Effects of Pilocarpine Hydrochloride on the Hyposalivation Induced by Psychotropic Drugs

The aim was to study the secretagogue action of pilocarpine on the murine parotid glands submitted to chronic treatment with psychotropic drugs by salivary flow rate determinations and histological alterations. Fifty four male Wistar rats were equally divided in three groups： C group （control） received saline solution for 30 days; AD group （n = 18） received AmitriptylineR and DiazepamR for 30 days, and ADP group （n = 18） received Amitriptyline R and DiazepamR for 30 days and AmitriptylineR, DiazepamR and pilocarpine for further 30 days, resulting in 60 days of treatment. Saliva samples were collected 30 h after the end of treatment. Parotids were removed and processed for hematoxylin-eosin histological analysis. Dedicated software for image processing allowed the determination of cell number and volume. Significant differences between paired-groups C-AD （P 〈 0.01） and AD-ADP （P 〈 0.01） were observed for glands size and weight. The volume of serous cells was greater in AD, suggesting a hypertrophy of the salivary glands. For salivary flow rate, C group showed the highest average. The number of serous cells was similar between groups ADP and C, with the lowest average being found in AD group （P 〈 0.05）.

Psychotropic drugs and liver disease:A critical review of pharmacokinetics and liver toxicity

The liver is the organ by which the majority of sub-stances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. This fact is particularly true in drugs with extensive first--pass metabolism, highly protein bound drugs and drugs depending on phase I hepatic metabolic reactions. Psychopharmacological agents are also associated with a risk of hepatotoxicity. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury. High-risk psychotropics are not advised when there is pre-existing liver disease, and after starting a psychotropic agent in a patient with hepatic impairment, frequent liver function/lesion monitoring is advised. The authors carefully review the pharmacokinetic disturbances induced by end-stage liver disease and the potential of psychopharmacological agents for liver toxicity.

Keep in mind sex differences when prescribing psychotropic drugs

Women represent the majority of patients with psychiatric diagnoses and also the largest users of psychotropic drugs.There are inevitable differences in efficacy,side effects and long-term treatment response between men and women.Psychopharmacological research needs to develop adequately powered animal and human trials aimed to consider pharmacokinetics and pharmacodynamics of central nervous system drugs in both male and female subjects.Healthcare professionals have the responsibility to prescribe sex-specific psychopharmacotherapies with a priority to differentiate between men and women in order to minimize adverse drugs reactions,to maximize therapeutic effectiveness and to provide personalized management of care.

Aging effects on QT interval： Implications for cardiac safety of antipsychotic drugs

Objectives To explore the effect of aging on cardiac toxicity specifically the interaction of age and antipsychotic drugs to alter the QT interval. Methods The Medline databases were searched using the OvidSP platforms with the search strategy： ＂QT interval＂ or ＂QT＂ and ＂age＂ or ＂aging＂. The entry criteria were： over 10,000 apparently healthy individuals with data on both sexes; QT interval corrected for heart rate （QTc） and an expression of its variance for multiple age decades extending into the older ages. Results QTc increased in duration with increasing age. Considering a modest one SD increment in QTc in the normal population, the addition of Chlorpromazine produced a QTc on average greater than 450 ms for ages 70 years and older. Risperidone, that did not on average alter QTc, would be expected to produce a QTc of 450 ms in persons in their mid 70 years under some circumstances. QTc prolongation 〉 500 ms with antipsychotic drugs is more likely for persons with QTc initially at the 99th percentile. It may occur with Haloperidol which does not on average alter QTc. Conclusions The range of values for the QT interval in apparently normal older men or women, when combined with the range of expected QT interval changes induced by antipsychotic drugs, can readily be associated with prolonged QTc. Individuals with QTc at the 99th percentile may have serious QTc prolongation with antipsychotic drugs even those that are not usually associated with QTc prolongation.

