Current Psychopharmacology - Volume 3, Issue 2, 2014

Extracts of Ginkgo biloba have been broadly prescribed for the treatment of cognitive dysfunction ranging in severity from mild to severe memory loss. Piracetam is a nootropic remedy correlated to inhibitory γ-aminobutyric acid (GABA) neurotransmitter. It improves cognitive function without sedation. Objective: The aim in the attending study is to evaluate the outcome of Ginkgo biloba and or piracetam on cognitive, psychomotor performances and working memory functions in normal healthy volunteers. Methods: Thirty subjects (all are males) arbitrarily chosen from medical college students. The contributors were allowed to perform mutually on the psychomotor performance device tester and the computerized n-back test (working memory task) to obtain knowledge from those tests sooner before the commencing of the examination. All psychometric response time and working memory test parameters were calculated previous to the experimental research, so the identical volunteers considered as control and through four days of receiving the Ginkgo biloba 60mg/day (trunature GSL), piracetam 800mg/day (nootropil) or both drugs. The enrolled participants were divided into three groups. Group (A) were given Ginkgo biloba, group (B) were given piracetam and group (C) were given piracetam and Ginkgo biloba. Results: Piractam significantly improves cognitive and working memory at all levels (P value is <0.05) while; it showed insignificant effects on psychometric reaction time parameters except it ameliorates the total reaction time (TRT) (P value is <0.05). The differential effects of Ginkgo biloba showed significant effects on psychometric reaction time and cognitive central Integrity (P value is <0.05) and insignificant effects on working memory accuracy except at І-Back level where it produced significant effects P<0.05. Combined effects of ginko biloba and piracetam on psychomotor performances, cognitive function and working memory produced significant effects (P value is <0.05). Conclusion: Combined effects of piracetam and Ginkgo biloba produced more significant effects on psychomotor performances and working memory functions in healthy young subjects than either Ginkgo biloba or piracetam alone in healthy young subjects.

Attention-deficit/hyperactivity disorder (ADHD) is an impairing psychiatric disorder that affects not only children, but also adult patients. The symptoms of ADHD often produce an impairment of interpersonal functioning and educational performance with an increased school dropout risk. The aim of the present review is to provide an update of the empirical evidences of efficacy and safety that have been collected for stimulant and non-stimulant drugs in the treatment of ADHD patients. A systematic search of published randomized controlled trials of medications for ADHD was performed on the Pubmed and Cochrane databases from 2010 to 2013. Reviews and meta-analyses of older data were also examined. The first line drugs for ADHD without comorbidity or with comorbid conduct disorder are the stimulants methylphenidate (MPH) and dexmetylphenidate (d-MPH), available in immediate- and extended-release formulations. Other drugs with evidences of efficacy include both stimulants, such as amphetamines, and non-stimulants, such as atomoxetine and alpha agonists. A few non-stimulant agents, like reboxetine, have still limited data, but are under evaluation. Among the various treatment options, stimulants have generally demonstrated superiority compared to non-stimulants. Most of the studies are trials comparing methylphenidate, amphetamine and atomoxetine versus placebo, but comparison of active drugs is hindered by the absence of head-to-head works. Some meta-analyses have tried to overcome this problem, but further investigations directly comparing different active compounds are needed.

Objective: The objective of this study is to determine the increase in the prevalence of antipsychotic polypharmacy in Dokuz Eylul University Psychotic Disorder Outpatient Unit over a period of 10 years. Methods: All accessible records of the patients, examined in the Dokuz Eylul University Psychotic Disorder Outpatient Unit between 1994 and 2000, and in 2010 were evaluated. Ninety one schizophrenia patients who had been examined between 1994 and 2000 and 102 schizophrenia patients who had been examined in 2010 were compared in terms of drug prescription patterns. Results: The point prevalence of antipsychotic polypharmacy showed a significant difference between two groups (p=0.022), polypharmacy increased from 32% to 49%. The number of first-generation antipsychotic (FGA) medications decreased from 46% to 26%, while the number of second-generation antipsychotic (SGA) medications increased from 71% to 99%. Conclusion: The prevalence of antipsychotic combinations both with other antipsychotics and other psychotropic medicines increased significantly over a period of 10 years.

A comprehensive approach to the management of anxiety disorders continues to be a clinical challenge as current therapies have shown only limited efficacy. Quetiapine (available as an immediate-release and an extended-release [XR] formulation) is an atypical antipsychotic agent with primary dopaminergic and serotonergic blocking activity, which has well-established records of clinical efficacy and tolerability in the treatment of schizophrenia and bipolar disorder. Recent controlled trials provide increasing evidence in support of the role of quetiapine XR as both monotherapy and as an augmentation therapy in the treatment of several anxiety disorders, including generalized anxiety disorder, social anxiety disorder, obsessive compulsive disorder, and posttraumatic stress disorder. To date, there is only limited evidence for its use in panic disorder. Quetiapine XR is an important alternative especially for patients who had a partial remission of symptoms or who have not responded to first-line treatments for mood and anxiety disorders. It may also provide an important option in patients whose anxiety disorder is comorbid with an underlying bipolar mood disorder. Quetiapine’s safety and tolerability profile in the management of anxiety disorders is comparable to what is observed when quetiapine is used for other psychiatric conditions, however, it has yet to receive FDA approval for use in generalized anxiety disorder due to potential long-term metabolic adverse effects. Thus, given its efficacy and tolerability, it is important to consider the potential benefit of its ability to manage mood and anxiety disorder symptomatology, while closely monitoring for the more worrisome adverse events.

