To assess how effective paliperidone is for psychotic symptoms of patients with HIV/AIDS and to assess neuropsychiatric, liver and metabolic side effects associated with paliperidone.

The participants were 9 patients with HIV/AIDS who had psychotic symptoms. These patients were assessed with the brief psychiatric rating scale (BPRS), and the cut-off point was 21. Neurocognitive impairment was assessed with the mini-mental state examination (MMSE), using a cut-off point of 28. Hemathological tests serum transaminases were performed to determine liver function and metabolic syndrome study was implemented as defined by the National Cholesterol Education Program. All patients started taking medication with paliperidone up to 3-9 mg/kg. After a one, three and six-month period of treatment, the patients were reassessed using UKU side-effect rating scale, BPRS, hemathological tests and a full metabolic symdrome study.

Paliperidone is an effective antipsychotic drug: only one patient had psychotic symptoms. Paliperidone didn’t cause any side-effect in none of the nine patients, had a good profile of tolerance regarding liver function, any patient suffered changes in hemathological tests serum transaminases and there wasn’t any significant change in metabolic parameters of the nine patients. Any patient suffered cognitive impairment using MMSE.

Paliperidone can be considered a highly effective treatment for patients with psychotic symptoms and HIV/AIDS. This drug has a good antipsychotic profile, doesn’t affect liver function, doesn’t cause neuropsychiatric side-effects and doesn’t cause metabolic syndrome after a six-month treatment. These findings support this drug as first choice treatment of this kind of patients.

To value medication adherence and discontinuation of treatment among first episode psychosis patients (FEP) treated with quetiapine or extended release of quetiapine (XR).

Patients with a first episode of psychosis, age 26+/- 2(N=24) were randomly assigned to treatment with quetiapine 300 mg for twice daily(n=12), or quetiapine rp 300mg/day in one administration daily(n=12),for a 6 months period

The drop-out of patients for any cause thought the 6-months study was:2 for quetiapine and 6 for quetiapine XR. However, symptom reduction were the same in both groups.

To conclude: According to a interview conducted with patients, there is more compliance to therapy for patients treated with quetiapine XR, they prefer to be given a day instead of twice daily administration. Fewest drop-out with quetiapine XR is probably also due to steady-state quetiapiana rp is reached more quickly and better maintained, resulting in greater clinical control.

Transcranial magnetic stimulation (TMS) is a novel treatment for patients with depressive disorder. TMS is a noninvasive method to excite neurons in the brain: weak electric currents are induced in the tissue by rapidly changing magnetic fields. We report two cases suffering from pharmacoresistant depression and the efficacy of TMS in their treatment.

The first case was a 45-year-old male Caucasian patient suffering from unipolar depression and the second case was a 53-year-old female Caucasian patient suffering from bipolar depression.

The patients were under treatment with SSRI, SNRI, NASSA (one medicine or combination of them) without any or minor improvement.

So TMS sessions were performed daily in both patients for a period of one month.

A marked reduction of depressive symptoms was demonstrated in both patients. Thus, TMS sessions may help the pharmacoresistant depression by minimizing physical and subjective discomfort. Furthermore TMS appears to be safer and better tolerated than many others medicines or electroconvulsive therapy. Further studies are needed in order to investigate the effect of TMS in resistant depression

To describe the socio-demographic and clinical characteristics, complications and therapeutic response of patients treated with ECT in the Psychiatric Unit of the General Hospital from University of Campinas-Brazil (1993-2007).

All medical records of the patients who underwent ECT were reviewed and compiled for subsequent statistical analysis by SPSS program.

156 patients were studied. Ages ranged from 13 to 78 years-old, with a mean of 39.9±17.8 years-old [95% CI: 37.2-42.8 years]. There were 64 (41%) men and 92 (59%) women. The main diagnostic categories of the patients submitted to ECT were: schizophrenia (33.9%), depression without psychotic symptoms (30.8%), depression with psychotic symptoms (39.1%), bipolar disorder (18.6%) and schizoaffective disorder (3.2%). Complications occurred during the procedure in 98 cases (62.8%), immediately after the application in 85 cases (54.5%) and three days after the last session in 33 cases (21.2%).

