Aims: In this systematic review, the effectiveness and safety of viloxazine ER in the treatment of ADHD in children and adolescents aged between 6–17 years will be assessed.

Methods: This review identified articles through a systematic approach using PubMed, EMBASE, and the Cochrane Library. Randomized controlled trials with viloxazine ER in an active comparator condition versus placebo or other stimulant/non-stimulant ADHD drugs were included.

The first set of outcomes for assessing efficacy was a decrease in the severity of ADHD symptoms as measured by the ADHD-RS-5 and CGI-I scales. Safety outcomes comprised comparability in the rates of adverse events and treatment discontinuation rates.

Results: A meta-analysis showed that viloxazine ER is effective in managing ADHD symptoms compared with placebo at 10–12 weeks. Very few side effects were reported with this medication and those reported were mostly mild to moderate in nature. Mild side effects were noted to be decreased appetite, somnolence, and headache. The rates of treatment disappearance were similar compared with other oral ADHD drugs.

Conclusion: The research implies that viloxazine ER may be useful to paediatric patients with ADHD as a new treatment approach. We hypothesize that its profile of being an NRI and 5-HT2B antagonist may be beneficial for patients who have not shown sufficient improvement with more common treatments. The use of once daily dosing of the extended release formulation may enhance compliance compared with drugs taken more than once per day.

In a general manner, viloxazine ER seems to be a safe and efficacious therapy in children and adolescents affected by ADHD. Because it has a unique mechanism of action and can be taken once daily, it complements other ADHD medications well. More prospective, multicentre trials of longer duration are, therefore, required to determine the success and risks of the technique in the long run.

Aims: Elevated prolactin levels due to antipsychotic drugs are prevalent in elderly patients and may cause multiple complications. Hence, the purpose of the present study is to compare the effectiveness of changing existing antipsychotic treatments with prolactin-sparing antipsychotics or adding dopaminergic agents to the existing treatment in patients with clinically insignificant hyperprolactinaemia in later life.

Methods: The sample for this systematic review was identified using a broad search strategy in key electronic databases including Pubmed, SIGLE, CINAHL, Web of Science and OVID. To complete the search, only citations that included elderly or geriatric patient populations and hyperprolactinemia associated with antipsychotic medications were used. Normalization of prolactin levels, psychiatric status, and side effects were the main results measured.

Results: The review flagged several main studies: The efficacy of antipsychotic aripiprazole use in the treatment of schizophrenia is discussed about its impacts on prolactin levels in individuals of different ages and gender. There was no effect on prolactin plasma concentrations in postmenopausal patients with depression and a small but significant positive impact in schizophrenia patients.

An innovation that supplements the pattern of traditional Chinese medicine together with a low dose of aripiprazole can be useful for treating antipsychotic-induced amenorrhea. Prolonged exposure to prolactin-elevating antipsychotics was found to raise the risk of fractures, a finding that provided insight into other health risks.

Conclusion: The approach to the management of antipsychotic-induced hyperprolactinemia in older adults is beyond general management. Although studies that counter the aversive effects of antipsychotics with drugs like aripiprazole seem promising, its benefits are somehow relative across populations. Since there may be long-term health risks such as fractures in the future, it is taken fairly seriously and requires vigilance with a concrete individual management plan.

Regarding the limitation of the present study, it is recommended that future research incorporates different antipsychotics, follow-up outcomes longer, and provide strategies to avoid such risk factors among this population.

Aims: This study through systematic review approaches and meta-analysis aimed to determine safe drug options for treating male sexual dysfunction due to erectile dysfunction by comparing sildenafil, tadalafil, vardenafil, mirodenafil, coenzyme Q and testosterone.

Methods: Systematic review methodology was used to retrieve data from complete database searches done in PubMed/MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Randomized controlled trials research designs with adult male participants who presented with erectile dysfunction on sildenafil, tadalafil, vardenafil, mirodenafil, coenzyme Q and testosterone were included as part of the review. The Cochrane Risk of Bias version 2.0 was utilized by two independent reviewers for assessing bias risk and extracting data. Sensitivity analysis was used to reduce the risk of bias.

Results: Phosphodiesterase inhibitors type 5 (PDE 5) are the most effective medications for erectile dysfunction (ED). Participants on sildenafil had effective erections between 77–84% at doses of 50–100 mg and tadalafil emerged as the “Weekend pill” because of its 36-hour maximum effect duration of action. The concentration-focused activity along with higher potency values of vardenafil make it superior to other PDE5 inhibitors. The newly developed therapeutic medication mirodenafil exhibits better PDE5 selectivity than existing drugs within its operational mechanism. Minor variations were noted as a cohort of participants preferred tadalafil above sildenafil. Testosterone supplementation is beneficial for when monotherapy with a PDE5 inhibitor has not been effective.

