Medication-induced Side Effects Research Articles

Severe Hyperhidrosis Secondary to Bupropion Use and Treatment. A case report.

IntroductionHyperhidrosis, the excessive and uncontrollable sweating, is a well-documented side effect of various medications. Among these, bupropion, a commonly prescribed antidepressant and smoking cessation aid, has been associated with the development of severe hyperhidrosis in a subset of patients. This clinical report aims to shed light on a compelling case of severe hyperhidrosis induced by bupropion use and the subsequent treatment strategies employedThe patient under discussion is a 42-year-old female with a history of recurrent major depressive disorder and a previous favorable response to selective serotonin reuptake inhibitors (SSRIs). Due to side effect concerns and a desire to quit smoking, she was transitioned to bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI), at a standard therapeutic dose of 150 mg daily.Approximately four weeks after initiating bupropion therapy, the patient began experiencing debilitating symptoms of excessive sweating, particularly affecting her palms, soles, and axillae. The profuse sweating episodes occurred throughout the day and night, significantly impairing her quality of life, social interactions, and occupational functioning. No previous history of hyperhidrosis was reported, and physical examinations revealed no underlying medical conditions or dermatological issues.ObjectivesTo aknowledge the importance of recognizing and addressing medication-induced side effects within the realm of psychiatry and an early implementation of patient-centered treatment.MethodsClinical case report and a brief literature review.ResultsThe treatment of hyperhidrosis secondary to bupropion use presents a challenging clinical scenario that requires a delicate balance between managing the distressing side effect and ensuring the continued efficacy of psychiatric therapy. Given the rarity of severe hyperhidrosis as a side effect of bupropion, there is a limited body of evidence guiding treatment strategies. Gradual withdrawal in the dose of bupropion was initiated, with careful monitoring of depressive symptoms to prevent relapse, switching to Duloxetine 90mg daily, with adecuate efectiveness.In this particular case, the combination of medication adjustment and psychological support led to a significant reduction in hyperhidrosis symptoms. The patient reported improved social interactions, enhanced self-esteem, and restored occupational functioning. Importantly, her depressive symptoms remained well-managed, underscoring the success of the treatment strategy.ConclusionsThis clinical report highlights the importance of a patient-centered approach when addressing rare medication-induced side effects within the field of psychiatry. Bupropion withdrawal and regular follow-up showed effective in the treatment of the simptoms. Future research may provide additional insights and treatment options for cases like this, further enhancing patient care and outcomes.Disclosure of InterestNone Declared

Досвід застосування засобу «Біоплазмікс спрей для горла» в комплексному лікуванні гострих вірусних фарингітів у дітей з атопічним фоном

The problem of therapy of acute respiratory infections in children remains relevant. The most common infectious pathology of the upper respiratory tract in both children and adults is acute viral pharyngitis. Irrational prescribing of antibiotics leads to medication-induced side effects and the spread of resistance of microorganisms to antibiotics in society. Topical application of respiratory probiotics may be an important component in the supportive treatment of acute respiratory infections and reducing antibiotic dependence. The use of probiotics in children with an atopic background is of particular importance due to the possible occurrence of adverse reactions. Purpose - to assess the safety and effectiveness of the local application of Bioplasmix throat spray in the complex treatment of acute viral pharyngitis in children with an atopic background. Materials and methods. 45 children aged 6-18 years with acute viral pharyngitis took part in the study. 2 research groups were formed: the Group I - main (n=25) - received protocol treatment + Bioplasmix throat spray locally and the Group II - comparison (n=20) - only protocol treatment. All patients were assessed for the severity of clinical symptoms (fever, headache, sore throat, scratching, cough) and oropharyngoscopy data (hyperemia, swelling of the mucous membrane of the oropharynx, granularity of the back wall of the pharynx) on the 1st, 2nd, 3rd, 4th, 5th and 7th days of using the product. Results. The use of the local application of Bioplasmix throat spray for acute pharyngitis in children ensures a faster reduction in the severity of the main clinical manifestations and signs of inflammation of the oropharynx. In the Group I, compared to the Group II, there were better indicators of a decrease in the severity of cough (1.2±0.91 points vs. 1.76±0.85 points), a scratching (1.12±0.92 points vs. 1.7±0.86 points), sore throat (1.6±0.81 points vs. 2.23±0.76 points) and hyperemia of the pharynx (1.4±0.7 points vs. 2.1±0.9 points) from the 3rd day, swelling of the pharynx (1.22±0.86 points vs. 1.8±1.04 points) from the 4th day. Adverse reactions were not noted during the use of the local application of Bioplasmix throat spray. Conclusions. Local probiotic therapy is an important component of the complex therapy of acute pharyngitis, the use of bacteria of the genus Bacillus in the form of Bioplasmix throat spray shows a positive effect on the course of acute viral pharyngitis in children, which manifests by a faster decrease in the severity of subjective symptoms of pharyngitis and inflammatory signs of the oropharynx. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Pharmacologic Management of Parkinsonism and Other Movement Disorders

