Atypical Agents Research Articles

Antipsychotic Drug Poisoning in Children Under 12 Years Old in Loghman-Hakim Hospital During 2016-2022

Background: Unintentional pediatric poisoning with antipsychotic medications represents an important clinical entity. This study aimed to evaluate the epidemiology, clinical manifestations, and outcomes of antipsychotic poisoning among children presenting to a referral hospital.Methods: This descriptive, cross-sectional study reviewed medical records of children <12 years old hospitalized for antipsychotic drug poisoning at Loghman Hakim Hospital in Tehran from 2015-2016. Data extracted included demographic details, agent and dose ingested, clinical findings, treatments administered, and patient dispositions.Results: 141 cases were identified, comprising 2.3% of all pediatric poisonings. Patient ages ranged from 6 months to 12 years (mean 5.5 years), with a male predominance (52.5%). The most common offending agents were risperidone (53.2%) and olanzapine (13.4%). Unintentional exposures accounted for 72.3% of cases. Central nervous system (CNS) effects like somnolence (61.7%) and dysarthria (19.1%) were most prevalent. Significant toxicity was infrequent; no fatalities occurred. Mean length of stay was 2 days for uncomplicated admissions. Conclusion: Antipsychotic poisoning in children chiefly involves atypical agents with a largely benign course. Risperidone predominated due to prescribing patterns. Somnolence represented the principal clinical manifestation. With reasonable supportive care, favorable outcomes are achievable in the pediatric population.

Pediatric respiratory pathogen dynamics in Southern Sichuan, China: a retrospective analysis of gender, age, and seasonal trends.

To address the research gap in the epidemiology of pediatric respiratory tract infections (RTIs) in Luzhou, Southern Sichuan, China, by analyzing respiratory pathogens in a large pediatric cohort from 2018 to 2021, covering the pre- and during-COVID-19 periods. This study conducted a retrospective analysis of children with RTIs in Luzhou from July 2018 to January 2021. Strict exclusion criteria were applied to ensure an accurate representation of the pediatric population. Pathogen detection included viruses, bacteria, and atypical agents. Pathogens were identified in 52.8% of 12,546 cases. Viruses accounted for 32.2% of infections, bacteria for 29.8%, and atypical agents for 29.7%, with significant findings of Staphylococcus aureus, Moraxella catarrhalis, and Mycoplasma pneumoniae. Age-related analysis indicated a higher incidence of bacterial infections in infants and viral infections in preschool-aged children, with atypical pathogens being most prevalent in 3-5-year-olds. Gender-based analysis, adjusted for age, revealed similar overall pathogen presence; however, females were more susceptible to viral infections, while males were more prone to Streptococcus pneumoniae. Notably, there was an unusual increase in pathogen cases during spring, potentially influenced by behavioral changes and public health measures related to COVID-19. Co-infections were identified as a significant risk factor for the development of pneumonia. The study provides essential insights into the epidemiology of respiratory pathogens in pediatric populations, emphasizing the need for healthcare strategies tailored to age, gender, and seasonality. The findings highlight the impact of environmental and public health factors, including COVID-19 measures, on respiratory pathogen prevalence, underscoring the importance of targeted diagnostic and treatment protocols in pediatric respiratory infections.

Sclerotherapy in the Treatment of Hydroceles: A Comprehensive Review of the Efficacy, Types of Sclerosants, and Comparative Outcomes Against Hydrocelectomy.

While hydrocelectomy is the gold-standard for treating hydroceles, it poses an increased risk to patients and a greater burden to the healthcare system. Sclerotherapy is an alternative treatment for hydroceles that involves injecting a sclerosant into the hydrocele under ultrasound guidance. This literature review aimed to assess the types of sclerosants used and how sclerotherapy compares to hydrocelectomy. A literature search was conducted of MEDLINE and EMBASE using the terms "sclerotherapy" and "hydrocelectomy," which yielded 1058 studies, of which 29 met the inclusion criteria. Only studies published after 2000 were included to ensure the most recent information was reviewed. The results showed hydrocele sclerotherapy is done using a variety of sclerosants. The most used agents are polidocanol, phenol, and STS. Of these, phenol had the highest clinical success rate of 96.5%. There was evidence for the use of atypical agents, such as tetracycline antibiotics, which yielded cure rates up to 93%, and alcohol, which was found to be especially useful for treating multiseptated hydroceles. The results comparing sclerotherapy to hydrocelectomy indicated hydrocelectomy to be a more effective method in completely curing hydroceles. However, this came at the cost of more complications. Additionally, sclerotherapy was found to be more advantageous for secondary outcomes, such as healthcare costs and burden to patients. In conclusion, this review shows that while hydrocelectomy is more effective, sclerotherapy is a valuable alternative for treating hydroceles. Due to the lack of standardization among studies, a definitive conclusion cannot be made regarding which sclerosant is best to use.