HPTLC-MS as a Neoteric Hyphenated Technique for Separation and Forensic Identification of Drugs

Drugs are traditionally been identified on basis of chromatographic-spectroscopic hyphenated techniques in instrumental analysis. Gas chromatography (GC) and Liquid chromatography (LC) hyphenated with mass spectroscopy (MS) i.e. GC-MS and LC-MS give reliable and confirmatory results in drugs identification. In the present work the novel hyphenated technique High Performance Thin Layer Chromatography-Mass Spectroscopy (HPTLC-MS) has been used. This technique provides efficient, quick and simple method for identification and separation of Narcotic drugs and psychotropic substances. The drugs under study are Papaverine, Methadone, Cocaine, Ketamine, Caffeine, Codeine, Diazepam, Thebaine, Heroin, Methamphetamine, Carbamazepine, Morphine, Narcotine and Ephedrine. The present study comprising of sixteen drugs has been carried out on CAMAG HPTLC instrument with automatic sampling. Thin layer chromatography (TLC) plates were developed in various solvent systems, scanned under TLC scanner and the results in terms of Retention Factor (Rf value) and UV spectrum (λmax) are presented in the manuscript. Using hyphenated technique of HPTLC-MS (MS 2020 SHIMADZU) spots of these drugs from TLC plate was lifted with CAMAG TLC-MS interface and confirmed by the mass spectrum of the individual drugs by their m/z values thus delivering fast and accurate confirmatory result on the TLC plate.

Comparative Study of Solubility of Tranquilizers(Alternative Date Rape Drugs)in Stomach Acid

Date Rape Drugs are the members of tranquilizers and sedative class of drugs.These are the substances that make it easier for someone to rape or assault sexually.The person who is administrated by these drugs can cause sleepiness,slow breathing,slow heartbeat rate,trouble in muscle coordination,loss of consciousness.GHB(gamma-hydroxybutyric acid),Rohypnol(flunitrazepam),Ketamine are generally considered as date rape drugs.As Food and Drug Administration Department of Central Government of India considered this issue and placed these drugs under the schedule of Narcotic Drugs and Psychotropic Substances Act.Thereafter it is nearly impossible to get these drugs easily.But criminals have been searched new way through it.Normal tranquilizers and sedatives are also being used for committing such crimes.These drugs are also scheduled,but one can get them with prescription from a registered medical practitioner.So we carried out a comparative study of 3 tranquilizers from the benzodiazepine class that are Diazepam,Alprazolam,and Librium to check their dissolving rate in stomach acid.Estimation of action time of drug can help an investigator to identify the class of drug and time of drug injected(early phase).In our study,we found that the dissolving period of Diazepam and Alprazolam is more than conventional drugs.

Schizophrenia, When the Murmuration Stops

This article explores the concept of schizophrenia as a collapse of coordination and smoothness in brain function. The absence of murmuration leads to symptoms such as illogical verbal function, social disconnectedness, and inappropriate responses to environmental demands. Current treatment options are limited to electroshock therapy and medications like Clozaril, which have significant drawbacks. Future potential cures may involve genetic engineering, but this approach poses social, philosophical, and moral challenges.

基因检测在精神药物治疗中的应用

精神药物治疗在精神疾病领域中至关重要,由于个体差异导致的药物疗效和安全性问题不容忽视。遗传因素,特别是与药物代谢酶、药物作用靶点和风险相关的基因多态性,对药物反应具有显著影响。药物基因组学通过检测基因多态性,能够获知患者对药物的药效、药代动力学特性和潜在毒性的遗传倾向,进而预测药物治疗效果和不良反应,为个体化治疗提供指导。因此,基于药物基因组学的个体化用药有助于提高治愈率、降低复发率,同时减少医疗成本,对精神疾病临床用药具有重大意义。

Six psychotropics for pre-symptomatic ＆ early Alzheimer＇s (MCI), Parkinson＇s, and Huntington＇s disease modification

