Patients with Alzheimer's disease or other types of dementia often require long-term care in nursing facilities (NF) where they may display out-of-character behaviors complicating their care. While antipsychotic medications are sometimes prescribed for NF residents, their use is considered inappropriate for the control of dementia behaviors. The Centers for Medicare and Medicaid Services have rated Texas the worst state in the country for the inappropriate use of antipsychotic medications for NF residents with dementia. This project was guided by the star model of knowledge transformation with the goal to reduce inappropriate use of antipsychotic medications through NF staff education. The purpose of this project was to develop an educational program for nurses, direct care staff, pharmacists, and prescribers regarding appropriate use of antipsychotic medications, reduction efforts, alternative non pharmacological interventions, and an associated toolkit of educational resources. The program development was accomplished in conjunction with a team of local experts who provided process evaluation regarding their satisfaction with the planning process through the completion of an anonymous, 10-question, Likert-type survey. All participants scored their results with a (5) strongly agree or (4) agree. A descriptive analysis of the survey data provided information that positively supported the development of the project. At the end of the project, the education program and resources were delivered to the Texas Health and Human Services Commission, with a plan for later implementation and outcome evaluation. This project has the potential to achieve positive social change through reducing the numbers of Texan NF residents with dementia who are inappropriately prescribed antipsychotic medications, which will result in an increase in their quality of life.

no / Rationale Phencyclidine (PCP), a glutamate/N-methyl-d-aspartate (NMDA) receptor antagonist, has been shown to induce a range of symptoms similar to those of patients with schizophrenia, while d-amphetamine induces predominantly positive symptoms. Previous studies in our laboratory have shown that PCP can selectively impair the performance of an operant reversal-learning task in the rat. Furthermore, we found that the novel antipsychotic ziprasidone, but not the classical antipsychotic haloperidol, could prevent the PCP-induced deficit. Objectives The aim of the present study was to validate the model further using the atypical antipsychotic clozapine and then to investigate the effects of lamotrigine, a broad-spectrum anticonvulsant that is known to reduce glutamate release in vitro and is able to prevent ketamine-induced psychotic symptoms in healthy human volunteers. A further aim was to compare effects of PCP and d-amphetamine in the test and investigate the effects of the typical antipsychotic haloperidol against the latter. Methods Female hooded-Lister rats were food deprived and trained to respond for food in a reversal-learning paradigm. Results PCP at 1.5 mg/kg and 2.0 mg/kg and d-amphetamine at 0.5 mg/kg significantly and selectively impaired performance in the reversal phase of the task. The cognitive deficit induced by 1.5 mg/kg PCP was attenuated by prior administration of lamotrigine (20 mg/kg and 30 mg/kg) or clozapine (5 mg/kg), but not haloperidol (0.05 mg/kg). In direct contrast, haloperidol (0.05 mg/kg), but not lamotrigine (25 mg/kg) or clozapine (5 mg/kg), prevented a similar cognitive impairment produced by d-amphetamine (0.5 mg/kg). Conclusions Our findings provide further data to support the use of PCP-induced disruption of reversal learning in rodents to investigate novel antipsychotic drugs. The results also provide evidence for different mechanisms of PCP and d-amphetamine-induced disruption of performance in the test, and their different sensitivities to typical and atypical antipsychotic drugs.

No

Yes / Cognitive deficits in schizophrenia remain an unmet clinical need. Improved understanding of the neuro- and psychopathology of these deficits depends on the availability of carefully validated animal models which will assist the development of novel therapies. There is much evidence that at least some of the pathology and symptomatology (particularly cognitive and negative symptoms) of schizophrenia results from a dysfunction of the glutamatergic system which may be modelled in animals through the use of NMDA receptor antagonists. The current review examines the validity of this model in rodents. We review the ability of acute and sub-chronic treatment with three non-competitive NMDA antagonists; phencyclidine (PCP), ketamine and MK801 (dizocilpine) to produce cognitive deficits of relevance to schizophrenia in rodents and their subsequent reversal by first- and second-generation antipsychotic drugs. Effects of NMDA receptor antagonists on the performance of rodents in behavioural tests assessing the various domains of cognition and negative symptoms are examined: novel object recognition for visual memory, reversal learning and attentional set shifting for problem solving and reasoning, 5-Choice Serial Reaction Time for attention and speed of processing; in addition to effects on social behaviour and neuropathology. The evidence strongly supports the use of NMDA receptor antagonists to model cognitive deficit and negative symptoms of schizophrenia as well as certain pathological disturbances seen in the illness. This will facilitate the evaluation of much-needed novel pharmacological agents for improved therapy of cognitive deficits and negative symptoms in schizophrenia.

