RESUMO
Approximately 30% of people with schizophrenia fail to respond to first-line antipsychotic treatment which impacts the burden of the disease. Treatment-resistant schizophrenia (TRS) denotes patients with failure to respond to at least two adequate trials of different antipsychotics. Clozapine is a unique drug approved for treating treatment-resistant schizophrenia, however 1/3 of patients fail to respond to clozapine. Even though different strategies have been proposed for treating clozapine-resistant schizophrenia, the evidence is very limited, unclear, and of poor quality. A formal literature search was conducted and then, panel members were asked to complete 35 questions addressing different aspects of TRS. A modified Delphi method was used to unify expert opinion and achieve consensus. The expert consensus in diagnostic and treatment of TRS is the result of experts from the main national scientific societies under the organization of the Argentine Association of Biological Psychiatric (AAPB). The consensus statement aims to guide on diagnosis and treatment.
Assuntos
Antipsicóticos , Clozapina , Esquizofrenia , Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Quimioterapia Combinada , Humanos , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico , Esquizofrenia Resistente ao TratamentoRESUMO
The system of classification of psychiatric disorders has evolved during the last half-century. This article briefly reviews the modifications of the structure of the chapter "Schizophrenia spectrum and other psychotic disorders" in DSM-5; then analyzes in detail the changes that were specifically made for schizophrenia. Among them, the fundamentals are: a) the elimination of the special treatment of bizarre delusions and hallucinations of Schneiderian "first rank", b) the clarification of the definition of negative symptoms, and c) the addition of the requirement that at least one of the two required characteristic symptoms should be disorganized speech, hallucinations or delusions. It also discusses the elimination of subtypes of schizophrenia and the addition of psychopathological dimensions, and the consequences of the lack of validated biomarkers that could facilitate the diagnosis.
Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Esquizofrenia/classificação , Esquizofrenia/diagnóstico , HumanosRESUMO
The system of classification of psychiatric disorders has evolved during the last half-century. This article briefly reviews the modifications of the structure of the chapter "Schizophrenia spectrum and other psychotic disorders" in DSM-5; then analyzes in detail the changes that were specifically made for schizophrenia. Among them, the fundamentals are: a) the elimination of the special treatment of bizarre delusions and hallucinations of Schneiderian "first rank", b) the clarification of the definition of negative symptoms, and c) the addition of the requirement that at least one of the two required characteristic symptoms should be disorganized speech, hallucinations or delusions. It also discusses the elimination of subtypes of schizophrenia and the addition of psychopathological dimensions, and the consequences of the lack of validated biomarkers that could facilitate the diagnosis.
Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Esquizofrenia/classificação , Esquizofrenia/diagnóstico , HumanosRESUMO
The system of classification of psychiatric disorders has evolved during the last half-century. This article briefly reviews the modifications of the structure of the chapter "Schizophrenia spectrum and other psychotic disorders" in DSM-5; then analyzes in detail the changes that were specifically made for schizophrenia. Among them, the fundamentals are: a) the elimination of the special treatment of bizarre delusions and hallucinations of Schneiderian "first rank", b) the clarification of the definition of negative symptoms, and c) the addition of the requirement that at least one of the two required characteristic symptoms should be disorganized speech, hallucinations or delusions. It also discusses the elimination of subtypes of schizophrenia and the addition of psychopathological dimensions, and the consequences of the lack of validated biomarkers that could facilitate the diagnosis.
Assuntos
Esquizofrenia/classificação , Esquizofrenia/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , HumanosRESUMO
The modern era in the treatment of psychoses began with the synthesis of chlorpromazine in 1950. In the '60s it was already known that first generation antipsychotics were quite effective to reduce the positive symptoms of schizophrenia and allowed the de-institutionalisation of many people. In the '70s and '80s, research focused mainly on indications of antipsychotics and the benefits and risks of long-term pharmacotherapy. During the '90s, the rise of atypical or second generation antipsychotics generated enormous expectations about the possibility of further improving the treatment of schizophrenia. But in recent years we have seen that many of those expectations couldn't be met. This article reviews what happened with antipsychotics and their place in the treatment of schizophrenia in the past 20 years, and propose hypotheses about the reasons for that enthusiasm and subsequent disenchantment.
Assuntos
Antipsicóticos/uso terapêutico , Esquizofrenia/tratamento farmacológico , Antipsicóticos/classificação , Humanos , Padrões de Prática Médica/tendências , Fatores de TempoRESUMO
Schizophrenic patients have a life expectancy 20% shorter than general population, mainly due to cardiovascular disease. Several risk factors for cardiovascular disease are modifiable, and some, like blood glucose and lipids, and weight, can be worsened by antipsychotic drugs, mainly second generation ones. This article reviews the concept of metabolic syndrome and its relationship with schizophrenia and antipsychotic drugs. It also reviews the relationship between obesity, abdominal fat and schizophrenia, and the influence that second generation antipsychotics may have on weight. Antipsychotics are differentiated according to their liability of inducing weight gain, possible physiopathological mechanisms for weight gain are mentioned, and main pharmacological treatments to revert or prevent this situation are discussed. Some parameters for the periodic monitoring of the constitutive elements of metabolic syndrome to be used by psychiatrist in patients taking second generation antipsychotics are suggested.