The quest for neuroprotective drugs to slow the progression of neurodegenerative diseases （NDDs）, including Alzheimer＇s disease （AD）, Parkinson＇s disease （PD）, and Huntington＇s disease （HD）, has been largely unrewarding. Preclinical evidence suggests that repurposing quetiapine, lithium, valproate, fluoxetine, donepezil, and memantine for early and pre-symptomatic disease-modification in NDDs may be promising and can spare regulatory barriers. The literature of these psychotropics in early stage and pre-symptomatic AD, PD, and HD is reviewed and propitious findings follow. Mild cognitive impairment （MCI） phase of AD： salutary human randomized controlled trial findings for low-dose lithium and, in selected patients, donepezil await replication. Pre-symptomatic AD： human epidemiological data indicate that lithium reduc- es AD risk. Animal model studies （AMS） reveal encouraging results for quetiapine, lithium, donepezil, and memantine. Early PD： valproate AMS findings show promise. Pre-symptomatic PD： lithium and valproate AMS findings are encouraging. Early HD： uncontrolled clinical data indicate non-progression with lithium, fluoxetine, donepezil, and memantine. Pre-symptomatic HD： lithium and valproate are auspicious in AMS. Many other promising findings awaiting replication （valproate in MCI; lithium, valproate, fluoxetine in pre-symptomatic AD; lithium in early PD; lithium, valproate, fluoxetine in pre-symptomatic PD; donepezil in early HD; lithium, fluoxetine, memantine in pre-symptomatic HD） are reviewed. Dose- and stage-dependent effects are considered. Suggestions for signal-enhancement in human trials are provided for each NDD stage.

Pediatric off-label use of psychotropic drugs approved for adult use in Japan in the light of approval information regarding pediatric patients in the United States: a study of a pharmacy prescription database

Background Off-label use of psychotropic prescriptions for pediatric patients has been increasing in Japan.This study sought to clarify pediatric patients' off-label use of psychotropics approved only for adults in Japan.Methods This retrospective study on psychotropic utilization employed a pharmaceutical health insurance claims database supplied by a pharmacy for the fiscal year 2016.Seven psychotropic drugs were examined.For each drug,we calculated the proportion of patients aged < 16 years or who were under the approved age limit set in the United States out of all patients.The maximum daily dose of each drug within the study period was plotted by age.Results Data of 45,715 patients (female:26,799,male:18,916) with 331,920 prescriptions were examined in this study.For each drug,the proportion of pediatric patients aged < 16 years ranged from 0.15 to 1.1%,while the proportion of those under the approved age limit in the United States ranged from 0 to 0.27%.Olanzapine had the highest reported proportion.No drugs other than olanzapine were taken under the approved age limit in the United States.Conclusions We identified the pediatric off-label use of psychotropics that were limited to adult use in Japan.The results indicated the possibility of referring to international guidelines or evidence in clinical practice,but these factors do not discount the existing problems with off-label use.More clinical trials within the pediatric population in Japan are needed to address the issue of off-label use and obtain useful and reliable information in the package inserts for rational use in future pediatric patients.

Role of antipsychotics for treating behavioral and psychological symptoms of dementia

Over the past three decades, concerns about the high prevalence of antipsychotic use in the nursing homes （NHs） for the management of behavioral and psychological symptoms of dementia continue to be emphasized and intervened by many. However, despite the numerous side effects and the recent blackbox warning by the United States Food and Drug Administration about the increased risks for stroke and sudden death associated with the use of antipsychotics in dementia, the preva-lence of antipsychotic use in NHs remains high. While the use of antipsychotics appeared to have modest effcacy in reducing symptoms of aggression and psychosis in dementia, there is insuffcient evidence to routinely rec-ommend the use of alternative psychopharmacological treatments for these symptoms. Hence, clinicians have to balance the safety warnings against the need to treat these symptoms in order to prevent harm to the resident that may result from his/her dangerous behaviors. Although the use of antipsychotics may be warranted in some cases, organizational, resource and training support should be provided to encourage and equip NH staff to participate in interventions so as to minimize inappropriate use of these medicines in NHs. This review will discuss the place in therapy, the trend and appropriateness of antipsychotic use in NHs, as well as the effectiveness of current and future strategies for reducing antipsychotic use in the NHs.