Outbreak of dermatophytosis in rabbits caused by atypical agent Trichophyton quinckeanum

Outbreak of dermatophytosis in rabbits caused by atypical agent Trichophyton quinckeanum

Exacerbação pulmonar de fibrose cística por Brevibacterium sp. em criança: relato de caso e revisão de literatura

Cystic fibrosis (CF) is an autosomal recessive disease that usually affects the respiratory tract causing recurrent infections and deterioration of lung function. Other organs such as the digestive system and pancreas are also affected. In this report, we describe an 8-year girl with CF, previously colonized with Pseudomonas aeruginosa that developed pulmonary exacerbation not responsive to empiric treatment of broad spectrum antibiotics directed against prior colonization. Brevibacterium sp. was detected in culture of bronchoalveolar lavage during bronchoscopy. Antimicrobial treatment was changed to vancomycin, meropenem, amikacin and ciprofloxacin with clinical, laboratorial and radiologic improvement after 23 days of treatment. Patient received discharge 30 days after admission for ambulatory follow-up. Its important that healthcare workers consider the possibility of atypical agents causing pulmonary exacerbation in patients with cystic fibrosis, mainly in children with initial failure of empiric treatment

Pneumonies

Pneumonia is an inflammation of the alveolar space distal to the terminal bronchiole in the lung parenchyma. The inflammation seen in pneumonia is mostly caused by microorganisms such as viruses, bacteria, and fungi, but can also be caused by non-infectious causes (toxic substance inhalation, radiation damage, hypersensitivity reaction-pneumonitis, autoimmunity). Pneumonia can be observed in three forms: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Patients with pneumonia usually present with cough, fever, sputum, chest pain, dyspnea, and hemoptysis. In addition, patients may have nonspecific symptoms. CAPs are caused by typical (S. pneumoniae) and atypical (C. pneumoniae, M. pneumoniae, and L. pneumoniae) agents. On presentation, fever, pulse rate, respiratory rate, oxygen saturation, blood pressure, and auscultation should be performed. Typical chest radiographic findings in the diagnosis of CAP include lobar consolidations, interstitial infiltrates, and/or cavitations. Acute-phase reactants may be elevated in response to infection and inflammation in pneumonia. The first decision to be made in cases of pneumonia is the determination of the need for hospitalization and the choice of antibiotherapy. If possible, cultures should be taken before antibiotics are started on the patient for whom hospitalization is planned. After 72 hours, in patients with no symptom improvement, the reason for treatment non-response should be evaluated, and antibiotherapy should be changed if necessary.

Clinical Case of Postoperative Infectious Crystalline Keratopathy

Infectious crystalline keratopathy (ICK) is a sluggish infectious inflammation of the cornea. Described for the first time in 1983, it is currently a rare pathology. Most often, the etiological factor is gram-positive bacterial flora, which causes the typical formation of “crystals” in the anterior layers of the corneal stroma. Less often, infiltrates are formed by gram-negative bacterial flora, which is characterized by its location mainly in the posterior parts of the stroma. Atypical etiological agents include Mycobacteria and fungal microflora. The main predisposing factors for the development of ICK are drug immunosuppression and previous corneal surgery (through keratoplasty, layered keratoplasty, laser keratomilesis in situ — LASIK). This article describes an atypical clinical case of monolateral postoperative infectious crystalline keratopathy. The patient’s medical history includes bilateral LASIK surgery followed by drug therapy for postoperative keratitis of the right eye for 1 month.

