Treatment of Acute Mania

CNS Spectrums ◽  
2003 ◽  
Vol 8 (12) ◽  
pp. 917-928 ◽  
Author(s):  
Paul E. Holtzheimer ◽  
John F. Neumaier
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Drug Administration ◽  
Mood Stabilizers ◽  
Acute Mania ◽  
Treatment Resistant ◽  
Short Term ◽  
The Past ◽  
Term Tolerability

AbstractMood stabilizers have evolved considerably over the past decade. Lithium, divalproex, and olanzapine are currently Food and Drug Administration-approved for the treatment of acute mania. A number of new and traditional medications have also been tested and are commonly used in clinical practice. Several strategies for managing treatment-resistant mania have been suggested, but few have been rigorously tested. Emphases on rapid stabilization and fewer side effects have raised the bar for what is expected from mood stabilizers and the successful treatment of mania involves a delicate balance between swiftness, short-term tolerability, and long-term safety.

scholarly journals Classical Hodgkin Lymphoma; Real-World Observations from Physicians, Patients, and Caregivers on the Disease and Its Treatment (CONNECT)-a Cross-Sectional Survey of Patients with Stage III or IV Classical Hodgkin Lymphoma Compared By Age

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1966-1966
Author(s):  
Darcy R. Flora ◽  
Susan K. Parsons ◽  
Nicholas Liu ◽  
Kristina S. Yu ◽  
Katie Holmes ◽  
...  
Keyword(s):  
Side Effects ◽  
Hodgkin Lymphoma ◽  
Treatment Options ◽  
Stage Iii ◽  
Classical Hodgkin Lymphoma ◽  
Publicly Traded ◽  
Short Term ◽  
The Past

Abstract Introduction Hodgkin lymphoma (HL) represents ~10% of all lymphomas in the United States (US) with classical HL (cHL) accounting for ~95% of all HL cases. cHL has a bimodal age distribution with peaks at ages 15-39 and ≥75 years. As part of CONNECT, the first real-world survey in cHL to include physicians, patients, and caregivers, patient treatment preferences for those with stage III or IV cHL were explored and differences evaluated between those aged <40 years (corresponding to the upper end of the age range for adolescence and young adulthood [US National Cancer Institute]) and ≥40 years at diagnosis. Methods The CONNECT patient survey was a non-interventional patient-centered survey. Participants included were aged ≥18 years at the time of participation (aged ≥12 years at diagnosis), diagnosed with cHL within the past 10 years, and previously or currently being treated for cHL in the US. The CONNECT survey was reviewed and approved by the New England Institutional Review Board and administered from December 30, 2020, to March 1, 2021. Results In CONNECT, 182 participants had stage III or IV cHL (64% female; 77% Caucasian) with 64% aged <40 years at diagnosis. Overall, median (interquartile range) age at cHL diagnosis was 32 (25-50) years (aged <40, 27 [23-32] years; ≥40, 57 [49-64] years). Sixty-two percent of participants were diagnosed with stage III or IV cHL within the past 2 years and 27% were receiving treatment at time of survey. Cure was ranked as the first or second goal of initial cHL treatment for 86% of participants aged <40 years and 52% of participants aged ≥40 years (P < 0.001; Figure A). A higher percentage of participants aged ≥40 than <40 years ranked living longer (43% vs 28%) and having better quality of life (26% vs 8%, P = 0.001) as the first or second goal for initial cHL treatment. Among those with stage III or IV cHL in remission (<40, n=105; ≥40, n=11), 86% aged <40 and 100% age ≥40 years ranked staying in remission as the first or second most important survivorship goal. At diagnosis, a significantly higher percentage of participants aged <40 than ≥40 years preferred to treat their cancer aggressively (79% vs 60%, P = 0.016; Figure B). These participants were willing to trade off short-term risks for long-term efficacy (93% vs 71%, P < 0.001; Figure B). However, 44% of those aged <40 and 45% of those aged ≥40 years were willing to make that same trade-off for long-term risk reduction. A significantly higher percentage of participants aged <40 than ≥40 years reported being informed by their health care provider (HCP) about the following short-term side effects: nausea/vomiting (93% vs 80%, P = 0.015), hair loss (97% vs 74%, P < 0.001), fatigue (96% vs 74%, P < 0.001), risk of infection from low blood counts (90% vs 62%, P < 0.001), low blood count (87% vs 63%, P < 0.001), numbness and tingling (91% vs 45%, P < 0.001), and muscle weakness (74% vs 55%, P = 0.014). Regardless of age, fewer participants reported being told about the long-term risks of cHL treatment with those aged <40 years being more informed about the risk of developing other cancers (73% vs 55%; P = 0.028) and infertility (74% vs 22%; P < 0.001), and those aged ≥40 years being more informed about stroke (40% vs 13%; P < 0.001). Most participants reported being told about the short-term (<40 years, 85%; ≥40 years, 72%) and long-term (< 40 years, 75%; ≥40 years, 62%) side effects of cHL treatment during a discussion of treatment options with their HCP. When asked about long-term side effects of greatest concern, a significantly higher percentage of participants aged <40 compared with ≥40 years were concerned about secondary cancers (81% vs 46%; P < 0.001) and infertility (23% vs 6%; P = 0.007) whereas a significantly higher percentage of those aged ≥40 compared with those <40 years were concerned about heart disease and stroke (58% vs 42%; P = 0.046) and infections (31% vs 4%; P < 0.001). Conclusion Treatment goals differ significantly between participants with stage III or IV cHL based primarily on age, with those aged <40 years focusing on cure and aggressive treatments and those ≥40 years focusing on living longer and obtaining a good quality of life. Additionally, participants aged <40 compared with those ≥40 years were more willing to accept short-term risks in exchange for long-term benefits. Lastly, regardless of age, most participants were told about short-term and long-term side effects in discussion of treatment options with their HCP. Figure 1 Figure 1. Disclosures Flora: Seagen, Inc: Research Funding. Parsons: SeaGen: Consultancy. Liu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Yu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Fanale: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Kumar: Seagen, Inc: Consultancy. Byrd: Seagen, Inc: Research Funding.

