scholarly journals Case Report: Cariprazine Efficacy in Young Patients Diagnosed With Schizophrenia With Predominantly Negative Symptoms

2021 ◽  
Vol 12 ◽  
Author(s):  
Octavian Vasiliu
Keyword(s):  
Adverse Events ◽  
Clinical Global Impression ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Partial Agonist ◽  
D2 Receptor ◽  
Young Patients ◽  
Clinical Manifestations ◽  
Case Series ◽  
Global Functioning

Negative symptoms of schizophrenia are among the most invalidating clinical manifestations of this disorder, and they are correlated with poorer prognosis, lower quality of life, and fewer chances for successful social reintegration and professional rehabilitation. Although atypical antipsychotics have been associated with higher efficacy on negative symptoms than typical agents, not all of them are equally effective. Cariprazine is a new D3 and D2 receptor partial agonist, and its high D3 affinity may be useful for decreasing several adverse events (e.g., extrapyramidal symptoms or hyperprolactinemia), and also for increasing this drug's efficacy over negative symptoms. This case series presents three young adults with predominantly negative symptoms during treatment with an atypical antipsychotic, administered in stable dose within the therapeutic range, and for at least 4 weeks prior to the cariprazine switch. These patients (two male and one female, mean age 35.7 years) were diagnosed with schizophrenia, according to the DSM-5 criteria. They were evaluated using Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), and Global Assessment of Functioning (GAF). Their mean initial values were 80.3 on PANSS, 4.3 on CGI-S, and 48 on GAF. All these patients were already on a treatment with stable doses of atypical antipsychotics (olanzapine 10 mg/day, n = 1, risperidone 6 mg/day, n = 1, and quetiapine 600 mg/day, n = 1). Cross-titration to cariprazine was initiated, from 1.5 mg qd up to 6 mg qd, during a mean period of 2.7 weeks. After 12 weeks of cariprazine 6 mg/day, the positive scale of PANSS was relatively stable compared to baseline, while the negative mean score decreased by 22%. Also, the mean CGI-S improvement was 15.4% and the GAF mean score increased by 17%. The overall tolerability was good, without severe adverse events being reported. Conclusions: Cariprazine is well tolerated and efficient for patients diagnosed with schizophrenia who have significant negative symptoms that impair daily functioning. After 12 weeks cariprazine succeeded in improving negative symptoms, global functioning, and clinical global impression.

scholarly journals Intra-articular venous malformations of the knee: a diagnostic challenge

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Federico Diomeda ◽  
Maria Santaniello ◽  
Giulia Bracciolini ◽  
Angelo Ravelli ◽  
Adele Civino
Keyword(s):  
Early Recognition ◽  
Young Patients ◽  
Clinical Manifestations ◽  
Case Series ◽  
Venous Malformations ◽  
Mri Imaging ◽  
Diagnostic Challenge ◽  
Complete Excision ◽  
Hyperintense Signal ◽  
Hypointense Signal

Abstract Background Intra-articular venous malformations (IAVM) are rare benign vascular anomalies that usually affect young patients and most common locate in the knee. The terminology of these lesions is still ill-defined, as they are often termed in the literature as synovial hemangiomas. Early diagnosis can be difficult, because they usually present with nonspecific clinical manifestations that are similar those of other rheumatic diseases, especially juvenile idiopathic arthritis (JIA). Case series We conducted a retrospective analysis of five pediatric patients admitted to our units for recurrent swelling of the knee, and compared their characteristics with those of literature reports. The average age at first symptom and time from onset to diagnosis was 3.9 years (range 18 months-7 years) and 3.5 years (range 1-7 years), respectively. In our patients, an initial misdiagnosis of JIA, bleeding disorder or traumatic arthropathy was made. On MRI imaging, the features of the lesion were similar in all patients, and were marked by isointense-to-hypointense signal in T1-weighted images, and hyperintense signal in T2-weighted images. When performed, arthrocentesis led to aspiration of bloody fluid. The diagnosis was confirmed with a biopsy and histopathologic assessment in all patients. Open surgery enabled complete excision of the mass and was followed by stable remission over time in all cases. Conclusions Our report highlights the challenges that may be posed by the detection of knee IAVM and the frequent long delay between onset of symptoms and diagnosis. The key elements for early recognition include careful assessment of patient history, demonstration of bloody fluid on arthrocentesis, and proper interpretation of MRI scanning.

