Current Psychopharmacology - Volume 9, Issue 3, 2020

Neuroscientists and psychiatrists working in the areas of “pain and addiction” are asked in this perspective article to reconsider the current use of dopaminergic blockade (like chronic opioid agonist therapy), and instead to consider induction of dopamine homeostasis by putative pro-dopamine regulation. Pro-dopamine regulation could help pharmaceutical opioid analgesic agents to mitigate hypodopaminergia-induced hyperalgesia by inducing transmodulation of dopaminergic signaling. An optimistic view is that early predisposition to diagnosis based on genetic testing, (pharmacogenetic/pharmacogenomic monitoring), combined with appropriate urine drug screening, and treatment with pro-dopamine regulators, could conceivably reduce stress, craving, relapse, enhance well-being and attenuate unwanted hyperalgesia. These concepts require intensive investigation. However, based on the rationale provided herein, there is a good chance that combining opioid analgesics with genetically directed pro-dopamine-regulation using KB220 (supported by 43 clinical studies). This prodopamine regulator may become a front-line technology with the potential to overcome, in part, the current heightened rates of chronic opioid-induced hyperalgesia and concomitant Reward Deficiency Syndrome (RDS) behaviors. Current research does support the hypothesis that low or hypodopaminergic function in the brain may predispose individuals to low pain tolerance or hyperalgesia.

Background: The prevalence of psychiatric disorders, such as anxiety, is very common and affects many people all around the world. Currently, many synthetic pharmacological products/ drugs are available in the market to cure the disorder but associated with various adverse reactions or side effects, which may cause discomfort and sometimes other disorders to the patients. In the past years, the use of complementary and alternative medicine has increased. The exploration in the area of herbal psychopharmacology has received much attention as people are using more herbal treatment to benefit their health. Objective: To provide comprehensive information on anxiety disorder and its herbal treatment. Methods: In this review, we enlisted the plants, plant extracts and isolated components (if any) along with models used to explore anxiolytic property; in retrospect, still a lot of research required to establish them clinically. Result: Literature revealed that a variety of medicinal plants are effective for the treatment of anxiety like Ginkgo biloba, Passiflora incarnata, Gelsemium sempervirens, Piper methysticum, Bauhinia variegate, Matricaria recutita, Brassica oleracea, Hypericum perforatum, Echium amoenum, and Scutellaria lateriflora. Conclusion: Exploration of herbal plants may be beneficial to establish more potential compounds for the treatment of anxiety disorders.

Background: The negative symptoms of schizophrenia remain a major clinical trouble against psychiatric rehabilitation and available therapeutic treatments. Objective: Escitalopram is known as the most selective SSRI with minimal effects on norepinephrine and dopamine neuronal uptake. The aim of the present study is to assess the effect of escitalopram on negative symptoms of schizophrenia. Methods: This study was an eight-week, randomized, placebo-controlled trial of escitalopram set against placebo, as an add-on medication, in the treatment of 50 patients with a diagnosis of schizophrenia. While the Scale for Assessment of Negative Symptoms was used as the primary outcome measure, the Scale for Assessment of Positive Symptoms, the Simpson-Angus Scale and the Hamilton Depression Scale, as well, were used as a secondary measure for evaluation of positive, extrapyramidal and depressive symptoms, respectively. Results: The primary outcome of the present assessment was a significant reduction in the mean total score of the Scale for Assessment of Negative Symptoms (SANS) in the target group, compared to placebo, at the end of eight weeks. In this regard, most of the subscales of SANS, as well, demonstrated significant improvements by escitalopram. Conclusion: According to the findings, escitalopram can be helpful, as add-on medication, in amelioration of negative symptoms of schizophrenia.