The response to ECT was: good response in 132 (84.6%) patients, unchanged psychiatric symptoms in 14 (9%) patients and worsening in 3 (1.9%). The mean time of permanence inside the Psychiatric Unit was 57.5±38.2 days [95% CI: 51.4-63.2 days].

Table1 1: Complications during the procedure

Table 2: Complications immediately after the proce

Table 3: Complications at least three days after t

The diagnostic categories for which ECT therapy corresponded to those described in the literature. Data suggest that the incidence of complications was moderate and the response to treatment was positive in most cases, reinforcing the importance of this therapeutic method for the treatment of patients with severe mental illness.

To determine the outcome of patients who underwent ECT in a Brazilian General Hospital between 1993 and 2007.

Telephone contact with all patients (or their relatives) who were submitted to ECT during psychiatric hospitalization in HC-Unicamp-Brazil. Data were compiled for statistical analysis at SPSS.

There were 53 successful telephone contacts (33.9% of 153 patients who underwent ECT). Losses were due to changes of telephones/addresses. No refuses occurred. The mean time between the procedure and the contact was 55.4 months (3-170). Twenty patients (37.3%) and 37 relatives (69.8%) were interviewed. Most were women (60.4% n=32), 4 were inpatients by the occasion of the call and 4 died. The mean age was 42.9±19.4. The assessments of current mental state by patients were: excellent in 5-9.4% cases, good in 12-22.6%, poor in 2-3.8%. The evaluation by family members was: excellent in 11-20.8% cases, good in 11-20.8%, poor in 7-13.2% and very poor in 5-9.4%. In 42 cases (79.2%) the patient was still under psychiatric treatment (taking psychotropic medication in 39-73.6%). In 28 cases (54%) there was need for new admission in a psychiatric inpatient ward. In 38 cases (74%) the patient reported knowing that he/she had undergone ECT, and only in 5 cases (9.4%) there was a lasting side effect of treatment reported, which was change in memory.

Data of the evolution of patients corroborate the importance of treatment with ECT for severe mental disorders, and also shows the low rate of long-term complications related to the procedure.

To explore the relationship between symptomatic and functional outcomes in a five week, double blind, fixed dose, placebo controlled study in adults (age 18-65 years) with ADHD.

Post hoc-analysis of a five-week, double-blind (DB), parallel arm, placebo-controlled trial in adult subjects with ADHD (DSM-IV) and a Conners’ Adult ADHD Rating Scale (CAARS) score >= 24 at baseline. Subjects were randomized to OROS-MPH (18mg, 36mg, 72 mg/day) or placebo. Symptomatic outcomes were assessed by total CAARS score (TCS). Functional outcomes were assessed by Sheehan Disability Scale (SDS) total score and subscales (work, social life and family life), quality of life by Q-LES-Q total score. The relationship of CAARS with SDS and Q-LES-Q was assessed by Pearson's partial correlation analysis, with adjustment for baseline scores of CAARS, SDS, Q-LES-Q, CGI-S, age, sex, and randomization group.

401 subjects were enrolled (54.4% male, mean (SD) age 34 (10.24) yrs). There was a significant treatment effect as measured in TCS at DB endpoint for all OROS MPH treatment groups compared to placebo (P< 0.05). The absolute value of partial correlations of symptomatic outcome with functional outcomes and quality of life varied between 0.54 and 0.36; all correlations were significant (p< 0.0001). These correlations were compared between the functional and quality of life measures, but none differed significantly.

Subjects’ symptomatic improvements during treatment with PR OROS MPH are reflected in improvements in their vocational and social function as measured by the SDS, and quality of life.

For the investigation well be study binding of 3H-PK11195 with mitochondrial membranes prepared from different brain regions and the binding of 3H-PK 11195 with peripheral blood trombocytes were separated from fresh blood.

A comparative studies of 3H-PK11195 binding to PBR from brain cortex, caudatus and cerebellum in alcoholics (A) and non-alcoholics (NA) post-mortem showed that properties of PBR are not identical in different brain regions. The largest density of binding sites was found in brain cortex, the less one - in cerebellum and in nucleus caudatus (in A and in NA). The highest binding affinity for the PBR was found in nucleus caudatus than for PBR in brain cortex and in cerebellum (in A and in NA). Study of the properties of PBR in NA (non-alcoholic) and A (alcoholic) in different brain structures showed the reduction of the affinity and increasing of PBR binding sites in A. We found similar alterations of PBR in peripheral blood trombocytes that suggests close connection between central and peripheral benzodiazepine receptor systems

Complex central actions of ethanol could include effects on neurosteroid production mediated through peripheral types of benzodiazepine receptors located in mitochondrial membranes in nervous tissue and plasmatic membrane of trombocytes.

