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Nature and Science of Sleep 2024This study aimed to evaluate nocturnal sleep structure and anxiety, depression, and fatigue in patients with narcolepsy type 1 (NT1).
PURPOSE
This study aimed to evaluate nocturnal sleep structure and anxiety, depression, and fatigue in patients with narcolepsy type 1 (NT1).
METHODS
Thirty NT1 patients and thirty-five healthy controls were enrolled and evaluated using the Epworth sleepiness scale (ESS), Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Fatigue Severity Scale (FSS), polysomnography, multiple sleep latency test, and brain function state monitoring. Statistical analyses were performed using SPSS Statistics for Windows, version 23.0. Benjamini-Hochberg correction was performed to control the false discovery rate.
RESULTS
Apart from typical clinical manifestations, patients with NT1 are prone to comorbidities such as nocturnal sleep disorders, anxiety, depression, and fatigue. Compared with the control group, patients with NT1 exhibited abnormal sleep structure, including increased total sleep time ( =0.007), decreased sleep efficiency ( =0.002), shortening of sleep onset latency ( <0.001), elevated wake after sleep onset ( =0.002), increased N1% ( =0.006), and reduced N2%, N3%, and REM% ( =0.007, <0.001, =0.013). Thirty-seven percent of patients had moderate to severe obstructive sleep apnea-hypopnea syndrome. And sixty percent of patients were complicated with REM sleep without atonia. Patients with NT1 displayed increased anxiety propensity ( <0.001), and increased brain fatigue ( =0.020) in brain function state monitoring. FSS scores were positively correlated with brain fatigue ( <0.001) and mean sleep latency was inversely correlated with FSS scores and brain fatigue ( =0.013, =0.029). Additionally, ESS scores and brain fatigue decreased after 3 months of therapy (=0.012, =0.030).
CONCLUSION
NT1 patients had abnormal nocturnal sleep structures, who showed increased anxiety, depression, and fatigue. Excessive daytime sleepiness and fatigue improved after 3 months of treatment with methylphenidate hydrochloride prolonged-release tablets in combination with venlafaxine.
PubMed: 38873239
DOI: 10.2147/NSS.S452665 -
RSC Advances Mar 2024The current research work is based on the evaluation of a citric acid (CA) cross-linked ( M.) leaf hydrogel (CL-ALH) for pH-dependent and sustained drug release...
The current research work is based on the evaluation of a citric acid (CA) cross-linked ( M.) leaf hydrogel (CL-ALH) for pH-dependent and sustained drug release application. The CA was used in different concentrations (1.25, 2.5, 5.0, and 10.0%) to cross-link the ALH using homogenous reaction conditions. The synthesis of CL-ALH was confirmed through Fourier transform and nuclear magnetic resonance spectroscopic studies. The thermal analysis indicated that the ALH and CL-ALH were stable and decomposed in two steps. The scanning electron microscopic images of CL-ALH confirmed its porous nature due to the presence of interconnected channeling. The swelling of CL-ALH was evaluated at pH 1.2, 6.8, and 7.4 as well as in deionized water (DW). High swelling of CL-ALH was observed in DW, and at pH 7.4 and 6.8 whereas, less swelling of CL-ALH was witnessed at pH 1.2. CL-ALH also exhibited swelling/deswelling behavior in DW and ethanol, DW and normal saline, and at pH 7.4 and 1.2. Tablets were prepared from CL-ALH as a release retarding agent demonstrating the sustained release of venlafaxine hydrochloride (VFX) for 8 h. Whereas, VFX was released within 4 h from the ALH-based tablet formulation (un-cross-linked material) indicating the prolonged and sustained release behavior of CL-ALH. The VFX was released from CL-ALH tablets and followed zero-order kinetics. The mechanism followed by VFX release from CL-ALH tablets was non-Fickian diffusion. The fate of the tablet formulation was observed through an X-ray study. The CL-ALH-based tablet safely passed through the stomach of a stray dog without any significant erosion and then disintegrated in the small intestine and colon. These findings confirmed that the CL-ALH is an effective excipient for designing a sustained-release drug delivery system for the small intestine and colon.
PubMed: 38454944
DOI: 10.1039/d4ra00095a -
BMC Psychiatry Apr 2024Depressive episodes in adolescents are often accompanied by various physical symptoms, but few studies have explored the association between depression and fever, This...
BACKGROUND
Depressive episodes in adolescents are often accompanied by various physical symptoms, but few studies have explored the association between depression and fever, This case study is the first to report the relationship between unexplained recurrent high fever and depression.