Impact of FII’s and FDI’s on Indian Stock Market

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Dr. Kamlesh Kumar Shukla
Keyword(s):  
Stock Market ◽  
Financial Markets ◽  
Global Economy ◽  
Short Term ◽  
Earnings Growth ◽  
The Past ◽  
Bull Market ◽  
Indian Stock Market

FIIs are companies registered outside India. In the past four years there has been more than $41 trillion worth of FII funds invested in India. This has been one of the major reasons on the bull market witnessing unprecedented growth with the BSE Sensex rising 221% in absolute terms in this span. The present downfall of the market too is influenced as these FIIs are taking out some of their invested money. Though there is a lot of value in this market and fundamentally there is a lot of upside in it. For long-term value investors, there’s little because for worry but short term traders are adversely getting affected by the role of FIIs are playing at the present. Investors should not panic and should remain invested in sectors where underlying earnings growth has little to do with financial markets or global economy.

AB0578 LONG-TERM TOLERABILITY OF AMINAPHTONE IN A COHORT OF SYSTEMIC SCLEROSIS PATIENTS IN CONCOMITANT STANDARD THERAPY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1585.1-1586
Author(s):  
E. Gotelli ◽  
S. Paolino ◽  
F. Goegan ◽  
F. Cattelan ◽  
M. Patanè ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Side Effects ◽  
Standard Therapy ◽  
Control Group ◽  
Placebo Control ◽  
Research Support ◽  
Standard Dosage ◽  
Blood Tests ◽  
Term Tolerability

