Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients

Background: Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first-hand experience of recipients. Objective: To ascertain the experiences and opinions of an international sample of users of antipsychotic drugs, regarding positive and negative effects. Methods: An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date. Results: Over half (56%) thought, the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘helpful’ (41%) than found them ‘unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects. Conclusion: Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.

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P709 Is azathioprine safe as long-term treatment in paediatric patients with inflammatory bowel disease?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.837 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S573-S573

Author(s):

M A Martínez Ibeas ◽

I Bacelo Ruano ◽

S Rodríguez Manchón ◽

M Velasco Rodríguez-Belvís ◽

J F Viada Bris ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Side Effects ◽

Adverse Effects ◽

Term Treatment ◽

Tpmt Activity ◽

Duration Of Treatment ◽

Median Dosage ◽

Long Term Treatment ◽

Inflammatory Bowel

Abstract Background The toxicity of azathioprine (AZA) includes myelosuppression, infections, pancreatitis, photosensitivity, and hepatotoxicity. The aim of this study was to describe the adverse effects profile of azathioprine as long-term treatment in paediatric inflammatory bowel disease (IBD). Methods An observational, descriptive and retrospective study was performed in the paediatric IBD Unit of a tertiary care hospital from September 2008 to December 2018. It was included patients under 18 diagnosed with IBD who were treated with AZA during their follow-up. We recorded epidemiological data, thiopurine methyltransferase (TPMT) enzyme activity, AZA side effects, and the dosage the patients were receiving when these effects took place. Bone marrow suppression (BMS) was defined as leukopenia, thrombocytopenia and/or anaemia. Acute pancreatitis (AP) induced by azathioprine was considered when two of these criteria (Atlanta 2012) were met: lipase increase (> 3 times normal value), congruent signs and symptoms and/or echographic findings, without other possible aetiology and with complete recovery after AZA withdrawal. Results We included 52 patients, being 31 men (59.6%). They were diagnosed with Crohn′s disease (CD) (73%), ulcerative colitis (UC) (21%) and IBD-unclassified (6%). The median TPMT activity was 17 U/ml (14.2–19.2). Up to 63.5% developed adverse effects by AZA with a median time from the beginning of treatment of 11.4 months (2.6–26.4) and a median dosage of 2 mg/kg/day (1.7–2.3). The most frequent side effect was BMS (52%). These patients had a median TPMT activity of 16.9 U/ml (14.2–18.9), the median duration of treatment was 14 months (3.9–27.7), and the median dosage was 2 mg/kg/d (1.8–2.5). BMS was more frequent in patients with UC (p 0.04) and longer treatment (p 0.08). No differences were found according to age, sex or TPMT activity. Up to 11.5% developed AP, the median duration of treatment until its appearance was 1.5 months (0.7–43.3) and the median dosage was 2 mg/kg/d (1.5–2.5). No differences were found related to age, sex, diagnosis or dosage. Other side effects were: 3 flu-like symptoms, 3 opportunistic infections, 2 hypertransaminasemia, and 1 patient with elevated pancreatic enzymes and hyperbilirubinemia. AZA was discontinued in 14 patients (43.8%): in 6 due to AP, in 4 due to severe lymphopenia, in 2 because of Epstein-Barr virus infection, in 1 due to flu-like symptoms and in 1 with several adverse effects. Conclusion More than half of the patients treated with AZA presented side effects, mainly BMS, although most of them were mild and temporary, and the withdrawal of the drug was not necessary. It seems that TPMT activity is not useful to predict BMS, but this adverse effect could be related to a longer treatment.

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Combination of Prednisolone and Azathioprine for Steroid-Responsive Meningitis-Arteritis Treatment in Dogs

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-7019 ◽

2020 ◽

Vol 57 (1) ◽

pp. 1-7

Author(s):

Lucile Giraud ◽

Maud Girod ◽

Laurent Cauzinille

Keyword(s):

Side Effects ◽

Relapse Rate ◽

Primary Treatment ◽

Immunosuppressive Drug ◽

Duration Of Treatment ◽

Glucocorticoid Treatment ◽

Immune Mediated

ABSTRACT Treatment with high corticosteroid dosages for steroid-responsive meningitis-arteritis (SRMA) is correlated with severe adverse effects and worse quality of life. In order to improve immunosuppression and decrease dosage and duration of glucocorticoid treatment, a second immunosuppressive drug is commonly used in most of the immune-mediated diseases. The objective of this retrospective study was to evaluate the efficacy, tolerability, and occurrence of relapse for the combination of prednisolone and azathioprine. All dogs received azathioprine 2 mg/kg q 24 hr for 1 mo and then 2 mg/kg every other day for 2 mo; prednisolone was started at an immunosuppressive dosage and tapered off gradually during a mean of 3 mo. Twenty-six dogs met inclusion criteria. Twenty-one dogs (81%) were in clinical remission with no relapse observed within the 2 yr follow-up period. Treatment was well tolerated in all dogs and side effects were most of the time mild and self-limiting. The relapse rate (19%) was lower than most published rates. A prednisolone and azathioprine combination appeared to be effective for primary treatment of dogs with SRMA and allows a quicker tapering in prednisolone dosage, a decrease in long-term side effects of steroids, a shorter duration of treatment, and a low relapse rate.

