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4 results

  • P03-47 - The Differences in Producing Cognitive Deficit Between First and Second-Generation Antipsychotics - Our Experiences

  • J. Djedovic, A. Tomcuk, N. Radoman, M. Roganovic, B. Cizmovic, N. Matkovic
  • Journal:
    European Psychiatry / Volume 25 / Issue S1 / 2010
    Published online by Cambridge University Press:
    17 April 2020, 25-E1157
    • Article
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  • Objectives

    Contemporary researches of the cognitive impairment in schizophrenic patients were conducted in three directions: Cognitive declining as a developmental precursor of schizophrenia, evolution of the cognitive deficit during the illness, and at last, impact of pharmacological treatment on cognitive functioning. The main aim of our study is to evaluate differences between first and second-generation antipsychotics in manifestations and course of the cognitive declining, in patients with first episode of paranoid schizophrenia.

    Material and methods

    We conducted open label, prospective trial, at the sample of 12 patients during first episode of paranoid schizophrenia. Diagnosis was made according to the criteria of the International classification of diseases 10th revision. The sample was divided in two clusters with 6 patients in each one. In the first cluster, patients received first-generation antipsychotics, and in the second one was administered second-generation antipsychotic - risperidone. Cognitive functions was evaluated by Mini Mental State Examination Test which is modified with adding two simple neuropsychological tests: Clock Drawing Test and Test of Verbal Fluency.

    Results

    We found more prominent cognitive declining in first cluster patients - particularly mnestic deficit.

    Conclusions

    First-generation antipsychotics posses more prominent negative impact on cognitive functioning in comparison to second generation antipsychotic - risperidone.

  • 17 - Depression in the context of alcoholism and other substance-use disorders

  • from Section 2 - Medical management
  • Edited by J. John Mann, Columbia University, New York
  • Edited in association with Patrick J. McGrath, Columbia University, New York, Steven P. Roose, Columbia University, New York
  • Book:
    Clinical Handbook for the Management of Mood Disorders
    Published online:
    05 May 2013
    Print publication:
    09 May 2013, pp 234-244

  • Summary

    Eleven drugs are approved by the US Food and Drug Administration (FDA) for acute mania. For bipolar maintenance, only lithium, aripiprazole, olanzapine, lamotrigine, and adjunctive quetiapine are FDA approved. The standard medications for acute mania include monotherapy and combined therapy. The standard medications for maintenance include lithium, valproate, carbamazepine and second-generation antipsychotics (SGAs). The other established acute and maintenance treatments include benzodiazepines, electroconvulsive therapy (ECT), clozapine and experimental antimanic treatments. All of the medications reviewed have potentially serious adverse consequences that obligate careful pretreatment and ongoing monitoring, and that call for personalized treatment selection. The traditional mood stabilizers, lithium, valproate, and carbamazepine, are teratogenic, particularly in the first trimester, although the risk of cardiovascular malformation with lithium is thought by some to have been over-estimated. In general first-generation antipsychotics (FGAs), SGAs, and, if necessary ECT, are preferred for mania in pregnancy.

  • Chapter 23 - Management of aggressive and violent behavior in the emergency department

  • from Section 4. - Treatment of the psychiatric patient
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 170-176

  • Summary

    Excited delirium syndrome (ExDS) is a specific type of extreme agitation. As patients with ExDS are often transported to an emergency department (ED), they are also cared for by emergency medicine clinicians. Currently, the majority of reported cases of ExDS are associated with stimulant drug use, such as cocaine or methamphetamine, although cases of ExDS still occur in psychiatric patients who are untreated or have abruptly discontinued their medication. This chapter reviews the existing literature on evaluation and treatment considerations for ExDS. Expert consensus guidelines recognize three classes of medications for initial calming of agitated patients: benzodiazepines, first-generation antipsychotics (FGA), and second-generation antipsychotics (SGA). Attention to airway maintenance, breathing adequacy, and volume resuscitation, along with rapid treatment of hypoglycemia, hyperthermia, and metabolic acidosis may be life saving. ExDS is a medical emergency, and cooperative protocols are needed between law enforcement, EMS, and local emergency departments to best manage these patients.

  • 9 - Evidence-based pharmacotherapy of post-traumatic stress disorder

  • Edited by Dan Stein, University of Cape Town, Bernard Lerer, Stephen M. Stahl, University of California, San Diego
  • Book:
    Essential Evidence-Based Psychopharmacology
    Published online:
    05 August 2012
    Print publication:
    05 July 2012, pp 171-189

  • Summary

    This chapter presents the authors' interpretation of the core evidence about the pharmacological treatment of schizophrenia. It summarizes the interpretation of the discussion about second-generation antipsychotics (SGAs) versus first-generation antipsychotics (FGAs), and which is the best SGA, mainly based on recent systematic reviews and effectiveness studies CATIE. The author interprets the meta-analyses such that overall clozapine, amisulpride, olanzapine and risperidonemay be somewhat more efficacious than FGAs and other SGAs. Depressive symptoms are frequently present in acutely ill patients with schizophrenia and may first improve with antipsychotics alone. Neuroleptic-induced depressive symptoms might be ruled out by anti-parkinson medication or switching to a drug with fewer extrapyramidal side-effects (EPS). Post-psychotic depression may be treated with an antidepressant. Electroconvulsive therapy (ECT) is recommended only as a last resort, but advantageously compared with the other augmentation strategies, it is effective as monotherapy and has a different mechanism of action than antipsychotics.