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Message for Psychiatrists

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EX XÙ¨£» Zk ƒÔ܉zËā*@ìCYðZ™wÅ(Hypnosis )/‹ð3FG454 Xƒã‚W~pg}hg¹~Ï+0 {i ÒWÃ!%) fg ÆTMš,FC;z6fÅ!% / Xö»W=g+&`´ ]Zzg zg x zZg ß,6gîÆ!%ãzۈƾZŠ / X÷Dƒ2~ºnïgZ ÖÐÄÅV ßÍ Zyā*@ÔqË~)®)´ŠÅ!%ˆÆ¾ZŠ / X] zg xB‚ê ZzgZ ‚gZ ÐVß zZ yÆ!%,6gî{+Z‡*! / ûûûìììCCC¯¯¯ŠŠŠ»ÐÐÐVVVzzzVzuuuzzzŠŠŠÃÃÃwwwh]]]¯¯¯cccZZZ™™™ìììggg»»»iii§§§{{{zzz{ztttüüü }}}ppp„zzz :::ÑÑÑ‚‚‚ ]]],,, :::;;;:;âââ ]]],,, EEE---ÊÊÊ 94 3ÆÆÆ(((Schizophrenia )))111ðððBBBGGGâââáááZZZzzzZzäää™™™¿ccc]]]æææsssîîî XXX1 (Understanding Long-Acting Injectable Antipsychotics for Better Treatment Adherence) 104 XXXMMMš,,,FFFÅÅÅÛÛÛZZZ+++DDDCCCôôôZZZÅÅÅ(((ECT ))) ```´´´©©©âââ©âŠŠŠz XXX11 (Safety and Fidelity in Electroconvulsive Therapy.) 110 XXXììì***@@@,,,777***™™™*™ooo‚‚‚»»»1ÃÃÃ&&&ZZZpppÜÜ܉‰‰zzzÆÆƬ XXX17 (Normalise That Time of the Month .) 114 XXXkkkÎÎÎYYY¢¢¢ZZZuuuZZZ,,,WWWZZZ***!!! XXX21 (Influential Israeli Spy Who Posed as an Arab ) 123 XXX÷÷÷DDDƒƒƒiiiZZZiZ+++000ZZZ,,,WWWZZZÌÌÌ,,,666VVV”””ÆÆÆyyyZZZy ]]]Z]uuuZZZzzzZ {{{z{ŠŠŠ1ÆÆÆ‚ÆÆÆ'''ZZZppp XXX30 (A mother's Experience of Early Adversity Has a Transgenerational Impact ) 126 XìììhhhÑÑÑ{{{çççÃÃÃVVVâââ***!!!iiiòòò£££~~~kkk%%%ZZZbbbZb§§§¾¾¾ÐÐÐCOVID-19 XXX33 (How Covid-19 Threatens Native Languages of Red Indians in America) 133 „(((gggzzzg ZZZz ```Z`¯¯¯ XXX40 137 ïïשּׁ¬P XXX44 141 yyy***!!!iiiòòò¸¸¸~~~ggg~gøøøzzzŠŠŠgggZZZgZ XXX48 1 EEE---ÊÊÊ 3ÆÆÆ(((Schizophrenia )))111ðððBBBGGGâââáááZZZzzzZzäää™™™¿c]]]æææsssîîî `( ´4 D ~È0*4) (Michael.W.Jan D.Pharm, FCP )8Ïp gxÔZ à yÔe~ YÚe¡â ]]]ïïïëëëZZZ E-Ê (Long Acting Injectable Antipsychotics )3Æ]c*zŠZ1ðBGâŠgŠ~ZsîD1 Xìi§+4q-Z»Oç`´ Db g~g YÒÃnÆ z~ cÅ ZkÃnçpÔ÷D™ŠšiŠ«Ã¿7ÅV7 Zy ÒZ!%D2 X’e*™* {ŠâWnÆV7 ZzgZy *Î Zi{ 0+Z»~È0*ÅVÉ%6,äWnƤçg!*ÙCX’e ŠH¬ŠF,Ñ!*Ð(Oral Antipsychotics V) CÍ (Zzg Placebo zZ) Š{6,gîÇÃV7 DZy 3 Xì E-Ê ]c*zŠZ1ðBGâŠgÆ(Second Generation )±~uzŠ (Zzg First Generation )±«D4 X÷Z Z] W,Zµ6,ŸpÔìÜq-gZ ÑzŠZ°ZÆe$ŠÃZÅV7Æ(Antipsychotics ) :÷MhYØŠÐV²z ;: â÷,Z30*k,ŠÆ±~uzŠX5 (((7[[[øøø777ŠŠŠ~~~yyyÎÎÎ000***ttt111)))XXX)XLauroxil, Paliperidone, Palmitate, Aripiprazole wwwqqq»»»!%%%qqq---ZZZ øá Å (Schizophrenia )«CÛz²I{â6nÆTì» !