Treatment Of Drug-resistant Patients Research Articles

Combined use of ECT and psychotropic drugs.

Electroconvulsive therapy (ECT),despite a significant psychopharmacological development and introduction of modern drugs in recent years, is still an important, biological treatment of proven, high clinical efficacy. In the management algorithms it is still considered as a method of choice in treatment of drug-resistant patients. No wider use of ECTmay in part result from fears of potential interactions with pharmacotherapy, or need to interrupt the current treatment. The issue of potential impact of pharmacotherapy on many procedure parameters, including mostly seizure threshold and therefore indirectly clinical effect, is still up-to-date. Systematic studies have revised the existing theories about restrictions in the administration of medications during ECT treatment. Nowadays more often not only the safety of such procedure, but also possibility of synergistic therapeutic effect of ECT and psychopharmacology is highlighted. The authors present previous reports on combined use of pharmacotherapy and ECT, safety or potential risks associated with this treatment and proposals of scientific bodies in this regard. Interpretative limitations of conducted research, including especially case reports or observations of small groups, which requires further studies involving more numerous patient populations is noteworthy.

EPA-0030 – The effects of bilateral subthalamic nucleus stimulation on cognitive and neuropsychiatric functions in parkinson's disease: a case-control study

Introduction Parkinson's disease is one of the most disabling neurological diseases; however much progress has been made in the treatment of drug resistant patients through electrode implantation and stimulation of the subthalamic nucleus (STN). This new neurosurgical method may lead to some neuropsychological side effects in patients. The main aim of this study was to evaluate the neuropsychiatric effects of this treatment. Method This case-control study was designed to compare two groups of patients with Parkinson's disease. Thirty patients who underwent electrode implantation and deep brain stimulation were compared with 60 patients treated with antiparkinson drugs. These two groups were matched for age, sex, duration and severity of Parkinson's disease. Measurements The UPDRS was used to assess the severity of Parkinson's disease. The Beck Depression Inventory questionnaire and the Hamilton Anxiety Rating Scale were used to evaluate depression and anxiety as a consequence of DBS. The Mini Mental Status Examination and Clock Drawing Test (CDT) were used to evaluate the cognitive and executive function. Results Thirty months after STN stimulation, a lower level of anxiety and depression were seen in the DBS patients compared with drug treated subjects, but the differences were not significant. However, cognitive status deteriorated to a greater extent in study subjects compared to the control group. The MMSE results were not significantly different, but the differences in CDT scores were significant. Conclusion Patients who have undergone DBS surgery must be followed up for neuropsychiatric symptoms, particularly for subcortical cognitive deterioration in the long term.

Interferon Status during the Treatment of Drug Resistant Patients with Paranoid Schizophrenia

A total of 73 patients with neuroleptic-resistant paranoid schizophrenia were studied. Patients were divided into two groups: a study group (37 patients) and a reference group (36 patients). Both groups of patients received standard psychopharmacotherapy. Patients of the study group also received a combination of Reamberin and Cycloferon. Before treatment, both groups of patients showed significant impairments to interferon status, characterized by decreases in serum interferon (sIFN) activity and blood α- and γ-interferon (IFN) levels. This combination of agents was found to have positive effects on both the clinical picture of the disease and on measures of interferon status, with normalization of sIFN activity and increases in blood α- and γ-IFN levels.