Microflora of the lungs in health and disease, the impact of vaccination

The development of new methods for diagnosing infectious diseases, such as polymerase chain reaction, sequencing, and mass spectrometry, has made it possible to expand our understanding of the microflora of the human body in general and of the respiratory tract in particular. The most common microorganisms in lungs include Proteobacteria (Pseudomonas spp., Haemophilus spp.), Bacteriodetes (Prevotella spp., Porphyromonas spp.) and Firmicutes (Veillonella spp., Streptococcus spp.). Pathological processes in the lower respiratory tract change the microbiome. Consequently, Moraxella, Haemophilus, and Acinetobacter microorganisms are found in patients with chronic obstructive pulmonary disease. The main causative agents of community-acquired pneumonia include Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Klebsiella pneumoniae and other enterobacteria. Atypical causative agents of pneumonia include Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila. The wide prevalence of S. pneumoniae in the population confirms the need for vaccines to prevent the development of invasive and noninvasive forms of infection.The aim of the study was to analyze literature data on the structure of the normal microflora of the lung and to investigate its role in the development of pathological conditions.Conclusion. A growing body of research confirms the important role of the normal microflora of the respiratory tract. Vaccination against diseases of the bronchopulmonary system may reduce the incidence and mortality of pneumonia. However, the problem of community-acquired pneumonia is still relevant. In particular, the changes in the structure of the pathogens of this disease is of great interest. Vaccination against respiratory pathogens in combination with uncontrolled use of antibiotics during the pandemic of the new coronavirus infection could contribute to a change in the structure of both the lower respiratory microflora in general and the pathogens of bacterial community-acquired pneumonia in particular. The detection of a change in the predominant pathogen calls for revising etiotropic treatment and organizing planned prophylaxis if the appropriate vaccines are available.

Body mass index as a predictor of the outcomes of acute clozapine toxicity: a cross-sectional study.

Acute antipsychotic overdose is frequently reported nowadays. Clozapine is one of the atypical agents that are highly lipophilic, highly protein-bound, has a large volume of distribution, and accumulates in the brain and other tissues. Obesity is an essential factor controlling patients' treatment and clinical course. The current study aimed to study the prognostic value of body mass index (BMI) in patients with acute clozapine poisoning. All patients were evaluated on admission using the Poison Severity Score (PSS) and Glasgow Coma Score (GCS). The BMI was calculated. Mortality and the need for ICU admission were defined as primary outcomes, whereas secondary outcomes included cardiovascular complications and the need for mechanical ventilation. Thirty-eight patients presented with acute clozapine poisoning. The mean age of included patients was 25.2±6. Patients were categorized regarding BMI into average weight (26.3%), overweight (31.6%), and obese (42.1%). Pearson's correlation indicated a significant positive correlation between BMI and respiratory rate (r=.364, p=.025). A significant negative correlation existed between BMI and GCS (r=.674, p≤.001). ROC curve reveals that BMI is an excellent predictor for the requirement of mechanical ventilation area under the curve (AUC>.9), a fair predictor of ICU admission AUC (.747). BMI had a sensitivity of 100% and specificity of 51.7 for the prediction of ICU admission. In conclusion, obesity increased the severity of toxicity and the incidence of poor clinical outcomes in patients with acute clozapine poisoning.

Therapeutic management of atypical antipsychotic‑related metabolic dysfunctions using GLP‑1 receptor agonists: A systematic review.

Metabolic disorders (MDs) like obesity, dyslipidemia, and type 2 diabetes are more frequently observed in patients diagnosed with psychiatric disorders undergoing treatment with antipsychotics, particularly atypical agents, than in the general population. The second generation of antidiabetics (SGAD) has been associated with cardiovascular benefits in large clinical trials which represent an important advantage over first-generation agents and might be of interest in the psychiatric population where multiple risk factors for cardiovascular disease (e.g., smoking, lack of exercise, and lack of healthy diet) are common occurrences. Therefore, this systematic review focused on the evaluation of the glucagon-like peptide-1 receptor agonists (GLP1-RAs), as a representative of the SGAD, to determine whether these agents may be recommended in patients with psychiatric disorders and MDs. For analysis, three electronic databases and clinical trial registers were explored for papers published between January 2000 and November 2022. After applying the inclusion and exclusion criteria, 20 clinical and preclinical trials, therapeutic guidelines, and meta-analyses were reviewed, and clinical recommendations were formulated. The large majority of the reviewed data (nine papers) were graded 'moderate' based on the GRADE criteria. The efficacy and tolerability of liraglutide and exenatide in the management of antipsychotic-induced MDs were supported by evidence of average quality, while the results regarding other GLP-1RAs were not sufficient to formulate a recommendation for their administration in this specific population. Clozapine and olanzapine had the most negative consequences on body weight, glycemic, and lipid metabolism. Therefore, careful monitoring of metabolic parameters is required when these are prescribed. Liraglutide and exenatide may be recommended as augmentative agents to metformin therapy, especially in patients receiving these two atypical antipsychotics, but most of the reviewed data supported the efficacy of GLP-1RAs only during the treatment administration. The two follow-up studies retrieved in the literature reported modest effects after GLP-1RA discontinuation after 1 year; therefore, long-term monitoring of metabolic parameters is required. More research is needed, and three randomized clinical trials are already ongoing, to evaluate the effects of GLP-1RAs in decreasing body weight, but also on other important metabolic variables, such as HbA1c status, fasting glucose levels, and lipid levels in patients receiving antipsychotic treatment.

