5 results
Which one is the best anaesthetic agent for Ect?
- H. Saiz Garcia, L. Montes Reula, A. Portilla Fernandez, V. Pereira Sanchez, N. Olmo Lopez, E. Mancha Heredero, A.S. Rosero Enriquez, M.E. Martinez Parreño
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S702
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Introduction
The most frequently used anesthesiologic agents are methohexital, thiopental, etomidate, propofol, ketamine, and sevoflurane. The objective is to clarify the differences on recovery, cardiovascular variables, cognitive functions, and response to treatment showed by these drugs.
MethodsA review was conducted aiming to clarify the differences between anaesthetic agnets used in ECT. The literature search was conducted in PubMed data reviewing articles dating between 2015 and 2016.
Results– Propofol seems to have better hemodynamic effects in comparison with etomidate in patients with schizophrenia and depression;
– The seizure duration was significantly shorter with propofol, but this did not cause a difference regarding clinical improvement;
– The seizure duration was longer with etomidate in many studies. It did not decrease in a dose-dependent fashion with etomidate in a study comparing methohexital, etomidate, and propofol;
– The most frequently observed adverse effects were arrhythmias and nausea and they occurred more frequently in patients who were given thiopental. The pain at the injection site was more frequent in patients who were given propofol;
– Etomidate seems to have better clinical improvement than thiopental. Thiopental seems to have better results than propofol, which has an anticonvulsant feature effects.
ConclusionsIn order to figure out which anaesthetic agent was the most indicated for undergoing ECT, we found that both EEG-based seizure duration and motor seizure duration showed the sequence etomidatemethohexical>thio- pental>propofol. These items are directly related with clinical improvement. When a drug is chosen, It is important to individualize the treatment according to the patients’ comobidity.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Modafinil: A smart drug with psychiatric implications
- H. Saiz Garcia, L. Montes Reula, A. Portilla Fernádez, V. Pereira Sanchez, N. Olmo Lopez, E. Mancha Heredero, A.S. Rosero Enriquez, M.E. Martinez Parreño
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s877
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Introduction
Modafinil is approved to treat excessive somnolence but it is also off-spec used as a treatment for ADHD and as a cognitive enhancer. Research on the effects of modafinil on cognitive function have yielded mixed results. Modafinil interact with dopamine, noradrenaline, serotonin, glutamate, orexin, histamine and GABA levels. The regulation of these neurotransmitters is widely known to be implicated in most of the neuropsychiatric disorders.
MethodologyA review was conducted aiming to clarify the biological mechanisms of action of modafinil; its effects on attention, learning, executive functions and creative thinking; as well as possible neuropsychiatric disorders associated to its intake. The literature search was conducted in PubMed data reviewing articles dating between 2015 and 2016.
Results(1) Empirical evidence for cognitive enhancing effects of one of the most frequently used substances, modafinil, is sparse. Studies suggest that with more protracted and complex testing, more benefits are associated to modafinil use.
(2) Modafinil may be implicated in alterations of reward-related behaviour. Compared to placebo, modafinil leads to an enhanced tendency to make previously rewarded choices compared to the avoidance of previously punished choices. This pattern of altered choice behaviour is probably induced by an increase of the dopamine level and a potential contribution of elevated noradrenaline.
ConclusionsSome people share information about this drug in social network. Off-label use of this drug may be implicated in alterations of reward-related behaviour and patients with previous psychiatric disorders should be aware of its possible adverse effects.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Nootropics: Emergents drugs associated with new clinical challenges
- H. Saiz Garcia, L. Montes Reula, A. Portilla Fernandez, V. Pereira Sanchez, N. Olmo Lopez, E. Mancha Heredero, A.S. Rosero Enriquez, M.E. Martinez Parreño
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. s877-s878
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Introduction
The “nootropic” or simplified as a “smart drug”, is a common term that will tag along with the compound responsible for the enhancement of mental performance. Certain individuals with a history of mental or substance use disorders might be particularly vulnerable to its adverse effects.
MethodologyA review was conducted aiming to clarify the mechanisms associated of how these drugs increase mental functions including memory, motivation, concentration, and attention; and which kind of individuals are at risk of developing adverse effects when taking these drugs. The literature search was conducted in PubMed data reviewing articles dating between 2015 and 2016.