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Tatlandırıcılar ve Metabolizma Hastalıklarıyla İlişkisi

Turkish Journal of Agriculture - Food Science and Technology ◽

10.24925/turjaf.v5i2.191-198.1033 ◽

2017 ◽

Vol 5 (2) ◽

pp. 191

Author(s):

Nildem Kızılaslan

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Human Health ◽

Sweet Taste ◽

Food Additive ◽

Artificial Sweeteners ◽

General Tendency ◽

Negative Effects ◽

Sugar Alcohols

Sweeteners that sugar substitute is a food additive that provides a sweet taste like that of sugar while containing significantly less food energy. Some sugar substitutes are produced by nature, and others produced synthetically. Sweeteners can be classified as sugar alcohols (polyols), artificial sweeteners and natural sweeteners. The need to avoid the adverse effects of sugar cannot stop feeling the taste on humans has resulted in intense use of sweeteners nowadays. There are positive and negative opinions about the effects of their use on human health. The general tendency of food producers is to reduce the amount of sugar in the groats due to negative effects in parallel. Food sweeteners are intended for a large group of consumers, and one of the main points of the sector operators is to provide healthier, natural, nutritional and low calorie sweeteners to these consumers. In this study, we evaluated the sweeteners which are most commonly used. Many studies have been done to demonstrate the safety of sweeteners. There are also studies showing that there may be side effects even if there are few. Some sweeteners have been associated with a number of symptoms. There is a need for comparative long-term work in this area.

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PATIENT/CARERS' RECOLLECTION OF MEDICINES RELATED INFORMATION FROM AN OUT-PATIENT CLINIC APPOINTMENT

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-311535.53 ◽

2016 ◽

Vol 101 (9) ◽

pp. e2.49-e2

Author(s):

Jeff Aston ◽

Natasha Patel ◽

Justin Smuels ◽

Teena Aujla ◽

Georgia Malesi ◽

...

Keyword(s):

Patient Safety ◽

Side Effects ◽

Adverse Effects ◽

Dose Regimen ◽

Therapeutic Indication ◽

Duration Of Treatment ◽

Convenience Sample ◽

Related Information ◽

Clinic Appointment

AimTo identify what medicines related information children/young people or their parents/carers are able to recall following an out-patient clinic appointment.MethodA convenience sample of patients' prescribed at least one new long-term (>6 weeks) medicine were recruited from a single UK paediatric hospital out-patient pharmacy.A face-to-face semi-structured questionnaire was administered to participants when they presented with their prescription. The questionnaire included the following themes: names of the medicines, therapeutic indication, dose regimen, duration of treatment and adverse effects.The results were analysed using Microsoft Excel 2013.ResultsOne hundred participants consented and were included in the study. One hundred and forty-five medicines were prescribed in total. Participants were able to recall the names of 96 (66%) medicines and were aware of the therapeutic indication for 142 (97.9%) medicines. The dose regimen was accurately described for 120 (82.8%) medicines with the duration of treatment known for 132 (91%). Participants mentioned that they had been advised about side effects for 44 (30.3%) medicines. Specific counselling points recommended by the BNFc1, were either omitted or not recalled by participants for the following systemic treatments: cetirizine (1), chlorphenamine (1), desmopressin (2), hydroxyzine (2), itraconazole (1), piroxicam (2), methotrexate (1), stiripentol (1) and topiramate (1).ConclusionFollowing an out-patient consultation, where a new medicine is prescribed, children and their parents/carers are usually able to recall the indication, dose regimen and duration of treatment. Few were able to recall, or were told about, possible adverse effects. This may include some important drug specific effects that require vigilance during treatment.Patients, along with families and carers, should be involved in the decision to prescribe a medicine.2 This includes a discussion about the benefits of the medicine on the patient's condition and possible adverse effects.2 Treatment side effects have been shown to be a factor in treatment non-adherence in paediatric long-term medical conditions.3 Practitioners should explain to patients, and their family members or carers where appropriate, how to identify and report medicines-related patient safety incidents.4 However, this study suggests that medical staff may not be comfortable discussing the adverse effects of medicines with patients or their parents/carers.Further research in to the shared decision making process in the paediatric out-patient clinic when a new long-term medicine is prescribed is required to further support medicines adherence and the patient safety agenda.