(018) Negative Perceptions Among Young Adult Males Towards Antidepressants and Their Sexual Side Effects: A Case For Atypical Agents?

Abstract Introduction The prevalence of depression and anxiety among young adults (YA) rose precipitously in the last decade, along with a rise in the provision of first-line antidepressants known as selective serotonin reuptake inhibiters (SSRIs). SSRIs are associated with extremely high rates of nonadherence - above 50% for all patients and accentuated in those under 35 years old. Concurrently, sexual dysfunction is estimated to affect as many as 65% of patients treated with an SSRI. Despite this, the association between sexual dysfunction and medication nonadherence in YA males has been poorly characterized. Further, there is limited research comparing the opinions of YAs towards SSRIs to newer, effective, sexual function-sparing antidepressants like Bupropion and Mirtazapine. Objective To determine if YA males are less willing to adhere to antidepressant treatment due to intolerable side effects, such as sexual dysfunction. Moreover, to characterize the attitudes of YA males towards first- and second-line antidepressants. Methods A cross-sectional, deidentified, compensated survey was designed using Qualtrics XM (Provo, UT). A participation flyer was distributed via social media to recruit biological males ages 18 to 35. Participants were asked to indicate their perceptions of three deidentified medications (SSRI-class, Bupropion, and Mirtazapine) after being prompted with their most common side effects. Respondents also rated the potential negative impact of common antidepressant side effects (1=no impact; 10=worst possible impact) and whether these side effects, if experienced weekly, would trigger nonadherence. Parametric statistical tests were conducted using Stata (College Station, TX). Results From 665 surveys delivered via email, we received 505 completed forms (response rate: 76%), of which 486 were included after excluding those submitted in under 180 seconds. Age was normally distributed with a mean of 27.4 years (SD: 3.6). Participants were 40% non-white, 21% LGBTQ+, and 89% sexually active. The majority of our respondents were employed full-time (60%), while 36% were graduate or undergraduate students. As illustrated by Figure 1, participants' willingness to take Bupropion or Mirtazapine was significantly greater than an SSRI when compared by paired t-test (P<0.0001) with no significant difference between the atypical agents (P=0.26). Further, 73% of YA males preferred sexual function-sparing medications to an SSRI (P<0.0001). Additionally, the negative impact of sexual side effects, such as erectile dysfunction (6.2) or anorgasmia (6.0), scored significantly higher than other common antidepressant side effects like weight gain (5.4), nausea (5.3), and dry mouth (4.8). Finally, participants indicated that experiencing any weekly sexual dysfunction while taking an antidepressant medication would lead to medication nonadherence at a higher frequency than any other common side effect assessed (erectile dysfunction: 71%; anorgasmia: 71%; low libido: 70%). Conclusions To our knowledge, our study is the largest investigation to date of YA males’ perceptions of antidepressant medications. Our findings indicate that the risk of experiencing sexual side effects when taking antidepressants could lead YA males to become nonadherent to these medications. As mental illness and suicide continue to rise dramatically among YA males, strategies to augment the effectiveness of antidepressants, such as shared decision-making and the use of sexual function-sparing agents, are critical. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dadi, Teleflex, Lina.

