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Current Opinion in Psychiatry Mar 2013Combining psychotropic medications is common for people diagnosed with schizophrenia facing a variety of clinical circumstances. This review provides an update on... (Review)
Review
PURPOSE OF REVIEW
Combining psychotropic medications is common for people diagnosed with schizophrenia facing a variety of clinical circumstances. This review provides an update on evidence regarding the effectiveness of polypharmacy approaches.
RECENT FINDINGS
Epidemiology studies have demonstrated that polypharmacy is extremely common, but evidence regarding all polypharmacy approaches for schizophrenia from randomized controlled trials remains scarce. Combinations of antipsychotic medicines are unsupported by evidence. Antidepressants are commonly used to treat depressive symptoms; this logical role for antidepressants has little support from randomized controlled trials (RCTs) but may be associated with lower suicide and all-cause mortality. Insufficient evidence supports the use of benzodiazepines for schizophrenia; possible risks of benzodiazepines, including increased mortality rates revealed in observational studies, warrant caution and further study.
SUMMARY
The lack of evidence regarding common treatment strategies exacerbates the tremendous challenge of providing optimal pharmacotherapy for individuals with schizophrenia. Comparative effectiveness research, using observational methods when appropriate and RCTs when possible, is needed to inform clinical practice, use resources wisely and improve outcomes.
Topics: Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Humans; Polypharmacy; Schizophrenia
PubMed: 23318662
DOI: 10.1097/YCO.0b013e32835d9efb -
Advanced Drug Delivery Reviews Dec 2021With rapid emergence of multi-drug resistant microbes, it is imperative to seek alternative means for infection control. Optical waveguides are an auspicious delivery... (Review)
Review
With rapid emergence of multi-drug resistant microbes, it is imperative to seek alternative means for infection control. Optical waveguides are an auspicious delivery method for precise administration of phototherapy. Studies have shown that phototherapy is promising in fighting against a myriad of infectious pathogens (i.e. viruses, bacteria, fungi, and protozoa) including biofilm-forming species and drug-resistant strains while evading treatment resistance. When administered via optical waveguides, phototherapy can treat both superficial and deep-tissue infections while minimizing off-site effects that afflict conventional phototherapy and pharmacotherapy. Despite great therapeutic potential, exact mechanisms, materials, and fabrication designs to optimize this promising treatment option are underexplored. This review outlines principles and applications of phototherapy and optical waveguides for infection control. Research advances, challenges, and outlook regarding this delivery system are rigorously discussed in a hope to inspire future developments of optical waveguide-mediated phototherapy for the management of infection and beyond.
Topics: Communicable Diseases; Humans; Low-Level Light Therapy; Nanoparticle Drug Delivery System; Photochemotherapy; Photosensitizing Agents
PubMed: 34740763
DOI: 10.1016/j.addr.2021.114036 -
CA: a Cancer Journal For Clinicians 1991
Topics: Antineoplastic Agents; Drug Therapy; History, 20th Century; Humans; Neoplasms
PubMed: 1878782
DOI: 10.3322/canjclin.41.5.261 -
The Journal of Spinal Cord Medicine Nov 2017Individuals with chronic spinal cord injury (SCI) are susceptible to central and visceral obesity and it's metabolic consequences; consensus based guidelines for obesity... (Review)
Review
CONTEXT
Individuals with chronic spinal cord injury (SCI) are susceptible to central and visceral obesity and it's metabolic consequences; consensus based guidelines for obesity management after SCI have not yet been stablished.
OBJECTIVES
To identify and compare effective means of obesity management among SCI individuals.
METHODS
This systematic review included English and non-English articles, published prior to April 2017 found in the PubMed/Medline, Embase, CINAHL Psychinfo and Cochrane databases. Studies evaluating any obesity management strategy, alone or in combination, including: diet therapy, voluntary and involuntary exercise such as neuro-muscular electric stimulation (NMES), pharmacotherapy, and surgery, among individuals with chronic SCI were included. Outcomes of interest were reductions in waist circumference, body weight (BW), body mass index (BMI) and total fat mass (TFM) and increases in total lean body mass (TLBM) from baseline. From 3,553 retrieved titles and abstracts, 34 articles underwent full text review and 23 articles were selected for data abstraction. Articles describing weight loss due to inflammation, cancer or B12 deficiency were excluded. The Downs and Black reported poor to moderate quality of the studies.
