Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards. The PERSEO study

BACKGROUND: Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management). METHOD: Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO – Psychiatric EmeRgency Study and EpidemiOlogy). RESULTS: 253 FPA aged <= 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers. CONCLUSION: Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved significantly from admission to discharge both for FPA and non-FPA patients

Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units: the PERSEO (psychiatric emergency study and epidemiology) survey

<p>Abstract</p> <p>Background</p> <p>The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management). The aims of this paper are: (i) to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii) to assess the clinical management, subjective wellbeing and attitudes toward medications.</p> <p>Methods</p> <p>A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period.</p> <p>Results</p> <p>Almost half of patients (46%) showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%), than in aggression toward other people (20%). A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%), followed by depression (16%) and personality disorders (14%), and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge), while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge) and depression (41 vs 32% during stay and 44 vs 25% at discharge). Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%). Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self-reported compliance increased during hospital stay.</p> <p>Conclusion</p> <p>Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.</p

Overdose da Risperidone: determinazione del farmaco e del suo principale metabolita in plasma umano

Il Risperidone è un farmaco antipsicotico atipico che mostra grande affinità per i recettori serotoninergici 5-HT2A e 5-HT7. Il suo particolare profilo farmacodinamico rende la molecola efficace nel trattamento della schizofrenia e del disturbo bipolare. Il risperidone viene somministrato in dosi giornaliere di 4-6 mg per os e quindi largamente metabolizzato dal sistema del CYP450 nel suo principale metabolita attivo, il 9-idrossi risperidone. La “active moiety” è data dalla somma delle concentrazioni plasmatiche del principio attivo e del suo metabolita. Sebbene il risperidone, nei normali dosaggi terapeutici, sia generalmente un farmaco abbastanza sicuro, sono stati riportati casi di morte di adulti in seguito all’ingestione di 403 mg di risperidone; in particolare, livelli plasmatici della “active moiety” di 1.8 µg/mL sono risultati fatali. Scopo del presente lavoro è la messa a punto di un affidabile e accurato metodo cromatografico per la determinazione di risperidone e del suo metabolita in plasma di pazienti schizofrenici in casi di overdose. L’analisi HPLC è stata condotta usando come fase stazionaria una colonna C8 e come fase mobile una miscela di tampone fosfato pH 3.5 e acetonitrile. Il pretrattamento del campione è stato effettuato mediante estrazione in fase solida, impiegando come fase adsorbente cartucce C8. Sono stati ottenuti valori della resa d’estrazione, per risperidone e 9-idrossirisperidone, superiori al 95%, pertanto molto soddisfacenti. L’applicazione del metodo analitico ad un caso di intossicazione volontaria da risperidone in paziente schizofrenico, dopo ingestione di 50 compresse di Risperdal®, ha permesso di rivelare livelli plasmatici di risperidone e 9-idrossi-risperidone di 10 ng/mL e 178 ng/mL, rispettivamente. Il paziente pur presentando livelli plasmatici della “active moiety” non fatali, mostrava chiari sintomi di intossicazione acuta. Il metodo cromatografico ha inoltre consentito la simultanea determinazione plasmatica di altri farmaci co-somministrati, quali lorazepam e venlafaxina, dimostrando una buona selettività

HPLC-DAD determination of plasma levels of the antipsychotic risperidone and its main metabolite for toxicological purposes

A new, rapid analytical method, based on liquid chromatography with diode array detection, has been developed and applied to the determination of risperidone and its main active metabolite 9-hydroxyrisperidone in human plasma. The chromatographic separation was obtained on a C8 (150 x 4.6 mm, 5 \ub5m) column, using a mobile phase composed of acetonitrile (27%) and a pH 3.0 phosphate buffer (73%). A sample clean-up procedure was carried out by using C8 cartridges and eluting the analytes with methanol. The extraction yield was very satisfactory for both analytes, with average absolute recovery values of about 95%. The experimental conditions permitted the quantitative determination of risperidone and 9-hydroxyrisperidone with high precision (RSD &lt; 3.6%) and satisfactory sensitivity (LOQ = 4 ng/mL). The method was applied to plasma samples from a patient who had tried to poison himself with 150 mg of risperidone, and was undergoing polypharmacy

Monitoraggio terapeutico dei farmaci antiepilettici gabapentin e vigabatrin in plasma umano mediante analisi HPLC-F

