23 research outputs found
EVOLUTION OF PSYCHOPHARMACOTHERAPY IN RECENT YEARS, WITH AN EMPHASIS ON ANTYPSYCHOTICS, FROM THE PERSPECTIVE OF THE CLINIC FOR PSYCHIATRY OF UHC SPLIT
EVOLUTION OF PSYCHOPHARMACOTHERAPY IN RECENT YEARS, WITH AN EMPHASIS ON ANTYPSYCHOTICS, FROM THE PERSPECTIVE OF THE CLINIC FOR PSYCHIATRY OF UHC SPLIT
Long-Acting Antipsychotics
DugodjelujuÄi antipsihotici predstavljaju važno sredstvo u lijeÄenju shizofrenije, ali sve viÅ”e i drugih poremeÄaja s elementima psihotiÄnosti. Sve se viÅ”e naglaÅ”ava važnost njihova ranog uvoÄenja, pa i u prvoj psihotiÄnoj epizodi. NadmoÄni su nad oralnim antipsihoticima s obzirom na stopu rehospitalizacija, uÄestalost i težinu nuspojava, razinu oporavka funkcionalnosti i stopu mortaliteta. U Republici Hrvatskoj dostupni su dugodjelujuÄi 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 razliÄite naÄine mogu približiti njihove prednosti i umanjiti stigmu dugodjelujuÄih antipsihotika kao terapije rezervirane za teÅ”ke kliniÄke slike. Na temelju domaÄih i inozemnih iskustava može se unaprijediti naÄin rada s pacijentima koji koriste dugodjelujuÄe antipsihotike te proÅ”iriti njihova primjena. Od toga u konaÄnici korist imaju pacijenti, njihove obitelji, lijeÄnici 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 mokraÄi bolesnika lijeÄenog 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 patientās 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 mokraÄe Å”iroko su prihvaÄena metoda brzog otkrivanja moguÄe zloporabe psihoaktivnih supstanca. NajÄeÅ”Äe koriÅ”teni testovi analize mokraÄe na droge su imunokemijske metode, unatoÄ Äinjenici da su prijavljeni brojni sluÄajevi lažno-pozitivnih rezultata za mnoge od testova za brzo otkrivanje. Potvrda moguÄih pozitivnih probira mokraÄe na lijekove, koja je neophodna kako bi se smanjio broj prijava lažno pozitivnih rezultata, može biti skupa i zahtijevati veÄi utroÅ”ak vremena za analizu. Prikazuje se sluÄaj bolesnika T.M. zaprimljenog u Kliniku za psihijatriju KliniÄkog bolniÄkog centra Split poradi akutne psihotiÄne reakcije (F23). U mokraÄi bolesnika testiranog na metadon isti je otkriven, ali bez potvrde konzumacije istog. Analiza mokraÄe provedena je testom COBAS Integra Methadone II (kinetiÄka interakcija mikroÄestica u otopini, metoda KIMS) tvrtke Roche. Lijekovi koji su pokazali križnu reaktivnost s metadonom sadrže tricikliÄnu strukturu s atomima sumpora i duÅ”ika u srednjem prstenu, Å”to je zajedniÄko i kvetiapinu i metadonu. Stoga je za pretpostaviti da je strukturna sliÄnost 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 mokraÄe. 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