Parkinsonism and other movement disorders constitute a diverse group of neurodegenerative conditions characterized by disturbances in motor control. This abstract provides an overview of the pharmacologic management strategies employed in the treatment of these disorders. Parkinson's disease, the most prevalent form of Parkinsonism, is primarily managed through dopaminergic therapies aimed at replenishing dopamine levels or enhancing its effects in the central nervous system. Levodopa, a precursor of dopamine, remains the gold standard, often combined with dopaminergic agonists or monoamine oxidase-B inhibitors for optimal efficacy.In addition to Parkinson's disease, other movement disorders such as essential tremor, dystonia, and chorea pose unique challenges. Beta-blockers and anticonvulsants, like primidone, are commonly prescribed for essential tremor, while dystonia may respond to anticholinergic agents or botulinum toxin injections. Huntington's disease, characterized by chorea, is managed through dopamine-depleting agents, tetrabenazine being a notable example.Recent advances in pharmacotherapy include the development of adenosine A2A receptor antagonists and glutamate receptor modulators, providing promising alternatives and adjuncts to traditional therapies. However, challenges such as medication-induced side effects, disease progression, and the need for personalized treatment plans persist.This abstract underscore the evolving landscape of pharmacologic interventions for managing Parkinsonism and other movement disorders. A comprehensive understanding of the underlying pathophysiology, coupled with ongoing research efforts, promises to enhance therapeutic options and improve the quality of life for individuals affected by these debilitating conditions.

The challenges in managing co-occurring Parkinson's and schizophrenia spectrum disorders

This article explores the relationship between Parkinson's and schizophrenia spectrum disorders, discussing not only the possibility that they can be comorbid conditions but that the presence of one could increase the chances of developing the other. They are rarely documented together, other than in relation to medication-induced side effects, and this could be due to diagnostic overshadowing, or the widely held belief that these conditions are not able to co-exist. It also briefly discusses treatment options available and gaps identified for future research.

How Does Deep Brain Stimulation Change the Course of Parkinson's Disease?

A robust body of evidence from randomized controlled trials has established the efficacy of deep brain stimulation (DBS) in reducing off time and dyskinesias in levodopa‐treated patients with Parkinson's disease (PD). These effects go along with improvements in on period motor function, activities of daily living, and quality of life. In addition, subthalamic DBS is effective in controlling drug‐refractory PD tremor. Here, we review the available data from long‐term observational and controlled follow‐up studies in DBS‐treated patients to re‐examine the persistence of motor and quality of life benefits and evaluate the effects on disease progression, major disability milestones, and survival. Although there is consistent evidence from observational follow‐up studies in DBS‐treated patients over 5–10 years and beyond showing sustained improvement of motor control, the long‐term impact of DBS on overall progression of disability in PD is less clear. Whether DBS reduces or delays the development of later motor and non‐motor disability milestones in comparison to best medical management strategies is difficult to answer by uncontrolled observational follow‐up, but there are signals from controlled long‐term observational studies suggesting that subthalamic DBS may delay some of the late‐stage disability milestones including psychosis, falls, and institutionalization, and also slightly prolongs survival compared with matched medically managed patients. These observations could be attributable to the sustained improvements in motor function and reduction in medication‐induced side effects, whereas there is no clinical evidence of direct effects of DBS on the underlying disease progression. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Defining the Optimal Strategies for Achieving Drug-Free Remission in Rheumatoid Arthritis: A Narrative Review.