A Systematic Review on the Duration of Antipsychotic Exposure and the Risk of Cerebrovascular Events in Elderly Patients (P11-5.020)

<h3>Objective:</h3> To evaluate the impact of duration of exposure to antipsychotic medications on the risk of cerebrovascular events (CVE) in elderly patients. <h3>Background:</h3> The FDA issued black box warnings for typical (1st generation) and atypical (2nd generation) antipsychotic medications (APM) regarding an increased risk of stroke and death in elderly patients with dementia. Several studies have compared the cerebrovascular risk profiles of typical and atypical antipsychotic agents in elderly patients, but the influence of duration of antipsychotic exposure on this risk remains unclear. <h3>Design/Methods:</h3> A comprehensive literature search was performed on PubMed in June 2022, the results of which were systematically screened using predefined inclusion and exclusion criteria. Included articles adequately controlled for confounding variables and reported on the duration of continuous exposure to APM and the risk of CVE in patients over 65. Quality assessment of the included studies was performed using the Newcastle-Ottawa scoring system. <h3>Results:</h3> From the 7,515 articles generated by the search, five observational studies reporting on APM duration and CVE in elderly patients were selected based on quality as they satisfied the inclusion criteria. Four studies found that long-term (&gt; 90 days), but not short-term, use of typical APM conferred a greater CVE risk than atypical APM used for the same duration. One study including only patients with dementia did not identify a difference with short or long-term use of typical versus atypical APM. <h3>Conclusions:</h3> The duration of therapy with APM may influence the risk of CVE in elderly patients. Although atypical agents are associated with the development of metabolic syndrome, long-term use of typical APM may confer a greater risk of CVE than atypical APM. Differences in the risk of CVE are less salient in short-term use of APM. <b>Disclosure:</b> Mr. Devine has nothing to disclose. Dr. Memon has nothing to disclose.

Peripheral Neuropathy: A review of mechanism-based treatments with a focus on metformin as a possible choice

Purpose: Despite the troublesome nature of Peripheral Neuropathy (PN) and the possibility of irreversible complications, there is still no approved strategy for the treatment of PN. However, some atypical analgesic agents such as gabapentin, pregabalin, and duloxetine have beneficial effects.

Evaluation of the Epidemiological, Clinical and Radiological Features of Pneumonia Cases Caused by Mycoplasma pneumoniae in Childhood

The current study aimed to investigate the clinical, laboratory and radiological findings of the pneumonia cases in children that were confirmed as M.pneumoniae by polymerase chain reaction (PCR) testing and to reveal the factors that can be decisive in the diagnosis. Seventy-seven children were included in this study. The median age of the patients was 31 months (1 month-17 years 4 months). The 63.6% of the patients were younger than five years of age, 53.2% were girls and 46.8% were boys. During the eight-year research period, the frequency of M.pneumoniae in the patients hospitalized with the diagnosis of pneumonia was found to be 3.1%. The rate of M.pneumoniae as the underlying factor of pneumonia was found to be statistically significantly lower in patients aged 0-60 months compared to the patients aged 61-216 months. In patients with M.pneumoniae accompanied by viruses, the age group was more likely to between 0-60 months. The most common symptoms were cough (96.1%) and fever (74%). Physical examinations revealed that 70.1% of the patients had rales, 63.6% had tachypnea, 45.5% had oropharyngeal hyperaemia, 35.1% had subcostal-intercostal retraction, 31.2% had long expiration period, 26% had rhonchus, 24.7% had decrease in breath sounds, 15.6% had cervical lymphadenopathy, 13% had tachycardia, 3.9% had otitis media, 3.9% had tonsil hypertrophy and 2.6% had a maculopapular rash. The rate of hypoxemia was found to be 42.2%. When the physical examination findings of patients with only M.pneumoniae detected in multiplex PCR analysis and those with accompanying viruses in M.pneumoniae were compared, tachypnea, oropharyngeal hyperemia and decreased breath sounds were found to be statistically significantly higher in patients with M.pneumoniae only. Retraction was detected more frequently in patients with accompanying viruses. When the laboratory results of the patients were evaluated according to age, leukocytosis was detected in only 18.2% of the patients, while the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found to be high in 75% and 85.7% of the patients, respectively. In the multiplex PCR analysis, the CRP values of the patients with only M.pneumoniae were found to be higher than the patients with accompanying viruses. M.pneumoniae was accompanied by viruses at the rate of 40.3%. The most common accompanying viruses were rhinovirus, adenovirus, bocavirus and metapneumovirus. The 55.8% of the patients had lobar-segmental consolidation, 46.8% had parahilar-peribronchial thickening, 18.2% had atelectasis, 11.7% had pleural effusion, 9.1% had increase in reticulonodular density, 6.5% had lymphadenopathy whereas no abnormality was observed in 5.2% of them. No diffuse interstitial involvement was recorded. The CRP value of the patients who had lobar segmental consolidation which was detected through chest X-rays were statistically higher than those without consolidation. In multiplex PCR analysis, the rate of parahilar-peribronchial thickening detected in chest X-ray findings was found to be higher in patients with M.pneumoniae accompanied by viruses compared to those with only M.pneumoniae. The rate of the patients who were given empirical antibiotics against atypical agents was 45.5%. The rate of empirically administered antibiotic treatment for atypical agents after being hospitalization was higher in patients diagnosed with only M.pneumoniae compared to patients with M.pneumoniae and viruses. One patient (1.3%) died. As there are no typical clinical, laboratory or radiological findings specific to M.pneumoniae pneumonia, all of the findings should be assessed as a whole to establish a diagnosis. Besides, for the detection of M.pneumoniae, diagnostic tests which are cost effective, with rapid results and are capable of distinguishing colonisation from active infection should be developed.

