Behavioral and psychological symptoms represent common complications in patients with different types of dementia. Predominantly, they comprise psychosis, agitation and mood disorders, disinhibited behavior, impairment of the sleep and wakefulness rhythm, wandering, perseveration, pathological collecting, or shouting. Their appearance is related to more rapid progression of the disease, earlier institutionalization, use of physical restraints, and higher risk of mortality. Consequently, appearance of behavioral and psychological symptoms of dementia leads to higher costs of care provided and greater distress for caregivers. Clinical guidelines recommend nonpharmacological approaches as the first choice in the treatment of behavioral and psychological symptoms. Pharmacological therapy should be initiated only if the symptoms were not the result of somatic causes, did not respond to nonpharmacological interventions, or were not caused by the prior medication. Acetylcholinesterase inhibitors, memantine, antipsychotic drugs, antidepressants, mood stabilizers, and benzodiazepines are used. This review summarizes the current findings about the efficacy and safety of the treatment of the neuropsychiatric symptoms in dementias with psychopharmaceuticals. Recommendations for treatment with antipsychotics for this indication are described in detail as this drug group is prescribed most often and, at the same time, is related to the highest risk of adverse effects and increased mortality.
Introduction25-OH vitamin D level is an immediate precursor metabolite of the active form of vitamin D that leads to expression of more than 200 genes.AimsThe aim of our study was to examine 25-OH vitamin D deficiency (<50nmol/L) and its relationship to demographic factors in recently hospitalised patients with schizophrenia spectrum disorders (SSD).MethodsWe assessed 25-OH vitamin D serum level in 41 SSD patients (54% of males, 46% with first episode, 63% during sunny season [May to October]), mean age 30 ± 10.4 years, within first days of hospitalization. The serum 25-OH vitamin D level was analysed with electrochemiluminiscence, using imunoanalysators Elecsys Roche.ResultsThe serum level was significantly higher in sunny season (41.3 ± 27.2 nmol/L) than in November to April (28.4 ± 11.2 nmol/L): t-test, P < .05. Sixty-nine percent of patients suffered from 25-OH vitamin D deficiency (< 50nmol/L) in May to October and 100% during November to April. The 25-OH vitamin D serum levels were not different between males and females, or between first-episode and multiple-episode patients. No significant correlation between age and 25-OH vitamin D level was found.ConclusionsThe high prevalence of 25-OH vitamin D deficiency (< 50nmol/L) suggests that some patients with SSD may benefit from vitamin D supplementation.FundingThis study is a result of the research funded by the project Nr. LO1611 with a financial support from the MEYS under the NPU I program.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Introduction: Patients with schizophrenia have an increased risk of venous thromboembolism (VTE). The increased risk is more marked among new users and those prescribed atypical antipsychotic drugs. Platelet activation, changes of plasma coagulation, or fibrinolysis are likely to be responsible for the increase in thrombotic events. Methods: In the prospective ANTRE (ANtipsychotics ThRombosis Embolism) study we investigated the plasma levels of markers indicating activation of platelets (soluble P-selectin), coagulation (factor VIII) and fibrinolysis (D-dimers) in a group of thirty patients (seventeen males) with newly diagnosed psychosis (mean age 28.2, range 18-52 years) and in thirty-one healthy volunteers who were matched for age, gender and body mass index. We measured the haemostatic parameters at the time of patients' admission) and after three and twelve months during outpatient antipsychotic treatment. Results: At baseline there were significantly increased plasma levels of sP-selectin (P = 0.0003), D-dimers (P = 0.0007) and factor VIII (P = 0.0076) in the group of patients with acute psychosis as compared to healthy volunteers. After three and twelve months of patients' follow up we still observed increased levels of sP-selectin and D-dimers. Plasma levels of factor VIII were significantly increased after 3 months, but decreased after 12 months. Conclusions: We found an increase in markers of activation of haemostasis in patients in acute as well as in chronic stage of psychosis. Our results could explain the possible pathological mechanisms of VTE that are independent from antipsychotic treatment and play a role mainly in the acute phase of the disease.
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