To compare prescribing practices of hypnotics against NICE guidelines (National Institute of Clinical Excellence) and to develop recommendations with action plan. The NICE recommends:

• • Due consideration should be given to non-pharmacological measures prior to hypnotic prescription.

• • Hypnotics should be prescribed for short periods of time only (maximum 4 weeks)

• • The drug with the lowest purchase cost should be prescribed.

• • Switching from one hypnotic to another should only occur if a patient experiences adverse effects.

The audit tool was developed. The data was compiled using medical records of the patients who were seen during a specified three month time period in an out-patient setting. A total sample size of 308 was generated out of which 41(12.5%) were being prescribed hypnotics. The medical records of these 41 patients were scrutinised to gather evidence whether NICE guidelines were adhered to. The data was analysed using the tool recommended by NICE.

The significant results are:

• • Only 25% of the patients were advised Non-pharmacological measures.

• • Duration of prescription ranged from one week to more than 10 years, with 33% approximately being prescribed for less than one year, and 10% being prescribed for more than 10 years.

• • There is no evidence that consideration was given to cost while prescribing.

• • Only in one patient hypnotic was switched. However, there was no evidence of adverse reaction which could be directly related to the hypnotic prescribed.

The overall compliance with guidelines was found to be 42%.

When comparing the efficay of antipsychotics in clinical studies it would be of high practical relevance to know which doses of the respective drugs would result in equivalent blocking of dopamine-D2-receptors. This study aimed to find clinically applicable dose equivalents for haloperidol, risperidone and olanzapine.

As the occurrence of EPS correlates closely with a blockade of about 80% or more of dopamin-D2-receptors the proportion of patients developing EPS in relation to various doses of either Haloperidol (n=5252), risperidone (n=5017) or olanzapine (n =5029) was calculated. This retrospective, observational study included 20.252 inpatients from 20 hospitals with a diagnosis of schizophrenia and related disorders (ICD10 F20-25). The prescription of anticholinergic medication was utilized as surrogate parameter for the occurrence of EPS. OR, RR and NNH under different doses of AP were calculated and data entered into a probit model to predict the risk of EPS over a continuous dose range. For filtering the data ToscanaJ (FBA) was used.

1. 1.) Same doses of risperidone and haloperidol induced the same proportion of EPS, reflected in a constant dose ratio of both drugs of ∼ 1:1 over the whole dose range.

2. 2.) Over the whole dose range there was no linear relation between olanzapine on one hand and haloperidol and risperidone on the other hand.

3. 3.) The results were corroborated by the probit analysis.

Previous clinical trials comparing olanzapine, risperidone and haloperidol found higher risks of EPS for Haloperidol. We propose a new model to calculate dose equivalents.

Escitalopram is considered to be more effective than citalopram and to have less side effects. Previous studies have found that common cardiac manifestations of escitalopram overdose are QT prolongation and bradycardia. Some case reports inform about bradycardia without ECG abnormalities with therapeutic doses of escitalopram.

We report of a 29-year-old female patient diagnosed with major depression, hospitalized for 2 weeks. She had no history of any treatment with antidepressive drugs. After administration of 5 mg/day escitalopram the patient's blood pressure and pulse rate were mildly reduced and we observed presyncopal episodes daily. After 1 week of treatment the dose of escitalopram was raised to 10 mg/day and she complained about dizziness. In this case we found that presyncopal episodes lasted longer and both hypotension and bradycardia increased. These symptoms disappeared within 24 hours after escitalopram treatment was discontinuated. Results from routine laboratory tests, ECG, EEG, brain CT were normal. No other farmacologic causes were supposed to induce the above mentioned vegetativ symptoms.