Background: It is now accepted that the optimum treatment goal for rheumatoid arthritis (RA) is sustained remission, as this has been shown to be associated with the best patient outcomes. There is little guidance on how to manage patients once remission is achieved; however, it is recommended that patients can taper therapy, with a view to discontinuing and achieving drug-free remission if treatment goals are maintained. This narrative review aims to present the current literature on drug-free remission in rheumatoid arthritis, with a view to identifying which strategies are best for disease-modifying anti-rheumatic drug (DMARD) tapering and to highlight areas of unmet clinical need. Methods: We performed a narrative review of the literature, which included research articles, meta-analyses and review papers. The key search terms included were rheumatoid arthritis, remission, drug-free remission, b-DMARDS/biologics, cs-DMARDS and tapering. The databases that were searched included PubMed and Google Scholar. For each article, the reference section of the paper was reviewed to find additional relevant articles. Results: It has been demonstrated that DFR is possible in a proportion of RA patients achieving clinically defined remission (both on cs and b-DMARDS). Immunological, imaging and clinical associations with/predictors of DFR have all been identified, including the presence of autoantibodies, absence of Power Doppler (PD) signal on ultrasound (US), lower disease activity according to composite scores of disease activity and lower patient-reported outcome scores (PROs) at treatment cessation. Conclusions: DFR in RA may be an achievable goal in certain patients. This carries importance in reducing medication-induced side-effects and potential toxicity, the burden of taking treatment if not required and cost effectiveness, specifically for biologic therapy. Prospective studies of objective biomarkers will help facilitate the prediction of successful treatment discontinuation.

Surgical outcomes of medically failed prolactinomas: a systematic review and meta-analysis.

In Prolactinomas, surgery or radiation are reserved for DA failure due to tumor resistance, intolerance to medication-induced side-effects, or patient preference. This systematic review and meta-analysis summarizes the currently available literature regarding the effectiveness of surgery to treat prolactinomas in patients who have failed DA therapy. A literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that reported outcomes of medically resistant and intolerant prolactinoma treated surgically. 10 articles (Total N = 816, Surgery N = 657) met the inclusion criteria. 38% of patients who underwent surgery following DA failure achieved remission without need for further treatment (p < 0.001, I2 = 67.09%) with a median follow-up of 49.2 +/- 40 months. 62% achieved remission with multimodal treatment (p < 0.001, I2 = 93.28%) with a median follow-up of 53 +/- 39.8 months. 16% of cases demonstrated recurrence after early remission (p = 0.02, I2 = 62.91%) with recurrence occurring on average at 27 +/- 9 months. Overall, 46% of patients required reinstitution of postoperative DA therapy at last follow up (p < 0.001, I2 = 82.57%). Subgroup analysis of macroprolactinoma and microprolactinoma has demonstrated that there is no statistical significance in achieving long-term remission with surgery stand-alone in macroprolactinoma group (p = 0.49) although 43% of patients were able to achieve remission with multimodal therapy at last follow-up in the same group (p < 0.001, I2 = 86.34%). This systematic review and meta-analysis revealed 38% of operated patients achieved remission, while 62% achieved remission when additional modes of therapy were implemented. Therefore, although surgery has not been initial therapeutic choice for prolactinoma, it plays a significant role in medically failed prolactinoma care.