Phencyclidine (PCP) is a non-competitive NMDA receptor antagonist that has been shown to induce schizophrenia-like psychotic symptoms that are clinically indistinguishable from schizophrenia in patients. When administered to rodents, PCP produces an array of behaviours that are characteristic of schizophrenia. Schizophrenia is associated with continual and treatment resistant cognitive deficits which are now recognised as a core feature of the disease. The aim of the studies reported in chapter 3 were to establish a set of objects with equal preference in the NOR (novel object recognition) test. Furthermore, the inter-trial-interval (ITI) of the NOR test was investigated in an attempt to elucidate the effects of time and location of the rats during the ITI on the cognitive impairments following sub-chronic PCP treatment. The experiments in chapter 4 were designed to compare the performance of male and female rats in the NOR test following treatment with acute d-amphetamine (d-amph), PCP and sub-chronic PCP treatment. In chapter 5, validation of the cognitive deficits induced by sub-chronic PCP treatment was assessed using carefully selected pharmacological agents. The aim of the studies in chapter 6 was to determine the effects of isolation rearing on cognitive performance in the NOR test following increasing ITIs. Additionally, the sensitivity of isolation reared rats compared to social controls following acute administration of PCP and d-amph was assessed using the NOR test. Studies in chapter 8 utilised the 16-holeboard maze to determine the effects of acute treatment with d-amphetamine, PCP and scopolamine on working memory in the rat. NOR is a visual learning and memory test that measures recognition memory which is impaired in patients with schizophrenia. Studies presented in this thesis demonstrate the importance of careful pilot studies when selecting objects for use in the NOR test. Initial studies in sub-chronic PCP (2 mg/kg for 7 days followed by 7 days drug free) treated female hooded-Lister rats revealed a preference of the rats for the wooden cone object; subsequently this object was eliminated from further NOR experiments. Sub-chronic PCP treated rats were found to be highly susceptible to the disruptive influence of distraction during the short 1 min inter-trial-interval (ITI) in the NOR test. These results are consistent with clinical findings of the effects of distraction on cognition in schizophrenia patients. Following the initial validation experiments, a 1 min ITI in the home cage was selected for all subsequent NOR studies. Further experiments provided evidence to confirm that information presented in the acquisition trial is encoded but not retained in the retention trial of the NOR test by IV PCP-treated rats. Male rats were less sensitive to the recognition memory deficits induced by acute treatment with PCP and d-amphetamine compared with females. Following sub-chronic PCP treatment, both males and females showed object recognition deficits, however, the impairments were more robust in female rats. Female rats were therefore selected for all subsequent experiments. Pharmacological validation was carried out using carefully selected agents which were assessed for their ability to restore the sub-chronic PCP induced cognitive deficit in the object recognition test. It was found that the classical antipsychotic agents haloperidol and fluphenazine, the benzodiazepine anxiolytic chlordiazepoxide and the SSRI antidepressant fluoxetine were ineffective. Further studies showed that the atypical antipsychotic agents, clozapine and risperidone, the analeptic agent modafinil, the nAChR full agonist nicotine, and full agonist and positive allosteric modulator of the ¿7 nAChR (PNU-282987 and PNU120596 respectively) reversed the recognition memory deficit induced by sub-chronic PCP treatment in the NOR test. Isolation rearing of rats at weaning is an environmental stressor that has relevance for modelling the symptomatology and pathology of schizophrenia. Isolates had a significantly increased locomotor activity (LMA) response to a novel environment and enhanced sensitivity to time delay-induced recognition memory deficits, compared with their socially reared counterparts. Isolates were less sensitive to an acute PCP-induced recognition memory deficit but more sensitive to an acute d-amphetamine induced recognition memory deficit in the NOR test compared to social controls. Preliminary results from the 16-holeboard maze experiments reveal that acute administration of the mAChR antagonist scopolamine, d-amphetamine, PCP and sub-chronic PCP treatment reduced working memory scores compared to vehicle treated controls. Taken together, these findings suggest that sub-chronic treatment with PCP induces cognitive deficits in behavioural tests of relevance to cognition associated with schizophrenia. This may allow the detection of novel pharmacotherapies to alleviate these cognitive deficits and exploration of the nature of cognitive disturbances in these patients.