Background:Aminaphtone (AMI) is a bioflavonoid compound, classically used for “capillary disorders”.In vitroAMI interferes with adhesion molecules (sELAM-1 and sVCAM-1) and with vascular endothelial cadherin degradation thus defending vessels permeability. Moreover, it counteracts vasoconstriction, downregulating endothelin-1 production at a gene level (1-3).In vivoAMI ameliorates clinical symptoms of several clinical conditions, above all Raynaud’s phenomenon (RP), either primary or secondary to systemic sclerosis (SSc), as demonstrated by a recent six-month study (4).Objectives:To evaluate long-term tolerability of standard dosage of AMI in a real-life cohort of SSc patients with secondary RP.Methods:Seventy-eight SSc patients (mean age 65±13 years; mean disease duration 9±7 years) treated with AMI due to active RP were enrolled (ACR/EULAR 2013 criteria). They were taking various concomitant treatments, including aspirin, calcium-channel blockers, cyclic intravenous iloprost, immunomodulators, endothelin receptor antagonists. SSc patients performed periodic clinical assessments and blood tests on average every four months per clinical practice. Duration of AMI administration, side effects, and self-assessment of Raynaud Condition Score (RCS) in a scale from 0 (absence of pain) to 10 (intolerable pain) were retrospectively taken into account.Results:Duration of AMI administration was between six and sixty-seven months (mean 31±20 months). AMI was administered at 75 mgbis in diedosage, as standard initial posology. At baseline, mean RCS was 7.3±0.8. After 3 months of treatment sixty-four patients (82%) yet referred a subjective improvement of RCS (3.5±0.8, p=0.03), whereas 14 patients (18%) were clinically unsatisfied (RCS 6.1±0.4, p=1.12). In this last group, posology was increased to 75 mgtris in die, with a satisfactory amelioration in further nine patients (93,6%) (RCS 4.0±0.6 p=0.04), while five patients (6,4%) definitively discontinued therapy for subjective ineffectiveness within six months. Patients referred a sustained improvement of RCS along the observational period (31±20 months) (last RCS 3.7±0.7, p=0.03 vs baseline). During the follow-up, five patients (6,4%) referred headache as side effect: three of them had to reduce AMI posology to 75 mg per day, while maintaining clinical benefits. Periodic blood tests did not reveal any significant alteration attributable to AMI. No other side effects related to the drug appeared during the treatment period.Conclusion:AMI shows an acceptable medium-long-term tolerability along with sustained efficacy in the management of SSc-related RP, without disabling side effects. However, the retrospective design, the absence of a placebo-control group and the concomitant standard therapy limit the results, and a randomized controlled trial for AMI use in the management of SSc-related RP is desirable.References:[1]Scorza R et al. 2008.Clin Ther30(5):924-9.[2]Felice F et al. 2018.Phlebology33(9):592-599.[3]Scorza R et al. 2008.Drugs R D9(4):251-7.[4]Ruaro B et al. 2019.Front Pharmacol10:293.Disclosure of Interests:Emanuele Gotelli: None declared, Sabrina Paolino: None declared, Federica Goegan: None declared, Francesco Cattelan: None declared, Massimo Patanè: None declared, Carmen Pizzorni: None declared, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha, Alberto Sulli Grant/research support from: Laboratori Baldacci

Afterword

2021 ◽  
pp. 244-248
Author(s):  
Michael J. Rosenfeld
Keyword(s):  
Social Change ◽  
Gay Rights ◽  
Marriage Equality ◽  
Short Term ◽  
The Past ◽  
The Many ◽  
The U.S ◽  
The Way

Gay rights and marriage equality have advanced so far in the U.S. in the past decade that it would be all too easy to assume that the struggle is over. The opponents of gay rights, however, remain powerful. Readers can take inspiration from how dramatically attitudes toward gay rights have liberalized in the past two decades and how transformative the liberalization of attitudes has been. We live in a world where political lies often seem to have the upper hand. It is worth remembering that despite the many short term advantages that lies can yield in politics, the truth has some long term advantages as well. The way the marriage equality movement prevailed should be a lesson to anyone who wants to make progressive social change.

