Can we prevent the neuroinflammation and neuroprogression produced by oxidative stress in euthymic bipolar patients, using mood stabilizers?

Bipolar Disorder (BD) is associated with systemic toxicity, represented by changes in the biomarkers, associated with mood episodes, leading to neurological damage, which may reflect on cognitive functions and functionality, and the progression of the disease. We aimed to analyze the effect of four biomarkers superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) enzymes, and thiobarbituric acid reactive substances (TBA-RS) related to oxidative stress in BD and to correlate them with cognitive functions and functionality. We studied 50 bipolar patients type I/II, in the euthymic phase, which was divided into two subgroups with 25 patients, (≤3 years and ≥10 years of diagnosis, from the first episode of mania), and 25 control patients. To analyze frontal cognitive functions and functionality, we used the tests: Frontal Assessment Battery (FAB) and Functioning Assessment Short Test (FAST), respectively. The FAST test scores results were ≤3 years (20.63±8.21), ≥10 years (27.80±12.50), and control group (9.80±5.94), p<0.001. Changes occurred in all domains. The FAB test scores were ≤3 years (14.64±2.48), ≥10 years (12.44±2.78), and control group (15.84±1.55), p<0.001, and showed lower scores in four domains. The oxidative stress showed an increase in TBA-RS levels: ≤3 years (3.18±1.17), ≥10 years (3.01±1.03) compared to the control group (1.62±0.28), p<0.0001; and in the CAT enzyme activity we found, ≤3 years (8.10±4.18), ≥10 years (9.41±4.95), compared to the control group (3.47±0.77), p<0.0001. Even during the euthymic phase, bipolar patients showed and maintained an increase in CAT activity and lipid peroxidation with significant changes in the FAB and FAST tests in different groups of patients, demonstrating impairment in cognitive functions and functionality since disease onset.

Mixed Depression: A Survey on Psychopathological, Diagnostic, and Therapeutic Approaches among a Sample of Italian Psychiatrists

Background: The Diagnostic and Statistical Manual for Mental Disorders (5th edition) introduced the specifier “with Mixed Features” to the diagnosis of Major Depressive Episode to designate the presence of (hypo) manic symptoms as part of the clinical presentation. This change has led to renewed attention on the operational definition, diagnosis, and treatment of Mixed Depression. Objective: To investigate the diagnostic and therapeutic approaches towards Mixed Depression among a representative sample of Italian psychiatrists. Methods: Between March and April 2021, 342 psychiatrists working in Italian adult mental health services were invited to participate in an anonymous online survey comprising 32 questions designed to investigate clinical and psychopathological approaches regarding the management of mixed depression in daily psychiatric practice. Results: 83.74% of participants reported having performed a diagnosis of mixed depression in the last five years, with the majority of respondents affirming that they had not used any diagnostic tool. Only 7,5% of the surveyed psychiatrists considered the DSM-5 criteria to be fully adequate in the description of this clinical entity. The most used pharmacological approach was combined therapy, in particular antipsychotics plus mood stabilizers. For monotherapy, the preferred drugs were Valproate and Quetiapine. Regarding the conceptualization of mood disorders, 199 of the participants chose the Kraepelinian unitary spectrum view; meanwhile, 101 expressed their preference for the binary model. Conclusion: Our results suggest a prominent position of mixed depression in the context of mood disorders. Univocal operational criteria and additional research on pharmacological treatment are also needed to ensure the correct recognition and management of mixed depression.

Lithium Plus Olanzapine: One of the Most Effective Combinations for Bipolar Disorder. A Case Report and a Concise Review of the Literature

Background: The recurrent nature of Bipolar Disorder (BD) is the main cause of disability associated with the illness. Despite the proliferation of drugs approved for the maintenance phase of BD, the relapse rate is still high. The combination of drugs, especially the potentiation of mood-stabilizers with second-generation antipsychotics, may reduce the risk of relapse and rehospitalization. However, studies on the efficacy of specific combinations are scarce. Case presentation: The clinical case of a 28-year-old woman involuntarily admitted to an Acute Psychiatric Unit is presented. She suffers a manic postpartum episode with mixed and psychotic features. During the hospitalization, she is successfully treated with a combination of lithium plus olanzapine. In the discussion, a concise narrative review of the scientific literature on the efficacy of such a combination in BD is made. Conclusion: The association of lithium plus olanzapine is one of the combinations with most evidence on its efficacy in BD, especially in mixed-featured episodes. Tolerability concerns should not be an obstacle to its use, although they must be considered

A NARRATIVE REVIEW OF THE MANAGEMENT OF BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA

