Several clinical studies have shown a large number of mental symptoms by immunomodulatory treatment with interferon (IFN). The most frequently described symptoms are depression, suicidal behaviour, manic symptoms, anxiety, psychosis and delirium, associated with other non-specific symptoms such as fatigue, irritability, psychomotor retardation, decreased libido, insomnia, difficulty in concentration and attention. Having a history of mental disorder contraindicates the use of IFN-alpha. These adverse effects that affect the mental state appear usually at the beginning of the treatment (most after 3 weeks of treatment). The incidence of psychotic episodes is low and the episodes usually remit when treatment is interrupted; only some cases require antipsychotic treatment. We present the case of a patient affected with hepatitis C who began to present self-referential delirious symptoms after receiving the treatment with IFN and who was successfully treated with paliperidone. This patient could be classified within the group of high-risk psychiatric patients given the family history of schizophrenia and his personal history of illegal drug consumption. The pharmacological actions of paliperidone are similar to other high potency atypical antipsychotics. The receptor-binding profile of paliperidone most closely resembles that of risperidone and ziprasidone. Paliperidone differs from risperidone and most other antipsychotics by its relatively low extent of enzymatic hepatic metabolism. To the best of our knowledge, this is the first case described that was successfully treated with paliperidone.
Wilson disease (WD) is an uncommon recessive genetic disorder affecting copper metabolism. Cardiac, neurological, hepatic and renal manifestations are well defined, nevertheless approximately 30% of patients debut with neuropsychiatric symptoms. These psychiatric alterations resulting from the accumulation of this heavy metal in the basal ganglia are some how less specific. We present a short review of psychiatric symptoms of WD and describe a case of a 37-year-old woman diagnosed with WD who presented neuropsychiatric symptoms and had a consequent delay in diagnosis and causal treatment. Patients who develop WD starting with a predominance of neuropsychiatric symptoms tend to manifest hepatic symptoms later, therefore have a longer delay of diagnosis and a poorer outcome than patients with hepatic symptoms. An early diagnosis of WD can avoid irreversible neurological damage.
IntroductionAripiprazole long-acting injection is the latest long-acting injectable (LAI) antipsychotic medication released in the market which requires a monthly injection.ObjectivesThe aim of our study is to present our experience in the use of Aripiprazole long-acting injection as maintenance therapy in patients with schizophrenia and other psychotic disorders.MethodologyOur sample consists of 20 patients who started treatment with long acting aripiprazole during the last 6 months of its release. Validated scales for collecting information on sociodemographic, clinical evaluation (CGI scale), quality of life (health questionnaire SF-36) and function (Sheehan Disability Inventory and social relationship scale SBS) were used.ResultsThe health condition of the patients was generally good and 68% reported feeling better than during the last year. Social functioning was adequate (level 1 or 2) in about 70% of the patients. Social, employment and family's disability was mild in 57% of cases, the average stress’ perception was 23% and the average social support perception was 72%. Regarding the clinical evaluation, in comparison to the initiation of the treatment 18% of the patients were slightly better, 45% moderately better and 36% much better.ConclusionA remarkable clinical improvement was observed, maintaining good health, with an acceptable level of functionality. This study shows that the incorporation of long-acting Aripiprazole to the treatment of our sample has been a significant improvement in overall functioning of the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionLong-acting injectable aripiprazole is the most recently introduced depot treatment in schizophrenia.ObjectivesThe objective of this study is to determine the tolerability and safety of this new treatment.AimsThe aim is to provide useful information regarding the use of this new drug.MethodsOur sample consists on 20 patients treated with a monthly dose of long-acting ariprazole. They were previously stabilized on oral aripiprazole before the first injection. The data on tolerability and safety were obtained by face-to-face interviews, using the Hogan Drug Attitude Inventory, the Patient Satisfaction with Medication Questionnaire and the UKU Side Effects Scale.ResultsOur sample consists of 20 patients, with a 50/50 gender distribution and a mean age of 39 years. The average score in the satisfaction scale Hogan was positive (an average of 7.25). In the Patient Satisfaction With Medication Questionnaire, 85% said they were satisfied with the new treatment, compared with 15% who showed some degree of dissatisfaction with the change. Overall, 90% of patients showed a preference for the current treatment compared to the previous. The patients showed good tolerance to medication, with a low score in the UKU scale (total score = 13.5). Side effects did not interfere with daily activity of the patient.ConclusionsLong acting injectable aripiprazole proved to be a safe treatment, with a good degree of acceptance among patients. These advantages makes of this new drug a useful addition to our kit tool.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Introduction: Current classification of bipolar disorder (BD) in type I or type II may be of little use in routine clinical practice to provide information on relevance epidemiological and clinical variables. New complementary coders like the predominant polarity (PP), which is defined as a clear tendency in the patient to present relapses in the manic polarity predominance (MPP) or in the depressive polarity predominance (DPP) along the disease may be important to develop clinical and pharmacological strategies to prevent any kind of relapse. Objectives: To define the concept of PP and the epidemiological and clinical variables associated with the PP in order to know the clinical implications of that specific diagnosis factor. Methods: We realized a systematic review in the principal medical databases (until June 2016) including key words as "bipolar disorder", "polarity" and "predominant polarity". Results: After apply the inclusion criteria we analysed 16 articles. The MPP was associated with manic onset of illness, history of substance abuse before the beginning of the disease and with a better response to atypical antipsychotics and mood stabilizers. Meanwhile the DPP is related with a depressive onset of the disease, a higher number of relapses, longer acute episodes, and a higher risk of suicide. Also, the delay until the correct diagnosis, the presence of mixed states and the comorbidity with anxiety disorders are more frequents in DPP that shows an increased use of quetiapine and lamotrigine. Conclusion: PP may be useful in the clinical management of BD. Further studies on biological and clinical factors are needed, with a common definition and a unified methodology.