Bradycardia and hypotonia have been previously reported with citalopram, but there are only a few case reports about these side effects induced by a therapeutic dose of escitalopram. Both central and - by directly inhibiting the entry of Ca into vascular smooth muscles resulting in vasodilatation - periferial effects of escitalopram are supposed to be responsible for these rare phenomena. This case report supports the importance of monitoring heart rate and blood pressure when escitalopram treatment is introduced, especially in cases of previously untreated depressive patients.

The response rate of obsessive compulsive disorder is 21.6% to 61.3%; which shows the relative resistance to current treatments and a need for novel methods. Here, we have reported a case of resistant obsessive compulsive disorder (OCD) with fast and dramatic response to a relatively new method named repeated transcranial magnetic stimulation (rTMS). In rTMS a pulse magnetic field is emitted from a coil over the surface of the scalp which induces a localized electrical current in the cortex below. Cortical activity can then be either inhibited or stimulated.

The patient is a 40 years old female admitted for severe OCD in Mashhad Ibn-e-Sina Psychiatric Hospital. The patient was treated with 10 sessions of rTMS on right supplementary motor area (SMA) with 110% intensity, 1 Hz frequency and duration of 30 minutes per day (a total of 1200 pulses per day). Improvement of patient was evaluated serially with Yale Brown scale. By the end of the 2nd day she reported a major improvement of her symptoms. Her improvement was so dramatic in obsessive and compulsive behaviors and her avoidance recovered completely. She also reported significant improvement in her ability to control her obsessive thoughts and impulses and her anxiety symptoms.

Considering that rTMS is a low risk method and has almost no interaction with the common medications and the faster response with this method, it seems that it can be used as supplementary treatment in resistant cases and even in the initial stages of OCD.

To analyze the use of Clozapine in six children and adolescents with Serious Conduct Disorder, whose symptoms had been refractory to other pharmacology treatment. Scalar analysis is supplied for the more important psychopathology aspects and the changes with therapeutic one.

Six patients diagnosed with Serious Conduct Disorder are described who had begun the use of Clozapine. They had been widely studied and received application of standardized instruments of infantile psychiatry (CBCL - Child Behavior Check List) before and after the use of this medication.

The patients had mainly significant improvement in relation to the level of aggressiveness and social behavior.

Although ample studies on the use of this medication in children and adolescents do not yet exist, more precisely for cases of Serious Conduct Disorder, the preliminary results are very positive and indicate that Clozapine could be an important tool in the handling of the aggressiveness in those refractory patients with Serious Conduct Disorder.

To evaluate the comparative efficacy of 3 antidepressants, each representative of a distinct psychopharmacologic class, in the treatment of depressive disorders associated to Parkinson disease with dementia (PDD).

A group of 23 patients, mean age 72.1, diagnosed with PDD for at least 2 years, who were admitted in our department for a major depressive episode (DSM IV TR), received antidepressant treatment with escitalopram (mean dose 15 mg daily, n=7), duloxetine (mean dose 45 mg daily, n=8) or trazodone (mean dose 150 mg daily, n=8). All patients received treatment for PDD with rivastigmine or donepezil continuously, for at least 12 months. The distribution of patients on the antidepressant treatment was randomized, in a single-blind manner. Patients were evaluated monthly, for 6 months, using Montgomery Asberg Depression Rating Scale, Hamilton Rating Scale for Depression- 17 items, Clinical Global Impression-Improvement and Mini Mental Status Examination.

Patients treated with duloxetine had the most significant improvement in the depressive symptoms, as the endpoint MADRS (-18.6+/-2.3, p< 0.01), HAMD (-13.2+/-1.1, p< 0.01) and CGI-I (- 3.2+/-0.5, p< 0.01) scores reflected. The differences between escitalopram and trazodone didn’t reach a significant level but, overall, both improved the depressive symptoms compared to baseline (p< 0.05). The difference between duloxetine and the other two antidepressants became significant after 8 weeks (p< 0.01). The severity of dementia symptoms didn’t vary significantly between the three groups at endpoint.

Duloxetine had proven itself more efficient than escitalopram and trazodone in the improvement of the depressive symptoms in PDD.

To evaluate the impact of depression treatment over the quality of life in oncologic patients.