RESULTS
Bariatric surgery produced the greatest permanent weight reduction and BMI correction followed by combinations of physical exercise and diet therapy. Generally, NMES and pharmacotherapy improved TLBM and reduced TFM but not weight.
CONCLUSIONS
The greatest weight reduction and BMI correction was produced by bariatric surgery, followed by a combination of physical exercise and diet therapy. NMES and pharmacologic treatment did not reduce weight or TFM but increased in TLBM.
Topics: Diet Therapy; Drug Therapy; Exercise Therapy; Humans; Obesity; Spinal Cord Injuries
PubMed: 28929907
DOI: 10.1080/10790268.2017.1370207 -
Canadian Medical Association Journal Apr 1965THREE THERAPEUTIC MODALITIES HAVE PROVED EFFECTIVE IN THE TREATMENT OF DEPRESSIVE SYNDROMES: electroconvulsive therapy (ECT), pharmacotherapy and psychotherapy. ECT... (Review)
Review
THREE THERAPEUTIC MODALITIES HAVE PROVED EFFECTIVE IN THE TREATMENT OF DEPRESSIVE SYNDROMES: electroconvulsive therapy (ECT), pharmacotherapy and psychotherapy. ECT gives the most reliable and most rapid results but may be contraindicated in certain cases. Psychotherapy is limited in its application to the reactive aspects of a depression. Pharmacotherapy is currently the most widely applied treatment of depression. Two classes of drugs are available which are effective in about 60% of depressed patients: the monoamine oxidase inhibitors and tricyclic compounds. Their mechanism of action is probably related to the regulation of the biogenic amine balance in the brain. The distinction between antipsychotic and antidepressant drugs is not as sharp as was formerly assumed. Maintenance pharmacotherapy has been shown to have prophylactic value in preventing relapses.
Topics: Amitriptyline; Antidepressive Agents; Convulsive Therapy; Depression; Depressive Disorder; Desipramine; Drug Therapy; Electroconvulsive Therapy; Imipramine; Mental Disorders; Monoamine Oxidase Inhibitors; Psychopharmacology; Psychotherapy; Toxicology; Tranquilizing Agents
PubMed: 14272501
DOI: No ID Found -
Journal of Psychiatry & Neuroscience :... Jul 2002There is a growing recognition that relapse and recurrence after the successful treatment of major depression is a common and debilitating outcome that has massive... (Review)
Review
There is a growing recognition that relapse and recurrence after the successful treatment of major depression is a common and debilitating outcome that has massive social costs. Although many patients achieve a sustained recovery with maintenance pharmacotherapy, the long-term outcome for a significant proportion of patients is still poor. The purpose of this review is to evaluate the role of combined psychological and pharmacological therapies in minimizing relapse and recurrence in the treatment of depression. Three approaches have been investigated: concurrent treatment, sequential treatment and crossover treatment. Concurrent therapy is as effective as monotherapy for the treatment of mild-to-moderate depressive disorder and shows evidence of a potential treatment advantage in cases where depression is more severe. Consecutive sequencing of pharmacotherapy and psychotherapy has demonstrated some benefit for both the conversion of partial to full response and the prevention of relapse and recurrence, especially in more severely depressed patients. Crossover treatments during the maintenance phase (i.e., switching patients from one treatment to a second after an adequate response to the first) show evidence of being beneficial in preventing relapse and recurrence. Variants of cognitive therapy that have been modified to specifically address residual symptoms in patients who have recovered from depression appear to be the most effective. A review of the studies to date indicates that cognitive therapy may play a role in improving remission rates and decreasing relapse and recurrence rates. Although most studies are small, there is a consistent suggestion of superior prophylaxis for patients receiving some type of sequenced or crossover treatment in which the delivery of antidepressant medication and structured antidepressant psychotherapy is combined. These approaches warrant greater attention; they may present another route for enhancing long-term recovery from major depression.
