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https://www.readbyqxmd.com/read/28334978/therapeutic-window-of-dopamine-d2-3-receptor-occupancy-to-treat-psychosis-in-alzheimer-s-disease
#1
Suzanne Reeves, Emma McLachlan, Julie Bertrand, Fabrizia D Antonio, Stuart Brownings, Akshay Nair, Suki Greaves, Alan Smith, David Taylor, Joel Dunn, Paul Marsden, Robert Kessler, Robert Howard
Antipsychotic drugs, originally developed to treat schizophrenia, are used to treat psychosis, agitation and aggression in Alzheimer's disease. In the absence of dopamine D2/3 receptor occupancy data to inform antipsychotic prescribing for psychosis in Alzheimer's disease, the mechanisms underpinning antipsychotic efficacy and side effects are poorly understood. This study used a population approach to investigate the relationship between amisulpride blood concentration and central D2/3 occupancy in older people with Alzheimer's disease by combining: (i) pharmacokinetic data (280 venous samples) from a phase I single (50 mg) dose study in healthy older people (n = 20, 65-79 years); (ii) pharmacokinetic, 18F-fallypride D2/3 receptor imaging and clinical outcome data on patients with Alzheimer's disease who were prescribed amisulpride (25-75 mg daily) to treat psychosis as part of an open study (n = 28; 69-92 years; 41 blood samples, five pretreatment scans, 19 post-treatment scans); and (iii) 18F-fallypride imaging of an antipsychotic free Alzheimer's disease control group (n = 10, 78-92 years), to provide additional pretreatment data...
February 4, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/28332374/comparison-of-dexmedetomidine-and-fentanyl-as-an-adjuvant-to-ropivacaine-for-postoperative-epidural-analgesia-in-pediatric-orthopedic-surgery
#2
Sang Jun Park, Seokyung Shin, Shin Hyung Kim, Hyun Woo Kim, Seung Hyun Kim, Hae Yoon Do, Yong Seon Choi
PURPOSE: Opioids are commonly used as an epidural adjuvant to local anesthetics, but are associated with potentially serious side effects, such as respiratory depression. The aim of this study was to compare the efficacy and safety of dexmedetomidine with that of fentanyl as an adjuvant to epidural ropivacaine in pediatric orthopedic surgery. MATERIALS AND METHODS: This study enrolled 60 children (3-12 years old) scheduled for orthopedic surgery of the lower extremities and lumbar epidural patient-controlled analgesia (PCA)...
May 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28293921/effects-of-intramuscular-midazolam-and-lorazepam-on-acute-agitation-in-non-elderly-subjects-a-systematic-review
#3
Sabrina Just Kousgaard, Rasmus W Licht, René Ernst Nielsen
Benzodiazepines are commonly used for the treatment of acute agitation in a psychiatric setting.We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant publications. Randomized trials evaluating intramuscular (IM) midazolam or lorazepam given as monotherapy or as add-on treatment, with more than 10 patients aged 18-65 years, conducted in a psychiatric setting, and published between January 1, 1980, and February 3, 2016, were included. 16 studies from a search result of 5 516 studies were included...
March 14, 2017: Pharmacopsychiatry
https://www.readbyqxmd.com/read/28286819/pain-management-via-ultrasound-guided-nerve-block-in-emergency-department-a-case-series-study
#4
Amir Nejati, Houman Teymourian, Leili Behrooz, Gholamreza Mohseni
INTRODUCTION: Pain is the most common complaint of patients referring to emergency department (ED). Considering the importance of pain management in ED, this study aimed to investigate the efficacy and feasibility of ultrasound-guided nerve blocks in this setting. METHODS: 46 patients who came to the ED with injured extremities were enrolled in the study and received either femoral, axillary or sciatic nerve block depending on their site of injury (1.5 mg Bupivacaine per kg of patient's weight)...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28283340/a-prospective-randomized-double-dummy-trial-comparing-intravenous-push-dose-of-low-dose-ketamine-to-short-infusion-of-low-dose-ketamine-for-treatment-of-moderate-to-severe-pain-in-the-emergency-department
#5
Sergey Motov, Mo Mai, Illya Pushkar, Antonios Likourezos, Jefferson Drapkin, Matthew Yasavolian, Jason Brady, Peter Homel, Christian Fromm
STUDY OBJECTIVE: Compare adverse effects and analgesic efficacy of low-dose ketamine for acute pain in the ED administered either by single intravenous push (IVP) or short infusion (SI). METHODS: Patients 18-65, presenting to ED with acute abdominal, flank, or musculoskeletal pain with initial pain score≥5, were randomized to ketamine 0.3mg/kg by either IVP or SI with placebo double-dummy. Adverse effects were evaluated by Side Effects Rating Scale for Dissociative Anesthetics (SERSDA) and Richmond Agitation-Sedation Scale (RASS) at 5, 15, 30, 60, 90, and 120min post-administration; analgesic efficacy was evaluated by Numerical Rating Scale (NRS)...