The Application of the Cognitive Behavioral Therapy in Schizophrenia

ObjectivesZZCognitive behavioral therapy for treatment of schizophrenia was designed as a psychological therapy for treatment of drug resistant patients with schizophrenia. This therapy is currently being widely applied from early psychosis to chronic condition. The aim of this article is to review the main results of research articles on cognitive behavioral therapy of schizophrenia and prompt practicing the therapy in Korean mental health services. MethodsZZThe important original and review articles were referred in order to understand the main results of research from published international books, and the English website Pubmed was searched in order to update recent findings. This article reviewed the results of four areas of different phases and types of cognitive behavioral therapy for treatment of schizophrenia: drug resistant chronic patients, acute psychotic state, prodromal phase, and group cognitive behavioral therapy. ResultsZZCognitive behavioral therapy for treatment of drug resistant patients with schizophrenia can attenuate the positive and general symptoms more than that for patients who receive supportive psychotherapy or treatment as usual. However, the effect appears to be less than previously expected, small to moderate. Cognitive behavioral therapy for patients of acute psychotic state can reduce the time of recovery from acute psychotic symptoms by approximately 25%. The result of cognitive behavioral therapy for patients of prodromal phase shows that the therapy can reduce the rate of transition to schizophrenia by up to one third. Group behavioral therapy has recently been tested. Group therapists have suggested that the therapy should be applied through the way of groups with relatively homogenous symptoms. However, whether the therapy can reduce the severity of hallucination in the voice hearer group is inconclusive. ConclusionZZAlongside pharmacotherapy for treatment of schizophrenia, cognitive behavioral therapy is a distinct psychological therapy for attenuation of psychotic symptoms. The effect of cognitive behavioral therapy appears to last for one year and requires additional therapeutic sessions after one year. The effect is not still clear in group cognitive behavioral therapy for treatment of schizophrenia. Cognitive behavioral therapy for treatment of schizophrenia should be practiced widely in the Korean mental health system. J Korean Neuropsychiatr Assoc 2012;51:359-366 KEY WORDSZZ Schizophr enia · Cognitive behavioral therapy · Drug resistant patient ·

Study on Macrolide resistance of mycoplasma pneumoninae

In recent years,more and more Macrolide resistance of Mycoplasma pneumoniae becomes a hot research.The current studies suggest that the mechanisms of Macrolide resistance are drug-binding site mutations,ribosome methylation,drug efflux,and drug related fire-fighting,in which the drug target 23srRNA gene 2063,2064 mutation is significant.It has been reported that drug-resistant patients have the poor effect,including the long total febrile days and high dressing.For treatment of drug-resistant patients,most studies still use the macrolide,early use of corticosteroids may be effective.It is uncertain whether the increase in resistant strains is related with the use of macrolide.It is significant to carry out future researches in this area for clinical therapy and put off the prevalence of drug-resistant strains. Key words: Mycoplasma pneumoniae; Drug resistance; Macrolide

The anticonvulsant retigabine potently suppresses epileptiform discharges in the low Ca ++ and low Mg ++ model in the hippocampal slice preparation

Retigabine ( N-(2-amino-4-(4-fluorobenzylamino)-phenyl) carbamic acid ethyl ester, D-23129) is a broad acting anticonvulsant currently undergoing phase II clinical trials. An opening effect on leakage conductance K + channels, potentiation of GABA induced currents and a weak blocking effect on Na + and Ca ++ channels were previously reported. The goal of this study was to investigate whether retigabine is capable of blocking epileptiform discharges in the low Ca ++ and low Mg ++ model in the hippocampal slice preparations and whether the anti-burst activity can be related to the K + channel opening effect. In the low Ca ++ model, synaptic transmission is blocked and discharges evolve from ephaptically-coupled neurons. Compounds which directly interfere with the threshold for action potential induction via alteration of ion channel function (i.e. Na + channel blocker) may alter the discharges, while compounds interfering with synaptic transmission are not active. Retigabine suppressed the discharges in a concentration-dependent manner. A significant reduction in frequency without effect on amplitude was observed after application of 1 μM, and a full block of all discharges after application of 25 μM. The opener of the ATP sensitive K + channels cromakalim was also active. Application of 300 μM cromakalim yielded to a lower frequency with no effects on the amplitude of discharges. Treatment with phenytoin and carbamazepine resulted in a marked reduction in amplitude accompanied by a rise in frequency; only at higher concentrations was a full block observed. The effect of retigabine therefore differs from sodium channel blockers and can be related to the K + channel opening effect. In the low Mg ++ model, excitatory neurotransmission is augmented by reducing the Mg ++ block of NMDA channels. This results in development of interictal-like epileptiform activity in area CA1 in isolated hippocampal slices. Treatment with retigabine 10 μM resulted in a significant reduction of the discharges, and discharges were fully blocked after application of 25 μM. Qualitatively similar effects were observed with cromakalim and valproate, albeit at higher concentrations. The data indicate that retigabine exerts potent broad spectrum activity making it an interesting candidate for treatment of drug resistant patients.