CASE PRESENTATION
H is a 15 year old adolescent female currently in junior year. 2 + months ago, H gradually felt depressed after a class change. Around the time, the patient suddenly developed chills with no obvious trigger and fever. H was treated with anti-infective and anti-viral treatments all of which did not show significant improvement. No significant abnormality was seen in any of the related examinations. Considering that the patient's anxiety, depression and somatic symptoms were obvious during the course of the disease, she was given venlafaxine hydrochloride extended-release capsule 75 mg/d; tandospirone citrate capsule 10 mg Bid; alprazolam tablets 0.4 mg qn to improve mood and sleep; supplemented with transcranial repetitive magnetic stimulation therapy 2 times/d; visible light therapy 1 time/d and psychological counseling once. Over the 6 days of treatment, the patient's body temperature gradually returned to the normal range and her mood improved significantly.
CONCLUSION
Depression should be considered a potential cause of unexplained recurrent fevers in adolescents, even when the temperature is significantly outside the normal range.
Topics: Humans; Adolescent; Female; Venlafaxine Hydrochloride; Psychotherapy
PubMed: 38627661
DOI: 10.1186/s12888-024-05705-3 -
International Journal of Pharmaceutics Jun 2024Breast cancer is the most frequently diagnosed cancer in women worldwide, and non-adherence to adjuvant hormonotherapy can negatively impact cancer recurrence and...
Breast cancer is the most frequently diagnosed cancer in women worldwide, and non-adherence to adjuvant hormonotherapy can negatively impact cancer recurrence and relapse. Non-adherence is associated with side effects of hormonotherapy. Pharmacological strategies to mitigate the side effects include coadministration of antidepressants, however patients remain non-adherent. The aim of this work was to develop medicines containing both hormonotherapy, tamoxifen (20 mg), along with anti-depressants, either venlafaxine (37.5 or 75 mg) or duloxetine (30 or 60 mg), to assess the acceptability and efficacy of this personalised approach for mitigating tamoxifen side effects in a clinical trial. A major criterion for the developed medicines was the production rate, specified at minimum 200 dosage units per hour to produce more than 40,000 units required for the clinical trial. A novel capsule filling approach enabled by the pharmaceutical 3D printer M3DIMAKER 2 was developed for this purpose. Firstly, semi-solid extrusion 3D printing enabled the filling of tamoxifen pharma-ink prepared according to French compounding regulation, followed by filling of commercial venlafaxine or duloxetine pellets enabled by the development of an innovative pellet dispensing printhead. The medicines were successfully developed and produced in the clinical pharmacy department of the cancer hospital Gustave Roussy, located in Paris, France. The developed medicines satisfied quality and production rate requirements and were stable for storage up to one year to cover the duration of the trial. This work demonstrates the feasibility of developing and producing combined tamoxifen medicines in a hospital setting through a pharmaceutical 3D printer to enable a clinical trial with a high medicines production rate requirement.
PubMed: 38871137
DOI: 10.1016/j.ijpharm.2024.124306 -
Medicine Apr 2024This report presents a unique case of a patient diagnosed with Primary Sjögren's syndrome and a relatively rare traditional Chinese medicine pattern, known as the...
RATIONALE
This report presents a unique case of a patient diagnosed with Primary Sjögren's syndrome and a relatively rare traditional Chinese medicine pattern, known as the combined cold and heat pattern and cold-dampness syndrome. The patient's condition was successfully managed using Chinese herbal medicine, specifically the modified Da-Chai-Hu decoction and Linggui Zhugan decoction.
PATIENT CONCERNS
A 56-year-old woman had chronic dry eye and mouth for over 10 years. She was initially managed with traditional Chinese herbal medicine (TCHM) prescriptions, including the Zengye decoction, but the therapeutic effects were unsatisfactory. As the disease progressed, she was diagnosed with an anxiety disorder due to symptoms of vexation and insomnia. Treatment with alprazolam and venlafaxine failed to alleviate these symptoms. Recently, her general condition gradually worsened, with symptoms including a bitter taste in her mouth, dizziness, hot flashes, chills, poor appetite, chest discomfort, and constipation.
DIAGNOSES
After a series of examinations, including a Schirmer test and labial gland biopsy, she was diagnosed with Sjögren's syndrome.
INTERVENTIONS
Despite regular treatment with pilocarpine, sodium hyaluronate eye drops, venlafaxine, and alprazolam, the dry mouth symptoms intensified. Consequently, she sought further intervention through the TCHM.
OUTCOMES
After 8 weeks of treatment with the modified Da-Chai-Hu decoction and Linggui Zhugan decoction, she reported a significant improvement in her dryness-related symptoms and sleep quality.
LESSONS
This case report demonstrates that TCHM can effectively treat Primary Sjögren's syndrome, and should be considered for broader applications. Furthermore, this underscores the importance of tailoring treatment formulas to patients by identifying their specific syndrome differentiation in a clinical setting.
