PA in the combination with THP has demonstrated the clear neuroprotective effect on the development, frequency and clinical presentations of neurological side-effects. The РА can be recommended as a drug of choice for correction and prevention of neuroleptic side-effects, it promotes their tolerability and improves quality of life during the course treatment.
Background: personalized approach considering the effectiveness and safety of the medication is the main goal of contemporary psychopharmacotherapy. Knowing special characteristics of any given drug allows a practitioner to choose the tactic meeting needs of the particular patient.The aim of this narrative review was to summarize the data about use Brexpiprazole of in pharmacotherapy of different mental disorders.Method: using the keywords “brexpiprazole”, “psychoses”, “treatment” we performed a scientific publications search in PubMed and PsychInfo databases over the last 10 years.Results: brexpiprazole is supposed to resemble such third generation antypsychotics as aripiprazole and cariprazine, lacking their drawbacks. There is a history of using brexpiprazole in schizophrenia and unipolar depression. Pilot studies and clinical cases were presented on the possible perspectives in use of brexpiprazole, such as Alzheimer disease, posttraumatic stress disorder, borderline personality disorder and bipolar affective disorder. On the basis of the reviewed data we conclude that brexpiprazole is effective for cupping and maintenance treatment of schizophrenia, for augmentation in recurrent depressive disorder and is also perspective in other fields of psychiatry. Brexpiprazole has a favorable safety profile with low incidence of metabolic, extrapyramidal and hyperstimulation symptoms.
Background: the results of previous studies suggest that the level of activation of inflammatory responses in the periphery correlates with the severity of cognitive impairment in patients with neurodegenerative diseases and can serve as an indicator of the activity of the current pathological process in the brain. Epigenetic factors are suggested to influence the regulation of (neuro)inflammation and cognitive recovery in elderly patients, which opens up a wide spectrum of therapeutic strategies for the treatment of age-associated diseases. Objective: to evaluate the possible effects of a comprehensive neurocognitive rehabilitation program on cognitive functioning and blood immunological parameters of elderly patients with mild cognitive impairment (MCI).Patients and methods: 507 participants of the “Memory Clinic” rehabilitation program with signs of MCI (F06.7, F06.78 according to ICD-10) were examined before the start of neurocognitive training and after its completion (after six weeks). Some patients (11.6%) were observed clinically one year after their inclusion in the program. Cognitive status was assessed using the Modified Hachinski Ischemic Scale, the Mini-Mental State Examination, the Montreal Cognitive Assessment, and the Clock Drawing Test. Enzymatic activity of leukocyte elastase (LE), functional activity of α1-proteinase inhibitor (α1-PI), and levels of antibodies to S-100B and myelin basic protein were determined in patients’ blood. The parameters of healthy donors were used as controls.Results: immunological examination of patients before the rehabilitation program revealed increased LE and α1-PI activity in the overall group compared to controls (p < 0.001 and p < 0.05). Using a previously developed regression model to identify a high-risk group for Alzheimer’s disease (AD) among patients with MCI, all subjects were divided into two groups (cut-off value p = 0.65). Group 1 (low-risk of AD, n = 330) was characterized by increased LE activity and α1-PI (p < 0.001), Group 2 (highrisk of AD, n = 177) was distinguished by decreased LE activity (p < 0.001) accompanied by high α1-PI activity (p < 0.001). After neurocognitive training, differently directed variants of the dynamics of immunological parameters associated with the severity of patients’ cognitive impairment on psychometric scales were identified in each group. For the most of the examined patients (61.3%) the training program turned out to be effective, which was confirmed by the positive dynamics of the psychometric scores and relative normalization of the blood inflammatory markers (p < 0.05). The highest effect of the rehabilitation program was typical for patients not included in the high-risk group for AD (p < 0.001). Follow-up examination revealed stabilization of cognitive functioning in 93.2% of those examined, most of whom were patients with an initially low risk of developing the disease (p < 0.01).Conclusion: neurocognitive rehabilitation of patients with MCI carried out in the “Memory Clinic” conditions can be considered as a social epigenetic factor modulating the current pathological process in patients with cognitive disorders, which is confirmed by objective immunological markers.
Objective: to develop and justify differentiated indications for the use of agomelatine (valdoxan) to treat the typological variants of endogenous depressions with varying severity on the basis of an analysis of its therapeutic efficacy.Patients and methods. An open prospective study was conducted using the clinical, psychopathological, and psychometric rating scales: the Hamilton Depression Rating Scale (HAMD-21); Udvalg for Kliniske Undersњgelser Scale (UKU); the Snaith-Hamilton Pleasure Scale (SHAPS) for assessing anhedonic disorders, and statistical methods. Examinations were made in 56 patients (mean age, 34.9 years) with moderate and severe endogenous depression within affective psychosis (n=42) and shift-like schizophrenia (n=14) (ICD-10 items F31.3–4; F32.1–2, and F33.1–2). The patients received a cycle treatment with agomelatine (valdoxan) 25–50 mg once a day in the evening for 4–8 weeks. The patients' status was evaluated over time on fixed days from a reduction in the mean total score (MTS) of the respective scales as insignificant (less than 19% reduction in disorders), moderate (20–49%), good (50–69%), and excellent (70% or more) effects. The effect of agomelatine was analyzed in two patient groups. The specific features of the antidepressive effect and its dynamics in the presence of endogenous depressions of different typologies (melancholic, anxious, and adynamic depressions) were studied in Group 1 (n=26); the effect of agomelatine on anhedonic endogenous depressions and manifestations of anhedonia in different mental activity areas (interests, social activity, emotional engagement and eating/drinking) was investigated in Group 2 (n=30).Results and discussion. There was a good tolerance and a high antidepressant activity of agomelatine during its treatment cycle for moderate and severe endogenous depressions. A significant improvement (an 84.4% reduction in HAMD-21 MTS) was noted in patients at 3 and 4 weeks of the treatment cycle and consistently persisted at a subsequent follow-up. Agomelatine showed a good effect (a 50% or more reduction in HAMD-21 MTS) just at 14 days of therapy. The drug was observed to have a balanced antidepressant effect, significant thymoleptic, stimulant, anxiolytic, and antianhedonic activities (reductions in the MTS of depressive disorders by 90.83, 84.9, 82.39, and 78.9%, respectively).Conclusion. The universal spectrum of the antidepressive effect of agomelatine, its good tolerability, high efficacy, and rapid improvement makes it the drug of choice in treating a wide range of psychopathological endogenous depressions: melancholic, apatho-adynamic, anxious, and anhedonic ones.
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