More than Half of Patients with Schizophrenia Are Receiving Polypharmacy and Co-Prescription of Anxiolytics in Pakistan —Findings from Research on Asian Prescription Pattern in 2016

Objective: Little is known about the prescription pattern of psychotropic drugs for patients with schizophrenia in Pakistan. The purpose of this study was to evaluate the characteristic features of psychotropic drug prescriptions for patients with schizophrenia in Pakistan. Methods: Three centers in Pakistan participated in a large scale collaborative study known as Research on Asian Prescription Pattern (REAP). The 2016 REAP survey included centers from 15 countries in Asia and used a unified research protocol. The design of the study was quantitative and of descriptive epidemiology. Analysis was made on the data collected from three centers i.e., Lahore, Karachi and Islamabad. The data collected in Pakistan were compared with those from other Asian countries. The details of REAP were presented on the homepage of REAP (http://www.REAP.Asia). Results: From Pakistan, 298 patients were included. Patients with schizophrenia in Pakistan received higher rate of antipsychotic polypharmacy and a higher rate of co-prescription of mood stabilizers and anxiolytics when compared with participants from other South Asian countries (India and Bangladesh). Conclusion: The main findings of the study were that a majority of the patients were prescribed antipsychotic polypharmacy drugs in Pakistan. Insufficient training on the use of psychotropic drugs and a lack of treatment guideline are considered to be the major contributing factors. Further education and training on the proper use of psychotropic drugs are recommended to psychiatrists in Pakistan. The guidelines on pharmacotherapy for patients with schizophrenia should also be developed and promoted in Pakistan.

医疗机构麻醉、第一类精神药品信息化管理模式探讨

麻醉、第一类精神药品是我国依法依规实行特殊管理的药品,是医疗机构药事管理工作的重点内容。由于其特殊性,我国医疗机构内麻醉、第一类精神药品管理主要以人工操作为主,智能化程度不高。随着医疗信息化的发展,传统管理模式已不足以满足现在医疗机构对麻醉、第一类精神药品的管理需求。本文通过分析传统管理模式中医疗机构内麻醉、第一类精神药品的管理难点及风险,探讨在医院信息系统下,结合智能化设备,构建麻醉、第一类精神药品智能化信息管理模式的方法及可达到的应用效果,为临床应用提供思路。

Psychotropic drug abuse in pregnancy and its impact on child neurodevelopment:A review

Substance abuse by women of child-bearing age and fetal in utero drug exposure has increased in the number of infants born with health issues.Prenatal exposure to psychoactive substances can lead to neurological and neurodevelopmental deficits later in life.Useful data concerning the effects of psychoactive drugs on fetal neurodevelopmental status are sparse.Understanding the neurodevelopmental consequences of prenatally drug-exposed children has become a pressing global concern.The aim of this review is to gather current evidence and information on neurodevelopmental outcomes of in utero drug exposure.A literature search was performed on the PubMed,Scopus,and Google Scholar databases using the terms“psychotropic drugs”,“neurodevelopmental consequences”,“prenatal drug exposure”,and“pregnancy”.Available studies on in utero drug exposure were reviewed and found to support the idea that some degree of health issues are present in fetuses and children.Different psychoactive substances have profound neurodevelopmental consequences,such as structural brain changes,poor attention span,Down syndrome,attention deficit hyperactivity disorder,autism spectrum disorder,imbalances in neurotransmitter levels,and many structural deficits.The pervasive use of psychoactive drugs in women of child-bearing age is an important health concern.Further scientific efforts are needed to investigate the effect of prenatal exposure to psychoactive drugs on children.

