Long-Acting Antipsychotics

Dugodjelujući antipsihotici predstavljaju važno sredstvo u liječenju shizofrenije, ali sve više i drugih poremećaja s elementima psihotičnosti. Sve se više naglašava važnost njihova ranog uvođenja, pa i u prvoj psihotičnoj epizodi. Nadmoćni su nad oralnim antipsihoticima s obzirom na stopu rehospitalizacija, učestalost i težinu nuspojava, razinu oporavka funkcionalnosti i stopu mortaliteta. U Republici Hrvatskoj dostupni su dugodjelujući haloperidol, flufenazin, risperidon, paliperidon, olanzapin i aripiprazol. Iako su izrazito potentni, nedovoljno se koriste. Potrebno je dodatno educirati psihijatre, ali i druge dionike zdravstvenog sustava o njihovim benefitima. Pacijentima se na različite načine mogu približiti njihove prednosti i umanjiti stigmu dugodjelujućih antipsihotika kao terapije rezervirane za teške kliničke slike. Na temelju domaćih i inozemnih iskustava može se unaprijediti način rada s pacijentima koji koriste dugodjelujuće antipsihotike te proširiti njihova primjena. Od toga u konačnici korist imaju pacijenti, njihove obitelji, liječnici i zdravstveni sustav.Long-acting antipsychotics are an important tool in the treatment of schizophrenia, but also of other disorders with psychotic elements. The importance of their early introduction, even in the first psychotic episode, is being emphasized more and more. Long-acting antipsychotics are superior to oral antipsychotics in terms of rehospitalization, frequency and severity of side effects, level of functional recovery and mortality rate. Long-acting haloperidol, fluphenazine, risperidone, paliperidone, olanzapine and aripiprazole are available in the Republic of Croatia. Although they are extremely effective, they are not used enough. It is necessary to inform psychiatrists and health workers on their benefits. Patients can benefit in different ways and reduce the stigma of long-acting antipsychotics as a therapy reserved for harsh clinical pictures. Based on national and global experiences, methods for patients who use long-acting antipsychotics can be improved and their use can be expanded. This ultimately benefits the patients, their families, doctors, and the healthcare system as a whole

Lažno pozitivni nalaz metadona u mokraći bolesnika liječenog kvetiapinom

We present a case of T.M. admitted to University Department of Psychiatry, Split University Hospital Center, in Croatia, because of the acute psychotic reaction (F23.9). The patient’s urine tested positive for methadone without a history of methadone ingestion. Urine drug screen was performed with the COBAS Integra Methadone II test kit (kinetic interaction of microparticles in solution /KIMS/ methodology) by Roche. Drugs that have been shown to cross-react with methadone feature a tricyclic structure with a sulfur and nitrogen atom in the middle ring, which is common for both quetiapine and methadone. Therefore, it is plausible that this structural similarity between quetiapine and methadone could underlie the cross-reactivity on methadone drug screen. Besides quetiapine, a number of routinely prescribed medications have been associated with triggering false-positive urine drug screen results. Verification of the test results with a different screening test or additional analytical tests should be performed to avoid adverse consequences for the patients.Testovi probira mokraće široko su prihvaćena metoda brzog otkrivanja moguće zloporabe psihoaktivnih supstanca. Najčešće korišteni testovi analize mokraće na droge su imunokemijske metode, unatoč činjenici da su prijavljeni brojni slučajevi lažno-pozitivnih rezultata za mnoge od testova za brzo otkrivanje. Potvrda mogućih pozitivnih probira mokraće na lijekove, koja je neophodna kako bi se smanjio broj prijava lažno pozitivnih rezultata, može biti skupa i zahtijevati veći utrošak vremena za analizu. Prikazuje se slučaj bolesnika T.M. zaprimljenog u Kliniku za psihijatriju Kliničkog bolničkog centra Split poradi akutne psihotične reakcije (F23). U mokraći bolesnika testiranog na metadon isti je otkriven, ali bez potvrde konzumacije istog. Analiza mokraće provedena je testom COBAS Integra Methadone II (kinetička interakcija mikročestica u otopini, metoda KIMS) tvrtke Roche. Lijekovi koji su pokazali križnu reaktivnost s metadonom sadrže tricikličnu strukturu s atomima sumpora i dušika u srednjem prstenu, što je zajedničko i kvetiapinu i metadonu. Stoga je za pretpostaviti da je strukturna sličnost kvetiapina i metadona uzrokom križne reaktivnosti u testu probira na metadon. Uz kvetiapin, velik broj rutinski propisivanih lijekova pokazao je povezanost s pojavom lažno-pozitivnih rezultata u testovima mokraće. Kako bi se izbjegle neželjene posljedice za bolesnike potrebna je verifikacija rezultata dodatnim metodama potvrde

METABOLIC SYNDROME AND INFLAMMATION MARKERS IN PATIENTS WITH SCHIZOPHRENIA AND RECURRENT DEPRESSIVE DISORDER

Background: The high prevalence of metabolic syndrome in patients with psychiatric disorders, almost double the prevalence reported for the general population, is worrying. The aim of this study is to investigate the presence of metabolic syndrome and inflammatory marker levels in patients with schizophrenia and recurrent depressive disorder in a Croatian psychiatric sample. Subjects and methods: This study included 62 inpatients with schizophrenia and 62 with recurrent depressive disorder treated at the Department of Psychiatry, University Hospital Centre Split, enrolled from November 2011 until May 2012. The cases were compared to 124 healthy subjects from the general population. Results: The presence of metabolic syndrome was found in 56.5% of the patients with schizophrenia and 53.2% of the patients with depression, which was significantly more prevalent than in the control group (32.3%). The levels of inflammation markers (i.e., C-reactive protein and PAI-1) were significantly higher among patients with metabolic syndrome. Conclusions: Patients with schizophrenia and recurrent depressive disorder demonstrate a high prevalence of metabolic syndrome that is also related to inflammation processes. In the context of integrative medicine, clinicians and researchers should consider psychiatric patients within a holistic approach

Blood lactate levels in patients receiving first- or second- generation antipsychotics

Aim To compare the blood lactate levels between patients with psychotic disorder receiving first- and those receiving second-generation antipsychotics. Methods The study was conducted at the psychiatric inpatient and outpatient clinics of the Split Clinical Hospital from June 6, 2008 to October 10, 2009. Sixty patients with psychotic disorder who were assigned to 6-month treatment were divided in two groups: 30 received haloperidol (first generation antipsychotic) and 30 received olanzapine (second generation antipsychotic). Blood lactate levels, other metabolic parameters, and scores on the extrapyramidal symptom rating scale were assessed. Results Patients receiving haloperidol had significantly higher blood lactate levels than patients receiving olanzapine (P < 0.001). They also more frequently had parkinsonism, which was significantly correlated with both haloperidol treatment at 1 month (P < 0.001) and 6 months (P = 0.016) and olanzapine treatment at baseline (P = 0.016), 3 months (P = 0.019), and 6 months (P = 0.021). Also, patients receiving haloperidol had significant correlation between blood lactate and dystonia at 1 month (P < 0.001) and 6 months (P = 0.012) and tardive dyskinesia at 1 month (P = 0.032). There was a significant difference between the treatment groups in lactate levels at all points from baseline to month 6 (P < 0.001). Conclusion It is important to be aware of the potential effect of haloperidol treatment on increase in blood lactate levels and occurrence of extrapyramidal side effects. Therefore, alternative antipsychotics should be prescribed with lower risk of adverse side effects. Trial identification number: NCT0113946