Exacerbação pulmonar de fibrose cística por Brevibacterium sp em criança: relato de caso e revisão de literatura

Cystic fibrosis (CF) is an autosomal recessive disease that usually affects the respiratory tract causing recurrent infections and deterioration of lung function. Other organs such as the digestive system and pancreas are also affected. In this report, we describe an 8-year girl with CF, previously colonized with Pseudomonas aeruginosa that developed pulmonary exacerbation not responsive to empiric treatment of broad spectrum antibiotics directed against prior colonization. Brevibacterium sp was detected in culture of bronchoalveolar lavage during bronchoscopy. Antimicrobial treatment was changed to vancomycin, meropenem, amikacin and ciprofloxacin with clinical, laboratorial and radiologic improvement after 23 days of treatment. Patient received discharge 30 days after admission for ambulatory follow-up. Its important that healthcare workers consider the possibility of atypical agents causing pulmonary exacerbation in patients with cystic fibrosis, mainly in children with initial failure of empiric treatment.

Animal models for the evaluation of antipsychotic agents.

Schizophrenia, the most serious among psychoses, has negative symptoms such as anhedonia, avolition and apathy, and cognitive defects in addition to positive symptoms such as hallucinations and delusions characterising all psychotic disorders. Traditional antipsychotics had dopamine D2 receptor antagonism as their principal mechanism of action, with disabling extrapyramidal symptoms as corollary. Newer atypical agents with diverse receptor actions introduced to circumvent this issue, nevertheless, had varied side effects such as agranulocytosis, insulin resistance, seizures, and cardiac events. Also, symptoms in cognitive and negative domains do not respond well even to newer agents creating an unmet need. Designing a valid animal model with translational relevance for a complex disease such as schizophrenia is a tedious process. Induction or suppression of certain animal behaviours by test compounds (behavioural models) and antagonising effects induced by compounds with psychotic potential (pharmacological models) are the conventional models used. One among the major disadvantages with conventional models is that these paradigms are induced acutely and relate to aberration of a single neurotransmitter system, which is in sharp contrast to the chronic nature and interplay of multiple neurotransmitter systems in psychotic diseases. However, with progress in elucidation of disease mechanisms, novel models are generated utilising developmental, genetic, and environmental factors (neurodevelopmental models) to effectively reflect the human disease pathogenesis and clinical manifestations, but with paucity of studies assessing the impact of drugs on them. This review presents an overview of schizophrenia hypotheses, requisites of a valid animal model, available animal models with their advantages and disadvantages.

A comparison of efficacy, mechanism, and side effects of clozapine and risperidone in patients with schizophrenia

Schizophrenia is a chronic psychotic disorder characterized by the presence of psychotic symptoms (hallucinations, delusions), negative symptoms (decreased expressiveness), and cognitive symptoms (lack of executive function). The exact etiology of schizophrenia is unknown, although it is thought to be linked to increased dopaminergic activity in the mesolimbic neuronal pathway and decreased dopaminergic activity in the prefrontal cortical pathway. Treatment of schizophrenia includes both pharmacological and psychosocial intervention. Nonpharmacological treatments are effective in treating the negative and cognitive symptoms of schizophrenia and increasing patient adherence to medications. The first-generation “conventional” antipsychotic drugs are high-affinity antagonists of dopamine D2 receptors that are most effective against psychotic symptoms and atypical agents differ pharmacologically from previous antipsychotic agents in their lower affinity for dopamine D2 receptors Clozapine and risperidone both are atypical antipsychotics. Clozapine has weak D2 blocking action. It mainly acts by blocking 5-HT2, alpha-adrenergic, and D4 receptors. Risperidone acts by blocking 5-HT, alpha-adrenergic and D2 receptors. It is a more potent D2 blocker than clozapine and can cause extrapyramidal symptoms at a high dose. Aggravation of seizures more with olanzapine and fewer chances with risperidone. Clozapine is a high potential atypical antipsychotic to cause metabolic side effects, while risperidone is a low potential antipsychotic to cause metabolic side effects. Clozapine is used in the treatment of resistant schizophrenia and risperidone is the most potent atypical antipsychotic agent available in long-acting injectable form.