Gabapentin (acido 2-[1-(amminometil)cicloesil]acetico) e vigabatrin (acido 4-ammino-5-esenoico) sono due farmaci antiepilettici a struttura aminoacidica. Mentre il preciso meccanismo d'azione del gabapentin \ue8 ancora ignoto, si ritiene che il vigabatrin agisca inibendo la GABA transaminasi, con effetti inbitori sulla trasmissione neuronale. Come per molti altri antiepilettici, anche per gabapentin e vigabatrin \ue8 necessario personalizzare la terapia, effettuando un accurato monitoraggio terapeutico dei pazienti. \uc8 stato quindi sviluppato un metodo, basato sulla cromatografia liquida, per l\u2019analisi simultanea di questi due farmaci in plasma umano. A tale scopo si \ue8 utilizzata una colonna a fase inversa C8 ed una fase mobile composta da tampone fosfato acido ed acetonitrile. Poich\ue9 le molecole non presentano cromofori significativi, la rivelazione spettrofotometrica non \ue8 direttamente applicabile. Pertanto, si \ue8 deciso di accoppiare all'HPLC una rivelazione spettrofluorimetrica dopo derivatizzazione degli analiti con dansil cloruro (eccitazione = 318 nm, emissione = 510 nm). Prima della derivatizzazione, i campioni biologici vengono purificati mediante estrazione in fase solida (SPE) con cartucce MCX (modalit\ue0 mista: fase inversa \u2013 scambio cationico). Il metodo \ue8 ora in fase di convalida, ma i risultati preliminari sono promettenti: le rese d'estrazione sono maggiori di 80% e si \ue8 ottenuta una buona linearit\ue0 nei range attesi di concentrazioni plasmatiche dei farmaci

Determination of orphenadrine plasma levels using HPLC with diode array detection and a novel solid-phase extraction procedure in psychiatric patients

Orphenadrine is an antimuscarinic agent mainly used for the treatment of parkinsonism and to alleviate the neuroleptic syndrome induced by antipsychotic drugs. A new, rapid analytical method, based on liquid chromatography with diode array detection (DAD), has been developed and applied to the determination of orphenadrine in plasma of schizophrenic patients for therapeutic drug monitoring and toxicological purposes. The chromatographic separation was performed on a penta&#64258;uorophenyl reversed phase column with a mobile phase composed of acetonitrile\u2013phosphate buffer mixture. DAD detection was carried out at 220 nm. A careful and rapid solid-phase extraction procedure on cyanopropyl cartridges was chosen for plasma sample puri&#64257;cation and pre-concentration obtaining good extraction yield values for the analyte (>96.0%). The assays showed a linear response for orphenadrine (30\u20131000 ng/mL). The method is also precise and selective. Thus, the method developed seems to be suitable for routine analysis of orphenadrine in psychiatric patients. Moreover, it was applied to plasma samples from a psychotic patient who had tried to poison himself with 1000 mg of orphenadrine and was undergoing polypharmacy

Determination of selected phenothiazines in human plasma by solid-phase extraction and liquid chromatography with coulometric detection

A new analytical method, based on a liquid chromatography with coulometric detection, has been developed and applied to the determination of selected phenothiazines (Chlorpromazine, Promazine, Fluphenazine and Levomepromazine) in human plasma. The drugs were separated on a Discovery HS F5 column, using a mobile phase composed of acetonitrile (32 %) and a pH 1.9 phosphate buffer (68 %). Promethazine was used as the internal standard. Detection was carried out at an oxidation potential of + 0.500 V. A novel clean-up procedure was developed by means of solid-phase extraction, using cyanopropyl cartridges, which allowed good extraction yield for all the analytes, with absolute recovery values higher than 91.0 %. The detector response was linear over a plasma concentration range of 0.5-250.0 ng/mL for Chlorpromazine, Promazine and Levomepromazine and of 0.2-4.0 ng/mL for Fluphenazine. Precision results, expressed by the intra-day and the inter-day relative standard deviation values, were good, being lower than 3.9 %. Accuracy data were satisfactory as well. The method has been successfully applied to the analysis of drug plasma levels of psychiatric patients undergoing therapy with selected phenothiazines

Determination of selected phenothiazines in human plasma by solid-phase extraction and liquid chromatography with coulometric detection.

A new analytical method, based on liquid chromatography with coulometric detection, has been developed and applied to the determination of selected phenothiazines (chlorpromazine, promazine, fluphenazine and levomepromazine) in human plasma. The drugs were separated on a Discovery pentafluorophenylpropyl column, using a mobile phase composed of acetonitrile (32%) and a pH 1.9 phosphate buffer (68%). Promethazine was used as the internal standard. Detection was carried out at an oxidation potential of +0.500 V. A novel clean-up procedure was developed by means of solid-phase extraction, using cyanopropyl cartridges, which gave good extraction yield for all the analytes, with absolute recovery values higher than 91.0%. The detector response was linear over a plasma concentration range of 0.5-250.0 ng mL(-1) for chlorpromazine, promazine and levomepromazine and of 0.2-4.0 ng mL(-1) for fluphenazine. Precision results, expressed by the intra-day and the inter-day relative standard deviation values, were good, being lower than 3.9%. Accuracy data were satisfactory as well. The method has been successfully applied to the analysis of drug plasma levels of psychiatric patients undergoing therapy with selected phenothiazine