Assuntos
Antipsicóticos/efeitos adversos , Síndrome Metabólica/induzido quimicamente , Esquizofrenia/tratamento farmacológico , Feminino , Humanos , Masculino , Obesidade/induzido quimicamenteRESUMO
OBJECTIVE: The objective of this study was to examine the prescribing practices of Argentinean psychiatrists in the treatment of major depression and to observe similarities and/or differences with some consensus or treatment guidelines. METHODOLOGY: Four hundred two psychiatrists were surveyed during a specialty meeting in October 2005. RESULTS: A total of 88.2 % of psychiatrists surveyed considered that every depressed patient must be treated with medication. The most prescribed antidepressants for outpatients were paroxetine, sertraline and fluoxetine. Venlafaxine was included for inpatients. The majority of psychiatrists indicated antidepressant therapy lasting from 12 to 24 months after remission of the first depressive episode. Antidepressant dosages remained unchanged during that period. A low percentage had used lithium or thyroid hormones as augmentation medications, the addition of other antidepressant being the most used augmentation strategy. The most prescribed antidepressant combination was dual antidepressants and SSRIs. Prescribing practices differed according to personal factors of the physicians. CONCLUSIONS: Discrepancies between clinical practice and treatment guidelines were observed. Further research over the underlying causes of these discrepancies and mechanisms to reduce them are necessary.
Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Uso de Medicamentos/estatística & dados numéricos , Serviços de Saúde Mental/normas , Padrões de Prática Médica/estatística & dados numéricos , Psiquiatria/normas , Argentina/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Humanos , Guias de Prática Clínica como Assunto , Inquéritos e QuestionáriosRESUMO
Psychiatric drugs bring indeniable benefits for the treatment of psychiatric disorders. But their use can come along with a varying degree of side effects, some of them known for a long time, and some that are at present starting to focus attention. In this group we can find metabolic side effects, because of their possible relationship with the mortality of patients with severe psychiatric disorders. In this article, effects of psychiatric drugs on glucose and lipids metabolism are revised.
Assuntos
Transtornos do Metabolismo de Glucose/induzido quimicamente , Hiperlipidemias/induzido quimicamente , Psicotrópicos/efeitos adversos , Diabetes Mellitus/etiologia , Humanos , Fatores de Risco , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológicoRESUMO
Psychiatric drugs bring indeniable benefits for the treatment of psychiatric disorders. But their use can come along with a varying degree of side effects, some of them known for a long time, and some that are at present starting to focus attention. In this group we can find metabolic side effects, because of their possible relationship with the mortality of patients with severe psychiatric disorders. In this article, effects of psychiatric drugs on glucose and lipids metabolism are revised.
RESUMO
Psychiatric drugs bring indeniable benefits for the treatment of psychiatric disorders. But their use can come along with a varying degree of side effects, some of them known for a long time, and some that are at present starting to focus attention. In this group we can find metabolic side effects, because of their possible relationship with the mortality of patients with severe psychiatric disorders. In this article, effects of psychiatric drugs on glucose and lipids metabolism are revised.
RESUMO
Incluye: elementos de farmacocinética aplicados a la psicofarmacología clínica; el efecto placebo; la farmacoeconomía y su impacto en la prescripción de psicofármacos; interacciones en psicofarmacología; modificaciones en los parámetros de laboratorio inducidos por psicofármacos; tratamiento farmacológico de la esquizofrenia, del trastorno depresivo mayor, de los trastornos de ansiedad, de los trastornos de la conducta alimentaria, del trastorno del límite de la personalidad, del trastorno por déficit de atención con hiperactividad en el paciente adulto, de los trastornos psiquiátricos durante el embarazo y la lactancia, de la demencia, de los trastornos psiquiátricos en el paciente anciano
Assuntos
Esquizofrenia , Transtorno Depressivo , Transtornos de Ansiedade , Transtornos da Alimentação e da Ingestão de Alimentos , Agitação Psicomotora , Transtornos do Sono-Vigília , Gravidez , Transtornos da Lactação , Demência , IdosoRESUMO
Incluye: elementos de farmacocinética aplicados a la psicofarmacología clínica; el efecto placebo; la farmacoeconomía y su impacto en la prescripción de psicofármacos; interacciones en psicofarmacología; modificaciones en los parámetros de laboratorio inducidos por psicofármacos; tratamiento farmacológico de la esquizofrenia, del trastorno depresivo mayor, de los trastornos de ansiedad, de los trastornos de la conducta alimentaria, del trastorno del límite de la personalidad, del trastorno por déficit de atención con hiperactividad en el paciente adulto, de los trastornos psiquiátricos durante el embarazo y la lactancia, de la demencia, de los trastornos psiquiátricos en el paciente anciano
Assuntos
Agitação Psicomotora , Demência , Esquizofrenia , Gravidez , Idoso , Transtorno Depressivo , Transtornos da Alimentação e da Ingestão de Alimentos , Transtornos da Lactação , Transtornos de Ansiedade , Transtornos do Sono-VigíliaRESUMO
Este libro está dirigido particularmente a los psiquiatras que deseen aprender a utilizar los psicofármacos actuales, pero también es accesible a los médicos de otras especialidades y a otros profesionales de la salud que trabajan con pacientes psiquiátricos. Está dividido en cuatro grandes capítulos: antidepresivos; ansiolíticos e hipnóticos; antipsicóticos y estabilizadores del ánimo