Conclusion: Being the first-line treatment for erectile dysfunction, PDE5 inhibitors should be prescribed based on the distinctive pharmacological attributes they possess. Medical treatment selection methods must take into account both the need of patients as well as their preference. The recent introduction of mirodenafil medication has opened new possibilities in the medical treatment of ED. The effectiveness of ED treatment brings optimistic outcomes to the quality of life to hundreds of millions of men across the globe and further studies will drive medical progress to improved treatment modalities including stem cell therapy.

Aims: Alzheimer’s disease continues to be a huge health concern around the globe. Although similar recent developments in anti-amyloid therapy are promising, there is concern about some side effects like ARIA. The purpose of this meta-analysis was to systematically review and compare the safety characteristics of three of the most promising anti-amyloid drugs: lecanemab, donanemab and aducanumab, specifically, the frequency of ARIA-E (oedema) and ARIA-H (haemorrhage).

Methods: The present systematic review included only high-quality randomized controlled trials, randomized controlled trials with non-parametric data, and meta-analyses. Data was analysed and visualized by using forest plots, funnel plots and bubble plots. The degree of heterogeneity was examined by I2 of statistics.

Results: The antibody lecanemab had the lowest ARIA-E rate at 12.6% and the highest infusion reaction rate at 26.4%. Mild ARIA-E was evident in 24.0% of the participants, whereas mild ARIA-H was detected in 19.7% of the subjects.

Of the four candidates, aducanumab showed the highest rate in ARIA-E (30.7%) but the lowest rate in infusion reaction (1.2%). The overall ARIA-H rates appeared to be moderate for all drugs (17.3–19.7%).

The odds ratios in the forest plot were above 1 for all the outcomes suggesting increased adverse event risk. There was moderate to high heterogeneity in all the studies examined (I2 = 84.7%).

Conclusion: In essence, the risks and benefits of each drug are different. The ARIA-E risk associated with lecanemab is lower than with aducanumab; however, infusion reaction rates remain high. There is reason to believe that such an aggressive ARIA-E profile would ultimately restrict the value of aducanumab and lecanemab. However, donanemab does bring a kind of medium between the two. This review emphasizes the importance of individualized interventions in treating Alzheimer’s dementia.

Future Directions: More research is thus needed to understand some of the factors that have confounded heterogeneity, and to find ways of managing some of the risks associated with ARIA. The current study indicates the importance of long-term safety data along with head-to-head comparisons regarding clinical decision-making.

Aims: With this systematic review, an attempt will be made to systematically compare the efficacy and side effects of Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) in Chronic Pain Conditions in terms of functional improvement and quality of life with placebo.

Methods: The relevant studies were included after conducting a literature search in OVID, PubMed/MEDLINE, EMBASE/SIGLE, CINAHL, and Web of Science. Randomized controlled trials that compared SNRIs in chronic pain were included in the review. In the assessment of study quality, the Cochrane Risk-of-Bias tool was used. A number of data extractors and analysts were used in the study so as to reduce possible bias in the study results.

Results: Duloxetine appeared to be the SNRI with the best therapeutic efficacy profile across different chronic pain types and aetiologies such as osteoarthritis, fibromyalgia, and chronic low back pain. It showed reasonable effectiveness in alleviating pain magnitude and enhancing motor activity. The results were consistent between standard and higher doses of single administration 60 mg. Duloxetine demonstrated a significant reduction in pain when compared with placebo. An improvement in functional status and quality of life measured through self-reported scales was also noted. This trend was more pronounced in the treatment of the patients on SNRI compared with those on placebo.

Conclusion: Duloxetine appears to be effective for chronic pain conditions and may help reduce pain intensity, increase functional status and improve the quality of life. Even though rigorous trials indicate that these drugs are superior to placebo after 8–16 weeks, long-term effect and safety profiles are not very clear, and more long-term studies are needed to understand the durability and application of the drugs in clinical practices. Further research should prospectively investigate the efficacy in long-term pain, different comorbid conditions, and include predictors of SNRI response.

Aims: This meta-analysis aims to review safety and effectiveness of pimavanserin compared with other antipsychotics in managing psychotic symptoms in Alzheimer’s disease and Parkinson’s disease dementia.

Methods: We conducted a comprehensive literature search of controlled trials evaluating efficacy of pimavanserin versus placebo and other antipsychotics. A thorough search was made using specific terms in Pubmed, Web of Science, EMBASE, SIGLE and CINAHL. Of 423 studies only 2 studies met our requirements once detailed ROB 2 analysis was performed. The primary dependent measure was NPI and the CGI-I as the secondary measure;safety data being the other dependent measure.

