scholarly journals Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing

2021 ◽  
Vol 11 (6) ◽  
pp. 320-333
Author(s):  
Danielle L. Stutzman
Keyword(s):  
Critical Evaluation ◽  
Significant Risk ◽  
Child And Adolescent Psychiatry ◽  
Psychotropic Medications ◽  
Mood Stabilizers ◽  
Supporting Evidence ◽  
Social Changes ◽  
Treatment Facilities

Abstract It is estimated that 8% to 12% of youth are prescribed psychotropic medications. Those in foster care, juvenile justice systems, residential treatment facilities, and with developmental or intellectual disabilities are more likely to be prescribed high-risk regimens. The use of psychotropic medications in this age group is often off-label and can be associated with significant risk, warranting critical evaluation of their role. Landmark trials, pediatric-specific guidelines, and state-driven initiatives play critical roles in supporting evidence-based use of psychotropic medications in children. Overall, there is a lack of literature describing the long-term use of psychotropic medications in youth—particularly with regard to neurobiological, physical, and social changes that occur throughout development. Deprescribing is an important practice in child and adolescent psychiatry, given concerns for over-prescribing, inappropriate polytherapy, and the importance of reevaluating the role of psychotropic medications as children develop.

scholarly journals Etiology of differentiated carcinoma of the thyroid current apprehension

2003 ◽  
Vol 50 (3) ◽  
pp. 51-55
Author(s):  
Ruben Han
Keyword(s):  
Animal Experiments ◽  
Growth Control ◽  
Significant Risk ◽  
Ionising Radiation ◽  
Sodium Iodide Symporter ◽  
Chemical Agents ◽  
Tsh Secretion ◽  
Genetic And Environmental Factors

It is apparent that in the last decade carcinoma of the thyroid is becoming increasingly prevalent. The multistage complex theory of thyroid carcinogenesis is based on observations made on cohort patients studies and during animal experiments over a period of last fifty years. The process of thyroid oncogenesis is conceived to be a series of events induced by genetic and environmental factors which alter follicular cells division and growth control. These factors can be considered as initiators (chemical agents and ionising radiation) and promoters (some goitrogenes and drugs). The first class of factors induce incipient tumorigenesis while the second augments TSH secretion and radically increases tumour growth. Normally silent, intracellular proto-oncogenes (of which Ret/PTC series are the most conceived ones) can become activated by chromosomal translocations, deletions or mutations and can transform normal follicular cell into a condition of uncontrolled division and growth. The most significant known cause of thyroid carcinomas in men is exposure to external or internal ionising radiation. Beside that, long-term iodine deficiency, effects of certain chemical carcinogens, drugs and goitrogenes must be considered as significant risk factors. Possible role of sodium/iodide symporter is becoming an objective of the most recent investigations.

The role of medication

2017 ◽  
Author(s):  
Tom Burns ◽  
Mike Firn
Keyword(s):  
Side Effects ◽  
Antipsychotic Medication ◽  
Mood Stabilizers ◽  
Clozapine Therapy

This chapter focuses mainly on the importance of maintenance antipsychotic medication and mood stabilizers. It examines procedures to support persistence with these drugs and maintain engagement. The techniques for initiating and monitoring clozapine therapy in the community for patients with resistant schizophrenia are outlined. The practical processes for ensuring and conducting regular structured reviews of long-term medication, both to assess progress and to identify side effects, are described in detail. In addition, the judicious use of antidepressants and benzodiazepines is outlined.

scholarly journals Metabolic Reprogramming and Cell Adhesion in Acute Leukemia Adaptation to the CNS Niche

2021 ◽  
Vol 9 ◽  
Author(s):  
Nitesh D. Sharma ◽  
Esra’a Keewan ◽  
Ksenia Matlawska-Wasowska
Keyword(s):  
Cell Adhesion ◽  
Acute Leukemia ◽  
Poor Prognosis ◽  
Significant Risk ◽  
Leukemic Cell ◽  
Metabolic Reprogramming ◽  
Leukemic Cells ◽  
The Central Nervous System

Involvement of the Central Nervous System (CNS) in acute leukemia confers poor prognosis and lower overall survival. Existing CNS-directed therapies are associated with a significant risk of short- or long-term toxicities. Leukemic cells can metabolically adapt and survive in the microenvironment of the CNS. The supporting role of the CNS microenvironment in leukemia progression and dissemination has not received sufficient attention. Understanding the mechanism by which leukemic cells survive in the nutrient-poor and oxygen-deprived CNS microenvironment will lead to the development of more specific and less toxic therapies. Here, we review the current literature regarding the roles of metabolic reprogramming in leukemic cell adhesion and survival in the CNS.