A group of 27 patients, 14 male and 13 female, mean age 56,3, diagnosed with lung (n=7), gastric (n=7), prostate (n=5), colon (n=4) and breast (n=4) cancer, were also diagnosed with moderate or severe depression (Hamilton Depression Rating Scale-17 items score at the inclusion was over 14). These patients received a combined, psychopharmacological (escitalopram mean daily dose 15 mg, n=15 or mirtazapine, mean daily dose 30 mg, n=12) and psychotherapeutic (cognitive behavior therapy) approach for 3 months and were monitored using monthly HAMD, Global Assessment of Functioning and Lehman Quality of Life Interview (QOLI). Patients didn’t present any significant axis I, II or III comorbid condition.

Patients responded well to the combined therapy, as the final HAMD (-11.2, p< 0.01) and GAF (+12.3, p< 0.01) scores reflected, with no significant inter-group difference (p=0.23). The quality of life scales regarding health, family relations and social relations from the QOLI registered significant improvement compared to baseline (+10%, +12.2% and +12.5% respectively, p< 0.01). Patients who had the higher response rate to the treatment also had the higher rate of life quality improvement (r=0.65).

The treatment of depression in oncologic patients is a necessity, due to the impact of depressive symptoms over the patient quality of life and is associated with a significant rate of success. The improvements are observed especially in the patient perception of health, family and social relationship and functioning.

Comparative studies prove that levetiracetam therapy presents a major frequency of behavioral disturbances, producing problems of impulsive aggressiveness with a relative frequency. Principally if a previous psychiatric history is associated.

Report a case of Impulsive homicide aggression in a patient treated with Levetiracetam. Extensive bibliographical review.

We describe the case of a patient admitted in our Psychiatric acute unit because a major depressive disorder and mild cognitive impairment associated with vascular factors that developed strange impulsive aggressive behavior after the initiation of treatment with levetiracetam, even to try to assassinate his wife. Follow-up visits were performed at 6 and 12 months after discharge to assess aggressive behavior and the change in the Barratt impulsivity scale and the hostility inventory of Buss-Durkee. We conducted a literature review of behavioral and aggression problems associated with treatment with levetiracetam and its possible mechanisms.

After the phasing out of levetiracetam and replacement by oxcarbazepine, aggressive behaviors disappeared. No significant psychopathology was showed in the patient in the follow-up visits, except secondary to preexisting cognitive impairment.

According to studies reviewed a 7-13% of patients treated with levetiracetam may develop behavioral disorders with impulsive aggression that usually resolve after discontinuation of drug.

Comparative studies show that levetiracetam has a greater frequency of such effects, leading to problems of impulsive aggression relatively often, especially if there is a comorbid psychiatric pathology.

Improvement in symptoms of depression is typically delayed with antidepressant treatment. Pipamperone (PIP) at low doses acts as a highly selective 5HT2A/D4 receptor antagonist. The purpose of this study was to investigate whether the addition of PIP to the SSRI citalopram (CIT) would increase the rate of resolution of depressive symptoms.

This was an 8-week, double-blind, parallel-group, single-dummy study in patients with MDD who received either CIT 40 mg daily or PIP 5 mg bid plus CIT 40 mg daily (PIPCIT).

The mean total MADRS score (±SD) of the 165 patients (81% women; mean age, 40 y) was 32.6±5.5. More CIT than PIPCIT patients discontinued treatment in the first 4 weeks [15 (18%) vs 3 (4%); P=0.003]. Reductions in mean total MADRS scores were significantly (ITT LOCF) larger in patients receiving PIPCIT after 1 week [-6.42±6.18 vs -3.99±5.15; P=0.007] and 4 weeks [-15.06±8.48 vs - 12.11±8.30; P=0.025] compared with those receiving CIT alone. Significant differences in favor of PIPCIT were observed in MADRS items “reduced sleep,” “reduced appetite,” “concentration difficulties,” and “pessimistic thoughts.” Mean CGI-I scores were also improved after 1 week of PIPCIT [3.09±0.85 vs. 3.47±0.72; P=0.002]. There were no significant differences observed at 8 weeks. No additional, clinically significant adverse events were noted in the PIPCIT group.

A low dose of PIP added to CIT provided superior antidepressant effects and less discontinuations compared with CIT alone during the first 4 weeks of treatment, and especially in the first week, at apparently no tolerability/safety cost.

