RESUMEN
INTRODUCTION: The rate of pharmacoresistance among in patients diagnosed with schizophrenia is around 30%. Clozapineis the drug of choice for these patients; however, an adequate response to treatment doesn't always occur. One of the possible augmentation approaches, specifically for non-adherent patients, is the administration of long-acting parenteral antipsychotics. Our goal was to evaluate previous experiences of administering a combination of the atypical antipsychotic clozapine and long-acting injectable antipsychotics to pharmacoresistant patients at the Department of Psychiatry the Czech Republic and to assess the safety and effectiveness of such administration. METHODS: A retrospective evaluation of patient case studies was conducted for those who were hospitalized in the Ward for the therapy of Psychotic disorders between 2016 and 2020 and had a medication history of combining clozapine and depot antipsychotics. RESULTS: Over half of the patients had no illness relapses during the observed period. The clinical manifestation of adverse effects from combination therapy appears low in our patient sample, primarily involving mild and pharmacologically manageable side effects (tachycardia). Only one of the cases recorded neutropenia, which led to discontinuation of clozapine; the patient was maintained on long-acting injectable antipsychotics medication. CONCLUSION: From our findings, it can be inferred that augmenting clozapine with depot antipsychotics is a potential therapeutic intervention that pharmacoresistant patients could benefit from. However, it is essential to emphasize that this therapeutic approach should only be administered after carefully considering the patient's existing treatment. It should be strictly individualized based on the treating physician's or clinical pharmacist's sufficient professional experience.
Asunto(s)
Antipsicóticos , Clozapina , Esquizofrenia , Humanos , Antipsicóticos/efectos adversos , Clozapina/efectos adversos , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/inducido químicamente , Esquizofrenia Resistente al Tratamiento , Salud Mental , Estudios RetrospectivosRESUMEN
We have previously shown that patients with severe depressive episode exhibit higher aldosterone concentrations compared to those with moderate depressive episode. The present study was undertaken to test the hypothesis that circulating concentration of aldosterone reflect the clinical state in patients with schizophrenia. The sample consisted of 36 hospitalized patients (25 men, 11 women) with the first episode or long-term course of schizophrenia. The severity of psychopathology was evaluated using the Positive and Negative Syndrome Scale (PANSS). Samples for measurement of serum aldosterone were obtained immediately after awakening. The results showed that serum aldosterone concentrations were lower in patients with the first episode compared to those in patients with long-term course of schizophrenia. Importantly, lower aldosterone concentrations observed in patients with the first episode were associated with more severe clinical symptoms as indicated by all subscales of PANSS. Serum cortisol concentrations did not differ between the groups, while the aldosterone/cortisol ratio showed similar pattern as aldosterone concentrations. The present pilot study suggests that circulating aldosterone in patients with schizophrenia may reflect the severity of clinical symptoms but in an opposite direction than in patients with major depressive disorder.
Asunto(s)
Aldosterona/sangre , Hidrocortisona/sangre , Esquizofrenia/sangre , Adulto , Antipsicóticos/uso terapéutico , Correlación de Datos , Femenino , Humanos , Estudios Longitudinales , Masculino , Proyectos Piloto , Escalas de Valoración Psiquiátrica , Esquizofrenia/tratamiento farmacológicoAsunto(s)
Balneología , Pacientes/psicología , Enfermedades de la Columna Vertebral/terapia , Adulto , Actitud , Emociones , Femenino , Humanos , Masculino , Persona de Mediana Edad , SíndromeRESUMEN
A different structure of values and life frustrations was observed in subjects with psychosomatic disease than in healthy subjects. The subjects with ischemic disease were affected mostly in the sphere of working and existential needs, whereas their family and social relations were not disturbed, and they were not frustrated in the sphere of material needs, either. On the other hand subjects with ulcer disease felt much more affected in social relations and in primary material needs.