1,720,975 research outputs found
The unmasking of hidden severe hyponatremia after long-term combination therapy in exacerbated bipolar patients: a case series.
No full textHyponatremia is occasionally unmasked in psychiatric patients during hospitalization after routine blood and urinary tests, and correlates in most cases with an inappropriate secretion of antidiuretic hormone, mainly due to iatrogenic factors. Only a few studies have regarded the combination of psychotropic drugs as triggers of chronic, asymptomatic hyponatremia in bipolar patients, who require to be hospitalized because of the exacerbation of their mental illness. We presented three clinical cases of patients affected by a long-term psychiatric disorder and under polypharmacotherapy for several months. After excluding other potential factors, we hypothesized that pharmacological treatment with a mood stabilizer (oxcarbazepine) associated with a benzodiazepine (delorazepam), a second-generation antipsychotic (olanzapine) or an antidepressant (fluvoxamine), triggered severe hyponatremia ([Na+] ≤125 mEq/L), serum hypo-osmolarity, and elevated inappropriate urine osmolarity added to more diluted sodium concentration. When we discontinued the treatment, clinical conditions of our patients improved, despite the previous administration of hypertonic saline jointly with water restriction. Psychiatrists should consider that bipolar patients on long-term polypharmacotherapy may present a higher risk of severe hyponatremia not clinically detectable. Consequently, routine laboratory tests should be periodically repeated as they represent the only available tool to unmask such electrolyte imbalances
L’Olanzapina è più rapida dell’Aloperidolo nell’indurre Sindrome Metabolica in pazienti schizofrenici ma non nei bipolari
No full textIl profilo metabolico dell’olanzapina rispetto all’aloperidolo è stato indagato meno nei pazienti bipolari che
negli schizofrenici. Sono stati analizzati 343 pazienti che avevano completato un trattamento di tre anni con
aloperidolo o olanzapina e valutati i parametri metabolici. Il 23% dei pazienti presentava sindrome
metabolica (SM), con una prevalenza di 25.3% nei bipolari e 21.2% negli schizofrenici; il 20.3% degli
schizofrenici trattati con aloperidolo e il 22.4% di quelli con olanzapina sviluppava SM, che si rilevava invece
nel 17.1% dei bipolari trattati con aloperidolo e nel 32.9% di quelli con olanzapina. Variazioni significative si
notavano al follow-up per colesterolo totale, pressione sistolica, peso corporeo e BMI; tali parametri
presentavano variazioni più marcate nei pazienti trattati con olanzapina rispetto a quelli con aloperidolo in
entrambi i gruppi diagnostici. Inoltre, un numero significativo di pazienti presentava SM già nel primo mese
di trattamento, ma solo negli schizofrenici l’olanzapina era più rapida rispetto all’aloperidolo nell’indurre
tale effetto. Aloperidolo e olanzapina aumentano il rischio di sviluppare SM sia negli schizofrenici che nei
bipolari con una più alta prevalenza per l’olanzapina solo nei bipolariSCOPO
Il profilo metabolico dell’olanzapina rispetto all’aloperidolo è stato indagato meno nei pazienti bipolari che
negli schizofrenici.
MATERIALI E METODI
Sono stati analizzati 343 pazienti che avevano completato un trattamento di tre anni con aloperidolo o olanzapina
e valutati i parametri metabolici.
RISULTATI
Il 23% dei pazienti presentava sindrome metabolica (SM), con una prevalenza di 25.3% nei bipolari e 21.2% negli
schizofrenici; il 20.3% degli schizofrenici trattati con aloperidolo e il 22.4% di quelli con olanzapina sviluppava
SM, che si rilevava invece nel 17.1% dei bipolari trattati con aloperidolo e nel 32.9% di quelli con olanzapina.
Variazioni significative si notavano al follow-up per colesterolo totale, pressione sistolica, peso corporeo
e BMI; tali parametri presentavano variazioni più marcate nei pazienti trattati con olanzapina rispetto a quelli
con aloperidolo in entrambi i gruppi diagnostici. Inoltre, un numero significativo di pazienti presentava SM già
nel primo mese di trattamento, ma solo negli schizofrenici l’olanzapina era più rapida rispetto all’aloperidolo
nell’indurre tale effetto. Aloperidolo e olanzapina aumentano il rischio di sviluppare SM sia negli schizofrenici
che nei bipolari con una più alta prevalenza per l’olanzapina solo nei bipolari.