scholarly journals POLYPHARMACY IN DIABETIC PEOPLE: EVIDENCE FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING (ELSA)

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S482-S483
Author(s):  
Yun-Ting Huang ◽  
Paola Zaninotto ◽  
Andrew Steptoe ◽  
Li Wei
Keyword(s):  
Risk Factors ◽  
Older People ◽  
Significant Risk ◽  
Cross Sectional Study ◽  
Health Condition ◽  
Cross Sectional ◽  
Nationally Representative ◽  
English Longitudinal Study

Abstract Diabetes among older people is becoming more common worldwide, and usually accompanied by polypharmacy. However, the role of polypharmacy in older people with diabetes remains uncertain. A nationally representative cross-sectional study, ELSA 2012/2013, was used and 7729 participants aged 50-109 were investigated. Polypharmacy was defined as taking five to nine long-term used medications daily for chronic diseases or chronic symptoms, while using ten or more medications was excessive polypharmacy. The presence of illness was defined as either self-reported diagnosis or being prescribed specific medications for the condition. Data showed the prevalence of polypharmacy was 21.4%, and only 3% was excessive polypharmacy. 51.6% of diabetic people reported polypharmacy and 10.2% excessive polypharmacy. These rates were significantly higher than the 16.4% polypharmacy and 1.8% excessive polypharmacy among people without diabetes (p < 0.001). Among people with three or more comorbidities, polypharmacy was present in 61.5% of people with diabetes, compared with 36.0% in people without diabetes. Significant risk factors for polypharmacy were diabetes (Relative-risk ratios/RRR=4.06, 95% CI 3.38, 4.86), older age (RRR=1.02, 95% CI 1.01, 1.03), male (RRR=0.64, 95% CI 0.55, 0.75), more comorbidity (RRR=2.46, 95% CI 2.30, 2.62), living with a partner (RRR=1.20, 95% CI 1.01, 1.42), and less wealth (RRR=0.93, 95% CI 0.87, 0.98). However, age, cohabitation, and wealth were not significantly related to excessive polypharmacy. Diabetes and the number of comorbidities were predominant risk factors for excessive polypharmacy. Current evidences confirmed both health condition and socioeconomic status were associated with medication use in older adults.

Abstract P399: Endothelial Myc Deletion Reduces Doxorubicin-induced Cardiac Dysfunction And Remodeling

2021 ◽  
Vol 129 (Suppl_1) ◽  
Author(s):  
Jacqueline F Machi ◽  
Alejo A Morales ◽  
Yue Qi ◽  
Nikole Q Mendez ◽  
Augusto F Schmidt ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Significant Decline ◽  
Conditional Knockout ◽  
Collagen Content ◽  
Supporting Evidence ◽  
Cellular Functions ◽  
Dna Damage And Repair ◽  
Effective Drugs

Cardiotoxicity is the most common complication in patients undergoing chemotherapy, and the leading cause of death in long-term cancer survivors. Anthracyclines are highly effective drugs broadly used in cancer treatment, but with limited use due to cardiotoxicity. Currently, there is no effective treatment for anthracycline-induced cardiotoxicity. Recent studies have shown the role of endothelial cells in cardioprotection after anthracycline exposure, though mechanisms involved remain elusive. In the present study, we provide supporting evidence that endothelial Myc plays a role in anthracycline-induced cardiotoxicity. Myc is a stress sensor and master regulator involved in multiple cellular functions. Deregulated Myc expression has been linked to multiple pathological conditions. Using a conditional knockout model, we tested the hypothesis that loss of endothelial c-Myc is cardioprotective. Control (CT) and endothelial knockout (KO) juvenile mice were exposed to 15mg/kg cumulative dose of doxorubicin administered in 6 doses every 2-days along 2-weeks. Echocardiography was performed 3-days after last dose. Doxorubicin had a significant sex-specific impact in cardiac function as previously reported. In CT males, doxorubicin caused significant decline in stroke and diastolic volume, without changes in ejection fraction. In CT females, doxorubicin caused significant increase in heart rate, decline in ejection fraction, and increase in diastolic volume. KO animals showed attenuated response to these doxorubicin-induced alterations in both males and females. Pathology analysis of the heart 3-months after doxorubicin exposure showed significant decline in CT and KO male cardiac mass and collagen content, both of which were attenuated in KO animals. Doxorubicin did not show any impact on mass and collagen content in females. RNAseq analysis suggested modulation of distinct pathways in CT and KO hearts associated with inflammation, DNA damage and repair, cell death and fibrosis. Cdkn1a and TP53 were top upstream regulators predicted to be activated in CT and let-7 in KO hearts. Our findings support the potential targeting of endothelial Myc in doxorubicin-induced cardiotoxicity.

