Psychotropic Drugs in Pregnancy and Lactation

PEDIATRICS ◽  
1982 ◽  
Vol 69 (2) ◽  
pp. 241-244
Author(s):  
Sydney Segal ◽  
Albert W. Pruitt ◽  
Walter R. Anyan ◽  
Reba M. Hill ◽  
Ralph E. Kauffman ◽  
...  
Keyword(s):  
Psychotropic Drugs ◽  
Structural Changes ◽  
Drug Exposure ◽  
Final Decision ◽  
Behavioral Alterations ◽  
Drug Dosing ◽  
Behavioral Studies ◽  
Increased Risk ◽  
Pregnancy And Lactation

Accurate prediction of fetal/neonatal risks following maternal psychotropic drug consumption by the human will require much additional study. Based upon our present understanding of fetal exposure to psychotropic drugs, there would appear to be an increased risk for spontaneous malformations in the case of lithium. There have been inconsistent reports of structural abnormalities following exposure to phenothiazines and benzodiazepines. In animal models that demonstrate structural changes due to neuroleptic exposure, in general, extremely large dosages of medication had been given. Thus, their correlative value is limited. Behavioral alterations in animals following drug exposure during pregnancy tend to support increased concerns about the safety of psychotropic drugs for the fetus but cannot be used alone in making a final decision. Behavioral studies evaluating drugs in breast milk have been restricted to experimental animals; hence, the associated risks from this form of drug dosing in man remain unknown. At present, neither gross anatomic nor motor side effects have been apparent in the infant. The question of the development of subtle behavioral changes as a long-term consequence will remain undetermined until careful assessments have been completed.

Immunosuppression

2018 ◽  
Author(s):  
Dirk R. J. Kuypers ◽  
Maarten Naesens
Keyword(s):  
Immunosuppressive Therapy ◽  
Drug Exposure ◽  
Graft Loss ◽  
Plasma Concentrations ◽  
Mammalian Target Of Rapamycin ◽  
Interleukin 2 ◽  
Calcineurin Inhibitors ◽  
Increased Risk ◽  
Exposure Indicators

Combination immunosuppressive therapy produces excellent short-term results after kidney transplantation. Long-term graft survival has improved, but less dramatically. Death with a functioning graft remains the primary cause of graft loss. Dosing of current immunosuppressive therapy balances between careful clinical interpretation of time-driven immunological risk assessments and drug-related toxicity on the one hand, and the use of simple surrogate drug exposure indicators like blood/plasma concentrations on the other. The combined use of calcineurin-inhibitors (CNIs) with mycophenolic acids and corticosteroids has been fine-tuned over the last decade, based on empirically derived observations as well as on the results of large multicentre randomized clinical studies. Corticosteroid withdrawal and avoidance are feasible, at least in patients with a low immunological risk, but CNI-free protocols have had few long-term successes. Some minimization strategies have increased risk of developing acute rejection or (donor-specific) anti-HLA antibodies, with deleterious effects on the graft. Mammalian target of rapamycin inhibitors (mTORi) have shown limited benefit in early CNI replacement regimens and their long-term use as primary drug is hampered by intolerance. In the setting of particular malignant disease occurring after transplantation, such as squamous cell carcinoma of the skin and Kaposi’s sarcoma, mTORi seem promising. Induction agents (anti-interleukin 2 receptor monoclonal antibodies, antithymocyte globulins) effectively diminish the risk of early immunological graft loss in recipients with moderate to high immunological risk but at the price of more infectious or malignant complications. While personalized transplantation medicine is only in its early stages of development, attempts are made to quantitatively measure the clinical degree of immunosuppression, to tailor immunosuppressive therapy more specifically to the patient’s individual profile, and to monitor graft status by use of invasive (e.g. surveillance renal biopsies) and non-invasive biomarkers. These scientific endeavours are a necessity to further optimize the current immunosuppressive therapy which will remain for some time to come.

scholarly journals Beneficial effect of voluntary physical exercise in Plakophilin2 transgenic mice

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252649
Author(s):  
Karin P. Hammer ◽  
Julian Mustroph ◽  
Teresa Stauber ◽  
Walter Birchmeier ◽  
Stefan Wagner ◽  
...  
Keyword(s):  
Beneficial Effect ◽  
Structural Changes ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Voluntary Exercise ◽  
Loss Of Function ◽  
Functional Development ◽  
Increased Risk ◽  
Exercise Induced