Topics: Antidepressive Agents; Cross-Over Studies; Depressive Disorder, Major; Drug Therapy, Combination; Humans; Treatment Outcome
PubMed: 12174737
DOI: No ID Found -
Archives of Disease in Childhood Jul 2016Safe and effective paediatric pharmacotherapy requires careful evaluation of the type of drug substance, the necessary dose and the age-appropriateness of the... (Review)
Review
Safe and effective paediatric pharmacotherapy requires careful evaluation of the type of drug substance, the necessary dose and the age-appropriateness of the formulation. Generally, the younger the child, the more the attention that is required. For decades, there has been a general lack of (authorised) formulations that children are able to and willing to take. Moreover, little was known on the impact of pharmaceutical aspects on the age-appropriateness of a paediatric medicine. As a result of legislative incentives, such knowledge is increasingly becoming available. It has become evident that rapidly dissolving tablets with a diameter of 2 mm (mini-tablets) can be used in preterm neonates and non-rapidly dissolving 2 mm mini-tablets in infants from 6 months of age. In addition, uncoated 4 mm mini-tablets can be used in infants from the age of 1 year. Also, there is some evidence that children prefer mini-tablets over a powder, suspension or syrup. Other novel types of age-appropriate oral formulations such as orodispersible films may further add to the treatment possibilities. This review provides an overview of the current knowledge on oral formulations for infants and preschool children, the advantages and disadvantages of the different types of dosage forms and the age groups by which these can likely be used.
Topics: Administration, Oral; Age Factors; Chemistry, Pharmaceutical; Child, Preschool; Dosage Forms; Drug Therapy; Excipients; Humans; Infant; Pharmaceutical Preparations; Solutions; Tablets
PubMed: 26979250
DOI: 10.1136/archdischild-2015-308227 -
Trends in Endocrinology and Metabolism:... Dec 2019The global rise in the prevalence of obesity and affiliated metabolic syndrome poses a significant threat to human health. Various approaches, including bariatric... (Review)
Review
The global rise in the prevalence of obesity and affiliated metabolic syndrome poses a significant threat to human health. Various approaches, including bariatric surgery and pharmacotherapy, have been used in the clinical setting for obesity treatment; however, these conventional options remain ineffective and carry risks of adverse effects. Therefore, treatments with higher efficacy and specificity are urgently required. Emerging drug delivery systems use polymeric materials and chemical strategies to improve therapeutic efficacy and specificity through stabilization and spatiotemporally controlled release of antiobesity agents. In this review, we provide insights into current treatments for obesity with a focus on recent developments of polymeric carriers for enhanced antiobesity drug delivery.
Topics: Anti-Obesity Agents; Drug Delivery Systems; Humans; Obesity; Polymers
PubMed: 31668904
DOI: 10.1016/j.tem.2019.09.004 -
Discovery Medicine Jun 2014Acromegaly is a disease characterized by growth hormone (GH) excess originating, in approximately 95% of cases, from a somatotroph pituitary adenoma. Symptomatology and... (Review)
Review
Acromegaly is a disease characterized by growth hormone (GH) excess originating, in approximately 95% of cases, from a somatotroph pituitary adenoma. Symptomatology and clinical features are due to GH and insulin-like growth factor 1 excess; unfortunately, for most patients diagnosis is delayed by several years. Acromegaly patients' morbidity and mortality are higher than those of the normal population. However, with adequate biochemical control mortality rates can be restored to normal. Tumor size and location, symptoms, comorbidities, and lastly, but not least, patient preference, are all important aspects in treatment decision making, and treatment approach should be individualized. Current therapy includes medical, surgical, and radiation. This review focuses on recent significant developments in medical therapy. There are three major therapeutic drug classes: somatostatin receptor ligands (SRLs), which represent the mainstay of medical therapy, GH receptor blockers, and dopamine agonists. Multi-ligand receptor SRLs such as pasireotide, should increase therapeutic choices for acromegaly patients currently uncontrolled on available SRLs. Furthermore, significant research has been focused in the development of novel delivery modalities (e.g., oral and long acting subcutaneous administration).
Topics: Acromegaly; Dopamine Agonists; Drug Therapy; Drug Therapy, Combination; Human Growth Hormone; Humans; Receptors, Somatostatin
PubMed: 24979253
DOI: No ID Found -
The Cochrane Database of Systematic... Feb 2018Fibromyalgia is a chronic widespread pain condition affecting millions of people worldwide. Current pharmacotherapies are often ineffective and poorly tolerated.... (Review)
Review
BACKGROUND
Fibromyalgia is a chronic widespread pain condition affecting millions of people worldwide. Current pharmacotherapies are often ineffective and poorly tolerated. Combining different agents could provide superior pain relief and possibly also fewer side effects.
