Medication and aggressiveness in real-world schizophrenia. Results from the FACE-SZ dataset

IntroductionThe primary objective of this study was to determine if second generation antipsychotic (SGA) administration was associated with lower aggressiveness scores compared to first generation (FGA) in schizophrenia (SZ). The secondary objective was to determine if antidepressants, mood stabilizers and benzodiazepines administration were respectively associated with lower aggressiveness scores compared to patients who were not administered these medications.MethodsThree hundred and thirty-one patients with schizophrenia (n = 255) or schizoaffective disorder (n = 76) (mean age = 32.5 years, 75.5% male gender) were systematically included in the network of FondaMental Expert Center for Schizophrenia and assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders and validated scales for psychotic symptomatology, insight and compliance. Aggressiveness was measured by the Buss-Perry Aggression Questionnaire (BPAQ) score. Ongoing psychotropic treatment was recorded.ResultsPatients who received SGA had lower BPAQ scores than patients who did not (P = 0.01). On the contrary, patients who received benzodiazepines had higher BPAQ scores than patients who did not (P = 0.04). These results were found independently of socio-demographical variables, psychotic symptomatology, insight, compliance into treatment, daily-administered antipsychotic dose, the way of antipsychotic administration (oral vs long acting), current alcohol disorder and daily cannabis consumption.ConclusionThe results of the present study are in favor of the choice of SGA in SZ patients with aggressiveness, but these results need further investigation in longitudinal studies. Given the potent side effects of benzodiazepines (especially dependency and cognitive impairment) and the results of the present study, their long-term prescription is not recommended in patients with schizophrenia and aggressive behavior.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Medication and aggressiveness in real-world schizophrenia. Results from the FACE-SZ dataset

European Psychiatry ◽

10.1016/j.eurpsy.2015.09.309 ◽

2015 ◽

Vol 30 (S2) ◽

pp. S153-S154

Author(s):

M. Favez ◽

G. Fond ◽

L. Boyer ◽

P.M. Llorca ◽

A. Pelissolo

Keyword(s):

First Generation ◽

Second Generation ◽

Primary Objective ◽

Mood Stabilizers ◽

Significant Difference ◽

Cannabis Consumption ◽

The Face ◽

Aggression Questionnaire ◽

Axis I ◽

Long Acting

The primary objective of this study was to determine if second generation antipsychotic (SGA) administration was associated with lower aggressiveness scores compared to first generation (FGA). The secondary objective was to determine if antidepressants, mood stabilizers and benzodiazepines administration were respectively associated with lower aggressiveness scores compared to patients who were not administered these medications. 331 patients with schizophrenia (n = 255) or schizoaffective disorder (n = 76) (mean age = 32.5 years, 75.5 % male gender) were systematically included in the network of FondaMental Expert Center for Schizophrenia and assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders and validated scales for psychotic symptomatology, insight and compliance. Aggressiveness was measured by the Buss-Perry Aggression Questionnaire (BPAQ) score. Ongoing psychotropic treatment was recorded. Patients who received SGA had lower BPAQ scores than patients who did not (p = 0.01). More specifically, these patients had lower physical and verbal aggression scores. On the contrary, patients who received benzodiazepines had higher BPAQ scores than patients who did not (p = 0.04). No significant difference was found between BPAQ scores of patients respectively being administered mood stabilizers (including valproate), antidepressant, and the patients who were not. These results were found independently of socio-demographical variables, psychotic symptomatology, insight, compliance into treatment, daily-administered antipsychotic dose, the way of antipsychotic administration (oral vs long acting), current alcohol disorder and daily cannabis consumption. The results of the present study are in favor of a superior efficacy of second-generation antipsychotics in aggressiveness in patients with schizophrenia, but these results need further investigation in longitudinal studies. Given the potent side effects of benzodiazepines (especially dependency and cognitive impairment) and the results of the present study, their long-term prescription is not recommended in patients with schizophrenia and aggressive behavior.

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Incidência da utilização de protetores bucais em diversos esportes de contato

Full Dentistry in Science ◽

10.24077/2020;1245-118122 ◽

2020 ◽

Vol 12 (45) ◽

pp. 118-122

Author(s):

Victor Paes Dias Gonçalves ◽

Hugo Leonardo Matias Nahmias ◽

Marcus Menezes Alves Azevedo

Keyword(s):

Martial Arts ◽

Rio De Janeiro ◽

Dental Trauma ◽

Primary Objective ◽

Type Ii ◽

Contact Sports ◽

The Face ◽

Secondary Objective ◽

The City

Among contact sports, the practice of martial arts offers a greater risk of causing dental trauma and fractures as contact with the face is more frequent. The primary objective of the research is to evaluate the incidence of mouthguard use, and the secondary objective is to verify which type has a greater predominance and the difficulties in its use correlating to the type of mouthguard used. A documentary study was carried out with 273 athletes of different contact sports, among them: MMA, Boxing, Muay Thai, Jiu-Jitsu, and Taekwondo of the city of Campos dos Goytacazes, Rio de Janeiro, Brazil. It was concluded that the most commonly used mouthguard is PB Boils and Bites - Type II and its level of approval is poor, interfering with the athletes’ performance, mainly in relation to the breathing factor.