Arrhythmogenic right ventricular cardiomyopathy is a hereditary, rare disease with an increased risk for sudden cardiac death. The disease-causing mutations are located within the desmosomal complex and the highest incidence is found in plakophilin2. However, there are other factors playing a role for the disease progression unrelated to the genotype such as inflammation or exercise. Competitive sports have been identified as risk factor, but the type and extend of physical activity as cofactor for arrhythmogenesis remains under debate. We thus studied the effect of light voluntary exercise on cardiac health in a mouse model. Mice with a heterozygous PKP2 loss-of-function mutation were given the option to exercise in a running wheel which was monitored 24 h/d. We analyzed structural and functional development in vivo by echocardiography which revealed that neither the genotype nor the exercise caused any significant structural changes. Ejection fraction and fractional shortening were not influenced by the genotype itself, but exercise did cause a drop in both parameters after 8 weeks, which returned to normal after 16 weeks of training. The electrophysiological analysis revealed that the arrhythmogenic potential was slightly higher in heterozygous animals (50% vs 18% in wt littermates) and that an additional stressor (isoprenaline) did not lead to an increase of arrhythmogenic events pre run or after 8 weeks of running but the vulnerability was increased after 16 weeks. Exercise-induced alterations in Ca handling and contractility of isolated myocytes were mostly abolished in heterozygous animals. No fibrofatty replacements or rearrangement of gap junctions could be observed. Taken together we could show that light voluntary exercise can cause a transient aggravation of the mutation-induced phenotype which is abolished after long term exercise indicating a beneficial effect of long term light exercise.

scholarly journals Development of a Web-Based System for Exploring Cancer Risk With Long-term Use of Drugs: Logistic Regression Approach

10.2196/21401 ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e21401
Author(s):  
Hsuan-Chia Yang ◽  
Md Mohaimenul Islam ◽  
Phung Anh Alex Nguyen ◽  
Ching-Huan Wang ◽  
Tahmina Nasrin Poly ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cancer Risk ◽  
Drug Exposure ◽  
Conditional Logistic Regression ◽  
Population Based ◽  
Research Database ◽  
Web Based ◽  
Increased Risk ◽  
Web Based System

Background Existing epidemiological evidence regarding the association between the long-term use of drugs and cancer risk remains controversial. Objective We aimed to have a comprehensive view of the cancer risk of the long-term use of drugs. Methods A nationwide population-based, nested, case-control study was conducted within the National Health Insurance Research Database sample cohort of 1999 to 2013 in Taiwan. We identified cases in adults aged 20 years and older who were receiving treatment for at least two months before the index date. We randomly selected control patients from the patients without a cancer diagnosis during the 15 years (1999-2013) of the study period. Case and control patients were matched 1:4 based on age, sex, and visit date. Conditional logistic regression was used to estimate the association between drug exposure and cancer risk by adjusting potential confounders such as drugs and comorbidities. Results There were 79,245 cancer cases and 316,980 matched controls included in this study. Of the 45,368 associations, there were 2419, 1302, 662, and 366 associations found statistically significant at a level of P<.05, P<.01, P<.001, and P<.0001, respectively. Benzodiazepine derivatives were associated with an increased risk of brain cancer (adjusted odds ratio [AOR] 1.379, 95% CI 1.138-1.670; P=.001). Statins were associated with a reduced risk of liver cancer (AOR 0.470, 95% CI 0.426-0.517; P<.0001) and gastric cancer (AOR 0.781, 95% CI 0.678-0.900; P<.001). Our web-based system, which collected comprehensive data of associations, contained 2 domains: (1) the drug and cancer association page and (2) the overview page. Conclusions Our web-based system provides an overview of comprehensive quantified data of drug-cancer associations. With all the quantified data visualized, the system is expected to facilitate further research on cancer risk and prevention, potentially serving as a stepping-stone to consulting and exploring associations between the long-term use of drugs and cancer risk.

scholarly journals Development of a Web-Based System for Exploring Cancer Risk With Long-term Use of Drugs: Logistic Regression Approach (Preprint)

2020 ◽  
Author(s):  
Hsuan-Chia Yang ◽  
Md Mohaimenul Islam ◽  
Phung Anh Alex Nguyen ◽  
Ching-Huan Wang ◽  
Tahmina Nasrin Poly ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cancer Risk ◽  
Drug Exposure ◽  
Conditional Logistic Regression ◽  
Population Based ◽  
Research Database ◽  
Web Based ◽  
Increased Risk ◽  
Web Based System