March 3, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28283018/tramadol-vs-dexmedetomidine-for-emergence-agitation-control-in-pediatric-patients-undergoing-adenotonsillectomy-with-sevoflurane-anesthesia-prospective-randomized-controlled-clinical-study
#6
Nurdan Bedirli, Mehmet Akçabay, Ulku Emik
BACKGROUND: This study was designed to compare the efficacy of an intraoperative single dose administration of tramadol and dexmedetomidine on hemodynamics and postoperative recovery profile including pain, sedation, emerge reactions in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia. METHODS: Seventy-seven patient, aged 2-12, undergoing adenotonsillectomy with sevoflurane anesthesia was enrolled in this study. Patients were randomly assigned to receive either intravenous 2 mg/kg tramadol (Group T; n = 39) or 1 μg/kg dexmedetomidine (Group D; n = 38) after intubation...
March 11, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28264690/presentations-to-an-urban-emergency-department-in-bern-switzerland-associated-with-acute-recreational-drug-toxicity
#7
Evangelia Liakoni, Sabine Müller, Adrian Stoller, Meret Ricklin, Matthias E Liechti, Aristomenis K Exadaktylos
BACKGROUND: Although the recreational use of psychoactive substances is common there is only limited systematic collection of data on acute drug toxicity or hospital presentations. Currently, data from Switzerland are only available from the University Hospital of Basel. The present study aimed to describe the presentations due to recreational drug use at an emergency department in Bern, Switzerland during a 4 year period. METHODS: Retrospective analysis of cases presenting from May 2012 to April 2016 at the emergency department of the University Hospital of Bern, Switzerland, with symptoms/signs consistent with acute toxicity of recreational drug use...
March 7, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28259526/review-of-intranasally-administered-medications-for-use-in-the-emergency-department
#8
Abby M Bailey, Regan A Baum, Karolyn Horn, Tameka Lewis, Kate Morizio, Amy Schultz, Kyle Weant, Stephanie N Justice
BACKGROUND: Intranasal (IN) medication delivery is a viable alternative to other routes of administration, including intravenous (IV) and intramuscular (IM) administration. The IN route bypasses the risk of needle-stick injuries and alleviates the emotional trauma that may arise from the insertion of an IV catheter. OBJECTIVE: This review aims to evaluate published literature on medications administered via the IN route that are applicable to practice in emergency medicine...
March 1, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28258476/psychomotor-agitation-following-treatment-with-hydroxychloroquine
#9
Ciro Manzo, Pietro Gareri, Alberto Castagna
We describe the case of an elderly woman with elderly-onset rheumatoid arthritis, where the use of 4 mg/kg/day of hydroxychloroquine (HCQ) was followed by the onset of psychomotor agitation with marked physical and verbal violence towards her partner, including throwing objects at her partner. No disturbance in sleep and no anxiety, nervousness, or irritability had emerged before the onset of her psychomotor agitation. The disappearance of agitation following targeted pharmacologic intervention and HCQ interruption, its re-onset after reintroduction of the drug, and the high score (9) of Naranjo's algorithm are surely linked to the existence of a causal relationship between HCQ and psychomotor agitation...
December 2017: Drug Safety—Case Reports
https://www.readbyqxmd.com/read/28250481/comparison-of-oral-dexmedetomidine-versus-oral-midazolam-as-premedication-to-prevent-emergence-agitation-after-sevoflurane-anaesthesia-in-paediatric-patients
#10
M Kavya Prabhu, Sripada G Mehandale
BACKGROUND AND AIMS: Sevoflurane is the most often used inhalational agent in paediatric anaesthesia, but emergence agitation (EA) remains a major concern. Oral midazolam and parenteral dexmedetomidine are known to be effective in controlling EA. We attempted to elucidate whether oral dexmedetomidine is better than midazolam in controlling EA. METHODS: Prospective double-blinded study involving ninety patients aged 1-10 years, undergoing elective surgeries of <2 h of expected duration under sevoflurane general anaesthesia, randomised to receive either midazolam (Group A) or dexmedetomidine (Group B) as oral premedication was carried out to record level of sedation before induction, haemodynamic parameters and recovery time...