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Discontinuation, read missions and polytherapy with long-acting antipsychotics: An observational study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1997 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S540-S540

Author(s):

I. García Cabeza ◽

P. Pérez Marín ◽

H. De Diego

Keyword(s):

Observational Study ◽

First Generation ◽

Paliperidone Palmitate ◽

Categorical Variables ◽

Anticholinergic Drugs ◽

Psychoactive Drugs ◽

Oral Medications ◽

Competing Interest ◽

Long Acting

Introduction and aimLong-acting antipsychotics (LAIs) provide certain advantages over oral medications. The aim of our study is to determine whether there are differences between the various long-acting injectable antipsychotics available in our environment.MethodsA retrospective observational study with psychotic patients discharged with LAIs was designed. Data on discontinuation, relapses and associated drugs in the discharge and in a year follow-up were collected. Fifty-seven patients were included: 21 risperidone (RLAI), 20 paliperidone palmitate (PP) and 16 first-generation LAIs (FG). Odds ratio was used to compare discontinuation, χ2 test for categorical variables and Kruskal-Wallis test for independent samples.ResultsDiscontinuation was lower with PP: ORRLAI/PP = 2.74 and ORFGLAI/PP = 3.09. There were significant differences in readmissions: rehospitalizations (χ2 = 7.072, P = 0.029) and days of stay (χ2 = 8.251; P = 0.016), both lower in the PP group. We found less use of psychoactive drugs with PP, with significant differences in the discharge (χ2 = 11.518; P = 0.003) and in the follow-up (χ2 = 7.097; P = 0.029). There were also significant differences in the use of oral antipsychotics in the discharge (χ2 = 27.049, P = 0.000); anticholinergic drugs in the discharge (χ2 = 7.001, P = 0.03) and in the follow-up (χ2 = 11.699, P = 0.003) and benzodiazepines in the follow-up (χ2 = 8.493, P = 0.014), always lower in the group of patients treated with PP.ConclusionsTreatment with paliperidone palmitate may be more suitable than other long acting antipsychotics when it starts during the acute episode.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Depot aripiprazole as maintenance treatment in bipolar disorder: Report of a case

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1154 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S332-S332

Author(s):

C. Gómez Sánchez-Lafuente ◽

R. Reina Gonzalez ◽

A. De Severac Cano ◽

I. Tilves Santiago ◽

F. Moreno De Lara ◽

...

Keyword(s):

Bipolar Disorder ◽

Maintenance Treatment ◽

Oral Treatment ◽

Manic Episode ◽

Mood Stabilizers ◽

Community Center ◽

Psychotic Symptoms ◽

Competing Interest ◽

Long Acting

IntroductionRecently, depot aripiprazole was approved as a maintenance treatment for schizophrenia. However, long-acting antipsychotics has not been established efficacy in manic episode or maintenance treatment of bipolar disorder.AimsDescribe a clinical case of multiresistant bipolar disorder.MethodsThirty-nine years old male, diagnosed since 8 years ago with bipolar disorder, current episode manic with psychotic symptoms, admitted to Acute Psychiatrist Unit. It was his seventh internment. He was dysphoric, had insomnia, and showed many psychotic symptoms like grandiose delusions and delusions of reference. He thought he was a famous painter from nineteenth century.His disorder was refractory to mood stabilizers monotherapy and to many neuroleptic and, like olanzapine 30 mg/day, depot risperidone, zuclopenthixol, haloperidol, palmitate paliperidone, He was on treatment with lithium 1200 mg/day (lithemia 0.62 prior to admission) and oral aripiprazole 15 mg/day that he was not taking regularly. Poor compliance to oral treatment. No awareness of illness.Resultsduring the patient admission, we started long-acting aripiprazole 400 mg per 28–30 days. First 3 days he persisted dysphoric, hostile, and showing delusions of mind being read. From the fourth day, delusions disappeared and later he was calmer and more friendly, He was discharged 9 days later fully euthymic.For 6 months follow-up, the patient came once a month to community center for aripiprazole injection and he was taking lithium regularly. Last lithemia 0.65 mEQ/L.ConclusionLong-acting antipsychotics, like depot aripiprazole could be a useful alternative to oral medication, specially when there is no awareness of illness and there is low adherence to oral treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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A case of pharmacologic extrapyramidal syndrome

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1623 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s828-s829

Author(s):

O. Porta Olivares ◽

M. Juncal Ruiz ◽

B. Fernández Abascal Puente ◽

M. Gómez Revuelta ◽

G. Pardo de Santayana Jenaro ◽

...