Topics: Humans; Female; Middle Aged; Alprazolam; Drugs, Chinese Herbal; Medicine, Chinese Traditional; Sjogren's Syndrome; Venlafaxine Hydrochloride
PubMed: 38608118
DOI: 10.1097/MD.0000000000037744 -
Molecules (Basel, Switzerland) Jan 2024This article discusses a new method for monitoring drug concentrations in blood samples from patients with mood disorders. The method uses solid-phase microextraction to...
This article discusses a new method for monitoring drug concentrations in blood samples from patients with mood disorders. The method uses solid-phase microextraction to extract analytes directly from blood samples. It has been adapted to identify the most commonly used drugs in mood disorders, including amitriptyline, citalopram, fluoxetine, paroxetine, sertraline, trazodone, duloxetine, venlafaxine, lamotrigine, quetiapine, olanzapine, and mirtazapine. The analysis is carried out using high-performance liquid chromatography coupled with mass spectroscopy. The proposed DI-SPME/LC-MS method allows for a simple and quick screening analysis while minimizing the volume of the tested sample and solvent, in line with the principles of green analytical chemistry. The method was used to analyze 38 blood samples taken from patients with mood disorders, and drug concentrations were determined and compared with therapeutic and toxic dose ranges. This allowed for better control of the course of treatment.
Topics: Humans; Solid Phase Microextraction; Mood Disorders; Drug Monitoring; Immersion; Fluoxetine
PubMed: 38338419
DOI: 10.3390/molecules29030676 -
The Science of the Total Environment Jan 2024Reducing the risk posed by mixtures of pharmaceuticals is a goal of current initiatives such as the European Green Deal to reduce anthropological environmental impacts....
Reducing the risk posed by mixtures of pharmaceuticals is a goal of current initiatives such as the European Green Deal to reduce anthropological environmental impacts. Wastewater effluent typically contains large numbers of active pharmaceutical ingredients (APIs). For some APIs, existing technology such as conventional activated sludge (CAS) wastewater treatment plants (WWTPs) have removal rates below 20 %, thus the WWTP discharges are adding to the toxic burden of receiving waters. We present an environmental risk assessment of mixtures of 35 APIs in effluent samples from 82 Northern European WWTPs using the concentration addition model, and identify the respective risk-driving APIs. This is then compared to a corresponding mixture risk assessment of effluent samples from the Danish Hillerød WWTP subjected to post-treatment with varying specific ozone doses (0.15-1.05 mgO/mgDOC) and/or granulated activated carbon (GAC). All 82 WWTP effluent samples exceeded risk thresholds by at least a factor of 30, with a median RQ of 92.9, highlighting the need for effluent post-treatment and/or a substantial dilution in the recipient waters. Antibiotics, analgesics and anti-depressants were among the top risk drivers with 99 % of the average mixture risk attributable to azithromycin, diclofenac, venlafaxine, clarithromycin and mycophenolic acid. Effluent mixture risk was reduced by ozonation in a concentration-dependent manner, decreasing below threshold levels to a median RQ of 0.83 following treatment with 0.65 mgO/mg DOC. Fresh GAC was also effective at reducing the mixture risk both alone and with ozone treatment, with median RQ of 0.04 and 0.07 respectively. To our knowledge, this is the first study to present a risk assessment of pharmaceutical mixtures in effluent comparing "conventional" WWTP processes with additional post-treatment with ozone and/or GAC for reducing the joint risks of pharmaceutical mixtures for recipient waters. We demonstrate the need for additional WWTP treatment technologies, and the efficacy of GAC and ozonation in decreasing the risk to the aquatic environment from pharmaceutical mixtures to below acceptable threshold limits.
Topics: Wastewater; Charcoal; Ozone; Magnesium Oxide; Water Pollutants, Chemical; Risk Assessment; Pharmaceutical Preparations; Waste Disposal, Fluid
PubMed: 37774874
DOI: 10.1016/j.scitotenv.2023.167440 -
Journal of Pharmaceutical Policy and... Dec 2023The COVID-19 pandemic globally impacted healthcare provision. Prescribing changes in common medications can be used as a marker for new diagnoses. We describe how the...
INTRODUCTION
The COVID-19 pandemic globally impacted healthcare provision. Prescribing changes in common medications can be used as a marker for new diagnoses. We describe how the prescribing of specific psychotropics was impacted by the pandemic.