Results: With active treatment by pimavanserin, there was a mean reduction of 4.5 points on NPI score, the SMD was −1.07 compared with placebo. It was more effective than other antipsychotics and it came with more acceptable side effects. Side effects included extrapyramidal symptoms, however this was significantly lower in the pimavanserin group (7% versus 15% with olanzapine) and minimal metabolic side effects.

Conclusion: Pimavanserin stands as a relatively new treatment approach for management of neuropsychiatric symptoms in dementia that has similar effectiveness when compared with other antipsychotics, yet exhibiting fewer side effects. Its mechanism of action as a selective serotonin inverse agonist may offer some advantage in controlling and managing psychotic symptoms without worsening of motor functions in patients with Parkinson’s disease dementia.

Aims: This systematic review sought to compare the effect of assisted dying options on self-determination, patients’ quality of life, and specific/ethical concerns including suicidality for adults with severe psychiatric disorders and psychiatric or palliative care.

Methods: The data sources gathered for this review were PubMed, EMBASE, CINAHL and Cochrane databases. The search terms consisted of different forms of assisted dying to which various forms of psychiatric and mental health-related terms were added. The papers were restricted to systematic reviews and meta-analyses as these give high-quality evidence. Out of 343 studies after strict criteria such as ROBINS 1, ROB2 and AMSTAR, only 3 studies qualified for the review. The review centred on adults with severe psychiatric disorders, specifically patients with eating disorders who had assisted dying between 2012 and 2024.

Results: The present review estimated that at least 60 individuals with eating disorders who received assisted dying between 2012 and 2024 were reported across 10 peer-reviewed studies and 20 government reports. Clinical rationales for granting assisted dying requests fall into three main domains: non-treatability, prognosis and request of the patient. Most of the reports highlighted two aspects: that the patients had a terminal or untreatable disease, as well as sufficient decision-making abilities. Still, only a few reports were available for the government and many of them failed to provide adequate data on psychiatric conditions.

The review showed that there were significant gaps in reporting assisted deaths for psychiatric patients and ministers questioned accountability and patient safety. Some clinical justifications were void of rigour or evidence indicating the plausibility of the irremediability or lack of decisional capacity in psychiatric relatedness.

Conclusion: The findings of this systematic review can be concluded as indicating the lack of procedural clarity and strengthened precaution measures for assisted dying in the field of psychiatry. The results imply the applicability of the ethical principles as well as clinical considerations call for incremental case-by-case analyses. The study should be extended to propose improved reporting systems for assisted dying and to confirm clinical justification for several patients who received help in psychiatric practices, with the consideration of patient rights and safety.

Aims: Primary insomnia, a separate diagnosis that is now included within the newly broader categorization of insomnia, greatly affects the quality of life. This meta-analysis evaluates the efficacy and safety of orexin receptor antagonists (ORAs) and Z-drugs for insomnia in adults.

Pharmacological approaches to the management of insomnia include the use of our own rendition of those generic drugs commonly referred to as ORAs and Z-drugs. Z-drugs are mainly used; nevertheless, doubts as to their long-term security remain. Targeted at orexin receptors, ORAs are novel. This system consolidates knowledge for use in clinical evaluation and management.

Methods: Accordingly, a Cochrane-Central Register of Controlled Trials Database, a Systematic review using the keywords, ORAs, and Z-drugs was conducted. The criteria for patient inclusion involved all adults diagnosed with insomnia. Measurements of the extent of benefits from the interventions were: Total sleep time, sleep onset latency, and adverse effects.

Bias was determined using SRR and overall risk of bias was determined using the ROB 2 tool. This meta-analysis was conducted by applying random effects models.

Results: Six trials showed that ORAs shortened sleep onset latency compared with zolpidem and other Z-drugs (mean difference −15.3 min, 95% CI −22.1 to −8.5). Total sleep time was similar to total time between sleep onset and wake-up in both groups. ORAs demonstrated a superior safety profile, with lower incidence of next-day somnolence (risk ratio: 0).

This was associated with a decreased risk for cognitive impairment at follow up (risk ratio: 0.65, 95% CI: 0.52–0.81) and for dependency (risk ratio: 0.38, 95% CI: 0.25–0.58).

According to the funnel plot analysis there was no significant publication bias that exists within the studies.

Conclusion: They [ORAs] are at least as effective as the Z-drugs in the management of insomnia and are safer in terms of next-day implications and withdrawal especially in elderly patients. These experiments affirm using ORAs as a first-line pharmacological remedy in chronic insomnia in adults.