The Effect of Atypical Anti-psychotic Agents on Obesity and Glucose Metabolism

Atypical antipsychotics are more effective than typical antipsychotics and have fewer side effects such as tardive dyskinesia and extrapyramidal symptoms; therefore, prescriptions of atypical antipsychotics are increasing. However, recently, it has been reported that atypical antipsychotics have a higher incidence of diabetes, hyperglycemia, and obesity than typical antipsychotics. Atypical antipsychotics induce obesity-inhibiting appetite-related receptors such as serotonin and dopamine. Decreased exercise due to improving psychotic symptoms, and genetic characterictics can also cause weight gain. Hyperglycemia and hypoglycemia were another metabolic problem related to treatment with atypical antipsychotics. The mechanisms of hyperglycemia were mainly related obesity, decreased anorexigenic hormones, and increased insulin resistance in multiple organs. There are also reports that genes related to diabetes have an effect on the incidence of diabetes mellitus treated with atypical antipsychotics. On the other hand, although it is not clear why hypoglycemia occurs, it documented in case reports all over the world. There are more reports of atypical antipsychotics than typical antipsychotics and these are frequently reported in Asians. Further research on the mechanism of hypoglycemia related to atypical antipsychotics is strongly recommended.

Determining the Role of Psychiatric Nurse for Client Receiving Anti-Psychotic Drugs in India

The prevalence of mental diseases is increasing. Even the average person suffers from minor issues such as stress and anxiety due to various causes. Clients having psychiatric consultations require support and exceptional care from a psychiatric nurse; these clients are given multiple drugs with varied side effects that must be managed; the nurse is only present with the patient and manages the patient. As a result, this article discusses the numerous roles that a psychiatric nurse can play in this regard.

Evaluation of Anti-Psychotic potential of Phytocompound rich Fractions of Methanolic extract of Lagenaria siceraria (Bottle Gourd) fruits in Murine Models of Schizophrenia

Context: Psychosis is a mental disorder, which is characterized as the reducing association with certainty and conviction. Around 1-2% of the world's population suffers from psychosis. The people affected by psychosis have hallucinations, delusions, forgetfulness, abolition, and anhedonia. Currently existing most of the anti- psychotic medications express the adverse drug reactions. Thus for the management of psychosis, satisfactory and adequate remedies are not available. Lagenaria siceraria (Molina) Standley (LS) (Cucurbitaceae) fruits, popularly known as “bottle gourd” (English) and “Lauki” (Hindi), exhibit numerous intrinsic therapeutic properties and actions. However limited scientific investigations have been performed to determine the neuroprotective potential of LS fruits. With this background, the present study was intended to investigate LS fruits for the assessment of anti-psychotic activity. Aims and Objectives: The rationale of this study was to evaluate the anti-psychotic activity of the phytocompound rich fractions of the methanolic extract of LS i.e., chloroform fraction of the methanolic extract (CFME), and acetone fraction of the methanolic extract (AFME) by using experimental models of cataleptic and stereotypic behavior in Swiss Albino mice. Materials and Methods: Haloperidol-induced catalepsy and apomorphine-induced stereotypy were the experimental screening tests performed for the assessment of anti-psychotic activity of the phytocompound rich fractions of methanolic extract of LS fruits at the doses of 100, 200, and 400mg/kg, p.o. in mice. Results: CFME and AFME, 100-400 mg/kg, significantly reduced cataleptic score and stereotypic behavior in mice, in dose-dependent manner. At doses of 200 and 400mg/ kg, AFME (P<0.001) exhibited more significant effect than CFME. In addition CFME and AFME did not generate motor dysfunction in mice. Preliminary phytochemical screening on CFME revealed the presence of saponins, phytosterols, and terpenoids, while phytochemical investigations on AFME indicated the presence of saponins, phenolic compounds, flavonoids and tannins. This was the first scientific report, which indicates that the LS fruits exhibit anti-psychotic action, confirming the folklore claims. Future investigations and studies should emphasize separation, characterization, and identification of the bioactive phytoconstituents and also on evaluating the precise mechanism involved in the anti-psychotic activity of both the fractions.