Keyword(s):

First Generation ◽

Partial Agonist ◽

Functional Limitation ◽

Adjustment Disorder ◽

Psychotic Symptoms ◽

Extrapyramidal Syndrome ◽

Extrapyramidal Effects ◽

Competing Interest ◽

Clinically Significant ◽

Long Acting

IntroductionMore than 60% of patients receiving intensive treatment with first generation antipsychotic manifest some type of clinically significant extrapyramidal side effects. Parkinsonian syndrome is the most common and is characterized by rigidity, tremors, akinesia and bradykinesia and usually improves with discontinuation of antipsychotic drug or anticholinergic association.MethodsIt is a 60-year-old man, married with two children. Initiates contact with mental health in 2013 with a diagnosis of adjustment disorder. In February 2014 he requires hospitalisation, establishing the diagnosis of delusional disorder and starting treatment with long-acting injectable paliperidone palmitate (100 mg/month) with remission of psychotic symptoms in a few days. When we receive the patient in our clinic, he presents parkinsonian extrapyramidal symptoms (UKU subscale: 18), with significant functional limitation. We decrease the dose to 75 mg/month and an anticholinergic was added without improvement of Parkinsonian clinic, so we decided to switch to long-acting injectable aripiprazole 400 mg/month, objectifying complete remission of extrapyramidal syndrome (UKU subscale: 0).ConclusionsThe mechanism of action of aripiprazole m LAI (partial agonist of D2 receptors in the brain) without decreases in the nigrostriatal dopamine pathway, of improving extrapyramidal effects associated one other antipsychotics.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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A mirror image study of the utility of long acting aripiprazole

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.640 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s252-s252

Author(s):

R. Hodgson ◽

C. Aladakatti ◽

N. Kataria ◽

T. Saravanappa ◽

D. Brittany

Keyword(s):

Mental Health ◽

First Generation ◽

Time Frame ◽

Blood Parameters ◽

Mirror Image ◽

Image Study ◽

Intention To Treat ◽

Competing Interest ◽

Long Acting ◽

The Uk

Aims and backgroundAblify Maintena (AM) is a long acting injection of aripiprazole that received marketing authorisation in the UK in January 2014. It is costly compared to first generation antipsychotics (FGAs) LAIs and there are no robust trials comparing AM with FGAs. We examined the effectiveness and use of AM in a mental health trust.MethodsWe identified all patients prescribed AM in North Staffordshire (population: 470,000) since launch and examined records for demography, diagnosis, bed and medication use. We examined the effectiveness of AM using a mirror image design.ResultsThirty patients received AM in a time frame allowing a 1-year follow-up. Sixty-nine percent were male and the mean age was 39 years. Over half were detained under the 1983 Mental Health Act and 30% were inpatients on a psychiatric intensive care unit when AM was started. Twenty-eight patients had a psychotic diagnosis. There was a significant reduction in bed occupancy (63 v 6 days, P = 0.0001) and admissions (1.6 v 0.5, P = 0.0001). The median dose was 400 mg. Lack of effectiveness/poor adherence with prior treatments were the main reason for starting AM in 84%. Eighty-six percent of patients clinically improved on AM. Blood parameters were in the normal range.DiscussionWithin the limitations of the methodology, our results show a reduction in psychiatric bed use in the year following AM initiation on an intention to treat basis. The reduction in bed use equates to a minimum annual saving of £14,250 per patient. AM at the median study dose costs £2645 per year.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Institutionalization of patients with schizophrenia in the modern era

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2145 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S579-S579

Author(s):

P. Ifteni ◽

A. Szalontay ◽

A. Teodorescu

Keyword(s):