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Prophylaxis in people with haemophilia

Thrombosis and Haemostasis ◽

10.1160/th08-07-0483 ◽

2009 ◽

Vol 101 (04) ◽

pp. 674-681 ◽

Cited By ~ 36

Author(s):

Massimo Franchini ◽

Annarita Tagliaferri ◽

Antonio Coppola

Keyword(s):

Quality Of Life ◽

Cost Benefit ◽

Primary Prophylaxis ◽

Secondary Prophylaxis ◽

Severe Haemophilia ◽

Duration Of Treatment ◽

First Choice ◽

Long Term Treatment

SummaryA four-decade clinical experience and recent evidence from randomised controlled studies definitively recognised primary prophylaxis, i.e. the regular infusion of factor concentrates started after the first haemarthrosis and/or before the age of two years, as the first-choice treatment in children with severe haemophilia. The available data clearly show that preventing bleeding since an early age enables to avoid or reduce the clinical impact of muscle-skeletal impairment from haemophilic arthropathy and the related consequences in psycho-social development and quality of life of these patients. In this respect, the aim of secondary prophylaxis, defined as regular long-term treatment started after the age of two years or after two or more joint bleeds, is to avoid (or delay) the progression of arthropathy. The clinical benefits of secondary prophylaxis have been less extensively studied, especially in adolescents and adults; also in the latter better outcomes and quality of life for earlier treatment have been reported. This review summarises evidence from literature and current clinical strategies for prophylactic treatment in patients with severe haemophilia, also focusing on challenges and open issues (optimal regimen and implementation, duration of treatment, long-term adherence and outcomes, cost-benefit ratios) in this setting.

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Elucidating the Potential Side Effects of Current Anti- Seizure Drugs for Epilepsy

Current Neuropharmacology ◽

10.2174/1570159x19666210826125341 ◽

2021 ◽

Vol 19 ◽

Author(s):

Enes Akyüz ◽

Mohd. Farooq Shaikh ◽

Betül Köklü ◽

Cansu Ozenen ◽

Alina Arulsamy

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Adverse Effects ◽

Side Effect ◽

First Line ◽

Epileptic Patients ◽

Life Threatening ◽

Visual Problems ◽

Gaba Transmission

: Over the decades, various interventions have been developed and utilized to treat epilepsy. However, majority of epileptic patients are often first prescribed with anti-epileptic drugs (AED), now known as anti-seizure drugs (ASD), as a first line of defense to suppress their seizures and regain their quality of life. ASDs exert their anti-convulsant effects through various mechanisms of action including regulation of ion channels, blocking of glutamate-mediated stimulating neurotransmitter interaction, and enhancing the inhibitory GABA transmission. About one third of epileptic patients are often resistant to anti-convulsant drugs, while others develop numerous side effects which may lead to treatment discontinuation and further deterioration of quality of life. Common side effects of ASDs include headache, nausea and dizziness. However, more adverse effects such as auditory and visual problems, skin problems, liver dysfunction, pancreatitis and kidney disorders may also be witnessed. Some ASDs may even result in life-threatening conditions as well as serious abnormalities, especially in patients with comorbidities and in pregnant women. Nevertheless, some clinicians had observed a reduction in the development of side effects post individualized ASD treatment. This suggest that a careful and well-informed ASD recommendation to patients may be crucial for an effective and side-effect free control of their seizures. Therefore, this review aimed to elucidate the anticonvulsant effects of ASDs as well as their side effect profile, by discussing their mechanism of action and reported adverse effects based on clinical and preclinical studies, thereby providing clinicians with a greater understanding of the safety of current ASDs.

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Analysis of response of vitiligo to treatment with NBUVB

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20185105 ◽

2019 ◽

Vol 5 (1) ◽

pp. 37

Author(s):

J. Madhava Praveen ◽

Jatin Sidhwa

Keyword(s):

Adverse Effects ◽

Skin Disorder ◽

Environmental Risks ◽

Treatment Modalities ◽

Duration Of Treatment ◽

Autoimmune Attack ◽

Self Worth ◽

Good Treatment Response ◽

Dynamic Interplay

Background: Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, due to the loss of functioning melanocytes. The disease can have devastating consequences on an individual’s relationships with others and internal feelings of self-worth. Vitiligo is caused by a dynamic interplay between genetic and environmental risks that initiates an autoimmune attack on melanocytes in the skin. Long term phototherapy has shown good response in the management of vitiligo. In this study we explore the efficacy of phototherapy in management of our vitiligo patients.Methods: 30 subjects were included in the study. Subjects were started on NBUVB at 300mj/cm2. Weekly 3 doses were given. Doses were increased after every 3rd sitting by 10%. In case of adverse effects treatment is withheld till resolution of symptoms following which NBUVB is given at 50% of the last dose and patient managed based on the response.Results: A majority of the subjects showed significant and persistent improvement within the first 3 months of initiation of treatment. The proportion of the patients showing improvement increased with duration of treatment.Conclusions: Our study has revealed the standard and significant role the phototherapy plays in the treatment of vitiligo as a monotherapy or as an adjuvant with other treatment modalities. With good treatment response and minimal side effect incidence, phototherapy is an important treatment modality in the management of vitiligo.