Mental Health, Diabetes and Endocrinology

Mental Health, Diabetes and Endocrinology examines the main areas of clinical overlap between endocrinology and mental health to address key clinical conundrums. Drawing on the most recent developments from literature and clinical practice, this book gives specific attention to the main areas where clinical conundrums and treatment challenges arise across endocrinology, psychiatry, psychology and primary care. Common challenges in this area include depression which can impact on the person's ability to self-care and to adhere to treatment with consequences for their morbidity and mortality; 'diabulaemia' associated with high mortality rates; obesity and associated mental disorders; cognitive impairment and mental capacity; anti-psychotic medications and their endocrine sequelae; and specific setting-related considerations. Mental Health, Diabetes and Endocrinology is a useful resource for the overlapping conditions across these specialities, and provides clinically-focussed evidence-based resources for all health care professionals who encounter these issues.

COVID-19 related Psychotic Disorder: Symptomatology in Infected and Uninfected Patients

Introduction: Psychotic disorder has been rarely reported in patients with COVID-19 infection and also in patients affected by the pandemic but who do not have COVID-19 infection. It is unclear if the disorder occurs due to the stress of the pandemic or is due to a cerebral infection of the virus.Methods: on PubMed we searched for all reports of patients who developed a new psychosis during the COVID-19 pandemic to review their symptomatology.Results: Psychotic symptoms were similar in onset, description, duration and severity in patients who had been infected and those who were affected by the pandemic but did not have the infection. In both groups, most patients were young, without previous psychiatric history, had experienced severe external stress due to the pandemic, had an abrupt onset of symptoms, had severe hallucinations and delusions and needed psychiatric hospitalization. The disorder commonly lasted about a week, after which anti-psychotic medications could be stopped.Conclusion: External psychological stress and not cerebral COVID-19 infection is the likely cause of psychotic disorder in both infected and uninfected patients.

New Pharmacological Targets for the Treatment of Schizophrenia: A Literature Review

Background: The pharmacological treatment of schizophrenia is currently based on the employment of anti-psychotic medications showing an antagonism of dopaminergic and serotoninergic. 20-40% of patients are drug-resistant or residually symptomatic in the long-term anti-psychotic treatment, and new strategies are needed for improving their functional and cognitive impairment. Methods: This systematic review summarized the evidences from the literature regarding the newer pharmacological targets proposed for the treatment of psychosis. We included 128 peer-reviewed articles and 5 other relevant sources published from 2002 to 2020 on PubMed EMBASE, The Cochrane Library, Google Scholar. Results: It has been extensively described the possible role of glutamate and its receptors as targets of the anti-psychotic mechanism of action. Glutamatergic neurotransmission and NMDA receptors hypofunction are involved in the neurobiological explanatory model of psychosis and possibly targeted for the successful treatment of cognitive and residual symptoms. The rResults show an efficacy of D-cycloserine (antagonist at the Glycine site of the NMDA-R) in the treatment of negative symptoms of schizophrenia as well as Memantine (NMDA:- Receptor antagonist) on cognition and psychopathology. It will be also discussed Tthe putative anti-psychotic effect of cannabidiol on positive symptoms and cognition will also be discussed, even if more evidence is required needing more evidences. The action on serotoninergic and GABAergic receptors will be considered as a new pharmacological target, with a possible efficacy of Vabicaserin on symptoms of psychosis. Mynocicline has shown improvements of in cognitive symptoms in schizophrenia as well as Erythropoietin. Oxytocin reported an antipsychotic-like effect and COX-2 inhibitors reported a reduction of positive symptoms of psychosis , above all in the first episode of illness. Conclusion: This narrative report suggests a promising role of new agents in the treatment of Schizophrenia, even if more research is needed to approve their clinical employment.