First Generation ◽

Young Patients ◽

Chronic Patients ◽

Lower Education Level ◽

Younger Age ◽

Controlled Treatment ◽

Competing Interest ◽

Institutionalized Patients ◽

Long Acting ◽

Early Intervention In Psychosis

IntroductionPatients with schizophrenia requiring long-term institutionalization represent cases with poor outcome, often leading to high costs for patients and family and constituting a huge economical burden for society if patients are young.AimsThe aims were the evaluation of patient hospitalized for long period in a psychiatric hospital for chronic patients.ObjectivesThe objectives of the study were identification of characteristics and predictors of institutionalization in schizophrenia.MethodsRetrospective study of all institutionalized patients with schizophrenia in Brasov County, Romania, with a DSM-IV-TR lifetime diagnosis of schizophrenia institutionalized between 1995 and 2014.ResultsInstitutionalized patients between 2005 and 2014 (n = 172) had lower age (51.15 vs. 57.08, P < 0.05) and lower age at institutionalization compared with patients admitted between 1995 and 2004. Lower education level (8.23 vs. 13.22, P < 0.05), only one parent, multiple antipsychotics treatments and suboptimal response under first generation long acting antipsychotics are predictors for institutionalization. Haloperidol is the main treatment option (42.54%) followed by olanzapine 17.1% and clozapine 10.24%.ConclusionsOur study showed a tendency to institutionalize patients with schizophrenia at the younger age compared with past decades. Early intervention in psychosis, controlled treatment with SGAs should be solutions to avoid institutionalization of young patients with schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The Student Room Survey: Changes in the Post Graduate Study for Cardiothoracic Surgery

Journal of Surgical Sciences ◽

10.3329/jss.v23i2.46113 ◽

2020 ◽

Vol 23 (2) ◽

pp. 71-74

Author(s):

Md Faizus Sazzad ◽

Mohammed Moniruzzaman ◽

Dewan Iftakher Raza Choudhury ◽

Arif Ahmed Mohiuddin ◽

Raafi Rahman ◽

...

Keyword(s):

Thoracic Surgery ◽

Retrospective Analysis ◽

Primary Objective ◽

Graduate Study ◽

Postgraduate Students ◽

Depth Interview ◽

Secondary Objective ◽

Cardio Vascular ◽

The University ◽

Day By Day

Background: The number of postgraduate students in Cardiac surgical discipline is increasing day by day with incremental proportion are measurably suffering from the unnecessary lingering of the present course curriculum. The primary objective of this study was to find out the last 5 years’ of results of Masters in Surgery course under the University of Dhaka from a student room survey. A secondary objective was to find out positive changes that could show us the way of a step toward up-gradation. Methods: It is a retrospective analysis of all examination results of Cardio-vascular & Thoracic Surgery published since January 2008 to January 2013 from the University of Dhaka with in depth interview of 11 participants. Results: 85.24% students failed to pass part-I of Masters in Surgery for Cardio-vascular & Thoracic Surgery course while, 82.18% in part-II and 71.28% failed to pass the final part. Average 2.51 attempts needed to complete each part of the designed course resulted into lingering of course duration for 42.18 months/student. In the thoracic surgery discipline the number of students alarmingly reduced up to 0% in the recent academic sessions. Conclusions: Masters in Surgery is resulting in unnecessary prolongation of the course. We should step forward to meet the next generation challenge. Journal of Surgical Sciences (2019) Vol. 23(2): 71-74

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Epidemiology of pheochromocytoma and paraganglioma: population-based cohort study

Acta Endocrinologica ◽

10.1530/eje-20-0628 ◽

2021 ◽

Vol 184 (1) ◽

pp. 19-28

Author(s):

Alexander A Leung ◽

Janice L Pasieka ◽

Martin D Hyrcza ◽

Danièle Pacaud ◽

Yuan Dong ◽

...

Keyword(s):

Cohort Study ◽

Administrative Data ◽

Laboratory Data ◽

Population Based ◽

Incidence Rates ◽

Primary Objective ◽

Administrative Databases ◽

Secondary Objective ◽

True Frequency ◽

Clinical Records

Objective Despite the significant morbidity and mortality associated with pheochromocytoma and paraganglioma, little is known about their epidemiology. The primary objective was to determine the incidence of pheochromocytoma and paraganglioma in an ethnically diverse population. A secondary objective was to develop and validate algorithms for case detection using laboratory and administrative data. Design Population-based cohort study in Alberta, Canada from 2012 to 2019. Methods Patients with pheochromocytoma or paraganglioma were identified using linked administrative databases and clinical records. Annual incidence rates per 100 000 people were calculated and stratified according to age and sex. Algorithms to identify pheochromocytoma and paraganglioma, based on laboratory and administrative data, were evaluated. Results A total of 239 patients with pheochromocytoma or paraganglioma (collectively with 251 tumors) were identified from a population of 5 196 368 people over a period of 7 years. The overall incidence of pheochromocytoma or paraganglioma was 0.66 cases per 100 000 people per year. The frequency of pheochromocytoma and paraganglioma increased with age and was highest in individuals aged 60–79 years (8.85 and 14.68 cases per 100 000 people per year for males and females, respectively). An algorithm based on laboratory data (metanephrine >two-fold or normetanephrine >three-fold higher than the upper limit of normal) closely approximated the true frequency of pheochromocytoma and paraganglioma with an estimated incidence of 0.54 cases per 100 000 people per year. Conslusion The incidence of pheochromocytoma and paraganglioma in an unselected population of western Canada was unexpectedly higher than rates reported from other areas of the world.

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