Orexin (hypocretin) neuropeptides are produced by a cluster of neurons in the hypothalamus. They are central to a variety of functions, including promoting arousal and sleep, feeding and metabolism, addiction and regulating motivation. Deficiencies and over-activation in each of these functional systems have a great impact on the daily lives of millions. We need to apply the lessons learned from the current knowledge to potentially modulate them by pharmocological interference in a clinical setting.

To analyse current experimental literature on the orexin pathways in reward and addiction; assessing potential molecular targets for pharmacological interference; reviewing clinical evidence already available.

PubMed - searched with MeSH term “orexin” or “hypocretin”, with additional terms; “addiction”, “stress”, “relapse”, “VTA”, “Nucleus Accumbens”, “treatment”.

We outline all the important parmacological targets through which orexins have their effect via different downstream effectors. Moreover we propose that since orexins have an important interplay with corticotrophin-releasing-factor (CRF) in the role of stress-mediated drug-seeking behaviour; it is a ripe target for intervention. Novel, orally administered orexin antagonists, have potential to promote sleep and attenuate reward circuitry, however only within narrow therapeutic ranges.

Orexin functions are so wide-ranging that systemic orexin antagonism would cause detrimental side-effects, unless low enough doses are applied. Therefore molecule-specific and locationspecific down-stream targeting will be required, using knowledge of experimentally elucidated molecular mechanisms. Various orexin agonists and antagonists are available, and by understanding their mechanism of interaction we can potentially use them as a model for future treatments of addiction.

Tardive dyskinesia(TD) is a syndrome characterized by repetitive involuntary movements, usually involving mouth, face and tongue and sometimes the extremities. Atypical antipsychotics are of significantly lower risk for causing tardive dyskinesia, about one-fifth comparing with first generation antipsychotics. Furthermore, there is growing evidence that they may have a therapeutic effect on TD. We present a case that demonstrated a marked improvement in risperidone-induced TD following treatment with aripiprazole.

Mr. A is a 21-year-old single male with a DSM-IV-TR diagnosis of schizophrenia, of approximately 2 years duration. He was mainly maintained on risperidone 4-6 mg/day during this time. Upon his admittance to our clinic, he was suffering auditory hallucinations, persecutory delusions, social withdrawal and he was noticed to have had some involuntary mouth movements. The patient scored three out of four (moderate) on the ‘lips and peri-oral area’ subcategory of the- Abnormal Involuntary Movement Scale (AIMS). A cranial CT scan was unremarkable and there was no past history or family history of neuro-psychiatric disorders. He was started on aripiprazole 15 miligrams per day.

Within two weeks a marked improvement was seen in his psychotic symptoms and he scored 2 on the AIMS. Two months after starting aripiprazole, he was free of psychotic symptoms and dyskinetic movements.

Altough atypical antipsychotics are known to be associated with lower risk of developing tardive dyskinesia, psychiatrists should be aware of these rare conditions. Aripiprazole, as a partial dopamine agonist, might be an alternate pharmacotherapy in threating psychosis and atypical antipsychotic-induced TD.

We investigated biological and clinical-genealogical peculiarities in families of patients suffering from non-psychotic mental disorders with disturbance of respiratory system function - hyperventilation syndrome (HVS).

We studied content of alveomucin in serum of blood of 43 patients from them 40 women and 3 men. Age was from 18 to 63 years. Genealogies of families of patients with indication of mental and somatic health of relatives were composed.

In personal assessment of patients in 39 from 43 cases (90%) hysteric traits of various degree of severity. In 18 cases HVS was manifested as vegetative crises while in 25 cases disturbances of respiration were not abruptly expressed but permanent. Concentration of alveomucin in persons with hysteric disorders constitutes 20,87±1,85, in patients with adjustment disorders with predominance of depressive reactions this index is 24,91±3,36, what is somewhat higher of content of alveomucin in mentally healthy persons (20,21±4,17). In families of patients relatives of first degree with personal peculiarities and mental disorders have been revealed as well as somatic diseases of organs of respiratory system.

Non-psychotic mental disorders with disturbance of function of respiratory system are accompanied by increase of content of alveomucin in serum of blood of patients and mental peculiarities and diseases of respiratory system in nearest relatives.