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

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

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

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

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

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

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

Psychopharmacological management of acute alcohol withdrawal symptoms. A review

© 2020 The Authors. Published by Journalcmpr.com. 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://doi.org/10.24327/23956429.ijcmpr202005881Evidence based medicine suggest that implementations of a clinical protocol for the management of acute alcohol withdrawal symptoms improves patient’s outcome. Clinical guidelines were developed by several institutions mainly to ensure high quality, person centered, and safe management of alcohol withdrawal symptoms with a large variation in the local practice especially in the management of unplanned alcohol withdrawal with regards to the regime, choice of benzodiazepines and appropriate vitamin supplementation. Various health organizations advise integration of training for alcohol withdrawal management. Timely assessments and staff education increase patient monitoring, create a safer and caring environment, reduce the risks including agitation to staff and other patients and enhance the quality of care. This review looked at the various National Health Services Hospitals with guidelines and protocols providing a comprehensive review for the acute management of alcohol withdrawal symptoms

Fluoxetine in the management of major depressive disorder in children and adolescents: A meta-analysis of randomized controlled trials

This is an accepted manuscript of an article to be published by SAGE in Hospital Pharmacy on 04/06/2020. The accepted version of the publication may differ from the final published version.Fluoxetine is a serotonin specific reuptake inhibitor anti-depressant and is the only approved pharmacological treatment for major depressive disorder (MDD) in children and adolescent. We searched the published randomized controlled-trials (RCT) to review fluoxetine efficacy and tolerability using the databases PubMed, EUDRACT, ClinicalTrials.gov and Cochrane Central Register of Controlled Trials for fluoxetine role in managing MDD in children and adolescents. A meta-analysis was conducted using the identified 7 clinical trials to assess efficacy using the outcomes: Children’s Depression Rating Scale-Revised (CDRS-R), Clinical Global Impressions – Severity of Illness (CGI-S) and Clinical Global Impressions – Improvement (CGI-I) response rate. The risk of discontinuation due to adverse effects and common side effects were examined. The mean difference in change from baseline for CDRS-R was -2.72 [95% Confidence Interval (CI) -3.96, -1.48] favouring fluoxetine treatment (p<0.001). Similarly, mean difference for CGI-S was -0.21 [95% CI -0.36, -0.06]. The risk ratio (RR) of discontinuing due to adverse events was 0.98 [95% CI 0.54, 1.83], with RR for headache side effects 1.34 [95% CI 1.03, 1.74] and rash 2.6 [95% CI 1.32, 5.14]. Fluoxetine demonstrates significant improvements in symptom intensity control in young patients suffering from MDD and is considered well-tolerated with similar rates of trials discontinuation; however, fluoxetine was associated with a higher risk of headache and rash side effects. These findings will guide psychiatrists and pharmacists in their clinical role for supporting the care of young mental health patients

Cariprazine: pharmacology and clinical management of psychiatric disorders

This is an accepted manuscript of an article published by Slack in Psychiatric Annals on 11/02/2019, available online: https://journals.healio.com/doi/10.3928/00485713-20190213-01 The accepted version of the publication may differ from the final published version.Cariprazine is a new atypical antipsychotic for schizophrenia and bipolar disorders 2 management. In this article, the role of cariprazine, a partial D2 and D3 receptors 3 agonist with a higher D3 affinity, in the management of psychiatric conditions is 4 illustrated. Cariprazine caused significant improvements in psychiatric scales such 5 as Positive and Negative Syndrome scale (PANSS), clinical global impressions 6 (CGI) and young mania rating scales (YMRS) and was associated with side effects 7 such as akathisia, restlessness and insomnia. These findings will guide psychiatrists 8 and pharmacists in their clinical role for supporting psychiatric patients care