The Role of Omentectomy in Continuous Ambulatory Peritoneal Dialysis

1991 ◽  
Vol 11 (4) ◽  
pp. 330-332 ◽  
Author(s):  
Michael L. Nicholson ◽  
Paul R. Burton ◽  
Peter K. Donnelly ◽  
Peter S. Veitch ◽  
John Walls
Keyword(s):  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Surgical Technique ◽  
Proportional Hazards ◽  
Significant Risk ◽  
Peritoneal Catheter ◽  
Term Survival ◽  
Catheter Survival

Long-term survival of the peritoneal catheter is essential for successful CAPD. In our unit, all CAPD catheters are now placed by an open surgical technique, which in some cases has included performing a partial omentectomy. The aim of this study was to assess the influence of omentectomy on CAPD catheter survival. Three hundred consecutive CAPD catheters inserted over a 5-year period were analyzed. Omentectomy was performed in 113 cases (38%). Data relating to a number of potentially significant risk/benefit factors were analyzed using multiple regression analysis (proportional hazards method of Cox). Performing a partial omentectomy at the time of catheter insertion was found to significantly improve CAPD catheter survival (p=0.0002).

scholarly journals Animal models of chemotherapy-induced cognitive decline in preclinical drug development

2021 ◽  
Author(s):  
Jeena John ◽  
Manas Kinra ◽  
Jayesh Mudgal ◽  
G. L. Viswanatha ◽  
K. Nandakumar
Keyword(s):  
Animal Models ◽  
Human Cancer ◽  
Critical Evaluation ◽  
Significant Risk ◽  
Long Term Potentiation ◽  
Chemotherapeutic Agents ◽  
Therapeutic Interventions ◽  
Cognitive Changes ◽  
Tumor Bearing

Abstract Rationale Chemotherapy-induced cognitive impairment (CICI), chemobrain, and chemofog are the common terms for mental dysfunction in a cancer patient/survivor under the influence of chemotherapeutics. CICI is manifested as short/long term memory problems and delayed mental processing, which interferes with a person’s day-to-day activities. Understanding CICI mechanisms help in developing therapeutic interventions that may alleviate the disease condition. Animal models facilitate critical evaluation to elucidate the underlying mechanisms and form an integral part of verifying different treatment hypotheses and strategies. Objectives A methodical evaluation of scientific literature is required to understand cognitive changes associated with the use of chemotherapeutic agents in different preclinical studies. This review mainly emphasizes animal models developed with various chemotherapeutic agents individually and in combination, with their proposed mechanisms contributing to the cognitive dysfunction. This review also points toward the analysis of chemobrain in healthy animals to understand the mechanism of interventions in absence of tumor and in tumor-bearing animals to mimic human cancer conditions to screen potential drug candidates against chemobrain. Results Substantial memory deficit as a result of commonly used chemotherapeutic agents was evidenced in healthy and tumor-bearing animals. Spatial and episodic cognitive impairments, alterations in neurotrophins, oxidative and inflammatory markers, and changes in long-term potentiation were commonly observed changes in different animal models irrespective of the chemotherapeutic agent. Conclusion Dyscognition exists as one of the serious side effects of cancer chemotherapy. Due to differing mechanisms of chemotherapeutic agents with differing tendencies to alter behavioral and biochemical parameters, chemotherapy may present a significant risk in resulting memory impairments in healthy as well as tumor-bearing animals.

Safeguarding foster care youth from overmedication

2016 ◽  
Vol 33 (S1) ◽  
pp. S133-S134 ◽  
Author(s):  
C. Pataki ◽  
C. Thompson ◽  
G. Crecelius ◽  
J. Tesoro ◽  
G. Polsky ◽  
...  
Keyword(s):  
Mental Health ◽  
Foster Care ◽  
Psychiatric Care ◽  
Juvenile Court ◽  
Psychotropic Medications ◽  
Mood Stabilizers ◽  
List Type ◽  
Foster Care Youth ◽  
Competing Interest

