IS Amisulpride a great drug for Schizophrenia? Part 2

So what does this mean for the consumer?

The studies by the reviewers confirmed that Amisulpride is an effective 'atypical' antipsychotic drug for patients with schizophrenia. Amisulpride also is just as effective as risperidone or olanzapine. Overall, it was discovered to produce improved results such as enhancement of overall mental state and wide-ranging negative symptoms. Amisulpride may be more tolerable and acceptable than the conventional antipsychotics, especially when it comes to the motor side effects (e.g. extrapyramidal side effects).

The individual who is being treated with an older conventional anti psychotic may want to switch to Amisulpride if he or she has developed motor side effects or has negative symptoms of schizophrenia. For those individuals who are on risperidone or olanzapine, there is no solid evidence that Amisulpride is any better or worse. More studies are required to determine what role Amisulpride has on family responsibility, quality of life, and expense of the drug in the long term.

http://www.cochrane.org/reviews/en/ab001357.html

IS Amisulpride a great drug for Schizophrenia? Part 1

Drugs for the treatment of schizophrenia have been available for more than 50 years. Even though the older anti psychotic drugs are effective, they have many side effects. Over the years many newer anti psychotics have been developed. One of the most recent anti psychotic drug on the market is Amisulpride. Amisulpride is said to be an "atypical" antipsychotic that induces less movement disorder and is effective for the negative symptoms of schizophrenia. The “negative” symptoms include an inexpressive faces, blank looks, monotone, monosyllabic speech, few gestures, seeming lack of interest in everything, inability to feel pleasure or act spontaneously.

Many physicians have started to prescribe Amisulpride for treating their schizophrenic patients. The overall feeling is that the drug is safe and has fewer side effects compared to the older conventional anti psychotic drugs. However, Amisulpride is a much more expensive compared to the traditional drugs but is the expense worth it?

Cochrane reviews recently looked at several studies that compared Amisulpride with placebo, typical and atypical antipsychotic drugs for schizophrenia. The researchers looked at 19 randomized clinical studies with 2443 individuals. Data from four studies indicated that schizophrenics with negative symptoms did show improvement at doses of up to 300 mg/day. Not only was Amisulpride more effective than a placebo, but also it was better tolerated than the typical anti psychotic drugs. Amisulpride was less prone to cause strange motor symptoms. When Amisulpride was contrasted to one of the other atypical anti psychotic medication. Risperidone, with the exclusion of agitation, which was more common in the Amisulpride group no significant differences were documented on effectiveness or tolerability.

Aroma Oil Therapy for Dementia: Part 2

Evaluation of results revealed that there was a statistically significant treatment effect in support of aroma oil therapy intervention on measures of anxiety, agitation and neuropsychiatric symptoms.

So what does this mean for the consumer?

The results of one small study do indicate that aroma oil therapy has some benefits in individuals with dementia. However, it is hard to draw conclusions because the study was short, the number of patients small and there were some methodological problems in evaluating the study. Only a well designed randomize controlled study will determine if the effects of aroma oil therapy are real and beneficial in patients with dementia. In any case, the study did not reveal any major side effects from use of aromatic oils and there is little harm in trying these products.

No one really knows when one should start aromatic oils and for how long the treatment has to be continued in order to prevent or diminish symptoms of dementia. Until more data are available, consumers will have to make their own decisions on use of aromatic oils for dementia.

http://www.cochrane.org/reviews/en/ab003150.html

Aroma Oil Therapy and Dementia: Part 1

The treatment of dementia is not satisfactory and many caregivers/patients have been opting for non-conventional therapy. One such alternative therapy that has been hyped up to delay or prevent dementia is aroma oil therapy. Aroma oil therapy has been widely used to treat a number of medical ailments including insomnia, depression, anxiety and pain. Aroma oil therapy essentially involves use of pure essential oils from various fragrant plants like peppermint, sweet marjoram, and rose. The apparent minimal side effects of aromatherapy has been of magnetic attraction to alternative health care practitioners and patients.

Many herbal and health food stores advertise aromatic oils as first choice therapy in order to reduce symptoms of dementia and disturbed behavior. Anecdotal reports indicate that aromatic oils can also promote sleep and stimulate motivational behavior. It is for these reasons that many patients have increasingly turned to aromatic oils rather than pharmacological therapies.