No description available.

Yes / The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals. Method(s): A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave-AD scale), as well as documentation of pharmacological prescriptions and non-pharmacological management. Results: The overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p= 0.008). Nonpharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients’ admissions. Conclusions: Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion. / Alzheimer's Society; BUPA Foundation

Psychotropic drugs are commonly used group of pharmaceuticals, their main effect is to alter psychic condition, including mental diseases treatment. Symptoms of mental illnesses are more and more common, theref orenumber of patients diagnosed with mental illnes, and thus using psychotropics, is growing stronger. But using psychotropics during gestation is not without risks for mother and embryo itself. However, thanks to the absence of controlled human studies, the knowledge of emrbyotoxic effects of pschotropics is limited to casuistics, reported side effects and animal experimental studies. Many of those studies suggests emrbyotoxic potential of psychotropic drugs, on the other hand, others claim their safety. The goal of this thesis is to test at least some of them, using CHEST method, that allows us to observe direct effect of unmetabolized substance on chick embryo. In this thesis we tested selected psychotropics, very common antidepressant fluoxetine (prozac) and antipsychotic drug olanzapine, for embryotoxicity, using in ovo method CHEST with chick embryos as model organism. By bypassing the maternal organism and his metabolism, this method allows to observe direct effect of unmetabolized substance on chick embryo. Results revealed embryotoxic effect of fluoxetin in dosage 10-2 and 10-3 on 3rd and...