IntroductionThe main factors that are involved in a correct adherence to the therapeutic recommendations in Bipolar Disorder includes aspects related to age, sex, ethnicity, socioeconomic level and characteristics of the illness associated with the severity, comorbidity and adverse effects related to previous medicine.ObjectivesTo analyse the individual perception that the patient with Bipolar Disorder has regarding the positive and negative aspects of taking the recommended medication.MethodsDescriptive and interpretative observational study under the qualitative paradigm of research, extracting the data through the completion of four focus groups with ten patients everyone. To complete the codification of the content of the participant’s discourses, we rely on the QRS NVivo 10 computer program.ResultsIn the participant’s discourse concerning the main barriers to pharmacological treatment, for example “It’s because we live in a society and, because of that, we don’t go without medicine; if we didn’t live in society, we wouldn’t take medicine because we wouldn’t bother anyone”. Some examples of patient’s discourse, about perceived facilitators were: “I have to take medicine for my bipolar disorder, that’s it, I have a treatment, my illness has a name”.ConclusionsThe main facilitators regarding the use of pharmacological treatment in Bipolar Disorder are the perceived need for treatment in the acute phase and the recognition of the illness, the shared clinical decision and the causal biological attribution in the chronic phase. About perceived barriers, social control is identified in both phases, adverse effects in the acute cases and the absence of effective treatment in the chronic state.
IntroductionIt has been shown that long-acting treatments can significantly improve adherence, control symptom, and reduce the risk of relapse compared to oral drugs. However, limited real world evidence is available as to whether there are differences among the various formulations marketed.ObjectivesThis study aims to assess the impact on several prognosis variables of PP1M,PP3M,AOM and OAP drugs.MethodsAll adults (≥18 years) with schizophrenia who were initiated on PP1M, PP3M, AOM, or OAP treatment (chlorpromazine,levomepromazine,fluphenazine,haloperidol,ziprasidone,zuclopenthixol,olanzapine,quetiapine,asenapine,amisulpride, risperidone,aripiprazole,paliperidone) between 2017 and 2018 were identified in IQVIA’s database(1.8M of inhabitants from 4 Spanish areas). The rate of hospitalizations, emergency room visits, and treatment persistence was calculated using the Kaplan-Meier method. Survival curves were compared using the log-rank test (Sidak-adjustment),and Cox´s Hazard Ratios (HR) were used for the comparison between groups.ResultsData from 2275 patients were analyzed (PP1M= 387;PP3M=490;AOM=75;OAP=1323).The mean age of patients was 46.8(14.95) years, and 62.9% were male. The hospitalization rate at 12 months was significantly lower (p<0.01) for PP3M (8.3%) than for AOM (21.2%), PP1M (22.1%),and OAP (29.4%).When compared with PP3M use, the HRs were 2.17 for PP1M, 2.22 for AOM,and 2.90 for OAP. Emergency room visits rate at 12 months was also significantly lower (p<0. 01) for PP3M (23%) than for PP1M (36.9%), OAP (43.5%),and AOM (46.2%). Persistence rates were higher for PP3M (91%) than for any other treatment (p<0.01).ConclusionsOur results outline that patients treated with PP3M experienced fewer relapses and decompensations compared to all other treatments analyzed, which might help improve the prognosis and quality of life of patients.Conflict of interestThis study was sponsored by Janssen. M. García and P. López are employees of Janssen.
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