BACKGROUND Existing epidemiological evidence regarding the association between the long-term use of drugs and cancer risk remains controversial. OBJECTIVE We aimed to have a comprehensive view of the cancer risk of the long-term use of drugs. METHODS A nationwide population-based, nested, case-control study was conducted within the National Health Insurance Research Database sample cohort of 1999 to 2013 in Taiwan. We identified cases in adults aged 20 years and older who were receiving treatment for at least two months before the index date. We randomly selected control patients from the patients without a cancer diagnosis during the 15 years (1999-2013) of the study period. Case and control patients were matched 1:4 based on age, sex, and visit date. Conditional logistic regression was used to estimate the association between drug exposure and cancer risk by adjusting potential confounders such as drugs and comorbidities. RESULTS There were 79,245 cancer cases and 316,980 matched controls included in this study. Of the 45,368 associations, there were 2419, 1302, 662, and 366 associations found statistically significant at a level of <i>P</i>&lt;.05, <i>P</i>&lt;.01, <i>P</i>&lt;.001, and <i>P</i>&lt;.0001, respectively. Benzodiazepine derivatives were associated with an increased risk of brain cancer (adjusted odds ratio [AOR] 1.379, 95% CI 1.138-1.670; <i>P</i>=.001). Statins were associated with a reduced risk of liver cancer (AOR 0.470, 95% CI 0.426-0.517; <i>P</i>&lt;.0001) and gastric cancer (AOR 0.781, 95% CI 0.678-0.900; <i>P</i>&lt;.001). Our web-based system, which collected comprehensive data of associations, contained 2 domains: (1) the drug and cancer association page and (2) the overview page. CONCLUSIONS Our web-based system provides an overview of comprehensive quantified data of drug-cancer associations. With all the quantified data visualized, the system is expected to facilitate further research on cancer risk and prevention, potentially serving as a stepping-stone to consulting and exploring associations between the long-term use of drugs and cancer risk.

scholarly journals Administration of Rhodiola kirilowii Extracts during Mouse Pregnancy and Lactation Stimulates Innate but Not Adaptive Immunity of the Offspring

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Sławomir Lewicki ◽  
Ewa Skopińska-Różewska ◽  
Aleksandra Brewczyńska ◽  
Robert Zdanowski
Keyword(s):  
Immune System ◽  
Developmental Disorders ◽  
Hematological Parameters ◽  
Good Alternative ◽  
Immunological Parameters ◽  
Lactating Women ◽  
Increased Risk ◽  
Pregnancy And Lactation ◽  
Daily Oral Administration

The use of antibiotics during pregnancy and lactation is associated with an increased risk of developmental disorders. One of the natural medicinal plants—Rhodiola kirilowii, widely used as an immunostimulant in adults—might be a good alternative to antibiotic treatment. The aim of present study was to assess whether daily oral administration of 20 mg/kg of Rhodiola kirilowii aqueous (RKW) or 50% hydroalcoholic (RKW-A) extracts affected hematological and immunological parameters of 6-week-old mouse progeny. There was no significant change in hematological parameters of blood with the exception of hemoglobin, which was significantly higher (about 4%) in RKW group. Offspring of mothers fed Rhodiola kirilowii extracts had increased percentage of granulocytes and decreased percentage of lymphocytes. These changes correlated with decreased percentage of CD3+/CD4+ T-cells (RKW and RKW-A), decrease of CD8+ cells, and increase percentage of NK cells in RKW group. In addition, both types of Rhodiola kirilowii extracts stimulated granulocyte phagocytosis and increased level of respiratory burst. In conclusion, the long-term supplementation of mouse mothers during pregnancy and lactation with RKW or RKW-A extracts affects the immune system of their progeny. These results should be taken into consideration before administration of Rhodiola kirilowii to pregnant and lactating women.

scholarly journals Antipsychotic Medication during Pregnancy and Lactation in Women with Schizophrenia: Evaluating the Risk

2002 ◽  
Vol 47 (10) ◽  
pp. 959-965 ◽  
Author(s):  
Sheila W Patton ◽  
Shaila Misri ◽  
Maria R Corral ◽  
Katherine F Perry ◽  
Annie J Kuan
Keyword(s):  
Antipsychotic Medication ◽  
Atypical Antipsychotics ◽  
Medline Search ◽  
Maternal Illness ◽  
Relative Risks ◽  
Lack Of Information ◽  
Increased Risk ◽  
Pregnancy And Lactation ◽  
Medication Exposure

Objective: To review studies investigating the following: whether exposing developing infants to antipsychotic medication during pregnancy and lactation is associated with increased risks of teratogenic, neonatal, and long-term neurobehavioural sequelae; whether schizophrenia itself affects pregnancy outcome; and whether the course of schizophrenia symptoms is altered by pregnancy and lactation. Method: We summarize the results from articles identified via a MedLine search for the period January 1, 1966, to December 1, 2001. Results: Women with schizophrenia are at increased risk for poor obstetrical outcomes, including preterm delivery, low birth weight, and neonates who are small for their gestational age. A lack of information in the literature makes it difficult to comment on the relative risk of exposing developing infants to atypical antipsychotics. However, typical antipsychotics appear to carry an increased risk of congenital malformations when the fetus is exposed to phenothiazines during weeks 4 to 10 of gestation. Lack of information also precludes an understanding of whether changes associated with pregnancy and lactation significantly alter the course of schizophrenia symptoms. Conclusion: Research is needed so that physicians may more accurately inform women about the relative risks of using antipsychotic medications during pregnancy and lactation. Increased knowledge about the risks of medication exposure will allow clinicians to limit treatment to situations in which the risk of untreated maternal illness outweighs the risk of exposing a developing infant to medications.