Dementia is a chronic or progressive neurodegenerative condition which is organic in origin. There will be impairment of thinking, memory orientation, comprehension, language, calculation, and judgement. Alzheimer's disease facts and gures in 2021 according to Alzheimer's association shows Alzheimer's disease accounts for 60% to 80% of the total cases. Behavioural and psychological symptoms of dementia also known as neuropsychiatric symptoms are a group of symptoms with behavioural and psychological manifestations. Disturbances include behavioural symptoms like wandering, hoarding, physical aggression, sexually disinhibition, culturally inappropriate behaviour, agitation and psychological symptoms like apathy, depression, anxiety, delusions, and hallucinations, sundowning, elation. Scales like the Neuropsychiatric Inventory, the Behavioural Pathology in Alzheimer Disease rating scale, the Consortium to Establish a Registry for Alzheimer Disease Behaviour Rating Scale for Dementia, Dementia Behaviour Disturbance scale, and the Neurobehavioral Rating Scale can be utilized to recognise BPSD.Neuropsychological assessment also have an important role. Non-pharmacological methodologies contain different sorts of treatment: tactile stimulation, pressure point massage, fragrant healing, light treatment, garden exercises, music therapy, dance therapy, and Snoezelen multisensory therapy, psychological strategies of multicomponent treatment strategies. Broadly focussing on sensory stimulation, social activities, structural activities, behavioural activities, environmental activities, and training programmes. Pharmacological treatment includes antipsychotics, mood stabilizers and antidepressants in treating BPSD, and cholinesterase inhibitors and memantine for the situation of Alzheimer's dementia sedative/hypnotics for sleep issues. Treatment can be further categorized based on individual NPS like agitation, psychosis, apathy, depression, sleep problems and other symptoms. Future treatment which has less evidence as of now includes rTMS, TDCS and Photo biomodulation therapy

Anesthetic Considerations for Patients on Psychotropic Drug Therapies

Psychotropic drugs are used in the treatment of psychiatric and non-psychiatric conditions. Many patients who are on psychotropic medications may present for procedures requiring anesthesia. Psychotropic medications can have dangerous interactions with drugs commonly used in anesthesia, some of which can be life-threatening. In this review, we describe the current anesthetic considerations for patients on psychotropic drug therapies, including antidepressants, antipsychotics, mood stabilizers, anxiolytics, and stimulants. The pharmacology, side effects, and potential drug interactions of the commonly prescribed psychotropic drug therapies with anesthetic agents are described. Further, we highlight the current recommendations regarding the cessation and continuation of these medications during the perioperative period.

Detailing the effects of polypharmacy in psychiatry: longitudinal study of 320 patients hospitalized for depression or schizophrenia

Current treatment standards in psychiatry are oriented towards polypharmacy, that is, patients receive combinations of several antidepressants, antipsychotics, mood stabilizers, anxiolytics, hypnotics, antihistamines, and anticholinergics, along with other somatic treatments. In tandem with the beneficial effects of psychopharmacological drug treatment, patients experience significant adverse reactions which appear to have become more frequent and more severe with the rise of ubiquitous polypharmacy. In this study, we aimed to assess today’s acute inpatient treatment of depressive and schizophrenic disorders with focus on therapeutic strategies, medications, adverse side effects, time course of recovery, and efficacy of treatments. Of particular interest was the weighing of the benefits and drawbacks of polypharmacy regimens. We recruited a total of 320 patients hospitalized at three residential mental health treatment centers with a diagnosis of either schizophrenic (ICD-10: “F2x.x”; n = 94; “F2 patients”) or depressive disorders (ICD-10: “F3x.x”; n = 226; “F3 patients”). The study protocol included (1) assessment of previous history by means of the SADS Syndrome Check List SSCL-16 (lifetime version); (2) repeated measurements over 5 weeks assessing the time course of improvement by the Hamilton Depression Scale HAM-D and the Positive and Negative Syndrome Scale PANSS, along with medications and adverse side effects through the Medication and Side Effects Inventory MEDIS; and (3) the collection of blood samples from which DNA and serum were extracted. Polypharmacy was by far the most common treatment regimen (85%) in this study. On average, patients received 4.50 ± 2.68 medications, consisting of 3.30 ± 1.84 psychotropic drugs, plus 0.79 ± 1.13 medications that alleviate adverse side effects, plus 0.41 ± 0.89 other somatic medications. The treating psychiatrists appeared to be the main determining factor in this context, while «previous history» and «severity at baseline» played a minor role, if at all. Adverse drug reactions were found to be an inherent component of polypharmacy and tended to have a 2–3 times higher incidence compared to monotherapy. Severe adverse reactions could not be attributed to a particular drug or drug combination. Rather, the empirical data suggested that severe side effects can be triggered by virtually all combinations of drugs, provided patients have a respective vulnerability. In terms of efficacy, there were no advantages of polypharmacy over monotherapy. The results of this study underlined the fact that polypharmacy regimens are not equally suited for every patient. Specifically, such regimens appeared to have a negative impact on treatment outcome and to obfuscate the “natural” time course of recovery through a multitude of interfering factors. Evidence clearly speaks against starting just every therapeutic intervention in psychiatry with a combination of psychopharmaceuticals. We think that it is time for psychiatry to reconsider its treatment strategies, which are far too one-sidedly fixated on psychopharmacology and pay far too little attention to alternative approaches, especially in mild cases where psychotherapy without concurrent medication should still be an option. Also, regular exercises and sports can definitely be an effective therapeutic means in a considerable number of cases. General practitioners (GPs) are particularly in demand here.

Selection of psychotropics in dermatologic practice

There is an increased prevalence of psychiatric symptoms in dermatologic disorders. However, these are often underrecognized and undertreated contributing to suboptimal adherence and therapeutic outcomes. A working knowledge of psychotropic medications and their use in dermatology is essential for comprehensive management of psychodermatological conditions. The present review provides a framework for use of psychotropic agents in dermatological settings and is intended to serve as a ready reckoner for the dermatologist. We initially review the general considerations involved in prescribing psychotropic agents in skin conditions. Next, we discuss individual classes of psychotropic agents such as anti-depressants, mood stabilizers, antipsychotics, and anxiolytics focusing on preferred agents while prescribing. Finally, we discuss the common adverse cutaneous reactions reported with psychotropic agents.

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

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.