EJACULATORY DYSFUNCTION IN PATIENT WITH SCHIZOPHRENIA ON SERTINDOLE

The antipsychotic drugs can be of great benefit for the wide range of psychotic disorders, but all are associated with various adverse effects. Patients with psychotic disorder consider the sexual dysfunction to be among the most important side effects. Although, it is not uncommon for the patients with schizophrenia to report the sexual dysfunction, patients with untreated schizophrenia have fewer dysfunctions compared to those on antipsychotic medication. The decision whether the current treatment with a prolactin-increasing antipsychotic or sexual dysfunction inducing drug should be continued or switched to another antipsychotic drug, has to be made on the basis of the patient\u27s risk-benefit estimation. It has to be kept on mind that adverse effects are usually dose dependent. In this case report, sertindole treated patient with chronic schizophrenia developed sexual side effect manifested as ejaculatory dysfunction that was significantly ameliorated by drug-dose reduction

EJACULATORY DYSFUNCTION IN PATIENT WITH SCHIZOPHRENIA ON SERTINDOLE

The antipsychotic drugs can be of great benefit for the wide range of psychotic disorders, but all are associated with various adverse effects. Patients with psychotic disorder consider the sexual dysfunction to be among the most important side effects. Although, it is not uncommon for the patients with schizophrenia to report the sexual dysfunction, patients with untreated schizophrenia have fewer dysfunctions compared to those on antipsychotic medication. The decision whether the current treatment with a prolactin-increasing antipsychotic or sexual dysfunction inducing drug should be continued or switched to another antipsychotic drug, has to be made on the basis of the patient\u27s risk-benefit estimation. It has to be kept on mind that adverse effects are usually dose dependent. In this case report, sertindole treated patient with chronic schizophrenia developed sexual side effect manifested as ejaculatory dysfunction that was significantly ameliorated by drug-dose reduction

Dementia and Mental Disorders

Pojava psihičkih simptoma u osoba koje boluju od Alzheimerove bolesti i drugih demencija jedan je od većih izazova u skrbi za oboljele. Psihički poremećaji u smislu depresije, psihotične dekompenzacije stanja i delirija superponiranog na demenciju mogu znatno utjecati na kognitivne funkcije, ubrzati njihovu deterioraciju i odraziti se na funkcioniranje osoba s demencijom i njihovu samostalnost u aktivnostima svakodnevnog života. Psihički simptomi u okviru pojedinih kliničkih slika (primjerice, depresivne ili psihotične) nalažu intervencije u planu liječenja osoba s demencijom, primjenu psihofarmaka i niza nefarmakoloških metoda, kao i liječenje tjelesnog komorbiditeta uz razmjerno visok rizik od pojave nuspojava, interakcija lijekova i različitih komplikacija.The appearance of psychiatric symptoms in patients suffering from Alzheimer’s disease and other dementia is a great challenge. Mental disorders such as depression, psychotic decompensation and delirium superimposed on dementia may significantly affect cognitive functions, accelerate deterioration and negatively affect the functioning and the independence in activities of daily life. Mental symptoms within certain clinical pictures (eg, depressive or psychotic) in people with dementia require treatment through the use of psychopharmaceuticals and a range of non-pharmacological methods, as well as the treatment of somatic comorbidities with a relatively high risk of side effects, drug interactions and various complications

The Antimetastatic Effect of Macrophages Restored by Indomethacin: Concomitant Tumor Immunity Model

The role of macrophages acting as immunologic antitumor effectors and promoters of tumor growth are poorly understood as yet. We investigated the role of macrophage in model of concomitant immunity (CI), a phenomenon of secondary tumor rejection during the primary tumor growth. It has been shown that the period of CI weakening can coincide with appearance of tumor metastases. We used mammary carcinoma (MC) artificial lung metastases to evaluate the influence of macrophages from various period of CI on the development of metastases in mice. Our results indicated that macrophages are responsible for the late period of CI weakening and suppression. To investigate weather prostaglandins can mediate suppressive effect of macrophages we used experiments with indomethacin and we found that inhibition of prostaglandin E2 synthesis by indomethacin restored antimetastatic effect of concomitant immune macrophages

Delirium superimposed on dementia Σ clinical picture and recommendations for treatment

