Neuropsychopharmacologia Hungarica : a Magyar Pszichofarmakológiai Egyesület lapja = official journal of the Hungarian Association of Psychopharmacology
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Neuropsychopharmacol Hung · Oct 2007
Randomized Controlled Trial Comparative StudyComparison of propofol and etomidate regarding impact on seizure threshold during electroconvulsive therapy in patients with schizophrenia.
While propofol is known to shorten seizures during electroconvulsive therapy, in our previous study on patients with schizophrenia, there was no need for more frequent restimulations when using propofol compared with etomidate. We hypothesized that etomidate and propofol have similar effects on seizure activity in cases where seizure duration is shorter than 20 seconds. In this study, etomidate and propofol are compared regarding their impact on seizure threshold and seizure duration. ⋯ During the ECT of patients with schizophrenia, propofol was shown to possess significant seizure-shortening properties, but it does not elevate seizure threshold or drop seizure duration under the minimal threshold more frequently than etomidate does. Based on these findings, we conclude that the use of propofol does not result in a greater electric load on the patients than etomidate.
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Neuropsychopharmacol Hung · Dec 2006
Review[New formulations of olanzapine in the treatment of acute agitation].
Agitation is common in patients with acute schizophrenia or bipolar mania, and when severe can result in aggressive or violent behaviour. Pharmacotherapy for acute psychotic agitation includes the use of antipsychotic and benzodiazepine drugs, either alone or in combination. Although oral treatment is preferred, options in the pharmacotherapy of acute agitation include the parenteral administration of antipsychotics in order to facilitate onset of drug action and quickly alleviate symptoms. Until recently only conventional antipsychotic and benzodiazepine drugs were available as intramuscular injections. Olanzapine has been one of the first atypical antipsychotics available for intramuscular administration. Four randomized placebo and comparator controlled , double-blind clinical trials have demonstrated the efficacy of olanzapine in reducing acute agitation in patients with schizophrenia, bipolar mania and Alzheimer and vascular dementia. Evidence from these clinical trials has shown that IM olanzapine associated with faster onset of action and more favorable profile of adverse events, than monotherapy with IM haloperidol. Current clinical experience and one naturalistic study with intramuscular olanzapine suggest that it is efficacious and can be safely used in "real world" patients with severe agitation. Intramuscular olanzapine have shown ease of transition to same agent oral therapy once the acute agitation has diminished. The orally disintegrating tablet formulation of olanzapine was effective rapidly reducing psychopathology, while improving medication compliance, attitudes and behaviours. This new formulation of olanzapine may offer an alternative strategy in the treatment of acutely ill, noncompliant schizophrenic patients. Evidence suggests that the new formulations of olanzapine should be among the first-line choices in the treatment of agitation in acute psychosis. ⋯ olanzapine, intramuscular, orally disintegrating tablet, agitation, psychosis.
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Since suicide is a very complex, multicausal human behaviour, its prevention should also be complex. The prediction of suicide is very difficult at the level of the general population, but it is much easier among patients with certain mental disorders, because most persons who kill themselves have diagnosable and treatable psychiatric disorders. This article reviews the most important biological and non-biological suicide prevention strategies.
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Neuropsychopharmacol Hung · Mar 2004
Review Case Reports[Paralytic ileus during haloperidol therapy].
In the case of elderly patients, the serious side effects of haloperidol should be taken into account. The 83-year-old schizophrenic patient had had successful haloperidol treatment, but developed a sudden paralytic ileus. The unique side effect of haloperidol calls attention to the danger of neuroleptic treatment of elderly patients. The good solution is to change over from haloperidol to a second-generation antipsychotic agent.