Investigation of Microbial Etiology in Endotracheal Aspirate Samples of Severe Pneumonia Patients by Multiplex PCR and Culture Method

Objectives: The probability of detecting viral and atypical agents in pneumonia patients has increased with the molecular methods used in recent years. We aimed to investigate pneumonia pathogens in endotracheal aspiration samples (ETA) of patients with severe community-acquired (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) by multiplex polymerase chain reaction (m-PCR) and culture method. Methods: A prospective study was performed between December 2019 and October 2020. Patients 18 years and older with pneumonia followed in ICU on the mechanical ventilator were included. COVID-19 patients were excluded. Patients were grouped as CAP, HAP, and VAP. Two ETA samples were obtained from patients within 48 hours of the pneumonia diagnosis. Respiratory pathogens were investigated in samples by viral-bacterial m-PCR and bacterial culture methods. Results: 74 patients were included in the study. m-PCR of ETA samples achieved pathogen detection in 87.8% of patients compared with 58.1% with culture methods. The most common pathogen detected by m-PCR was Streptococcus pneumoniae in both CAP and HAP patients and Klebsiella spp. in VAP patients. The most common pathogen isolated by culture was Staphylococcus aureus in both CAP and HAP patients and Klebsiella spp. in VAP patients. Atypical pneumonia pathogens were positive for 14.9% of the patients. Atypical pathogens were recovered from 28.5% of CAP patients and 23.1% of HAP patients. Viruses constituted all of the atypical pathogens recovered from HAP patients. No atypical pathogen was found in VAP patients. Conclusion: In this study, S. pneumoniae was the most common pathogen detected with m-PCR, and S. aureus and Klebsiella spp. were the most common pathogens detected with culture. Determination of microbial etiology of lower respiratory tract samples by molecular methods for diagnosing severe CAP and HAP may be beneficial in terms of treatment. Keywords: pneumonia, multiplex PCR, endotracheal aspirate, conventional methods

Diagnosis of Bacteria Atypical Pneumonia Causative Agents by Using Indirect Immune Fluorescent Assay

Diagnosis of Bacteria Atypical Pneumonia Causative Agents by Using Indirect Immune Fluorescent Assay

Negative and Cognitive Symptoms of Schizophrenia: Are there Adequate Pharmacological Treatments?

IntroductionThe ongoing debate regarding the treatment efficacy for negative and cognitive symptoms in schizophrenia is a subject of continuous frustration among psychiatrists. These symptoms are reputedly hard to tackle therapeutically and their impact on long-term functional prognosis made them an important target for the maintenance treatment.ObjectivesTo review the literature in order to find the most adequate treatment options for negative and cognitive symptoms of schizophrenia.MethodsA literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE, www.clinicaltrials.gov) using the search paradigm “schizophrenia” AND “negative symptoms” AND “cognitive symptoms” AND “pharmacological treatment”. All papers published between January 2000 and August 2021 were included.ResultsThe efficacy of atypical antipsychotics over cognitive dysfunctions in schizophrenia decreases with time, without significant differences between the agents. Clozapine, amisulpride, olanzapine, and risperidone have superior efficacy over positive and negative symptoms, with small to moderate effect sizes. Meta-analyses show decreased severity of negative symptoms during treatment with atypical antipsychotics, especially with clozapine, amisulpride, olanzapine, zotepine, and risperidone. Atypical antipsychotics had a superior effect over neurocognitive domains when compared to the typical antipsychotics. Newer atypical antipsychotics, with partial D2/D3 agonism, are preferred to other atypical agents, although based on a low level of evidence. Antidepressants, especially mirtazapine, may be a solution for negative symptoms, while modafinil/armodafinil is also useful as an add-on.ConclusionsAlthough new therapeutic options are explored, there is a paucity of encouraging results from the pipeline regarding the treatment efficacy over negative/cognitive symptoms.DisclosureNo significant relationships.