ACUTE MANIA: AN UNUSUAL PRESENTATION OF SMALL CELL LUNG CANCER

TYPE: Case Report Publication TOPIC: Lung Cancer INTRODUCTION: We report a patient presenting with acute mania, and without symptoms typically associated with pulmonary malignancy, who was diagnosed with small cell lung cancer (SCLC). CASE PRESENTATION: Ms. D is a 63-year-old female with a past medical history of mild anxiety and tobacco use who was brought into the emergency department after exhibiting one month of bizarre and impulsive behavior. She never behaved like this before. Her only medication is alprazolam 0.5 mg as needed for anxiety. On presentation, her exam was notable for prominent flight of ideas, loose associations, affective lability, and pressured speech. Her sodium was 130 mmol/L, urine osmolality was 505 mOsm/kg, and urine sodium of 102 mmol/L. Urine drug screen was positive for benzodiazepines. She was given additional benzodiazepines without change in her behavior. Non-contrast computed tomography of the chest revealed a large right upper lobe nodule, bilateral mediastinal and right hilar adenopathy, and bilateral supraclavicular adenopathy. Biopsy of the supraclavicular lymph node showed SCLC. Brain magnetic resonance imaging (MRI) and lumbar puncture were unrevealing. She was discharged with follow-up with oncology and neurology, but lost to follow-up. DISCUSSION: Most patients with mania typically present before early adulthood, but for the 10% who develop mania later in life, alternative causes of mania should be considered. These include cerebral organic disorders, malignancy, and medication-induced side effects. Our patient’s mania was deemed to be of paraneoplastic etiology, possibly exacerbated by benzodiazepine use and SIADH. CONCLUSIONS: Our case underscores the importance of considering carefully all etiologies for elderly patients with new onset mania. DISCLOSURE: No significant relationships. KEYWORDS: Mania, Small cell lung cancer

Opioid-induced Euphoria Among Emergency Department Patients With Acute Severe Pain: An Analysis of Data From a Randomized Trial.

Parenteral opioids are commonly used to treat acute severe pain. We measured pleasurable sensations in patients administered intravenous analgesics to determine if these sensations were associated with receipt of an opioid, after controlling for relief of pain. Pleasurable sensations not accounted for by relief of pain were considered opioid-induced euphoria. These data were from a randomized study of 1mg of hydromorphone versus 120mg of lidocaine for abdominal pain. To assess euphoria, participants were asked to provide a 0 to 10 response to each of these questions: 1) How good did the medication make you feel? 2) How high did the medication make you feel? and 3) How happy did the medication make you feel? Pain at baseline and 30minutes was also measured on a 0 to 10 scale. To determine the relative importance of pain relief versus medication type, we built three linear regression models in which each euphoria question was the dependent variable and pain relief, medication type, and medication-induced side effects were the independent variables. Seventy-seven patients received lidocaine and 77 hydromorphone. Hydromorphone patients reported greater pain improvement than lidocaine patients (mean difference=1.5, 95% confidence interval [CI]=0.6 to 2.3) and higher scores on all three euphoria questions ("feeling good" difference=1.9, 95% CI=0.8 to 3.0; "feeling high" difference=1.5, 95% CI=0.4 to 2.7; "feeling happy" difference=1.7, 95% CI=0.6 to 2.8). In the regression models, hydromorphone administration (β-coefficient=0.16, p=0.03) and pain relief (β-coefficient=0.45, p<0.01) were both associated with "feeling good." "Feeling high" and "feeling happy" were associated with pain improvement (p<0.01) but not with hydromorphone administration (p=0.07 for "high" and p=0.06 for "happy"). Medication-induced side effects were not associated with these measures of euphoria. Among emergency department patients with acute pain, hydromorphone-induced euphoria, though measurable, was generally less important for patients than relief of pain.