CONCLUSIONI
Rispetto all’aloperidolo, l’olanzapina mostra uno sviluppo di SM più alto nei bipolari che negli schozofrenici,
mentre solo negli schizofrenici sembra essere più veloce dell’aloperidolo nell’indurre tali effetti
Second-Generation Antipsychotics’ Effectiveness and Tolerability: A Review of Real-World Studies in Patients with Schizophrenia and Related Disorders
No full textDespite methodological limitations, real-world studies might support clinicians by broadening the knowledge of antipsychotics’ (APs) effectiveness and tolerability in different clinical scenarios and complement clinical trials. We conducted an extensive literature search in the PubMed database to evaluate the effectiveness and tolerability profiles of second-generation antipsychotics (SGAs) from real-world studies to aid clinicians and researchers in selecting the proper treatment for patients with schizophrenia and related disorders. The present review evidenced that SGAs demonstrated superior effectiveness over first-generation antipsychotics (FGAs) in relapse-free survival and psychiatric hospitalization rate and for treating negative symptoms. Persistence and adherence to therapy were higher in SGAs than FGAs. Most studies concluded that switching to long-acting injectables (LAIs) was significantly associated with a lower treatment failure rate than monotherapy with oral SGAs. Considerable improvements in general functionality, subjective well-being, and total score on global satisfaction tests, besides improved personal and social performance, were reported in some studies on patients treated with LAI SGAs. Clozapine was also associated with the lowest rates of treatment failure and greater effectiveness over the other SGAs, although with more severe side effects. Effectiveness on primary negative symptoms and cognitive deficits was rarely measured in these studies. Based on the data analyzed in the present review, new treatments are needed with better tolerability and improved effectiveness for negative, affective, and cognitive symptoms
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Two Long-Acting Antipsychotics in a Patient with Treatment-Resistant Schizophrenia: A Case Report
No full textTreatment-resistant schizophrenia (TRS) poses significant therapeutic challenges due to persistent symptoms, poor adherence, and high relapse rates. Long-acting injectable (LAI) antipsychotics offer a promising approach, yet limited evidence exists regarding the combination of two LAI formulations. We report the case of a 62-year-old woman with TRS, characterized by recurrent hospitalizations and inadequate responses to oral and monotherapy treatments. During her latest hospitalization, she received alternating intramuscular administrations of haloperidol decanoate (100 mg/28 days) and aripiprazole (400 mg/28 days). The dual LAI strategy resulted in a marked improvement in psychotic symptoms, functional recovery, and treatment adherence, with no reported side effects. This case highlights the potential benefits of dual LAI therapy in managing TRS, particularly in patients with non-adherence to oral medications or limited response to standard treatments. Additional studies are required to evaluate the long-term effectiveness and safety of this innovative therapeutic approach
Drug safety warnings in psychiatry: Adverse drug reactions' signaling from 2002 to 2014
No full textObjective. Monitoring drug-related side effects in psychiatric patients is highly recommended. In fact, frequent exposure to long-term polipharmacotherapy, poor compliance to pharmachological treatment and comorbidity with organic illnesses requiring the prescription of other drugs are causes of pharmacokinetic/pharmacodynamic interactions. These vulnerability factors result in a certain increase in adverse drug reactions (ADRs). Methods. This study performes an analysis of Italian Medicine Agency data, in the section "signal analysis", to attempt an assessment of the safety warnings among the different psychotropic drug classes, belonging to the ATC class: N03 (antiepileptics), N05 (antipsychotics), N06 (psycho-analectic drugs). Then we analysed, in a descriptive way, the different association between the drug and the related ADR, evaluating the different safety profiles, in relation to experimental studies, supporting the importance of the signal. Results. In the last years, among the new 25 ADRs, 10 were related to antidepressant drugs (8 SSRI, 1 mirtazapine, 1 agomelatine). In relation to antipsychotic drugs, 6 new correlations were found between drug and ADR onset, mainly among atypical antispychotics. Other correlations (6 above all) were found among antiepileptic drugs. Among benzodiazepines, a signal linked to rabdomylysis onset was found. It is also recommended an evaluation of safety profile in relation to zolpidem prescription. Discussion. The results of our systematic review are a motivational input, considering the continuous increase of safety warnings, to attentively monitor drug's prescription. Spontaneous ADRs' signaling is a classical system to provide the required attention in relation to a potential risk. The clinician in charge must report this because he is the key figure in the drugs' safety process. Conclusions. In psychiatry, in which a long-term pharmachological therapy is frequent, clinicians are requested to find and signal ADRs to the competent authority
Variations on the Author
No full text“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
No full textWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
No full textWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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