At present, thousands of individuals use aromatic oils for personal health care. These products are readily available, do not require a prescription, and are relatively inexpensive. The question is. “do aromatic oils help treatment of dementia?”

The number of randomized studies looking at the benefits of aromatic products are small and solid data are difficult to come by. Recently Cochrane reviews looked at data from one small study where aromatic oil therapy was used for the treatment of agitation and other neuropsychiatric symptoms in individuals with dementia.

Do centrally acting anti hypertensive medications reduce dementia? Part 2

So what should patients do in the meantime?

It is far too early to start advocating ACE inhibitors for all elderly patients. Switching patients to centrally acting ACE inhibitors is a difficult and an expensive undertaking and should only be done on a case-by-case basis. The director of the above study, Dr Sink, recommends that, “if the patient does not have a contraindication for an ACE inhibitor, then switching to a centrally active ACE inhibitor is a reasonable choice. In addition, for those already on ACE inhibitors, our study results would support the use of a centrally active ACE inhibitor over a non–centrally active one."

Centrally active ACE inhibitors included captopril (Capoten, Bristol-Myers Squibb), fosinopril (Monopril, Bristol-Myers Squibb), lisinopril, perindopril, ramipril (Altace, King Pharmaceuticals), and trandolapril (Mavik, Abbott Laboratories). Non–centrally active ACE inhibitors included benazepril (Lotensin, Novartis Pharmaceuticals), enalapril (Vasotec, Merck), moexipril (Univasc, Schwarz Pharma), and quinapril (Accupril, Pfizer).

The study is published in the July 13 issue of Archives of Internal Medicine.

http://www.medscape.com/viewarticle/706401

Can Centrally Acting anti hypertensive medications reduce Dementia? Part 1

Angiotensin-converting enzyme (ACE) inhibitors are important for control of blood pressure and have made a profound impact on patients with diabetes and congestive heart failure. The ACE inhibitors, which act outside the brain, have had minimal impact on dementia of any cause. However, there is now evidence indicating that ACE Inhibitors which act inside the brain, may have the ability to reduce cognitive decline.

Recent observational data from the Cardiovascular Health Study revealed that that centrally active ACE inhibitors did diminish cognitive decline by 65% per year of exposure, an effect that is likely related to the drug’s ability to cross the blood-brain barrier.

The study included 414 subjects who had been administered ACE inhibitors and 640 who had taken other antihypertensive medications. The researchers found no connection between exposure to all ACE inhibitors and risk for dementia, difference in cognitive-function scores, or odds of disability.

However, further analysis according to type of ACE inhibitor showed an unusual benefit. The results revealed that centrally active ACE inhibitors were associated with 65% less decline in cognitive-function scores per year of exposure.

This lessening in cognitive decline is not felt to be due to better control of blood pressure but most likely related to the drug’s effects on the brain's intrinsic renin-angiotensin system, which is felt to be valuable in memory and cognition. There is some laboratory evidence showing that stimulation of the renin-angiotensin system also provokes activation of inflammatory mediators which have been implicated in causing degenerative dementias.

For patients with dementia, this may be good news. There has been a huge public demand to find an intervention that can prevent or slow cognitive decline. However, the above study has to confirmed in a randomized clinical trial to determine if the above results are in fact a true observation.

Finally a treatment for hair pulling? Part 2

How N acetyl cysteine prevents hair pulling is not fully understood but is believed to act in the brain and reduces activity of a neurotransmitter, called glutamate. It is believed that glutamate mat play a role in the compulsion to pull hair. When levels of glutamate are reduced, the drive to pull hair also disappears.

There have been previous anecdotal reports and case series which have also reported that N acetyl cysteine may reduce the urge to use illicit drugs like cocaine.

The dose of N acetyl cysteine used in the study varied from 1.2- 4 grams per day. Even though hair-pulling episodes declined, most individuals did not see a marked improvement in their quality of life.

So what about the individual who has Trichotillomania?

One should understand that this is only one study that shows benefits of N acetyl cysteine for hair pulling. The supplement is easily available without a prescription from any health food store and is relatively safe to ingest. The cost of N acetyl cysteine is also substantially lower than all presently prescribed drugs for the disorder. Therefore, if you have a habit of puling your hair and would like to stop it, N acetyl cysteine may not be a bad idea. Of course, if it does not work within 2-3 months, then the above study was hogwash.

Archives of general psychiatry, 2009-07-18