February 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28243464/caring-for-relatives-with-agitation-at-home-a-qualitative-study-of-positive-coping-strategies
#11
Juanita Hoe, Leah Jesnick, Rebecca Turner, Gerard Leavey, Gill Livingston
BACKGROUND: Trials of psychological interventions for reducing agitation in people with dementia living at home have been unsuccessful. AIMS: To inform future interventions by identifying successful strategies of family carers with relatives with dementia and agitation living at home. METHOD: Qualitative in-depth individual interviews were performed with 18 family carers. We used thematic analysis to identify emerging themes. RESULTS: Carers described initial surprise and then acceptance that agitation is a dementia symptom and learned to respond flexibly...
January 2017: BJPsych Open
https://www.readbyqxmd.com/read/28243098/delirium-after-a-traumatic-brain-injury-predictors-and-symptom-patterns
#12
Jutaporn Maneewong, Benchalak Maneeton, Narong Maneeton, Tanat Vaniyapong, Patrinee Traisathit, Natthanidnan Sricharoen, Manit Srisurapanont
BACKGROUND: Delirium in traumatic brain injury (TBI) is common, may be predictable, and has a multifaceted symptom complex. This study aimed to examine: 1) the sum score of Glasgow Coma Scale (GCS) and if its component scores could predict delirium in TBI patients, and 2) the prominent symptoms and their courses over the first days after TBI. METHODS: TBI patients were recruited from neurosurgical ward inpatients. All participants were hospitalized within 24 hours after their TBI...
2017: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/28242149/-hallucinations-etiological-analysis-of-children-admitted-to-a-pediatric-emergency-department
#13
D Vareilles, C Bréhin, C Cortey, A-L Chevrin, T Hamon, M Vignes, Y Chaix, I Claudet
Children's hallucinations pose the dual challenge of diagnosing a possible medical emergency and a possible psychiatric disorder. PURPOSE: The main objective was to analyze the causes of such hallucinations in children presenting to a pediatric emergency department. MATERIAL AND METHODS: We conducted a single-center, observational, retrospective study including all children aged less than 15 years experiencing hallucinations and admitted to our tertiary level pediatric emergency department between 1 January 2007 and 31 December 2015...
February 24, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28238395/profound-hypotension-and-bradycardia-in-the-setting-of-synthetic-cannabinoid-intoxication-a-case-series
#14
David O Andonian, Shauna R Seaman, Elaine B Josephson
Cannabinoids are the most commonly used illegal substances in the world [1]. Synthetic Cannabinoids (SCB) are also known as "Spice", "K2", "Spike", "herbal incense", "Cloud 9", "Mojo" and many others are becoming a large public health concern due to their increasing use, unpredictable toxicity, and abuse potential [2]. The most common reported toxicities with SCB use based on studies using Texas Poison control record are tachycardia, agitation and irritability, drowsiness, hallucinations, delusions, hypertension, nausea, confusion, dizziness, vertigo, chest pain, acute kidney injury, seizures, heart attacks and both ischemic and hemorrhagic strokes [3]...
January 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28237385/ketamine-as-a-first-line-treatment-for-severely-agitated-emergency-department-patients
#15
Jeff Riddell, Alexander Tran, Rimon Bengiamin, Gregory W Hendey, Patil Armenian
OBJECTIVE: Emergency physicians often need to control agitated patients who present a danger to themselves and hospital personnel. Commonly used medications have limitations. Our primary objective was to compare the time to a defined reduction in agitation scores for ketamine versus benzodiazepines and haloperidol, alone or in combination. Our secondary objectives were to compare rates of medication redosing, vital sign changes, and adverse events in the different treatment groups. METHODS: We conducted a single-center, prospective, observational study examining agitation levels in acutely agitated emergency department patients between the ages of 18 and 65 who required sedation medication for acute agitation...