Članak donosi pregled najnovije literature o deliriju superponiranom na demenciju, uključujući sadašnje spoznaje o patofiziologiji te raspravu o aktualnim preporukama koje se koriste pri dijagnosticiranju i liječenju delirija. Delirij je sindrom koji se pojavljuje u svim dobnim skupinama i na mnogim bolničkim odjelima, a najčešći je u jedinicama intenzivnog liječenja. Unutar psihijatrije posebno je značajan kod osoba starije životne dobi s Alzheimerovom i drugim demencijama. Uvijek intrigantan, na preklapajućem području somatske medicine, neurologije i psihijatrije, delirij je fenomen koji se javlja naglo, dramatično po kliničkoj slici te obvezuje na brzu reakciju, prepoznavanje i liječenje na bolničkom odjelu. U ovom tekstu zbog širine cijelog područja, usmjerit ćemo se na dijagnosticiranje i liječenje delirantnih stanja kod gerijatrijskih psihijatrijskih bolesnika od demencije.This article reviews the recent literature about delirium superimposed on dementia, including current knowledge about pathophysiology and the discussion on current recommendations that are used in diagnosing and treating delirium. Delirium is a syndrome occurring in all age groups at different hospital wards, and is most common in the intensive care units. In psychiatry, it is most relevant to older patients with Alzheimer’s and other types of dementia. Always intriguing, traddling the borders of somatic medicine, neurology and psychiatry, delirium is a phenomenon occurring abruptly, with a dramatic clinical picture, and committing us to quick reaction, recognition and treatment at the hospital ward. In this article, because of the broadness of the topic, we will focus on diagnosis and treatment of delirium within geriatric psychiatric patients suffering from dementia

SEXUAL SIDE EFFECTS OF ANTIPSYCHOTICS

Istraživanja su pokazala da seksualna disfunkcija kao nuspojava liječenja psihofarmacima bitno utječe na kvalitetu života i održavanje partnerskih veza. Rezultati istraživanja pokazuju da simptomi seksualne disfunkcije koji se javljaju tijekom liječenja više zabrinjavaju psihičke bolesnike nego ekstrapiramidni simptomi. Seksualne disfunkcije opisane su kod 50 % bolesnica na terapiji psihofarmacima. Unatoč mišljenju većine psihijatara da je seksualno funkcioniranje važno za pacijente, dvije trećine psihijatara uobičajeno ne postavlja pacijentima pitanja o seksualnom funkcioniranju. Stoga se seksualna disfunkcija kao nuspojava psihofarmaka nedovoljno često prepoznaje i liječi. Atipični antipsihotici imaju brojne potencijalne prednosti u odnosu na tipične antipsihotike s obzirom na njihov učinak na seksualno funkcioniranje. Pažnju je potrebno usmjeriti na hiperprolaktinemiju tijekom dugotrajnog liječenja, posebno kod primjene visokih doza, osoba ženskog spola, osoba s ranijim početkom bolesti i kod teških bolesnika. Prema rezultatima istraživanja podatci ukazuju da se povezanost između seksualne disfunkcije i psihopatologije odnosila samo na žene. Stoga, prigodom vođenja brige o pacijentima osnovno je razmotriti spolno-specifi čne odnose između psihopatologije i seksualnih problema. Kod muškaraca liječenih antipsihoticima opisane su različite vrste seksualnih disfunkcija uključujući erektilnu, ejakulatornu i orgazmičku. Seksualnoj disfunkciji induciranoj antipsihoticima treba pristupiti uvažavajući osjetljivost i individualne potrebe svakog bolesnika. Zaključno možemo reći da su seksualne disfunkcije kod primjene novijih antipsihotika značajan i često slabo prepoznati problem. Adekvatnim izborom atipičnog antipsihotika s odgovarajućim farmakološkim profi lom smanjuje se mogućnost pojave seksualnih poteškoća. Buduća istraživanja novih lijekova trebaju uzeti u obzir javljanje seksualnih disfunkcija.Investigations have shown that sexual dysfunction as a side effect of treatment with psychopharmaceuticals signifi cantly infl uences the quality of life and maintenance of relationships between partners. Results of investigations show that symptoms of sexual dysfunction that occur during treatment upset psychiatric patients more than extrapyramidal symptoms. Sexual dysfunction is described in 50% of female patients during therapy with psychopharmaceuticals. Despite the opinion of the majority of psychiatrists that sexual functioning is important for patients, two-thirds of psychiatrists usually do not ask patients questions about sexual functioning. Therefore, sexual dysfunction as a side effect of psychopharmaceuticals frequently is inadequately recognized and treated. Atypical antipsychotics have numerous potential advantages in comparison with typical antipsychotics regarding their effect on sexual functioning. Attention should be focused on hyperprolactinemia during long-term treatment, especially when applying high dosages, females, persons with earlier onset of illness, and in severely ill patients. According to results of investigations, data indicate that the connection between sexual dysfunction and psychopathology referred only to women. Therefore, considering gender-specifi c relations between psychopathology and sexual problems is elementary during medical care for patients. Different types of sexual dysfunction, including erectile, ejaculatory and orgasmic, have been described in men during treatment with antipsychotics. Sexual dysfunction induced by antipsychotics should be addressed, taking into consideration sensitivity and individual needs of each patient. In conclusion, we may say that sexual dysfunctions are an important and often poorly recognized problem in the treatment with newer antipsychotics. The probability of the occurrence of sexual disturbances is decreased by correct choice of atypical antipsychotic with appropriate pharmacological profi le. Future investigations of new medications should take the occurrence of sexual dysfunctions into consideration