It’s Not What You Think: Questions to Ask at Discharge

It’s Not What You Think: Questions to Ask at Discharge

SAMHSA SMI Grant Featured in AM Sessions

Back to table of contents Previous article Next article Association NewsFull AccessSAMHSA SMI Grant Featured in AM SessionsMark MoranMark MoranSearch for more papers by this authorPublished Online:12 Feb 2019https://doi.org/10.1176/appi.pn.2019.2b5AbstractOne session will provide background on an APA-led program for people with serious mental illness and how mental health professionals can participate. Three other sessions will address how to leverage technology and expert consultation for the treatment of serious mental illness.Four sessions at this year’s Annual Meeting will address the interdisciplinary care of people with serious mental illness (SMI). The sessions are part of the Clinical Support System for Serious Mental Illness (CSS-SMI), which is supported by a $14.2 million, five-year grant that APA received from the Substance Abuse and Mental Health Services Administration (SAMHSA).The CSS-SMI incorporates education and consultation to expand the base of clinicians—including physicians, nurses, recovery specialists, peer-to-peer specialists, and others—able to provide evidence-based care to individuals with SMI. (SMI typically includes schizophrenia, bipolar disorder, and major depressive disorder.)Session InformationSATURDAY, MAY 1810 a.m.-11:30 a.m.Hands-on With Smartphone Apps for Serious Mental Illnesses: An Interactive Tutorial for Selecting, Downloading, Discussing, and Engaging With AppsChair: John Torous, M.D. SUNDAY, MAY 193 p.m.-4:30 p.m.It Takes a Village: Interdisciplinary Approaches to the Use of Clozapine in Patients With Persistent PsychosisChair: Alexander Stehle Young, M.D., M.S.H.S. MONDAY, MAY 2010 a.m.-11:30 a.m.Better Care and Evidence-Based Treatment: An Introduction to the Clinical Support System for Serious Mental IllnessChair: Tristan Gorrindo, M.D. 1 p.m.-2:30 p.m.Successfully Addressing Weight Gain in Patients With Serious Mental IllnessChair: Amy CohenA major component of the program is the dissemination of information using novel technologies. APA will build web and smartphone platforms that will allow virtual consultations with experts and disseminate educational content through the SMI Adviser (www.SMIadviser.org).“This effort leverages assets that APA can uniquely provide—expert clinical wisdom, the highest-quality educational tools, and cutting-edge digital technology—to achieve goals to which APA is committed, namely, improving the care of people with serious mental illness,” said Tristan Gorrindo, M.D., director of APA’s Division of Education and a deputy medical director. “It’s a multi-year effort involving a lot of moving parts, but its goal is to significantly improve access to care for the millions of individuals with schizophrenia, bipolar disorder, and major depression who are not currently receiving adequate treatment.”One session, “Better Care and Evidence-Based Treatment: An Introduction to the Clinical Support System for Serious Mental Illness,” will introduce attendees to SMI Adviser and how they can participate and leverage its resources to care for patients with serious mental illness.The introductory session will be held Monday, May 20, 10 a.m. to 11:30 a.m.Three other sessions, offered as part of CSS-SMI, address specific aspects of using technology, measurement-based care, and other strategies to improve care for patients: Hands-on With Smartphone Apps for Serious Mental Illnesses: An Interactive Tutorial for Selecting, Downloading, Discussing, and Engaging With AppsPatients with SMI are increasingly interested in mental health smartphone apps and are seeking guidance from clinicians about their use. This interactive and step-by-step guided session will provide hands-on learning and skills that clinicians can use to help them make more informed decisions about apps for patients with SMI, download and install apps onto smartphones, and formulate treatment plans that ensure ethical, safe, legal, and effective use of these new digital tools.It Takes a Village: Interdisciplinary Approaches to the Use of Clozapine in Patients With Persistent PsychosisPersistent psychosis is common in individuals with schizophrenia and other chronic psychotic disorders. Through the use of measurement-based care and appropriate monitoring, interdisciplinary and team-based treatment of patients with persistent psychosis can improve medication adherence and reduce medication-induced side effects. This session will use a series of clinical cases to discuss treatment approaches, including the use of clozapine. Parameters for monitoring, required lab registry, and outcomes measures will be outlined. Prescribing and side-effect management will be discussed.Successfully Addressing Weight Gain in Patients With Serious Mental IllnessIndividuals with serious mental illness often have comorbid medical problems, including obesity and diabetes, which can be effectively managed with activity and diet. Typically, however, only a small proportion of patients receive appropriate services. This symposium presents a range of approaches for successful use of services targeting negative health behaviors in patients with SMI. Delivery methods that reach patients outside the clinic including web-based and mobile apps will be presented.Gorrindo urged APA members to take advantage of the educational offerings. “These sessions offer psychiatrists and mental health professionals attending the Annual Meeting a chance to get acquainted with an exciting new APA initiative and with a cutting-edge innovation in care for people with serious mental illness—leveraging technology and expert consultation to advance recovery.” ■ ISSUES NewArchived

Medical Cannabis for Older Patients.