Indication of depot antipsychotic treatment in the view of slovak psychiatrists

2016 ◽  
Vol 33 (S1) ◽  
pp. S553-S553
Author(s):  
M. Zelman
Keyword(s):  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Young Patients ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Depot Antipsychotic ◽  
Treatment Research ◽  
Competing Interest ◽  
Oral Antipsychotic ◽  
Depot Form

With the increasing number of atypical antipsychotics in depot form, there emerges question about plus and cons of their use in schizophrenia patients. We focused on the opinion of Slovak psychiatrists about use of this treatment in some specific situations of schizophrenia treatment. Research was realized via questionnaire on psychiatrists (n = 47) from ambulant and hospital care, during one conference in June 2015. First part of the questionnaire was focused on the preference of oral or depot form of antipsychotic treatment. Depot form would be indicated by psychiatrists (in more than 89%) when low compliance, anosognosia or frequent episodes. On the contrary, oral antipsychotic treatment is preferred in young patients or employed patients. The type of symptoms (e.g. positive, negative) has relatively small impact on the preference of treatment, where the preferences of each type were the lowest (fewer than 36%). According to the opinion of psychiatrists, depot antipsychotic treatment is not suitable in first episode of disorder (according to 81% of respondents), otherwise in second or third episode it would not be chosen by 6% of asked psychiatrists.From the aspects of the choice between atypical or typical depot, atypical antipsychotics in depot form were favored when presence of adverse reactions (80%), occurrence of negative symptoms (65%) and short duration of disorder (58%). Typical depot was preferred by psychiatrists in patients with chronic states.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Age of Atypical Antipsychotics

1996 ◽  
Vol 9 (2) ◽  
pp. 113-117
Author(s):  
Ronald Pies
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
D2 Receptor ◽  
Receptor Occupancy ◽  
Clinical Development ◽  
Pharmacological Management ◽  
Regional Brain

Atypical antipsychotics (AAPs) have led to refinements in the pharmacological management of schizophrenia and related disorders. Most AAPs produce fewer extra- pyramidal side effects than conventional agents, and appear to ameliorate "negative symptoms" to a greater degree. In general, many AAPs have a higher ratio of 5HT2 to D2 receptor occupancy than do conventional neuroleptics. This ratio may confer some of the "atypical" qualities to these agents, though regional brain selectivity may also be involved. Although clozapine and risperidone are the two AAPs clinicians now have available, many other similar agents are close to clinical development. Copyright © 1996 by W.B. Saunders Company

scholarly journals Beyond the dopamine receptor: novel therapeutic targets for treating schizophrenia

2010 ◽  
Vol 12 (3) ◽  
pp. 359-382 ◽  
Keyword(s):  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Dopamine D2 Receptor ◽  
Cognitive Impairments ◽  
D2 Receptor ◽  
Comparative Efficacy ◽  
Postmortem Imaging ◽  
Drug Challenge ◽  
Meta Analyses ◽  
Efficacy Studies

All current drugs approved to treat schizophrenia appear to exert their antipsychotic effects through blocking the dopamine D2 receptor. Recent meta-analyses and comparative efficacy studies indicate marginal differences in efficacy of newer atypical antipsychotics and the older drugs, and little effects on negative and cognitive symptoms. This review integrates findings from postmortem, imaging, and drug-challenge studies to elucidate a corticolimbic "pathologic circuit" in schizophrenia that may be particularly relevant to the negative symptoms and cognitive impairments of schizophrenia. Potential sites for pharmacologic intervention targeting glutatatergic, GABAergic, and cholinergic neurotransmission to treat these symptoms of schizophrenia are discussed.

