Effect of Olanzapine on Disruptive Behavior in Institutionalized Patients with Severe Intellectual Disability – A Case Series

Considerable number of intellectual disabled people experience some form of disruptive behavior. Antipsychotics are the most common treatment for these behaviors. Numerous patients were efficiently treated with thioridazine, recently withdrawn. The authors describe a case series of »thioridazine responders« treated with olanzapine. Thirty three patients with severe intellectual disability were recruited. All patients were assessed for seven types of disruptive behavior on five point scale. Patients with severe behavior disturbances were included in treatment. The time points of assessment were at day 0, 30, 60 and 180. Twenty one patient accomplished inclusion criteria. A significant decrease occurred at day 30 for all types of behavior. Total score, self injurious behavior, compulsive and destructive behavior showed further decrease at day 60 and became stable until the end of study. Olanzapine appears to be efficacious in the treatment of disruptive behavior in the intellectually disabled and could be substitute for thioridazine treatment

INVOLUNTARY EMOTIONAL EXPRESSION DISORDER IN ALZHEIMER\u27S DISEASE - PSYCHOPHARMACOTHERAPY ASPECTS

Involuntary emotional expression disorder (IEED) is syndrome characterized with relatively stereotypical episodes of uncontrollable crying and/or laughing. Additionally, this syndrome can include irritability, anger and frustration. This syndrome is common among a number of neurologic diseases like patients with a stroke or traumatic brain injury (TBI), patients with amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), as well as dementias such as Alzheimer`s disease (AD), and motor disorders such as Parkinson`s disease (PD). IEED is very common but misdiagnosed and consequently undertreated. Prevalence of IEED in AD is between 15-39%. Recent controlled clinical studies suggest that dextromethorphan (DM) and quinidine (Q) is an effective treatment for IEED. United States Food and Drug Administration (FDA) has accepted for filing and review its New Drug Application (NDA) for ZenviaTM (dextromethorphan hydrobromide and quinidine sulfate capsules) for the treatment of IEED. In Republic of Croatia current treatment involves antidepressants (tricyclic and selective serotonin reuptake inhibitors), antipsychotic agents, anxiolytics, antidementives and mood stabilizers. New promising treatment can reduce the frequency of episodes and improve the quality of life of patients and their families and caregivers

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

Effect of Olanzapine on Disruptive Behavior in Institutionalized Patients with Severe Intellectual Disability – A Case Series

Considerable number of intellectual disabled people experience some form of disruptive behavior. Antipsychotics are the most common treatment for these behaviors. Numerous patients were efficiently treated with thioridazine, recently withdrawn. The authors describe a case series of »thioridazine responders« treated with olanzapine. Thirty three patients with severe intellectual disability were recruited. All patients were assessed for seven types of disruptive behavior on five point scale. Patients with severe behavior disturbances were included in treatment. The time points of assessment were at day 0, 30, 60 and 180. Twenty one patient accomplished inclusion criteria. A significant decrease occurred at day 30 for all types of behavior. Total score, self injurious behavior, compulsive and destructive behavior showed further decrease at day 60 and became stable until the end of study. Olanzapine appears to be efficacious in the treatment of disruptive behavior in the intellectually disabled and could be substitute for thioridazine treatment

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

BURNOUT SYNDROME IN HEALTH PROFESSIONALS DURING THE COVID-19 PANDEMIC

Sindrom sagorijevanja na poslu (engl. burnout syndrome) rezultat je kroničnog stresa na poslu, uz korištenje relativno neučinkovitih strategija suočavanja sa stresom, a mnogobrojne studije provedene na medicinskim sestrama i liječnicima potvrđuju kako su mu posebno izloženi zdravstveni radnici. Tijekom pandemije bolesti COVID-19, zdravstveno osoblje postalo je izloženo i dodatnim stresnim čimbenicima, što povećava mogućnost razvijanja sindroma sagorijevanja. Ovaj pregledni rad donosi najnovije podatke o stopi prevalencije sindroma sagorijevanja u zdravstvenih radnika (medicinskih sestara i liječnika), prije i za vrijeme krize izazvane virusom SARS-CoV-19, te razmatra čimbenike koje utječu na razvitak sindroma sagorijevanja, s ciljem identificiranja čimbenika koji djeluju protektivno na mentalno zdravlje zdravstvenih djelatnika. Prikupljeni podaci u brojnim studijama potvrđuju kako je od velikog značenja pravovremeno razviti strategije prevencije, liječenja i rehabilitacije osoba sa sindromom sagorijevanja, čime bi se održalo mentalno zdravlje medicinskog osoblja, ali i kvaliteta skrbi koja se pruža pacijentima unutar zdravstvenog sustava.Burnout syndrome is a result of chronic stress at work, with the use of relatively ineffective coping strategies, and numerous studies conducted on nurses and physicians confirm that health professionals are particularly exposed to it. During the pandemic of COVID-19, medical staff has been exposed to additional stressors, which increase the possibility of developing burnout syndrome. This review paper provides recent data on the prevalence rate of burnout syndrome in healthcare professionals (nurses and physici-ans), before and during the SARS-CoV-19 virus crisis, and discusses the factors influencing the development of burnout syndrome, in order to identify the factors protecting the mental health of health professionals. The data collected in numerous studies confirm the importance of timely development of strategies for prevention, treatment, and rehabilitation of persons with burnout, which would maintain the mental health of medical staff, but also the quality of care provided to patients within the health system

[ČLANAK POVUČEN/ARTICLE RETRACTED] A novel concept to derive iodine status of human populations from frequency distribution properties of a hair iodine concentration

[ČLANAK POVUČEN/ARTICLE RETRACTED] Today, human iodine deficiency is next to iron the most common nutritional deficiency in developed European and underdeveloped third world countries, respectively. A current biological indicator of iodine status is urinary iodine that reflects the very recent iodine exposure, whereas some long term indicator of iodine status remains to be identified. We analyzed hair iodine in a prospective, observational, cross-sectional, and exploratory study involving 870 apparently healthy Croatians (270 men and 600 women). Hair iodine was analyzed with the inductively coupled plasma mass spectrometry (ICP MS). Population (n870) hair iodine (IH) respective median was 0.499μgg(-1) (0.482 and 0.508μgg(-1)) for men and women, respectively, suggesting no sex related difference. We studied the hair iodine uptake by the logistic sigmoid saturation curve of the median derivatives to assess iodine deficiency, adequacy and excess. We estimated the overt iodine deficiency to occur when hair iodine concentration is below 0.15μgg(-1). Then there was a saturation range interval of about 0.15-2.0μgg(-1) (r(2)=0.994). Eventually, the sigmoid curve became saturated at about 2.0μgg(-1) and upward, suggesting excessive iodine exposure. Hair appears to be a valuable and robust long term biological indicator tissue for assessing the iodine body status. We propose adequate iodine status to correspond with the hair iodine (IH) uptake saturation of 0.565-0.739μgg(-1) (55-65%)