Audit on prolactin monitoring for patients on oral risperidone, intramuscular risperidone, and intramuscular paliperidone

AimsThe aim of this audit was to investigate whether sufficient Prolactin monitoring was completed in a patient sample in the Torfaen area of Aneurin Bevan University Health Board. This audit targetted patients an oral or intra-muscular formulation of Risperidone in the year 2018 with the hypothesis that Prolactin monitoring is done less frequently than recommended.BackgroundRisperidone is the anti-psychotic drug most frequently associated with hyperprolactinemia which is often asymptomatic but can present with symptoms of oligomenorrhea, amenorrhea, galactorrhea, decreased libido, infertility, and decreased bone mass in women. Men with hyperprolactinemia may present with erectile dysfunction, decreased libido, infertility, gynecomastia, decreased bone mass, and rarely galactorrhea. The BNF advises monitoring of Prolactin at baseline, after 6 months, and then annually.MethodRetrospective review of 150 patients’ clinical letters to identify if they are on the above medications, using the local digital records system EPEX. Emails were also sent to community psychiatric nurses asking them if they could highlight any patients they were caseholding on the above medication. Depot clinic lists were also examined. Patients identified as being on the above medication had their blood tests reviewed on the online system Clinical Workstation (CWS) to determine whether they had their Prolactin level tested. A single spot sample of all patients on Talygarn ward in January 2019 was also included.Result1. 28 Risperidone2. 23 of 28 never had any Prolactin measurements3. 2 of 28 patients had the appropriate level of monitoring done for the year of 2018a. One patient complained of Galacotorrheab. Another patient had baseline done while on the ward and isn't due for any further monitoring at the time of writing.ConclusionThe above results identify that Prolactin monitoring is not being routinely completed for patients on the studied medication at an acceptable compliance level. Limitations around utitlity of prolactin monitoring may be the contributing factors; eg. Prolactin levels or medication dose may not be positively associated with adverse effects.. Further efforts were made to highlight the importance of baseline prolactin monitoring, as well as including a baseline Prolactin as an admission blood test for patients presenting with psychotic symptoms or on an anti-psychotic. A complete audit of metabolic monitoring and Prolactin levels for all patients on anti-psychotics would be an appropriate next step.

Physical health monitoring in antipsychotic depot clinic

AimsA service evaluation project to look at if annual bloods, ECG, physical examination, and medical review was completed within the last year for patients attending anti-psychotic depot clinic at Bassetlaw mental health services in Nottinghamshire HealthCare NHS Foundation Trust.MethodElectronic notes were examined in October 2020 for 25 patients who attend anti-psychotic depot clinic to ascertain if medical review and physical examination had been completed along with annual bloods and ECG.ResultOut of 25 patients attending depot clinic in 2020 at Bassetlaw Hospital, 21 had all their blood tests done, 1 patient had refused bloods and 2 patients did not have blood tests done. ECG was completed for 3 patients at Bassetlaw hospital and 8 patients had it requested from primary care with 2 patients refusing to have ECG done. For 12 patients there was no evidence of ECG being requested or completed. 8 patients had physical examination completed and rest 17 patients did not have the physical examination completed including due to refusal. Out of 25, only 14 patients had a medical review conducted.ConclusionPatients who attend depot clinic may have an allocated community psychiatric nurse (CPN) or get reviewed by medics in outpatient clinics and would usually have their blood tests, physical health examination and ECGs requested and monitored by them. Patients who do not have any allocated CPN or medic tend to miss out on blood tests and ECG. General Practitioners are expected to complete physical health checks for patients who do not have CPN or regular outpatient review. The results of these investigations may not always be received in depot clinic, hence there is no documentation on electronic RIO system. When these patients disengage from the depot clinic, it is often very difficult to track them. As a follow-up from this service evaluation, all depot clinic patients will be allocated a key worker/CPN. This will ensure that they have a responsible person to facilitate annual checks. This will be reviewed in a years' time to evaluate the effectiveness of this intervention.