± ‚24 q-(Z John )'' yY" E-Ê h+×'ÅheN zZ Š KZä ÔZk ˆÆ`´ðZ’Z[x»B‚ÆVCÍÅ]c*zŠZ1ðBG⊠Xg ¶ˆÅ ÷ÐäƒÙCª g{ !*zŠ]â´āHkCä:{IZÆ ZkˆV¸¼~ËÆ XZk Å7kC] zg ¢ Xì ˆƒ ¶~ Vñ¤/ux¬ Zzg äZÏqäyYÔ6,gîðZ’ XZ ŠHc*Š g{ t»3á zZ ]æsîq-ÔZ 6,µñÆ]‡5‹ZÅ Zk Karachi Psychiatric Hospital Bulletin 94 Month March 2021 2 9N zZ Š z{ ā ¬Šä:{IZÆ zgZyÔZk ŠÆVà2Œ XZ Çá3V1Í z{ āc*Š™gïZÆÈtÐ Æ XZy å;gázÛ»Vƒ zZ ŠK yZ YāZƒx¥ÂˆÅ2Ì ÅŠZ®ÅVCÍZ# ÔZzg å;gá7Ð h+×'Éσ7~4~]â´Å Zk ÂìLg7Zc¿6,`´ÐÏ°‡!*z{ ¤/Zā c*CÐZäÒç $Ë 7,] zg ¢Åä™4ZŠ~wõ7ZÐZÂìCƒ Z[yªÅ ]ZzgZk â´¤/ XZzgZ ìykZ»!Zy Xì Ø?HÙC„yYp¤/XZ ŠHH7 g{ !*zŠ g{ t» (Long Acting Injections )3Cæsî 3 Cæ sî Ì ä :{ IZ Æ XZk 1 ™ ègZ ÐZ ä nç p Ôå ;g™ kC XìÅe$×Å`´Ð (Long Acting Injections ) E +i E5éG4¢jXìCƒ~4~]gßÅ`´Ð(Long Acting Injections )3Š~Zsî G-4E& [ø7Š~M%Z~1960 (LAI )qCæsî»±« (Ô Fluphenazine enthate ) ïHŸW GZ E Zw i+cì ZZzg ƒ[ø7Š~}‚Æ1970 (Fluphenazine decanoate ),Mre+i E5éG4¢jZƒ XŠHƒ[ø7Š~ð;ŠÅ 1980 (Haloperidol decanoate ),Mre ¡%O%ZÃ(Risperidone microsphere () LAI )qŠÓZsîª »±~uzŠD XåHgà~2003 ä(FDA ) :÷[ø7Š(LAI ) 3ŠOZsîƱ~uzŠvŠ&sÜ܉z DZk (Zzg Paliperidone palmitate Zy) i+c³ (Ô Olanzapine pamoate )àZ DZz * 7 45G", (7ŠñÌðÃÐ~ Zy ~yÎ01 X) ÷[øŠ(Aripiprazole lauroxil izw) F5éGFkZ E 3}uzŠzŠ z{ ´Æ(inj. Fluphenazine )+i E5éG4¢j bZ¬Æ]æsîƱ« £G-G4E5F" £G-G4E5F" Ì(Inj. Flupentixol Depot w) ði½ j (Zzg Inj. Clopenthixol Depot w) ði½ ³ X÷[ø7Š~yÎ0* E-Ê E-Ê Ì3Æ ]c*zŠZ Å 1ðBGâŠgƱ~uzŠ Zzg ±«)]c*zŠZ1ðBGâŠg LAI Ʊ~uzŠ Å (FDA )¡%O%ZÌnÆ`´ zgZy ŠÆàbc*ð’ZÆ(Schizophrenia )«CÛz² Karachi Psychiatric Hospital Bulletin 95 Month March 2021 3 Ùp (Zzg Schizo Affective Disorder )ä8L c*›«CÛzçEG.¿]à XZy ìÝq g~ àÐs§ XìŠHHgàÌnÆ(Bipolar Affective Disorder)8L c*Zzg .Å X÷ W,ñ{Šc*i3 ŠG5é š Z sî~ «£Æ VCÍ Å «CÛzæE¾]āì Zƒ "$U*Ð V1Š k$ (Risperidone V) 1ÍÅ zy i+çG.F2 Gg~ïq-Z~«£(LAI )Ʊ~uzŠ» LAI Ʊ« » ¤/B5.0±11.7 Haloperidol i+ ì ¤/B1.9±4.9 XH¨£ Zx( gZu p () Zy) c Zx(Zzg E gZu p H¢ E-Ê (397 =N () Schizophrenia or Schizo affective disorder Wgeg) ek ðG34»G5 zZ ²c*1ðBGâ k$ X¶W,ñ{Šc*i zy i+çGF.2 Gg ~ VÉ%Æ iÕ E-Ê z{ ÂÔìCƒÐ`´B‚Æ]c*zŠZ1ðBGâŠg] zg ¢Åw¸NŠCæsîÃ!