Antimicrobial Applications of Nanoparticles

2022 ◽  
pp. 269-288
Author(s):  
Ayesha Kanwal ◽  
Zeeshan Ahmad Bhutta ◽  
Ambreen Ashar ◽  
Ashar Mahfooz ◽  
Rizwan Ahmed ◽  
...  
Keyword(s):  
Antibacterial Activity ◽  
Side Effects ◽  
Antibacterial Agent ◽  
Antibacterial Agents ◽  
The Other ◽  
Drug Resistant ◽  
Short Term ◽  
Human Mortality ◽  
Recent Developments

Human mortality due to drug-resistant infections is becoming more prevalent in our society. Antibiotics are impotent due to abuse and/or misuse, leading to new, more expensive, and more effective medicines and treatments. Therefore, it causes many short-term and long-term side effects in the patient. On the other hand, nanoparticles have exhibited antibacterial activity against various pathogens due to their small size and ability to destroy cells by various mechanisms. Unlike antibiotics for the treatment of patients' diseases and infections, nanomaterials provide an exciting way to limit the growth of microorganisms due to infections in humans. This has led to the development of a number of nanoparticles as active antibacterial agents. Therefore, the authors have carefully reviewed the recent developments in the use of nanomaterials for antibacterial applications and the mechanisms that make them an effective alternate antibacterial agent.

Lithium and related mood stabilizers

2012 ◽  
pp. 1198-1208
Author(s):  
Robert M. Post
Keyword(s):  
Bipolar Disorder ◽  
Side Effects ◽  
Mood Stabilizer ◽  
Term Treatment ◽  
Careful Consideration ◽  
Mood Stabilizers ◽  
Illness Onset ◽  
Predictors Of Response ◽  
Long Term Treatment