Combination Chlorambucil/Firocoxib or Chlorambucil/Prednisolone Treatment for Inflammatory Colorectal Polyps in Miniature Dachshunds

2018 ◽  
Vol 54 (3) ◽  
pp. 161-166 ◽  
Author(s):  
Akira Murakami ◽  
Ayami Shibahashi ◽  
Ryota Iwasaki ◽  
Mifumi Kawabe ◽  
Mami Murakami ◽  
...  
Keyword(s):  
Adverse Events ◽  
Alternative Treatment ◽  
Clinical Manifestations ◽  
Case Series ◽  
Colorectal Polyps ◽  
Retrospective Case ◽  
Prednisolone Treatment ◽  
Immune Mediated ◽  
Causative Relationship

ABSTRACT Inflammatory colorectal polyps (ICRP), which are more commonly recognized in miniature dachshunds, are thought to represent an immune-mediated disease. This retrospective case series describes six miniature dachshunds with refractory ICRP, who were treated with chlorambucil (CLB) combined with firocoxib or prednisolone. Improvement in clinical manifestations was seen in five of the six dogs by the end of the study period; four were treated with CLB/firocoxib and one with CLB/prednisolone. One dog had nonregenerative anemia after 23 mo of treatment with CLB, but whether there was a causative relationship was unclear. No severe adverse events were observed during treatment in the remaining five dogs. CLB in combination with firocoxib or prednisolone appears to be an effective alternative treatment for ICRP in dogs. Further studies are needed to confirm the effectiveness and long-term complications of CLB treatment for ICRP in dogs.

scholarly journals Negative Symptoms Management in Schizophrenia

2021 ◽  
Vol 10 (1) ◽  
pp. 6
Author(s):  
Maria Francisca Intan Primasiwi Lolobua ◽  
Khairina Khairina ◽  
Ida Aju Kusuma Wardani ◽  
Angelina M. Mirna Santoso
Keyword(s):  
Side Effect ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Behavioral Therapy ◽  
D2 Receptor ◽  
Dissociation Rate ◽  
European Medicines Agency ◽  
Cognitive Improvement ◽  
The Difference ◽  
Primary Type

Clinicians often overlook the presence of negative symptoms in treating schizophrenia. The burden borne by patients, families, and society is quite heavy. These symptoms not only have high costs, but also affect the functional prognosis in independence and socializing. There is a need for adequate therapy of negative symptoms of schizophrenia which can improve the patient’s quality of life. Negative symptoms are characterized by blunt affect, alogia, avolition, anhedonia, and asociality. Knowing the difference between the primary and secondary types of negative symptoms of schizophrenia can bring big impact on the therapy. The primary type of negative symptoms is an integral part of schizophrenia, while the secondary one is caused by external conditions of schizophrenia, such as depression. Management of negative symptoms of schizophrenia includes psychopharmaceuticals and non-psychopharmaceuticals. Atypical antipsychotics remain the drug of choice due to their affinity not only to D2 receptor, but also to serotonin, glutamate, histamine, α adrenergic, and muscarinic receptors. In addition, the higher dissociation rate of D2 receptors of atypical antipsychotics allow for minimal motor side effect. Cariprazine has been approved by The Food and Drug Associaton and The European Medicines Agency to treat primary and persistent negative symptoms due to its minimal side effect. Non-pharmacological therapies such as Cognitive Behavioral Therapy (CBT) and Motivation and Engagement Training (MOVE) can optimize the treatment efficacy. These therapies will enhance the cognitive improvement, adaptation, and social skill development of the patients.

scholarly journals Etiologies and clinical characteristics of young patients with angle-closure glaucoma: a 15-year single-center retrospective study

2021 ◽  
Author(s):  
Feng Gao ◽  
Jiajian Wang ◽  
Junyi Chen ◽  
Xiaolei Wang ◽  
Yuhong Chen ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Anterior Segment ◽  
Young Patients ◽  
Case Series ◽  
Neovascular Glaucoma ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Uncommon Presentation ◽  
Underlying Causes