Interest in the medicinal use of cannabis and cannabinoids is mounting worldwide. Fueled by enthusiastic media coverage, patients perceive cannabinoids as a natural remedy for many symptoms. Cannabinoid use is of particular interest for older individuals who may experience symptoms such as chronic pain, sleep disturbance, cancer-related symptoms and mood disorders, all of which are often poorly controlled by current drug treatments that may also incur medication-induced side effects. This review provides a summary of the evidence for use of cannabinoids, and medical cannabis in particular, for this age group, with attention to efficacy and harms. Evidence of efficacy for relief of an array of symptoms is overall scanty, and almost all study participants are aged < 60years. The risk of known and potential adverse effects is considerable, with concerns for cognitive, cardiovascular and gait and stability effects in older adults. Finally, in light of the paucity of clinical evidence and increasing patient requests for information or use, we propose a pragmatic clinical approach to a rational dialogue with older patients, highlighting the importance of individual benefit-risk assessment and shared patient-clinician decision making.

A Head-Scratcher: Humira Causing Enthesitis of the Skull in a Patient with Crohnʼs?

Enthesopathy of the skull has been described in association with ankylosing spondylitis, psoriatic arthritis and reactive arthritis. Enthesitis, inflammation of the bone insertion sites of tendons and ligaments, typically occurs in the heels and knees of individuals with inflammatory bowel disease. This is the first report of an individual with Crohn's disease managed with adalimumab who presents with skull enthesitis without spondyloarthropathy or psoriatic arthritis. A 40 year old woman with a history of Crohn's disease involving her stomach, small bowel and colon without extraintestinal manifestations presented following an emergency room evaluation for posterior skull pain. Her disease had been previously managed with 6-mercaptopurine (discontinued due to hepatotoxicity) and infliximab (discontinued due to serum sickness). She was being treated with adalimumab 40 mg weekly for 15 months with clinical and histologic remission of her gastrointestinal disease. In the emergency room, she described 2 days of progressively worsening posterior skull pain. Examination revealed 5 areas of localized, posterior skull tenderness. Her labs were unremarkable, including inflammatory markers (ESR 2, CRP 0.1). She was diagnosed with skull enthesitis and treated with prednisone with improvement but without complete resolution. Subsequent allergy consultation was notable for persistent posterior skull tenderness and cervical adenopathy. Rheumatology evaluation confirmed enthesitis. Her skull pain gradually resolved with a 3 week course of tapering prednisone. She was advised by the allergist to discontinue adalimumab. This is an unusual case of skull enthesitis in an individual with inflammatory bowel disease without extraintestinal symptoms who was maintained on adalimumab. While adalimumab has been associated with adenopathy, it has not been reported to result in enthesitis. It is uncertain if this patient has IBD-associated enthesitis or medication-induced side effects. Continued observation for similar circumstances can provide clarification of the etiology of enthesitis in individuals with inflammatory bowel disease and offer potential guidance for management.

New Cancer Pain Treatment Options.