Introduction: Drug-induced torsade de pointes (TdP) is a rare life-threatening adverse drug reaction (ADR) which is strongly influenced by gender and age. A number of antipsychotics have been linked to TdP and sudden death. In the present study, the electrocardiographic changes induced by olanzapine and risperidone were compared with each other among a group of female schizophrenic patients. Method: Two hundred and sixty eight female inpatients with diagnosis of schizophrenia, according to the criteria of DSMIV- TR, were entered in either of the two parallel groups, to participate in an open study for random assignment to olanzapine (n=148, 5-25 mg/day) or risperidone (n=120, 4-8 mg/day). Standard 12-lead surface ECG was taken from each patient at baseline, and then again at the end of the treatment. The parameters that had been assessed included: heart rate (HR), P-R interval, QRS interval, Q-T interval (corrected = Q-Tc), Ventricular Activation Time (VAT), ST segment, T wave, Axis of QRS and finally inter-ventricular conduction process. Results: 37.83% of the cases in the olanzapine group and 30% of them in the risperidone group showed some Q-Tc changes. 13.51% and 24.32% of the patients in the olanzapine group showed prolongation and shortening of the Q-Tc interval, respectively. The abovementioned changes in the risperidone group were restricted to only prolongation of Q-Tc. Comparison of means, between baseline Q-Tc of risperidone group against its post-treatment measurement showed a significant increment (p = 0.02). In addition, comparison of proportions in the olanzapine group showed that the quantity of cases with shortening of Q-Tc was significantly more than the number of the patients with Q-Tc prolongation (p =0.01). The mean modal dose of olanzapine and risperidone during the present assessment was 19.49±5.51 and 5.14±2.86 mg/day, respectively. Conclusion: Comparable tendency of olanzapine and risperidone, for induction of significant electrocardiographic changes, demands as much as necessary watchfulness by clinicians, especially with respect to Q-T interval alterations.

Introduction: The essential feature of borderline personality disorder (BPD) is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity. While according to some studies olanzapine and aripiprazole are effective agents in BPD, there are other studies that deny such an effect. So, with respect to these controversies, an assessment was performed to compare the efficacy and safety of olanzapine vs aripiprazole in this group of patients. Method: Twenty four patients, were entered into one of the two groups (n=12 in each group) for participating in an 8- week, open-label study for random assignment to olanzapine or aripiprazole in a 1:1 ratio. Primary outcome measure included Brief Psychiatric Rating Scale (BPRS) for estimation of baseline psychopathology, clinical outcome and treatment response. In addition, Buss-Durkee Hostility Inventory (BDHI) for the assessment of anger& hostility, and Clinical Global Impressions-Severity Scale (CGI-S), for assessment of overall illness severity were used as secondary scales. The patients were assessed by means of BPRS at baseline (week 0), and weeks 2, 4 and 8. The other scales were scored at baseline and at the end of the assessment. Results: According to the findings both olanzapine and aripiprazole showed a significant improvement in BPRS at the end of the trial (p=0.01 and p=0.04, respectively). BDHI and CGI-S as well improved significantly by olanzapine (p=0.04 and p=0.03, respectively), while it was not so regarding aripiprazole (p=0.06 and p=0.07, respectively). Effect size (ES) analysis for changes in BPRS, indicated a large improvement with both of olanzapine and aripiprazole. Conclusion: Both olanzapine and aripiprazole had relatively comparable effect on general symptoms of BPD, in spite of a bit greater influence of olanzapine on some of the secondary outcome measures.

Reports on prenatal exposure to some first generation antipsychotic drugs like, haloperidol (HAL), and their effects on fetal neurotoxicity and functional impairments in the offspring are available; but studies on in utero exposure to second generation antipsychotics, especially quetiapine (QUE) and its effects on fetal neurotoxicity, neurobehavioral consequences, are lacking. Therefore, the present study was undertaken to evaluate the effect of prenatal administration to equivalent therapeutic doses of QUE on fetal brain size and weight, neuroarchitectural and neurohistopathological changes; and its long-lasting impact on neurobehavioral disturbances in youngadult offspring. Pregnant Wistar rats were exposed to selected doses (55 mg, 80 mg and 100 mg/kg) of QUE from gestation day (GD) 6-21 orally with control subjects. These doses were equivalent to human therapeutic doses of QUE. Half of the pregnant subjects of each group were sacrificed on GD 22 for histopathological studies and the rest of the dams were allowed to deliver normally. Their pups were reared postnatal up to 10 weeks of age for neurobehavioral observations. In prenatally QUE treated groups, substantial reduction in fetal brain size and weight, significant alterations in total neocortical thickness and in typical six layers of neocortex (cortical thinning), and loss of neuronal cells in the neocortex were found. Further, long-lasting impact of the drug was also observed on behavioral impairments in young-adult rat offspring. Therefore, QUE should be used with cautions to consider its developmental neurotoxicological and neurobehavioral potential in animal models, rat.

The search for novel, effective, and safe psychotropic medications for use in children and adolescents is an ongoing journey. Specifically, several atypical antipsychotics have received FDA indications for use in children and adolescents, although carry the risk of potentially serious side effects such as extrapyramidal symptoms, tardive dyskinesia, weight gain, metabolic syndrome, and symptoms of hyperprolactinemia. Three newer antipsychotics – asenapine, iloperidone, and lurasidone – have been considered by some as alternatives to use in children and adolescents with various psychiatric conditions. However, the data on the use of these medications in this population is limited. We review the current literature regarding the use of these agents in children and adolescents. Although these medications may have similar properties to current agents with approved indications, there is not sufficient evidence at this time to recommend their use in children and adolescents. More research is needed regarding the efficacy, safety, and tolerability of these medications in the pediatric population.