Dementia is More Frequent in Women

Demencija je sindrom globalnog i progresivnog oštećenja stečenih kognitivnih sposobnosti pri očuvanoj svijesti prouzročen organskom bolešću središnjeg živčanog sustava u kojem su posebno oštećene sposobnosti pamćenja, učenja, apstraktnog mišljenja, orijentacije te poimanja vidno‐prostornih odnosa. Prevalencija i incidencija Alzheimerove bolesti (AB), najčešćeg uzroka demencije, znatno je veća kod žena nego kod muškaraca, a ta se razlika s dobi povećava. Dvostruko veća učestalost AB kod žena u odnosu na muškarce djelomično se može objasniti time što žene imaju očekivano dulji životni vijek. Žene imaju lošiju kognitivnu izvedbu na mnogim neuropsihologijskim testovima u odnosu na muškarce u istom stadiju bolesti, odnosno višestruke kognitivne funkcije kod žena teže su i šire zahvaćene nego kod muškaraca. Mogući razlozi za ovakvu nepovoljnost naspram žena su redukcija estrogena u postmenopauzi, veće kognitivne rezerve muškaraca te utjecaj apolipoproteina E. Određeni biološki čimbenici također bi mogli objasniti različite kliničke manifestacije AB s obzirom na spol. Osim što prema prezentiranim podatcima žene češće obolijevaju od AB, žene su također te koje u bitno većoj mjeri pružaju neformalnu njegu ljudima s demencijom, te su oko dvije trećine neformalnih njegovatelja žene. Zaključno, u daljnjem istraživačkom i kliničkom radu s AB svakako bi trebalo obratiti pozornost na spoznaje o spolnim razlikama u razvoju i progresiji ove bolesti.Dementia is a syndrome of global and progressive impairment of acquired cognitive abilities with preserved consciousness caused by an organic illness of the central nervous system with especially pronounced damage to the ability to memorise, learn, think abstractly, orientate, and perceive spatial relations. The prevalence and incidence of Alzheimer’s Disease (AD), the most common cause of dementia, is considerably greater in women than in men, and that difference increases with age. The fact that AD occurs twice as often in women than in men may be partially explained by a longer life expectancy among women. Women show worse cognitive performance on numerous neuropsychological tests in comparison to men during the same stage of the disease, meaning that multiple cognitive functions are more widely and severely impaired in women than in men. Possible reasons for such unfavourable results among women are a reduction of oestrogen during post-menopause, larger cognitive reserves in men, and the influence of apolipoprotein E. Certain biological factors may also explain various clinical manifestations of AD regarding sex. Apart from the fact that, according to presented data, women develop AD more often than men, women are also those who offer informal care to people with dementia in much greater numbers, and almost two thirds of informal caregivers are women. In conclusion, further research and clinical work with AD should certainly pay attention to insights about sex differences in the development and progression of this disease