Coming Together Through Falling Apart

2019 ◽  
Vol 40 (2) ◽  
pp. 151-168
Author(s):  
Heather Churchill ◽  
Jeremy M. Ridenour
Keyword(s):  
Data Analysis ◽  
Qualitative Data ◽  
Structural Changes ◽  
Systematic Approach ◽  
Qualitative Approach ◽  
Psychological Assessments ◽  
Transference And Countertransference ◽  
Testing Data ◽  
Psychoanalytically Oriented Psychotherapy

Abstract. Assessing change during long-term psychotherapy can be a challenging and uncertain task. Psychological assessments can be a valuable tool and can offer a perspective from outside the therapy dyad, independent of the powerful and distorting influences of transference and countertransference. Subtle structural changes that may not yet have manifested behaviorally can also be assessed. However, it can be difficult to find a balance between a rigorous, systematic approach to data, while also allowing for the richness of the patient’s internal world to emerge. In this article, the authors discuss a primarily qualitative approach to the data and demonstrate the ways in which this kind of approach can deepen the understanding of the more subtle or complex changes a particular patient is undergoing while in treatment, as well as provide more detail about the nature of an individual’s internal world. The authors also outline several developmental frameworks that focus on the ways a patient constructs their reality and can guide the interpretation of qualitative data. The authors then analyze testing data from a patient in long-term psychoanalytically oriented psychotherapy in order to demonstrate an approach to data analysis and to show an example of how change can unfold over long-term treatments.

Economic Institutions and Growth Nexus: The Role of Governance and Democratic Institutions—Evidence from Time Varying Parameters’ (TVPs) Models

2016 ◽  
Vol 55 (4I-II) ◽  
pp. 675-688
Author(s):  
Ghulam Murtaza ◽  
Muhammad Zahir Faridi
Keyword(s):  
Structural Changes ◽  
Jel Classification ◽  
Economic Institutions ◽  
Time Varying ◽  
Democratic Institutions ◽  
Main Hypothesis ◽  
Dynamic Relationship ◽  
Rolling Window

The present study has investigated the channels through which the linkage between economic institutions and growth is gauged, by addressing the main hypothesis of the study that whether quality of governance and democratic institutions set a stage for economic institutions to promote the long-term growth process in Pakistan. To test the hypothesis empirically, our study models the dynamic relationship between growth and economic institutions in a time varying framework in order to capture institutional developments and structural changes occurred in the economy of Pakistan over the years. Study articulates that, along with some customary specifics, the quality of government and democracy are the substantial factors that affect institutional quality and ultimately cause to promote growth in Pakistan. JEL Classification: O40; P16; C14; H10 Keywords: Economic Institutions, Growth, Governance and Democracy, Rolling Window Two-stage Least Squares, Pakistan

Individual differences in white and grey matter structure associated with verbal habits of thought

2019 ◽  
Author(s):  
Justin C. Hayes ◽  
Katherine L Alfred ◽  
Rachel Pizzie ◽  
Joshua S. Cetron ◽  
David J. M. Kraemer
Keyword(s):  
Individual Differences ◽  
White Matter ◽  
Cognitive Processing ◽  
Grey Matter ◽  
Structural Changes ◽  
Structural Integrity ◽  
Diffusion Tensor ◽  
Self Report ◽  
White Matter Tracts

Modality specific encoding habits account for a significant portion of individual differences reflected in functional activation during cognitive processing. Yet, little is known about how these habits of thought influence long-term structural changes in the brain. Traditionally, habits of thought have been assessed using self-report questionnaires such as the visualizer-verbalizer questionnaire. Here, rather than relying on subjective reports, we measured habits of thought using a novel behavioral task assessing attentional biases toward picture and word stimuli. Hypothesizing that verbal habits of thought are reflected in the structural integrity of white matter tracts and cortical regions of interest, we used diffusion tensor imaging and volumetric analyses to assess this prediction. Using a whole-brain approach, we show that word bias is associated with increased volume in several bilateral language regions, in both white and grey matter parcels. Additionally, connectivity within white matter tracts within an a priori speech production network increased as a function of word bias. These results demonstrate long-term structural and morphological differences associated with verbal habits of thought.

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