emotional abuse was significant after a multiple logistic regression analysis OR (IC 95%): 4.4 (1.7–11.2), even accounting for gender adjusted OR [AOR] 4.0; (IC 1.5–10.5); psychiatry family history AOR 3.8 (1.4–10.5); previous suicide attempted AOR 3.7; (1.4–10.5) and Hopelessness AOR 3.2 (1.11–9.4). Thus, these findings demonstrate emotional abuse as a significant risk factor to be part of the mechanism involved in the pathogenesis of depression related to early life stress
Trauma and stressor-related disorders
Trauma and Stressor-Related Disorders are psychiatric conditions related to exposure to a traumatic or stressful event, resulting in significant psychological distress social, professional and other relevant areas of the individual’s life. The clinical presentation of these disorders is characterized by symptoms of anxiety and fear, anhedonia, dysphoria, externalizations of anger, aggressiveness and dissociative symptoms. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic categories included in this spectrum are Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder and Adjustment Disorders. The objective of this review is to introduce the debate on clinical conceptualization and therapeutic guidelines of Trauma and Stressor-Related Disorders, directing professional’s choice for proper therapeutic practices related to such diagnostic categories. Also, the authors discuss the consequences of early life stress (traumatic situations that occur in childhood and adolescence) in adulthoodOs Transtornos relacionados a traumas e a estressores sĂŁo quadros psiquiátricos relacionados a exposi- ção a um evento traumático ou estressante, resultando em sofrimento psicolĂłgico relevante, prejuĂzo social, profissional e em outras áreas importantes da vida do indivĂduo. A apresentação clĂnica de tais transtornos Ă© caracterizada por sintomas de ansiedade e de medo, anedonia, disforia, externalizações da raiva, agressividade e sintomas dissociativos. De acordo com a 5ÂŞ edição do Manual DiagnĂłstico e EstatĂstico de Transtornos Mentais (DSM-5), as categorias diagnĂłsticas inclusas nesse espectro sĂŁo Transtorno de Apego Reativo, Transtorno de Interação Social Desinibida, Transtorno de Estresse PĂłsTraumático, Transtorno de Estresse Agudo e os Transtornos de Adaptação. O objetivo desta revisĂŁo Ă© introduzir o debate sobre a conceituação clĂnica e as diretrizes terapĂŞuticas dos Transtornos Relacionados a Traumas e a Estressores, direcionando a escolha do profissional pelas práticas terapĂŞuticas adequadas relacionadas a tais categorias diagnĂłsticas. AlĂ©m disso, os autores discutem as consequĂŞncias do Estresse Precoce (situações traumáticas ocorridas na infância e adolescĂŞncia) na vida adult
- …