OBJECTIVES
To assess the efficacy, safety, and tolerability of combination pharmacotherapy compared to monotherapy or placebo, or both, for the treatment of fibromyalgia pain in adults.
SEARCH METHODS
We searched CENTRAL, MEDLINE, and Embase to September 2017. We also searched reference lists of other reviews and trials registries.
SELECTION CRITERIA
Double-blind, randomised controlled trials comparing combinations of two or more drugs to placebo or other comparators, or both, for the treatment of fibromyalgia pain.
DATA COLLECTION AND ANALYSIS
From all studies, we extracted data on: participant-reported pain relief of 30% or 50% or greater; patient global impression of clinical change (PGIC) much or very much improved or very much improved; any other pain-related outcome of improvement; withdrawals (lack of efficacy, adverse events), participants experiencing any adverse event, serious adverse events, and specific adverse events (e.g. somnolence and dizziness). The primary comparison was between combination and one or all single-agent comparators. We also assessed the evidence using GRADE and created a 'Summary of findings' table.
MAIN RESULTS
We identified 16 studies with 1474 participants. Three studies combined a non-steroidal anti-inflammatory drug (NSAID) with a benzodiazepine (306 participants); two combined amitriptyline with fluoxetine (89 participants); two combined amitriptyline with a different agent (92 participants); two combined melatonin with an antidepressant (164 participants); one combined carisoprodol, paracetamol (acetaminophen), and caffeine (58 participants); one combined tramadol and paracetamol (acetaminophen) (315 participants); one combined malic acid and magnesium (24 participants); one combined a monoamine oxidase inhibitor with 5-hydroxytryptophan (200 participants); and one combined pregabalin with duloxetine (41 participants). Six studies compared the combination of multiple agents with each component alone and with inactive placebo; three studies compared combination pharmacotherapy with each individual component but did not include an inactive placebo group; two studies compared the combination of two agents with only one of the agents alone; and three studies compared the combination of two or more agents only with inactive placebo.Heterogeneity among studies in terms of class of agents evaluated, specific combinations used, outcomes reported, and doses given prevented any meta-analysis. None of the combinations of drugs found provided sufficient data for analysis compared with placebo or other comparators for our preferred outcomes. We therefore provide a narrative description of results. There was no or inadequate evidence in any comparison for primary and secondary outcomes. Two studies only reported any primary outcomes of interest (patient-reported pain relief of 30%, or 50%, or greater). For each 'Risk of bias' item, only half or fewer of studies had unequivocal low risk of bias. Small size and selective reporting were common as high risk of bias.Our GRADE assessment was therefore very low for primary outcomes of pain relief of 30% or 50% or greater, PGIC much or very much improved or very much improved, any pain-related outcome, participants experiencing any adverse event, any serious adverse event, or withdrawing because of an adverse event.Three studies found some evidence that combination pharmacotherapy reduced pain compared to monotherapy; these trials tested three different combinations: melatonin and amitriptyline, fluoxetine and amitriptyline, and pregabalin and duloxetine. Adverse events experienced by participants were not serious, and where they were reported (in 12 out of 16 studies), all participants experienced them, regardless of treatment. Common adverse events were nausea, dizziness, somnolence, and headache.
AUTHORS' CONCLUSIONS
There are few, large, high-quality trials comparing combination pharmacotherapy with monotherapy for fibromyalgia, consequently limiting evidence to support or refute the use of combination pharmacotherapy for fibromyalgia.
Topics: 5-Hydroxytryptophan; Acetaminophen; Adult; Amitriptyline; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents; Benzodiazepines; Carisoprodol; Drug Therapy, Combination; Duloxetine Hydrochloride; Fibromyalgia; Fluoxetine; Humans; Magnesium; Malates; Melatonin; Monoamine Oxidase Inhibitors; Muscle Relaxants, Central; Pregabalin; Randomized Controlled Trials as Topic
PubMed: 29457627
DOI: 10.1002/14651858.CD010585.pub2