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Opioid Analgesia: Perspectives on Right Use and Utility

January 2018 - Pain Physician ◽

10.36076/ppj.2007/10/479 ◽

2007 ◽

Vol 3;10 (5;3) ◽

pp. 479-491 ◽

Cited By ~ 2

Author(s):

Jane C. Ballantyne

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Side Effects ◽

Clinical Decision Making ◽

Analgesic Efficacy ◽

Clinical Decision ◽

Opioid Analgesia ◽

Opioid Treatment

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the “principle of balance” may justify that “…efforts to address abuse should not interfere with legitimate medical practice and patient care.” Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients’ function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients’ rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of “producing good for the patient and protecting from harm,” so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain. Key Words: Opioids, chronic pain, addiction, side effects, utility, ethics

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The vulnerability of tidal flats and multi-channel estuaries to dredging and disposal

Anthropocene Coasts ◽

10.1139/anc-2020-0006 ◽

2021 ◽

Vol 4 (1) ◽

pp. 36-60

Author(s):

Wout M. van Dijk ◽

Jana R. Cox ◽

Jasper R.F.W. Leuven ◽

Jelmer Cleveringa ◽

Marcel Taal ◽

...

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Tidal Flats ◽

Main Channel ◽

Channel System ◽

Adverse Side Effects ◽

Limited Effectiveness ◽

Physical Scale ◽

Large Vessels

Shipping fairways in estuaries are continuously dredged to maintain access for large vessels to major ports. However, several estuaries worldwide show adverse side effects to dredging activities, in particular affecting morphology and ecologically valuable habitats. We used physical scale experiments, field assessments of the Western Scheldt estuary (the Netherlands), and morphodynamic model runs to analyse the effects of dredging and future stresses (climate and sediment management) on a multi-channel system and its ecologically valuable intertidal flats. All methods indicate that dredging and disposal strategies are unfavourable to long-term morphology because dredging creates and propagates the imbalance between shallow and deeper parts of the estuary, causing a loss of valuable connecting channels and fixation of the tidal flats and main channel positions, while countering adverse effects by disposal strategy has limited effectiveness. Changing the disposal strategy towards main channel scour disposal can be economically and ecologically beneficial for the preservation of the multi-channel system. Further channel deepening will accelerate the adverse side effects, whereas future sea-level rise may revive the multi-channel system.

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Comparative Effectiveness of Conservative Management Compared to Cryotherapy in Localized Prostate Cancer Patients

American Journal of Men s Health ◽

10.1177/1557988318781731 ◽

2018 ◽

Vol 12 (5) ◽

pp. 1681-1691 ◽

Cited By ~ 2

Author(s):

Surbhi Shah ◽

Henry N. Young ◽

Ewan K. Cobran

Keyword(s):

Prostate Cancer ◽

Side Effects ◽

Conservative Management ◽

Comparative Effectiveness ◽

Urinary Tract Obstruction ◽

Localized Prostate Cancer ◽

Long Term Outcomes ◽

Lower Urinary Tract Obstruction

The high frequency of treatment-related side effects for men with localized prostate cancer creates uncertainty for treatment outcomes. This study assessed the comparative effectiveness of treatment-related side effects associated with conservative management and cryotherapy in patients with localized prostate cancer. A retrospective longitudinal cohort study was conducted, using the linked data of the Surveillance, Epidemiology, and End Results and Medicare, which included patients diagnosed from 2000 through year 2013, and their Medicare claims information from 2000 through 2014. To compare the differences in baseline characteristics and treatment-related side effects between the study cohorts, χ2 tests were conducted. Multivariate logistic regression was used to assess the association between treatment selection and side effects. There were 7,998 and 3,051 patients in the conservative management and cryotherapy cohort, respectively. The likelihood of erectile dysfunction, lower urinary tract obstruction, urinary fistula, urinary incontinence, and hydronephrosis was reported to be significantly lower (53%, 35%, 69%, 65%, and 36%, respectively) in the conservative management cohort. Conservative management had a lower likelihood of treatment-related side effects compared to cryotherapy. However, further research is needed to compare other significant long-term outcomes such as costs associated with these treatment choices and quality of life.

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