%ÌËÑßZ E-Ê X÷ Cƒ :]c*zŠZ 1ðBGâ Šg Å ±« pì Y™ wEZ (L A I ) q ŠOZ sî EE E-Ê Z] W,ZµÆ äš/ ZzgZ õ/F4& »6,Ÿ~ ±~uzŠ Å (LAI )3Æ ]c*zŠZ 1ðBGâ ŠgŠOZ sî E-Ê ]c*zŠZÅ1ðBGâ51ÔìCY~ŠßF,ÐzzÅäƒÁ Z] W,ZtÆ(Extra pyramidal effects ) {X )z*ƒ{Šc*i» Ôziy −(,»]~ypā‰÷ Z] W,Zµ™LZÆ āāāÜÜÜ E-Ê E » - p ø7Š Æ Çà Û Šc* 40 ðBG⊠LAI Ú wZ Z Zy JEÌZ ÷[ n y ëZ Ðá²{ iÐw‚ 1 (g ) H¢ E-Ê Wgeg ek ðG34»G5 zZ ² c*1ðBGâ ~ ïò*ACLAIMS X’e *ƒ A @*ƒ 7 .24ÓG5F" .Å zy i+çGFG bZŠG5é š Z sî~ VÉ%á (zZ Schizophrenia or Schizo affective ) B‚ÆInj. Haloperidol Deconate zw) i+cß; » (Inj Paliperidone Palmitate ) E-Ê .Å k,Š¼ÐVCÍnÆ`´Æ1ðBGÃâ V7ŠG5é š ZsîƱ~uzŠXc*0*W,ñ‚q-ZÃVâzŠ Zzg H: Zi ñ EB-Ê J/43 µÂ÷D™ `´B‚Æ]c*zŠZÅ 1ðGâƱ~uzŠZ# X õG Xe*™* wEZˆÆä™ `´ ~yp ziyZzg éZn XZk ÷ −(,]~yp−(, ziy ª(Metabolic Syndrome ) Z] W,Z Karachi Psychiatric Hospital Bulletin 96 Month March 2021 4 6,V²zZÆ`´ (Zzg Hb1Ac )RÅ]Å{â3D6~ypÔ]~ypìg.nÆãZôÅ] Xìï÷á (Lipid Profile ) E-Ê ((( Abnormal Involuntary Movement Scale DDDAIMS )))g£ »•wÅŸ¬Ð ä™ zq Ñ]c*zŠZ 1ðBGâŠg E-Ê E-Ê B‚Æ1ðBGâŠgƱ~uzŠ:Ñ‚ Zzg B‚Æ1ðBGâŠgƱ«ˆ{â6ÙCÁ Zi ÁXìCYÅ gl \Å X’e*Yc*ZÙCŠ c*C~`´ÆPaliperidone Palminate Æ{â1 (Zzg Haloperidol decanoate LAI ) H4 5Å Ô Z] W,ZtÒÔ†ŸZ~ Zg lÅ (Prolactin )èE»Gz6,~ypÔª,™«™ Zzg q-Zāì ŠH X¸7Z]u zZ Æ(Galactorrhea )Â_|ŠzŠ (Zzg Gynecomastia ) −(,»VZY Karachi Psychiatric Hospital Bulletin 97 Month March 2021 5 Understanding Long-Acting Injectable Antipsychotics for Better Treatment Adherence Michael W. Jann, PharmD, FCP www.Psychiarictimes.com/view/assessing_malingered_voice_hearing Clinical Pearls - Long acting injectable antipsychotics (LAI) offer treating clinicians a viable option for the long term management of symptoms. - Patients often decline the offer of a (LAI ) psychotic at first, but this should not discourage clinicians from continuing the discussion at follow up visits; patient adherence should be assessed at every visit. - (LAI) antipsychotics have been shown to be better than placebo and oral antipsychotics in experimental and real world be studies. - The efficiency data of LAI first generation and second generation antipsychotics are similar, but their safety profiles differ. - Two LAI second generation antipsychotics can be given at greater than monthly intervals: Paliperidone Palmitate, Ariprazole Lauroxil. (Not available in Pakistan). CASE VIGNETTE "John" is a 24-year-old male