Background: Novel antipsychotics are superior to conventional antipsychotics, as they significantly reduce both positive and negative symptoms of schizophrenia and have lower risk of extra pyramidal syndrome (EPS). However, these drugs cause significant metabolic side effects. Objective: This study was carried out to assess the hospital prevalence of metabolic syndrome (MetS) and metabolic profile related to use of oral risperidone which is one of the most commonly used atypical antipsychotics. Methods: A cross-sectional study was carried out on a period sample of 6 months, to study the hospital prevalence and profile of MetS in adult patients on oral risperidone. Data was collected from pharmacy dispensing records, patients’ case record files, and subsequently patients were contacted telephonically and called to participate in this study. Results: Hospital prevalence of MetS was found to be 12.1% (13 out of 107) by NCEP ATP III criteria and 14.9% (16 out of 107) by IDF criteria in patients (aged 20 to 40 years) on risperidone. Ninety one patients (85%) of the sample were found to be in Overweight category and Central Obesity was found in 82(76.6%) patients. Twenty three (21.4%) of the patients had increased triglyceride (TG) levels. Out of the 16 patients with MetS, 11(68.75%) of them had total duration of illness (TDI) of >4 years, 11(68.75%) were in 30-40 years age group, 13 (81.25%) of them had continued illness or they were in partial remission, 11 (68.75%) of them were already exposed to any antipsychotics other than risperidone, 6(37.5%) of them were having diabetes mellitus (DM) in one parents. Conclusion: This study reported the hospital prevalence of MetS as 14.9% (IDF criteria) in young adult patients on oral risperidone. The triglyceride levels and central obesity was also found to be higher in patients, who otherwise had low prevalence of MetS.

Backgrounds: It is unknown whether second-generation antipsychotics are safer than first-generation antipsychotics in terms of seizure induction. Objective: In the present assessment, the relationships between the incidence of seizure attacks among a great sample of non-western psychiatric inpatients and prescribed typical and atypical antipsychotics have been probed and analyzed based on the existing data in the literature. Methods: Razi psychiatric hospital, as one of the largest and oldest public psychiatric hospitals in the Middle East, had been selected as the field of study in the present retrospective estimation. For assessment, all inpatients that had suffered a seizure during the last sixtyfour months had been included in the current study. Results: Among seventy-four patients who had experienced seizure attack during the inpatient management, and had been prescribed antipsychotics for symptomatic management of primary psychiatric disorders, 67.56% had received atypical antipsychotic and the remaining (32.43%) had received typical antipsychotics, which revealed a significant quantitative difference between them (p<0.000). Among atypical antipsychotics, olanzapine was the most recommended antipsychotic (33.78%), followed by risperidone (34%), quetiapine (9.45%), and clozapine (n=1, 1.35%). Among typical antipsychotics, too, haloperidol (28.37%) was significantly more prescribed than chlorpromazine (2.70%) and thioridazine (1.35%) (p<0.000). By the way, there was no significant difference, quantitatively, between olanzapine and haloperidol in the present evaluation (p<0.47). Conclusion: Atypical antipsychotics have comparable potentiality, as typical antipsychotics, for triggering seizure attacks, which demands indispensable cautiousness by clinicians when prescribing such a group of medications for epileptic and neuropsychiatric patients.

Background: Carbamazepine has been used in the treatment of bipolar disorder, both in acute mania and maintenance therapy, particularly in developing countries. Not only its interaction with various drugs and auto-inducer nature, but the narrow therapeutic range of carbamazepine also makes monitoring necessary to guarantee the adequacy of its safety and therapeutic concentration. To date, the most common biological specimen used for therapeutic drug monitoring (TDM) purposes is still plasma, but saliva can become an alternative biological matrix since its level in saliva strongly correlates with carbamazepine plasma concentration. Objective: This study validated the bioanalytical method parameters used for carbamazepine in spiked-saliva in accordance with the Food and Drug Administration (FDA) criteria in the Guidance for Industry Bioanalytical Method Validation. Methods: HPLC-UV detector was employed at 285 nm λ with methanol: water: glacial acetic acid (65:34:1) as the mobile phase and C8 as the stationary phase (4.6x150 mm; 5 μm). Results: The linearity test in a range of 0.0 - 5 μg/mL carbamazepine concentration resulted in a correlation coefficient of 0.999 with 0.20 μg/mL LoD, 0.30 μg/mL LLoQ, and 0.61 μg/mL LoQ. The coefficient of variation and %diff in the selectivity, accuracy, and precision parameters remained below 20%, indicating fulfillment of the criteria for a bioanalytical method, while the average % recovery was more than 90%. Conclusion: The currently-developed bioanalytical method has fulfilled the stipulated validation criteria to be used for determining carbamazepine concentration in spiked-saliva as an alternative method for relative bioequivalence studies or TDM application in a clinical setting.