液相色谱串联质谱法检测10种精神药物的实验室间比对

目的通过实验室间比对,了解液相色谱串联质谱法检测10种精神药物(氯氮平、奥氮平、利培酮、喹硫平、阿立哌唑、舍曲林、艾司西酞普兰、文拉法辛、度洛西汀、丙戊酸)及5种代谢物(去甲氯氮平、9-羟利培酮、N-脱烷基喹硫平、脱氢阿立哌唑、O-去甲文拉法辛)血清浓度的技术能力、质量管理现状及存在的问题,推进治疗药物监测工作的健康发展。方法选择8家已使用液相色谱串联质谱法开展了精神药物治疗药物监测的实验室,进行问卷调查,并进行质控血清及患者血清检测的实验室间比对试验。结果8家实验室使用的液相色谱串联质谱仪包括Waters、AB SCIEX、Agilent、岛津、德米特等,检测方法均为实验室自建,采用的样本前处理方法包括蛋白沉淀法和液液萃取法,液相和质谱等相关参数存在差异,方法学确证的批内和批间精密度均小于11%。8家实验室均开展了检测项目的室内质控,参加了室间质量评价活动。除去甲氯氮平外,其他被分析物质的质控血清检测结果的实验室间变异系数(CV)均小于25%。除去甲氯氮平低浓度水平、舍曲林低浓度水平外,其他被分析物质的质控血清检测结果的稳健变异系数(RCV)均小于15%。除去甲氯氮平、脱氢阿立哌唑外,在临床样本的检测范围内,各药物或代谢物超90%患者血清样品检测结果的实验室间CV小于15%。脱氢阿立哌唑患者血清样品检测结果的实验室间CV偏大,但也小于25%。对于去甲氯氮平,实验室E无论检测的质控血清还是患者血清,均存在大于50%的系统误差,剔除该实验室检测结果后,去甲氯氮平在其他实验室间检测结果的CV小于25%。结论液相色谱串联质谱法检测本研究所涉及药物或代谢物血清浓度的实验室间一致性尚可,检测结果具有可比性。部分实验室在标准曲线范围的设定、允许总误差的设定及应用、量值溯源等方面存在问题,需要进一步研究解决。

五灵胶囊防治精神类药物致肝损伤的作用及对患者睡眠质量的影响

目的 探讨五灵胶囊防治精神类药物致肝损伤的作用及对患者睡眠质量的影响。方法 将2021年1月—2023年12月收治的使用精神类药物的抑郁症患者240例作为研究对象,用随机数字表法分为对照组和观察组,每组120例。对照组用盐酸度洛西汀肠溶胶囊治疗,观察组在对照组治疗的基础上加用五灵胶囊治疗。治疗12周后,比较2组主要肝功能指标[丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(aspartate aminotransferase,AST)、谷氨酰转肽酶(glutamyl transpeptidase,GGT)、总胆红素(total bilirubin,TBiL)],匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评分及不良反应发生率。结果 治疗后,观察组的AST[(33.45±8.32) U·L^(-1)]、ALT[(35.45±5.35) U·L^(-1)]、GGT[(31.12±5.15) U·L^(-1)]、TBiL[(6.44±2.53)μmol·L^(-1)]均低于对照组,组间比较差异均有统计学意义(P<0.05);治疗后,观察组的PSQI评分优于对照组(P<0.05);观察组的不良反应发生率(8.33%)低于对照组(26.67%),P<0.05。结论 五灵胶囊可有效防治由精神类药物造成的肝损伤,且有助于改善患者的情志抑郁、焦虑和失眠的症状,患者的生活质量明显改善,且安全性较好。

