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Optimization of antipsychotic use in the elderly with severe mental illness; a review of three cases.
- A. Izquierdo De La Puente, I. Ramos García, G. Bracchitta, E. Martín Ferrer
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S932
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Introduction
A descriptive study is presented on three cases in which the adjustment of antipsychotic treatment has led to an improvement in the patients’ quality of life.
ObjectivesThe objective is the description of the process of treatment optimization in elderly people, with the secondary improvement in the quality of life.
MethodsThese are three female patients, with an average age of 73 years, institutionalized in the ORPEA Puerta de Hierro Specialized Mental Health Center for the Elderly. Two of them have a diagnosis of paranoid schizophrenia, and the third has a diagnosis of delusional disorder. The average age at the onset of symptoms was 21 years old.
All three were receiving treatment with biweekly zuclopenthixol, 200mg DMD together with haloperidol at a mean dose of 7.5mg of haloperidol. For the extrapyramidal side effects presented they were on treatment with biperiden 4mg DMD.
In addition to psychopathological examinations and subjective impressions, previous and current status were compared with the Barthel Scale, GDS and family satisfaction scale.
ResultsThe treatment of the three patients was modified, in a period of three months, replacing the treatment with zuclopenthixol 200mg DMD to paliperidone extended release 150mg every 21 days, as well as with oral paliperidone, at an average dose of 10mg DMD. Also, biperiden treatment could be completely withdrawn and the dose of haloperidol could be reduced to 2.25mg.
In addition to the reduction of polypharmacy doses, an overall improvement is observed in relation to psychotic symptoms, without presenting exacerbations and improvement in the control of chronic psychotic symptoms. Likewise, they have improved at the affective level, presenting less negative symptoms, improvement of the affective flattening, being more resonant in the interaction with peers and with increased participation in joint activities. On the other hand, at a cognitive level, a significant improvement has been observed.
ConclusionsFirst generation antipsychotics produce a high rate of side effects, such as prolactin increase, affective blunting and extrapyramidal symptoms. In contrast, second-generation antipsychotics, in addition, act as 5HT2A antagonists, thus reducing the rates of unwanted effects.
Some studies have shown that paliperidone increases prolactin to a lesser extent than risperidone and causes fewer extrapyramidal and cognitive effects. Furthermore, because of its safety profile, paliperiona may be a first-choice strategy in psychosis in the elderly, even in its intramuscular extended-release form in nonadherent patients.
In conclusion, the elderly are a vulnerable population and to a greater extent when they suffer from a severe mental disorder. The aim of any treatment must be directed not only to control positive symptoms, but also to slow down the deterioration of the disease itself, as well as to improve quality of life and functionality.
Disclosure of InterestNone Declared
Optical Properties of CdS and CdTe Sensitized ZnO Nanorods
- C. J. Pereyra, F. Ferrer, R. E. Marotti, C. Gómez, L. Campo, L. I. Amy, F. Martín, D. Leinen, J. R. Ramos-Barrado, E. A. Dalchiele
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1707 / 2014
- Published online by Cambridge University Press:
- 10 June 2014, mrss14-1707-uu06-10
- Print publication:
- 2014
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Optical properties of ZnO-CdTe electrochemically prepared on a core-shell nanostructure (NS) were studied. Numerical simulations based on effective medium approximation give higher absorption than ZnO-CdS samples and a sensitive dependence on CdTe content. The absorption edges for deep black samples found by transmittance (T(λ)) and diffuse reflectance (Rdiff(λ)) measurements were at 1.33eV and 1.55eV, respectively. A split-off band edge was also found by Rdiff(λ) at ∼2.5eV. The red shift observed in T(λ), previously observed in ZnO-CdS, and may confirm the enhancement of sub-bandgap absorption due to the NS nature of samples.
Contributors
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- By Waiel Almoustadi, Brian J. Anderson, David B. Auyong, Michael Avidan, Michael J. Avram, Roland J. Bainton, Jeffrey R. Balser, Juliana Barr, W. Scott Beattie, Manfred Blobner, T. Andrew Bowdle, Walter A. Boyle, Eugene B. Campbell, Laura F. Cavallone, Mario Cibelli, C. Michael Crowder, Ola Dale, M. Frances Davies, Mark Dershwitz, George Despotis, Clifford S. Deutschman, Brian S. Donahue, Marcel E. Durieux, Thomas J. Ebert, Talmage D. Egan, Helge Eilers, E. Wesley Ely, Charles W. Emala, Alex S. Evers, Heidrun Fink, Pierre Foëx, Stuart A. Forman, Helen F. Galley, Josephine M. Garcia-Ferrer, Robert W. Gereau, Tony Gin, David Glick, B. Joseph Guglielmo, Dhanesh K. Gupta, Howard B. Gutstein, Robert G. Hahn, Greg B. Hammer, Brian P. Head, Helen Higham, Laureen Hill, Kirk Hogan, Charles W. Hogue, Christopher G. Hughes, Eric Jacobsohn, Roger A. Johns, Dean R. Jones, Max Kelz, Evan D. Kharasch, Ellen W. King, W. Andrew Kofke, Tom C. Krejcie, Richard M. Langford, H. T. Lee, Isobel Lever, Jerrold H. Levy, J. Lance Lichtor, Larry Lindenbaum, Hung Pin Liu, Geoff Lockwood, Alex Macario, Conan MacDougall, M. B. MacIver, Aman Mahajan, Nándor Marczin, J. A. Jeevendra Martyn, George A. Mashour, Mervyn Maze, Thomas McDowell, Stuart McGrane, Berend Mets, Patrick Meybohm, Charles F. Minto, Jonathan Moss, Mohamed Naguib, Istvan Nagy, Nick Oliver, Paul S. Pagel, Pratik P. Pandharipande, Piyush Patel, Andrew J. Patterson, Robert A. Pearce, Ronald G. Pearl, Misha Perouansky, Kristof Racz, Chinniampalayam Rajamohan, Nilesh Randive, Imre Redai, Stephen Robinson, Richard W. Rosenquist, Carl E. Rosow, Uwe Rudolph, Francis V. Salinas, Robert D. Sanders, Sunita Sastry, Michael Schäfer, Jens Scholz, Thomas W. Schnider, Mark A. Schumacher, John W. Sear, Frédérique S. Servin, Jeffrey H. Silverstein, Tom De Smet, Martin Smith, Joe Henry Steinbach, Markus Steinfath, David F. Stowe, Gary R. Strichartz, Michel M. R. F. Struys, Isao Tsuneyoshi, Robert A. Veselis, Arthur Wallace, Robert P. Walt, David C. Warltier, Nigel R. Webster, Jeanine Wiener-Kronish, Troy Wildes, Paul Wischmeyer, Ling-Gang Wu, Stephen Yang
- Edited by Alex S. Evers, Washington University School of Medicine, St Louis, Mervyn Maze, University of California, San Francisco, Evan D. Kharasch, Washington University School of Medicine, St Louis
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- Book:
- Anesthetic Pharmacology
- Published online:
- 11 April 2011
- Print publication:
- 10 March 2011, pp viii-xiv
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