Abstract Purpose To investigate the etiologies and the clinical characteristics of angle-closure glaucoma (ACG) patients younger than 40 years old in Chinese. Methods Inpatients with diagnosis of ACG and diagnosed age younger than or equal to 40 years old, who were admitted in Eye, Ear, Nose, and Throat Hospital Fudan University from 2002 to 2017, were included in this retrospective non-comparative case series. The underlying causes and clinical features for all the patients were analyzed by comprehensive review of medical charts. Results A total of 298 patients (463 eyes) met the criteria, including 153 females (51.3%) and 145 males (48.7%); the mean age was 25.6 ± 13.0 years. Primary angle-closure glaucoma (PACG), uveitis, and anterior segment dysgenesis (ASD) were the top three etiologies in our patients, which accounted for 32.6%, 20.3%, and 15.1% of the total patients respectively. PACG mainly occurs after 30 years of age and ASD is the top reason of ACG in patients younger than 20 years old. Other known etiologies include iridocorneal endothelial syndrome, neovascular glaucoma, nanophthalmos, retinitis pigmentosa, spherophakia, bestrophinopathy, persistent fetal vasculature, iridociliary cysts, congenital retinoschisis, Marfan’s syndrome, retinopathy of prematurity, familial exudative vitreoretinopathy, congenital retinal folds, Coat’s disease, and neurofibromatosis. Conclusions We described the uncommon presentation of ACG in Chinese young patients. Although unusual, most of the etiologies could be identified. Therefore, more careful and comprehensive examinations are needed for early detection and timely treatment for young ACG patients.

scholarly journals Olaparib dose re‐escalation in ovarian cancer patients who experienced severe and/or uncommon adverse events: A case series

2021 ◽  
Vol 17 (S3) ◽  
pp. 3-11
Author(s):  
Siew‐Fei Ngu ◽  
Ka‐Yu Tse ◽  
Mandy M. Y. Chu ◽  
Hextan Y. S. Ngan ◽  
Karen K. L. Chan
Keyword(s):  
Ovarian Cancer ◽  
Adverse Events ◽  
Cancer Patients ◽  
Case Series

Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions

2017 ◽  
Vol 38 (5) ◽  
pp. 485-495 ◽  
Author(s):  
Riccardo D’Ambrosi ◽  
Camilla Maccario ◽  
Chiara Ursino ◽  
Nicola Serra ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Bone Graft ◽  
Repeated Measures ◽  
Osteochondral Lesion ◽  
Young Patients ◽  
Case Series ◽  
Autologous Bone Graft ◽  
Lesion Size ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Autologous Bone

Background: The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). Methods: Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). Conclusions: The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. Level of Evidence: Level IV, retrospective case series.

scholarly journals Acute Pancreatitis as a Complication of Antiepileptic Treatment: Case Series and Review of the Literature

2021 ◽  
Vol 13 (1) ◽  
pp. 98-103
Author(s):  
Agnieszka Pawłowska-Kamieniak ◽  
Paulina Krawiec ◽  
Elżbieta Pac-Kożuchowska
Keyword(s):  
Valproic Acid ◽  
Acute Pancreatitis ◽  
Metabolic Disorders ◽  
Genetic Factors ◽  
Clinical Symptoms ◽  
Gallstone Disease ◽  
Young Patients ◽  
Case Series ◽  
Review Of The Literature ◽  
Acid Therapy

Acute pancreatitis (AP) appears to be rare disease in childhood. In children, it has a different aetiology and course, and requires different management than in adult patients. The diagnosis of AP is based on at least two of the three criteria, which include typical clinical symptoms, abnormalities in laboratory tests and/or imaging studies of the pancreas. There are many known causes leading to AP in children including infections, blunt abdominal trauma, genetic factors, gallstone disease, metabolic disorders, anatomical defects of the pancreas, systemic diseases, as well as drugs, including antiepileptic drugs, and especially preparations of valproic acid. In our study, we present four cases of young patients diagnosed with acute pancreatitis as a complication of valproic acid therapy and we present a review of the literature. We believe that the activity of pancreatic enzymes should be monitored in children treated with valproate preparations in the case of clinical symptoms suggesting AP.

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