北京市二级及以上医院麻醉科麻精药品管理现状及分析

目的调查北京市二级及以上医院麻醉科麻醉药品、精神药品管理情况,为不同级别医院麻醉科对于麻精药品管理提供依据。方法通过北京市临床麻醉质量控制和改进中心平台由专人一对一对有麻醉科建制的二级以上医院发放问卷星链接,调查问卷包括医院基本信息,目前麻醉科内麻精药品管理制度、使用现状以及建议等内容。结果本次调查共发放问卷159份,共回收有效问卷139份,其中二级医院及其他专科医院50家,三级综合医院89家,有效回收率为87.4%。调查结果显示北京市二级及以上医院麻醉科主要使用的麻精药品种类:枸橼酸舒芬太尼注射液、注射用盐酸瑞芬太尼、盐酸麻黄碱注射液、枸橼酸芬太尼注射液等。参与药品管理的人员包括麻醉科医生(63.3%)、麻醉科护士(45.3%)、手术室护士(45.3%)、临床药师(11.5%),存在交叉共管现象。在管理和使用麻精药品过程中存在的主要问题包括药品积压过期浪费(36.4%)、麻精药品无处方或处方错误(31.8%),不同药品存放问题、管理人员数量有限但身兼多职等问题。结论北京市不同级别医院麻醉科在法律规范基础上应结合自身特点建立麻精药品管理制度,明确岗位职责、规范临床人员资质,建议可引入智能化药车、设立麻醉科护士岗位,提升麻精药品管理效率。

刑法中毒品概念的再审视

为进一步加强对毒品犯罪的打击,前置性规范中麻醉药品和精神药品列管品种不断增加、范围不断扩张,这与刑法中的毒品概念应具备相对明确性、确定性之间存有内在冲突。应当重新审视刑法中的毒品概念,明晰麻醉药品、精神药品与毒品概念的关系。刑法中的毒品概念应当具备国家管制性、致瘾癖性、麻精药品和非法用途等四个基本要素。区别于前置法中麻精药品的概念,建议在刑事立法中进一步明确毒品的非法用途要素,即在毒品概念层面通过考察麻精药品的用途,将医疗、教学、科研用途的麻精药品排除出毒品的范围。

贩卖麻醉药品、精神药品行为刑法规制的困境与出路——以《昆明会议纪要》为视角

麻醉药品和精神药品具有药品、毒品和化学的多元属性,贩卖此类物品在司法认定及法律适用上需要坚持更高的要求和标准,紧扣认定罪名的构成要件。贩卖毒品罪的适用条件模糊、“代购型”贩卖等特殊贩卖行为所产生的认定争议,以及妨害药品管理罪与非法经营罪适用混乱导致的定罪偏差,是刑法规制过程中亟待解决的问题。为破解前述现实困境,应以主观目的之认定为重要依据,明确贩卖毒品罪中“明知”在先、“治疗疾病”在后的主观判断顺序,并综合考量具体行为的违法程度,坚持法律效果与社会效果协调统一理念的指引,提出相对应的路径优化建议。在具体优化路径方面,从药品性质、销售对象和方式等角度出发,为主观目的之认定提供客观参考标准;整理“代购型”贩卖、网络销售两种特殊贩卖行为的刑法规制思路,厘清所涉及的走私、贩卖毒品罪和非毒品犯罪之间的认定逻辑;妨害药品管理罪与非法经营罪中关于“许可”的具体指向不同,应以此为基点辨析两罪的适用界限,并深化构成要件的理解,为该类案件的办理提供参考。

An overview of management of narcotics and psychotropic drugs in China

Narcotics and psychotropic drugs are known as controlled drugs with special management and super vision due to their psychic and physiological dependence. Based on the literature review, experts interview and policy comparative analysis, our study summarized and reviewed the status of related legislation and regulations since the enactment of the Narcotics and Psychotropic Drugs Regulations in 2005. We found the problems of legal loopholes, the complexity of supervision system and the irrational use of narcotics in the treatment of chronic non-cancer. Our analysis suggested that China should reinforce legislation, strengthen the cooperation among departments, establish the information network and improve the guideline of narcotics and psychotropic drugs for clinical treatment as quickly as possible.