Lithium is the paradigmatic mood stabilizer. It is effective in the acute and prophylactic treatment of both mania and, to a lesser magnitude, depression. These characteristics are generally paralleled by the widely accepted anticonvulsant mood stabilizers valproate, carbamazepine (Table 6.2.4.1), and potentially by the less well studied putative mood stabilizers oxcarbazepine, zonisamide, and the dihydropyridine L-type calcium channel blocker nimodipine. In contrast, lamotrigine has a profile of better antidepressant effects acutely and prophylactically than antimanic effects. Having grouped lithium, valproate, and carbamazepine together, it is important to note they have subtle differences in their therapeutic profiles and differential clinical predictors of response (Table 6.2.4.1). Response to one of these agents is not predictive of either a positive or negative response to the others. Thus, clinicians are left with only rough estimates and guesses about which drug may be preferentially effective in which patients. Only sequential clinical trials of agents either alone or in combination can verify responsivity in an individual patient. Individual response trumps FDA-approval. Given this clinical conundrum, it is advisable that patients, family members, clinicians, or others carefully rate patients on a longitudinal scale in order to most carefully assess responses and side effects. These are available from the Depression Bipolar Support Alliance (DBSA), the STEP-BD NIMH Network, or www.bipolarnetworknews.org and are highly recommended. The importance of careful longitudinal documentation of symptoms and side effects is highlighted by the increasing use of multiple drugs in combination. This is often required because patients may delay treatment-seeking until after many episodes, and very different patterns and frequencies of depressions, manias, mixed states, as well as multiple comorbidities may be present. Treating patients to the new accepted goal of remission of their mood and other anxillary symptoms usually requires use of several medications. If each component of the regimen is kept below an individual's side-effects threshold, judicious use of multiple agents can reduce rather than increase the overall side-effect burden. There is increasing evidence of reliable abnormalities of biochemistry, function, and anatomy in the brains of patients with bipolar disorder, and some of these are directly related to either duration of illness or number of episodes. Therefore, as treatment resistance to most therapeutic agents is related to number of prior episodes, and brain abnormalities may also increase as well, it behooves the patient to begin and sustain acute and long-term treatment as early as possible. Despite the above academic, personal, and public health recommendations, bipolar disorder often takes ten years or more to diagnose and, hence, treat properly. In fact, a younger age of onset is highly related to presence of a longer delay from illness onset to first treatment, and as well, to a poorer outcome assessed both retrospectively and prospectively. New data indicate that the brain growth factor BDNF (brain-derived neurotrophic factor) which is initially important to synaptogenesis and neural development, and later neuroplasticity and long-term memory in the adult is involved in all phases of bipolar disorder and its treatment. It appears to be: 1) both a genetic (the val-66-val allele of BDNF) and environmental (low BDNF from childhood adversity) risk factor; 2) episode-related (serum BDNF decreasing with each episode of depression or mania in proportion to symptom severity; 3) related to some substance abuse comorbidity (BDNF increases in the VTA with defeat stress and cocaine self-administration); and 4) related to treatment. Lithium, valproate, and carbamazepine increase BDNF and quetiapine and ziprasidone block the decreases in hippocampal BDNF that occur with stress (as do antidepressants). A greater number of prior episodes is related to increased likelihood of: 1) a rapid cycling course; 2) more severe depressive symptoms; 3) more disability; 4) more cognitive dysfunction; and 5) even the incidence of late life dementia. Taken together, the new data suggest a new view not only of bipolar disorder, but its treatment. Adequate effective treatment may not only (a) prevent affective episodes (with their accompanying risk of morbidity, dysfunction, and even death by suicide or the increased medical mortality associated with depression), but may also (b) reverse or prevent some of the biological abnormalities associated with the illness from progressing. Thus, patients should be given timely information pertinent to their stage of illness and recovery that emphasizes not only the risk of treatments, but also their potential, figuratively and literally, life-saving benefits. Long-term treatment and education and targeted psychotherapies are critical to a good outcome. We next highlight several attributes of each mood stabilizer, but recognize that the choice of each agent itself is based on inadequate information from the literature, and sequencing of treatments and their combinations is currently more an art than an evidence-based science. We look forward to these informational and clinical trial deficits being reduced in the near future and the development of single nucleotide polymorphism (SNP) and other neurobiological predictors of individual clinical response to individual drugs. In the meantime, patients and clinicians must struggle with treatment choice based on: 1) the most appropriate targetting of the predominant symptom picture with the most likely effective agent (Table 6.2.4.1 and 6.2.4.2) the best side-effects profile for that patient (Table 6.2.4.2 and 6.2.4.3) using combinations of drugs with different therapeutic targets and mechanisms of action (Table 6.2.4.3 and 6.2.4.4) careful consideration of potential advantageous pharmacodynamic interactions and disadvantageous pharmacokinetic drug-drug interactions that need to be avoided or anticipated.

Delirium on clozapine: A tale of friend turned foe-A case report

2020 ◽  
pp. 009121742097282 ◽  
Author(s):  
Aparna Das ◽  
Rebecca Minner ◽  
Lewis Krain ◽  
John Spollen
Keyword(s):  
Case Report ◽  
Clinical Practice ◽  
Side Effects ◽  
Adverse Effects ◽  
Older Adult ◽  
Psychiatric Illness ◽  
Management Strategies ◽  
Treatment Resistant ◽  
Drug Of Choice ◽  
Life Threatening

Treatment resistant schizophrenia (TRS) is often encountered in clinical practice. Clozapine remains the drug of choice in the management of TRS. Several studies have shown that clozapine is the most effective antipsychotic medication to date for TRS. But it is also well known that it has multiple side effects. Some side effects are transient and relatively benign, while other adverse effects are menacing, serious and life-threatening. Delirium may occur with clozapine and is a therapeutic challenge as there is always a risk of precipitating delirium on clozapine rechallenge. Limited management strategies are available as alternatives for the management of psychiatric illness stabilized on clozapine. In this case report, we describe an older adult patient who developed delirium on clozapine. The aims of this case report are to discuss the mechanism by which clozapine leads to delirium, revisit various factors which could possibly lead to delirium, and discuss the different management strategies available for management of psychiatric illness for a patient previously stabilized on clozapine.

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