who 6 months ago received a diagnosis of schizophrenia. After successful initial treatment with an oral antipsychotic, he felt no further need to take his medications. Subsequently, over the next several months, his family noticed that delusional symptoms began reappearing and withdrawal behaviors from current activities increased. Karachi Psychiatric Hospital Bulletin 98 Month March 2021 6 At his next outpatient appointment, the prospect of a long-acting inject able antipsychotic was introduced. Initially, John refused the injectable antipsychotic saying that he can take oral medications. Over the next 2 weeks, his family noticed that only part of his medication was taken and, when looking over the number of tablets, it appeared that John was taking about half of his medication. His clinician told him that if inconsistent adherence to treatment continues, the symptoms likely will not get better and could get worse. If the symptoms and his thinking get worse, he may need to be hospitalized The option of a LAI was reintroduced. Although John was seemingly reluctant, he was convinced by the treatment team and agreed to give the LAI a try for the next few months. His family whole-heartedly supported the LAI option knowing that this option would eliminate gaps in his pharmacotherapy. Long-acting injectable (LAI) antipsychotics address both adherence and nonadherence issues. Fluphenazine enthate, a first-generation antipsychotic, became available as a LAI in the US in the 1960s; Fluphenazine Decanoate LAI became available in the 1970s; and Haloperidol Decanoate LAI became available in the 1980s. - The first second-generation antipsychotic LAI, Risperidone Microsphere, was FDA approved in 2003. - Only three other LAI second-generation antipsychotics are currently available: - Olanzapine Pamoate, Paliperidone palmitate, and Aripiprazole (available as monohydrate and lauroxil formulations). - Paliperidone palmitate has two formulations for monthly or three-month injection intervals. - Aripiprazole lauroxil also has formulations that allows for monthly, a 6-week, or 8-week administration intervals.
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