IntroductionThere are increasing concerns regarding long-term psychotropic polypharmacy prescribed for foster care youth 3.5 to 5 times more often than in at-home youth (Kreider et al., 2014). Polypharmacy risks include weight gain, glucose intolerance and type 2 diabetes. (De Hert et al., 2011). In view of these risks, novel interventions are essential to safeguard foster care youth from overmedication.ObjectivesTo present guidelines for identification and management of polypharmacy in foster care youth.AimsTo demonstrate a novel intervention to monitor and diminish polypharmacy and enhance psychiatric care in foster care children.MethodsPolypharmacy is identified using LA County Juvenile Court Mental Health Service (JCMHS) Psychotropic Parameters* to review medication consent forms from treating psychiatrists. Polypharmacy triggers an in-person JCHMS consultation. *(Parameters 3.9 for JCMHS PMAF Review, Revised May 2015).JCMHS Psychotropic Parameters (summary):– age 0–5 years:– 2 or > psychotropic medications,– Any antipsychotic (*except Risperidone in ASD);– age 6–8 years:– 3 or > psychotropic medications;– age 9–17 years:– 4 or > psychotropic medications;– All age youth:– 2 or > psychotropic medications in the same class (antipsychotics, antidepressants, stimulants, mood stabilizers, alpha agonists).Psychotropic medication doses in excess of recommended (*LA County Department of Mental Health Parameters 3.8 for use of Psychotropic Medications for Children and Adolescents).ResultsApproximately 25% of JCMHS annual psychiatric consultations were initiated by JCMHS parameters for polypharmacy. Corresponding consultations included education and recommendations discussed with treating psychiatrists regarding polypharmacy and optimal psychiatric management.ConclusionsJCMHS Psychotropic Parameters is a useful tool to identify polypharmacy and enhance psychiatric care of foster care youth.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Critical Role of Technological Analysis for Prehistoric Anthropological Inference

1990 ◽  
Vol 185 ◽  
Author(s):  
Gary O. Rollefson
Keyword(s):  
Critical Role ◽  
Critical Evaluation ◽  
Middle Part ◽  
Neolithic Period ◽  
Environmental Implications ◽  
Lime Plaster ◽  
Hearsay Evidence

AbstractPrehistoric archaeology has profited enormously from the expanding role of technological examination of artifactual materials, particularly in the past couple of decades. Indeed, the rapid growth of materials sciences studies has evidently begun to outpace the capacity of many prejistoric archaeologists to accomodate the results of technological analyses into anthropological models to explain perceived changes in the prehistoric archaeological record. The sheer numbers of published technological reports, which increasingly appear in a growing number of specialized journals and other publications, account for some of the communications lag among prehistorians and smaterials scientists. But long-held and persistent myths and “hearsay” evidence also contribute to a widening gap between relevant data and critical evaluation.The case study presented below compares scenarios that purport to explain striking contrasts in the northern and southern parts of the Levant during the middle part of the Neolithic period, particularly from ca. 6,500-5,000 b.c. One hypothesis (climatic change) is briefly dismissed; the other hinges principally on the environmental implications of plaster production that characterized the cultures of the region. The “collapse” of the southern Levantine settlements is understandable when the specific requirements of lime plaster manufacture are taken into account, while the conditions for the persistence of long-term site continuity in the northern Levant are clear under the less pressing environmental demands of gypsum plaster production.

Electron Microscopy of Metal-Matrix Composites

1970 ◽  
Vol 28 ◽  
pp. 404-405
Author(s):  
A. Lawley ◽  
M. R. Pinnel ◽  
A. Pattnaik
Keyword(s):  
Electron Microscopy ◽  
Metal Matrix Composites ◽  
Metal Matrix ◽  
Critical Evaluation ◽  
Elastic Behavior ◽  
Matrix Composites ◽  
Directionally Solidified ◽  
Fracture Characteristics ◽  
Broad Program

As part of a broad program on composite materials, the role of the interface on the micromechanics of deformation of metal-matrix composites is being studied. The approach is to correlate elastic behavior, micro and macroyielding, flow, and fracture behavior with associated structural detail (dislocation substructure, fracture characteristics) and stress-state. This provides an understanding of the mode of deformation from an atomistic viewpoint; a critical evaluation can then be made of existing models of composite behavior based on continuum mechanics. This paper covers the electron microscopy (transmission, fractography, scanning microscopy) of two distinct forms of composite material: conventional fiber-reinforced (aluminum-stainless steel) and directionally solidified eutectic alloys (aluminum-copper). In the former, the interface is in the form of a compound and/or solid solution whereas in directionally solidified alloys, the interface consists of a precise crystallographic boundary between the two constituents of the eutectic.

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