Seguindo como um dos transtornos mais desafiadores, apesar dos avanços dos estudos que tentam elucidar sua fisiopatologia, a esquizofrenia continua sendo objeto de estudo de pesquisa na busca de novas opções de tratamento. Explicações que vão além da teoria dopaminérgica da esquizofrenia têm estimulado pesquisas, em particular as relacionadas a neurotransmissão glutamatérgica (com foco nos receptores N-metil-D-Aspartato - NMDA), receptor influenciado por diversas substâncias além do glutamato, como por exemplo, os aminoácidos D-serina e glicina, assim como os esteroides neuroativos, como a pregnenolona. Com a existência de estudos clínicos já sugerindo efeitos positivos da D-serina e da pregnenolona, como tratamento adjuvante aos antipsicóticos, tem-se acumulado interesse pelo estudo do papel desta na fisiopatologia da esquizofrenia. Ao mesmo tempo, pergunta-se se os antipsicóticos não influenciariam de alguma maneira a neurotransmissão gabaérgica e glutamatérgica, através de alteração nos níveis da pregnenolona e/ou de aminoácidos neuroativos, como a D-serina. Assim, este estudo objetivou a avaliação dos efeitos dos antipsicóticos atípicos clozapina e ziprasidona sobre os níveis cerebrais de aminoácidos neuroativos, como a D-serina, assim como da pregnenolona. Os testes foram feitos em cérebros de ratos após o tratamento com as medicações ou o placebo, após uso agudo (1, 3 e 24 horas) e subagudo (7 e 21 dias). Com grupos de 4 a 5 ratos, as medições dos aminoácidos e dos esteroides nos cérebros foram feitas através de cromatografia líquida de alta performance (CLAP) para os aminoácidos e de cromatografia gasosa/espectroscopia de massa para os esteroides neuroativos. Os dados foram analisados com software SPSS 17, através dos testes ANOVA e pós teste Student Newman Keuls. Como resultados, não observamos alterações dos níveis dos aminoácidos após o uso das medicações quando comparadas ao placebo. Já em relação a pregnenolona, esta se mostrou aumentada após o uso dos antipsicóticos, mas este aumento não manteve sua significância após análises pós teste. Apesar de estudos já terem demonstrado diferenças nos níveis de aminoácidos após uso de antipsicóticos, em regiões cerebrais de ratos, nosso estudo não evidenciou tal influência nas concentrações globais deaminoácidos nos cérebros estudados, assim como não demonstrou mudanças nos níveis de pregnenolona após o uso agudo e subagudo dos antipsicóticos. Considerando dados prévios, que apontavam para alterações de esteroides neuroativos após uso de psicotrópicos, inclusive com estudos demonstrando previamente efeitos da clozapina nos níveis de pregnenolona, nosso estudo obteve dados discordantes, que podem ser explicados pelo desenho de uso agudo das medicações. As observações feitas no presente estudo trazem novos dados em relação ao que já existia na literatura, quanto ao potencial de alterações dos níveis cerebrais de aminoácidos e esteroides neuroativos. Assim, esperamos contribuir de alguma forma, para um melhor entendimento do mecanismo de ação das medicações antipsicóticas, apesar de ressaltar a necessidade de estudos mais amplos que avaliem as alterações nos níveis das moléculas aqui estudadas, mas que considerem mensurações em regiões específicas cerebrais. / It is considered one of the most challenging disorders, despite advances in studies that attempt to elucidate its pathophysiology, schizophrenia continues to be the subject of research in the search for new treatment options. Explanations that go beyond the dopaminergic theory of schizophrenia, have stimulated research, in particular, those related to glutamatergic neurotransmission (focusing on N-methyl-D-Aspartate - NMDA receptors), a receptor influenced by several substances besides glutamate, , amino acids D-serine and glycine, as well as neuroactive steroids, such as pregnenolone. With the existence of clinical studies already suggesting positive effects of D-serine and pregnenolone, as an adjunctive treatment to antipsychotics, interest has been accumulated in the study of its role in the pathophysiology of schizophrenia. At the same time, it is questioned whether antipsychotics would not, in some way, influence gabaergic and glutamatergic neurotransmission, through changes in the levels of pregnenolone and / or neuroactive amino acids, such as D-serine. Thus, this study aimed to evaluate the effects of atypical antipsychotics clozapine and ziprasidone on brain levels of neuroactive amino acids, such as D-serine, as well as pregnenolone. Tests were performed on rat brains after treatment with the medications or placebo, after acute (1, 3 and 24 hours) and subacute (7 and 21 days) use. With groups of 4 to 5 mice, measurements of amino acids and pregnenolone in the brains were made by high performance liquid chromatography (CLAP) for amino acids and gas chromatography / mass spectroscopy for pregnenolone. Data were analyzed using SPSS 17 software, using ANOVA and Student Newman Keuls post hoc test. As a result, we did not observe changes in amino acid levels after the use of the medications when compared to placebo. Regarding pregnenolone, it was shown to be increased after the use of antipsychotics, but this increase did not maintain its significance after post-test analysis. Although studies have shown differences in amino acid levels after antipsychotic use in rat brain regions, our study failed to demonstrate such an influence on overall amino acid concentrations in the brains studied, as well as to demonstrate changes in pregnenolone levels after use acute and subacute antipsychotics. Considering previous data, which pointed to neuroactive steroid alterations after the use of psychotropic drugs, including studies showingpreviously effects of clozapine on pregnenolone levels, our study obtained discordant data, which can be explained by the design of acute use of medications. The observations made in the present study bring new data in relation to what already existed in the literature, regarding the potential of alterations of the cerebral levels of aminoacids and neuroactive steroids. Thus, we hope to contribute in some way to a better understanding of the mechanism of action of antipsychotic medications, although it emphasizes the need for broader studies that assess changes in the levels of the molecules studied here, but that consider measures in specific regions of the brain.

The prescription rate of antipsychotics in patients with dementia varies between 20% and 50% for the common and troubling neuropsychiatric symptoms experienced by patients with dementia. The use of these antipsychotic medications has been linked with increased risk of morbidity and mortality due to associated Parkinsonism, over sedation, gait disturbances, cognitive decline, and cardiovascular adverse events. The purpose of this project was to assess whether development of an evidence-based clinical practice guideline (CPG) for a long-term care facility would increase awareness about issues that govern the safe use of antipsychotic medications. The conceptual framework for the project was Watson's model of caring. The Fineout-Overholt tool was used to rank and score information retrieved following an extensive literature review. An expert panel made up of 2 medical doctors and 4 nurse practitioners had 100% agreement that objectives were clear; content was relevant and easy to understand; the CPG was well-organized and easy to follow; and knowledge learned would be used in practice. From 66.6% to 83.3% agreed that the CGP led to an improved understanding of dementia, neuropsychiatric symptoms, medication adverse events, and nonpharmacologic interventions. The expert panel agreed to launch the CPG upon implementation of an educational program for frontline nursing staff and a behavioral log to track occurrence and frequency of behaviors and the use of nonpharmacologic interventions and their effectiveness in managing behaviors. Safe implementation of this CPG might be adapted to other long-term facilities to optimize dementia care, which would bring about a positive social change.