Cancer pain is often incapacitating and discouraging to patients; is demoralizing to family members and care takers; and is taxing and difficult to subdue for the pain specialists. The consequences of implementing suboptimal treatment are far-reaching; therefore, effective treatment methods are in a great demand. The face of cancer pain management has changed in considerable ways, and interventional procedures have become an integral part of providing multimodal analgesia in cancer pain treatment. The goals of this review are to draw attention to the critical role that regional anesthetic nerve blocks and interventional pain management techniques play in treating malignancy-related pain and emphasize the benefits provided by the aforementioned treatment strategies. A large proportion of cancer patients continues to struggle with an inadequately treated pain despite a strict adherence to the WHO analgesic step ladder. The previous pain treatment algorithm has been modified to include peripheral neural blockade, neuro-destructive techniques, neuromodulatory device use, and intrathecal drug delivery systems. The accumulated evidence highlights the opioid-sparing qualities and other benefits afforded by these modalities: decreasing medication-induced side effects, reducing economic burden of poor analgesia, and overall improvement in quality of life of the patients afflicted with a painful neoplastic disease. The rising prevalence of cancer-related pain syndromes is paralleled by an unmatched growth of innovative treatment strategies. Modified WHO analgesic ladder represents one of the greatest paradigm shifts within the domain of oncologic pain treatment. The cancer patient population requires a prompt and liberal, albeit judicious, delivery of unorthodox pain treatment options freed from the rigid bonds of conventional guidelines and standard practices.

Long-term effectiveness and safety of once-daily, single-entity, extended-release hydrocodone in patients of ≥75 years of age with moderate to severe nonmalignant and nonneuropathic pain

In elderly (≥75 years) individuals, age-associated physiologic changes and a higher prevalence of comorbidities, polypharmacy, and increased susceptibility to medication-induced side effects complicate pain management. Hysingla® ER (HYD) is a once-daily, single-entity, extended-release hydrocodone formulation approved for the treatment of chronic pain that is insufficiently controlled by alternative treatments. In this post-hoc analysis of a previously reported study, the effectiveness and safety of HYD for the treatment of moderate-to-severe chronic pain among the elderly (≥75 years) for a 52-week duration was investigated. HYD dose administered during the maintenance period-remained relatively stable and provided clinically meaningful decreases in mean “pain over the last 24 h” and pain interference scores. Patients achieved pain control without additional non-study opioid use at the end of the study. Adverse events were typical of opioids. In summary, HYD provided clinically meaningful reduction of pain scores in elderly patients that were maintained over a 52-week period.

Balancing the basal ganglia circuitry: a possible new role for dopamine D2 receptors in health and disease.

Current therapies for treating movement disorders such as Parkinson's disease are effective but limited by undesirable and intractable side effects. Developing more effective therapies will require better understanding of what causes basal ganglia dysregulation and why medication-induced side effects develop. Although basal ganglia have been extensively studied in the last decades, its circuit anatomy is very complex, and significant controversy exists as to how the interplay of different basal ganglia nuclei process motor information and output. We have recently identified the importance of an underappreciated collateral projection that bridges the striatal output direct pathway with the indirect pathway. These bridging collaterals are extremely plastic in the adult brain and are involved in the regulation of motor balance. Our findings add a new angle to the classical model of basal ganglia circuitry that could be exploited for the development of new therapies against movement disorders. In this Scientific Perspective, we describe the function of bridging collaterals and other recent discoveries that challenge the simplicity of the classical basal ganglia circuit model. We then discuss the potential implication of bridging collaterals in the pathophysiology of Parkinson's disease and schizophrenia. Because dopamine D2 receptors and striatal neuron excitability have been found to regulate the density of bridging collaterals, we propose that targeting these projections downstream of D2 receptors could be a possible strategy for the treatment of basal ganglia disorders. © 2015 International Parkinson and Movement Disorder Society.

Medication-free Alternatives for Long-term Maintenance of Bipolar Disorder: A Case Series.

Psychopharmacological treatment has been the mainstay in long-term maintenance of bipolar disorder (BD) patients for the last 60 years. Conventionally accepted treatment options are primarily based on expert opinion rather than on well-executed, independently funded research. Investigation of maintaining patients without medications using treatment alternatives has been neglected. This clinical case series examines the outcomes of 7 BD patients who experienced a poor response or significant side effects with conventional treatment modalities. Patients were gradually and safely withdrawn from all medications. Treatment strategies were based on an individualized holistic approach using herbs, nutritional supplements, vitamins, amino acids, acupuncture, dietary recommendations, and behavioral modifications. Multiple treatment modalities were combined addressing the etiological causes for BD symptoms. Upon withdrawal from psychotropic medications, patients were free of medication-induced side effects and obtained psychiatric stability for at least 10 months. Further research is needed to investigate the long-term outcomes of BD treatment modalities based on well-defined successful outcome criteria, such as reduction in symptoms, improvement in quality of life, overall health outcomes, and cost effectiveness.