February 13, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28225482/a-case-report-of-posterior-reversible-encephalopathy-syndrome-in-a-patient-receiving-gemcitabine-and-cisplatin
#16
Hannah Cherniawsky, Neesha Merchant, Micheal Sawyer, Maria Ho
RATIONALE: Posterior reversible encephalopathy syndrome (PRES) is a subacute syndrome causing characteristic neurologic and radiologic findings. PRES is predominantly caused by malignant hypertension though it has been associated with immunosuppressive treatments such as chemotherapy. PATIENT CONCERNS: We describe a case of a 58 year old female who developed fluctuant level of consciousness, agitation. DIAGNOSIS: MRI findings were in keeping with posterior reversible encephalopathy syndrome following cycle 6 of palliative gemcitabine and cisplatin therapy for metastatic cholangiocarcinoma...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28222678/tracheal-extubation-in-deeply-anesthetized-pediatric-patients-after-tonsillectomy-a-comparison-of-high-concentration-sevoflurane-alone-and-low-concentration-sevoflurane-in-combination-with-dexmedetomidine-pre-medication
#17
Meiqin Di, Yuan Han, Zhuqing Yang, Huacheng Liu, Xuefei Ye, Hongyan Lai, Jun Li, Wangning ShangGuan, Qingquan Lian
BACKGROUND: Dexmedetomidine can facilitate a smooth extubation process and reduce the requirement of sevoflurane and emergence agitation when administrated perioperatively. We aimed to observe the extubation process and the recovery characteristics in pediatric patients undergoing tonsillectomy while anesthetized with either high-concentration sevoflurane alone or low-concentration sevoflurane combined with pre-medication of single dose of intravenous dexmedetomidine. METHODS: Seventy-five patients (ASA I or II, aged 3-7 years) undergoing tonsillectomy were randomized into three equal groups: to receive intravenous saline (Group D0), dexmedetomidine 1 μg/kg (Group D1), or dexmedetomidine 2 μg/kg (Group D2) approximately 10 min before anesthesia...
February 21, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28217058/sub-tenon-s-injection-versus-paracetamol-in-pediatric-strabismus-surgery
#18
A N Ibrahim, T Shabana
BACKGROUND: Emergence agitation, vomiting, and oculocardiac reflex (OCR) in children undergoing strabismus surgery under general anesthesia are common problems. The purpose of this study was to determine whether the effect of analgesia can reduce the incidence of these problems. We compared the effects of sub-Tenon's injection versus intravenous (IV) and rectal paracetamol in this surgery. METHODS: In a prospective, randomized, double-blind study, ninety patients ranging in age from 4 to 8 years scheduled for extraocular muscle surgery for strabismus were included in this study...
January 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28215471/dopamine-serotonin-stabilizer-rp5063-a-randomized-double-blind-placebo-controlled-multicenter-trial-of-safety-and-efficacy-in-exacerbation-of-schizophrenia-or-schizoaffective-disorder
#19
Marc Cantillon, Arul Prakash, Ajay Alexander, Robert Ings, Dennis Sweitzer, Laxminarayan Bhat
The study objectives were to evaluate the efficacy, safety, tolerability, and pharmacokinetics of RP5063 versus placebo. The study was conducted in adults with acute exacerbation of schizophrenia or schizoaffective disorder. This 28-day, multicenter, placebo-controlled, double-blind study randomized 234 subjects to RP5063 15, 30, or 50mg; aripiprazole; or placebo (3:3:3:1:2) once daily. The aripiprazole arm was included solely to show assay sensitivity and was not powered to show efficacy. The primary endpoint was change from baseline to Day 28/EOT (End-of-Treatment) in Positive and Negative Syndrome Scale (PANSS) total score; secondary endpoints included PANSS subscales, improvement ≥1 point on the Clinical Global Impressions-Severity (CGI-S), depression and cognition scales...
February 16, 2017: Schizophrenia Research
https://www.readbyqxmd.com/read/28210359/intentional-recreational-abuse-of-quetiapine-compared-to-other-second-generation-antipsychotics
#20
Lauren Klein, Stacey Bangh, Jon B Cole
INTRODUCTION: Case reports and poison center data have demonstrated that the second-generation antipsychotic quetiapine is being obtained and used for recreational abuse. The purpose of this study was to describe the relative rates of single-substance abuse for different atypical antipsychotics and compare their demographic and clinical features. METHODS: We conducted a 10-year retrospective analysis of the National Poison Data System (NPDS) database (2003 - 2013)...
February 2017: Western Journal of Emergency Medicine
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