METHODS
Primary Care Prescribing data for different classes of drugs from March 2017 to February 2022 were considered. To capture the impact during periods of restricted access to health services for new diagnoses/existing conditions, repeat prescriptions/episodic prescribing were included with account taken of historical trends. The pre-pandemic prescriptions issued each month from March 2018 to February 2020 were linearly extrapolated forward to give an expected annual growth (EAG). The monthly average expected prescriptions for the pandemic period (March 2020-February 2022) were compared.
RESULTS
Physical health medications had lower monthly prescriptions during the pandemic, most markedly for antibiotics - 12.5% (EAG - 1.3%). Bronchodilator prescribing showed a marked increase in the early pandemic months from March 2020 of 5% (EAG 0.1%). Mental health medication prescribing increased above trend for hypnotics/anxiolytics by 0.2% (EAG - 2.3%), while antidepressants fell by - 0.2% (EAG 5.0%), with no net change for antipsychotics (EAG 2.8%), but a temporary increase in antipsychotic prescribing in the early pandemic period. For all the main antidepressants prescribed in England (Sertraline, Mirtazapine, Venlafaxine, Fluoxetine and Citalopram), prescribing actually decreased in the main pandemic period vs historical trend.
CONCLUSIONS
The increase in anxiolytic/hypnotic prescribing above trend links to pandemic effects on anxiety/worry. If anything, there was a slight fall in prescribing of the main antidepressants prescribed, which given prevailing circumstances at the time, suggests that access to services may have restricted access to timely assessment.
PubMed: 38124123
DOI: 10.1186/s40545-023-00655-9 -
Heliyon Apr 2024Post-stroke pain is common after a stroke and might be underreported. We describe Persistent Facial Pain (PFP) developed in post-stroke patients.
BACKGROUND
Post-stroke pain is common after a stroke and might be underreported. We describe Persistent Facial Pain (PFP) developed in post-stroke patients.
METHOD
ology: This was a prospective hospital-based cohort study of stroke patients, and patients were followed up. Out of 415 stroke patients, 26 developed PFP.
RESULT
Out of all PFP patients, six patients had an ischemic stroke, and 20 had a hemorrhagic stroke. 57.7% of patients had hypertension, while 34.6 patients had diabetes. The stroke location was left-sided in 12 patients and right-sided in 14 patients. 46.15% of patients responded to venlafaxine, 30.77% responded to amitriptyline, and 23.08% responded to pregabalin.
CONCLUSION
Persistent facial pain is a pain syndrome that might be missed in patients post-stroke. It might be more common in hemorrhagic stroke patients than in ischemic stroke patients. It responds adequately to antidepressants. A high index of suspicion is required to diagnose and appropriately manage these patients.
PubMed: 38596128
DOI: 10.1016/j.heliyon.2024.e28557 -
European Neuropsychopharmacology : the... Feb 2024Major depressive disorder (MDD) is a highly prevalent psychiatric disorder, but chances for remission largely decrease with each failed treatment attempt. It is...
Major depressive disorder (MDD) is a highly prevalent psychiatric disorder, but chances for remission largely decrease with each failed treatment attempt. It is therefore desirable to assign a given patient to the most promising individual treatment option as early as possible. We used a polygenic score (PGS) informed electroencephalography (EEG) data-driven approach to identify potential predictors for MDD treatment outcome. Post-hoc we conducted exploratory analyses in order to understand the results in depth. First, an EEG independent component analysis produced 54 functional brain networks in a large heterogeneous cohort of psychiatric patients (n = 4,045; 5-84 yrs.). Next, the network that was associated to PGS for antidepressant-response (PRS-AR) in an independent sample (n = 722) was selected: an age-related posterior alpha network that explained >60 % of EEG variance, and was highly stable over recording time. Translational analyses were performed in two other independent datasets to examine if the network was predictive of psychopharmacotherapy (n = 535) and/or repetitive transcranial magnetic stimulation (rTMS) and concomitant psychotherapy (PT; n = 186) outcome. The network predicted remission to venlafaxine (p = 0.015), resulting in a normalized positive predicted value (nPPV) of 138 %, and rTMS + PT - but in opposite direction for women (p = 0.002) relative to men (p = 0.018) - yielding a nPPV of 131 %. Blinded out-of-sample validations for venlafaxine (n = 29) and rTMS + PT (n = 36) confirmed the findings for venlafaxine, while results for rTMS + PT could not be replicated. These data suggest the existence of a relatively stable EEG posterior alpha aging network related to PGS-AR that has potential as MDD treatment predictor.
Topics: Male; Humans; Female; Venlafaxine Hydrochloride; Transcranial Magnetic Stimulation; Depressive Disorder, Major; Prefrontal Cortex; Antidepressive Agents; Treatment Outcome; Aging
PubMed: 38000196
DOI: 10.1016/j.euroneuro.2023.11.002