Results– Glutaminergic Signalling, Cholinergic System, Amyloid Precursor Protein and Secondary Messenger may be related to the cognitive enhancement achieved by Nootropics. Others, like insulin and angiotensin receptor may involved too.
– Some of them, like Ginkgo biloba, seem to have neuroprotective effects observed in human and animal models, acting as antioxidant and antiapoptotic, also inducing inhibition effects against caspase-3 activation and amyloid-aggregation toward Alzheimer's disease.
– Synthetic nootropics, a lab created compound such as piracetam, especially in people with history of drug abuse, may be associated with psychiatric exacerbations of some patients.
ConclusionsYoung adults all over Europe, especially university students, are starting to use nootropic drugs to improve their academic results. Some of them seem to have beneficial effects over mental health but others are sometimes related with sudden and unexplained exacerbations in stable psychiatric patients. It is important to early identify symptoms and to treat them properly.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Sexual dysfunction associated with antidepressants and how to prevent it. Is vortioxetine effective?
- H. Saiz Garcia, L. Montes Reula, A. Portilla Fernandez, V. Pereira Sanchez, N. Olmo Lopez, E. Mancha Heredero, A.S. Rosero Enriquez, M.E. Martinez Parreño
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. S759-S760
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Introduction
One of the most common, and many times hidden, secondary effects of antidepressants drugs use is sexual dysfunction (SD). It has been noted that as many as 20% of patients will discontinue treatment with an SSRI, with one-third of these patients doing so due to adverse reactions.
MethodologyA review was conducted aiming to clarify the pathogenesis of sexual dysfunction in depressed patients or taking antidepressants and how to prevent and manage it. The literature search was conducted in PubMed data reviewing articles dating between 2015 and 2016.
Results(1) the sexual response cycle is negatively affected in individuals suffering from major depressive disorder, even before initiation of any psychotropic medication. The serotonergic system plays a largely inhibitory role on sexual desire, orgasm, and ejaculation with involvement of the hippocampus and amygdala. Tricyclic antidepressants increase the level of prolactin and indirectly suppress the level of testosterone. (2) Bupropion and vortioxetine are the only antidepressants that have level 1 evidence supporting that they either have a more favorable SD profile. (3) SD with vortioxetine was not statistically higher when compared with placebo, and was statistically lower compared with other SSRIs or SNRIs. (4) There is evidence that antidepressants that are also 5–HT1A receptor agonists (e.g. vortioxetine and vilazodone) may facilitate sexual performance.
ConclusionsIn case of SD pharmacologic and non-pharmacologic options are available. Vortioxetine seems to be a good pharmacologic option, with better NNH than SNRI and less SD.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Lithium and EKG abnormalities. A review
- A. Ballesteros, Á.S. Rosero, H. Sáiz, E. García-Parreño, G. Carlos, E. Manrique
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S750
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Introduction
The literature concerning possible cardio-toxic effects of lithium therapy in man is reviewed.
MethodologyA review was conducted to clarify the mechanisms associated with the occurrence of conducting abnormalities when using lithium and investigating (if so) whether these alterations depend on the dose. The literature search was conducted in PubMed data reviewing articles between 1982 and 2015.
Results(1) Related to pathopsychiology/risk factors: reports indicate T wave morphology changes with lithium therapy. Of particular concern are cases of sinus mode dysfunction or sinoatrial block and the appearance or aggravation of ventricular irritability. The incidence of cardiac complications, in general terms, may increase with age. Recent findings (a retrospective study of bipolar patients) of lithium-associated hypocalcaemia showed that hypocalcaemia resulting from medical diseases and bipolar patients with lithium-associated hypocalcaemia had significantly higher frequencies of conduction defects. (2) Related/unrelated to dose: therapeutic and toxic levels of lithium have infrequently been associated with serious cardiac dysfunction. Several case reports demonstrate two important points about Brugada syndrome unmasking: electrocardiograph abnormality severity may correspond to lithium levels and unmasking may occur in the therapeutic range of lithium. Other report shows a case of lithium induced sinus-node dysfunction in a patient with serum lithium levels in therapeutic range.
ConclusionsLithium abnormalities are rare and mostly not related to dose. Conducting heart anomalies may occur, especially when several factors are present (such as age or co-morbid illnesses that affect calcium serum levels).
Disclosure of interestThe authors have not supplied their declaration of competing interest.