Medical management of children after liver transplantation.

Successful outcomes in patient, graft survival, and quality of life depend on the prevention, early detection, and treatment of possible complications. The aim of the study was to highlight the common outcomes focusing on the unique features in children. Medical follow-up of children after liver transplantation includes monitoring of surgical complications: biliary and vascular, rejection, infections, posttransplant lymphoproliferative disease, other malignancies, recurrent disease, graft function, hypertension, diabetes, renal failure, among other conditions. The goal is to maintain normal graft function on minimal immunosuppression to avoid medication-induced side-effects. Recent findings include the importance of meticulous follow-up of Epstein-Barr virus and Cytomegalic virus viral load, leading to early diagnosis and improved prognosis, increased prevalence of renal toxicity, cognitive dysfunction, autoimmune, atopic and eosinophilic disease, oral hygiene and chronic hepatitis, and fibrosis of allografts. Caring for children after liver transplantation is extremely rewarding; however, careful attention must be paid to a variety of systems with understanding of the distinctiveness of pediatrics to assure optimal outcomes.

Olanzapine as a cause of peripheric edema in an elderly man

Edema can be observed as side-effect of many medications, of which calcium channel blockers are the best known. Elderly people use many more medications than their younger counterparts and are usually more prone to developing medication-induced side-effects. Atypical antipsychotics have occasionally been shown to induce peripheric edema. Age is put forward as a risk factor for olanzapine-induced edema. We present here the case of an elderly man who developed upper- and lower-limb edema during use of olanzapine to emphasize its relatively frequent association with edema in the elderly.

A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia

BackgroundAntipsychotic medications often have a variety of side effects, however, it is not well understood how the presence of specific side effects correlate with adherence in a real-world setting. The aim of the current study was to examine the relationship between these variables among community-dwelling patients with schizophrenia.MethodsData were analyzed from a 2007-2008 nationwide survey of adults who self-reported a diagnosis of schizophrenia and were currently using an antipsychotic medication (N = 876). The presence of side effects was defined as those in which the patient reported they were at least "somewhat bothered". Adherence was defined as a score of zero on the Morisky Medication Adherence Scale. To assess the relationship between side effects and adherence, individual logistic regression models were fitted for each side effect controlling for patient characteristics. A single logistic regression model assessed the relationship between side effect clusters and adherence. The relationships between adherence and health resource use were also examined.ResultsA majority of patients reported experiencing at least one side effect due to their medication (86.19%). Only 42.5% reported complete adherence. Most side effects were associated with a significantly reduced likelihood of adherence. When grouped as side effect clusters in a single model, extra pyramidal symptoms (EPS)/agitation (odds ratio (OR) = 0.57, p = 0.0007), sedation/cognition (OR = 0.70, p = 0.033), prolactin/endocrine (OR = 0.69, p = 0.0342), and metabolic side effects (OR = 0.64, p = 0.0079) were all significantly related with lower rates of adherence. Those who reported complete adherence to their medication were significantly less likely to report a hospitalization for a mental health reason (OR = 0.51, p = 0.0006), a hospitalization for a non-mental health reason (OR = 0.43, p = 0.0002), and an emergency room (ER) visit for a mental health reason (OR = 0.60, p = 0.008).ConclusionsAmong patients with schizophrenia, medication side effects are highly prevalent and significantly associated with medication nonadherence. Nonadherence is significantly associated with increased healthcare resource use. Prevention, identification, and effective management of medication-induced side effects are important to maximize adherence and reduce health resource use in schizophrenia.