Objectives: This study aimed to describe the clinical outcomes related to theintroduction of Paliperidone Palmitate in a specialty hospital in the Philippines. Methodology: Cross-sectional study among patients with Schizophrenia seen at thepsychiatry service of a specialty hospital catering to war veterans who were initiated onPaliperidone Palmitate. We reviewed and abstracted baseline patient data from themedical record of eligible patients. Outcome of treatment was collected through a one-time objective assessment of the patient by a third-party psychiatrist using theStructured Clinical Interview for Symptoms of Remission (SCI-SR) tool. Results: A total of 30 patients were recruited for the study from August 2020 and June2021, the majority of whom were males (80%), residents of the National Capital Region(50%) and single (20%). The median duration from schizophrenia diagnosis to initiation of Paliperidone treatment was 19.50 years (IQR: 16.60 – 33.50). In eight patients (22.67%),other antipsychotic drugs were discontinued following initiation of Paliperidonetreatment; in the remaining 22 participants (73.33%), Paliperidone was taken concurrentlywith other antipsychotic drugs. The median duration from the initiation of Paliperidonetreatment to follow-up assessment was 27.20 months (IQR: 24.73 – 30.50), with allparticipants having at least 6 months of treatment. At follow-up assessment, allparticipants were classified to be in remission. Conclusion In this study among patients with schizophrenia seen in a specialtyhospital in the Philippines, we found evidence that clinical outcomes with PaliperidonePalmitate were comparable to those given a combination of oral and long- actingantipsychotics.
Paliperidone Palmitate ; Schizophrenia

The purpose of this study was to investigate the effect of glutamate and its ionotropic receptor agonists on the response to acute hypoxia in rat carotid body in vitro. Briefly, after SD rats were anesthetized and decapitated, the bilateral carotid bifurcations were rapidly isolated. Then bifurcation was placed into a recording chamber perfused with 95% O₂-5% CO₂ saturated Kreb's solution. The carotid body-sinus nerve complex was dissected, and the carotid sinus nerve discharge was recorded using a suction electrode. To detect the response of carotid body to acute hypoxia, the chamber was perfused with 5% O₂-5% CO₂-90% N₂ saturated Kreb's solution for a period of 100 s at an interval of 15 min. To observe the effect of glutamate, ionotropic α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor agonist AMPA or N-methyl-D-aspartate (NMDA) receptor agonist NMDA on the response to acute hypoxia in rat carotid body, the chamber was perfused with 5% O₂-5% CO₂-90% N₂ saturated Kreb's solution containing the corresponding reagent. The results showed that glutamate (20 μmol/L), AMPA (5 μmol/L) or NMDA (10 μmol/L) inhibited the acute hypoxia-induced enhancement of carotid sinus nerve activity, and these inhibitory effects were dose-dependent. In summary, the activation of glutamate ionotropic receptors appears to exert an inhibitory effect on the response to acute hypoxia in carotid body of rats.
Rats ; Animals ; Glutamic Acid/pharmacology* ; alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid/pharmacology* ; N-Methylaspartate/pharmacology* ; Carotid Body ; Rats, Sprague-Dawley ; Carbon Dioxide ; Receptors, N-Methyl-D-Aspartate ; Receptors, AMPA ; Hypoxia

OBJECTIVE: To investigate the effect of parecoxib sodium preemptive analgesia on pain and stress response after surgery in elderly hip fracture patients. METHODS: The clinical data of 70 elderly patients with hip fracture treated in our hospital from October 2017 to October 2019 were prospectively analyzed. According to different analgesic patterns, 35 cases were randomly divided into experimental group, aged 65 to 86(78.5±9.1) years, 21 males and 14 females, including 18 femoral neck fractures and 17 femoral intertrochanteric fractures. There were 35 cases in control group, aged 66 to 88 (80.6±8.1) years, 18 males, and 17 females, including 20 cases of femoral neck fractures and 15 cases of intertrochantericfractures. The visual analogue scale (VAS) at 4 h, 12 h, 24 h, 48 h, and 72 h after surgery, the incidence of delirium and stress indicators of malondialdehyde (MDA), superoxide dismutase (SOD), cortisol (COR), and epinephrise (E) postoperatively in the two groups were observed. RESULTS: At 4 h, 12 h, 24 h, 48 h after surgery, the VAS score of experimental group was lower than that of the control group, and the difference was statistically significant ( CONCLUSION The advanced analgesic application of parecoxib sodium can significantly reduce the postoperative stress response of elderly hip fracture patients, enhance the postoperative analgesic effect, reduce the incidence of postoperative delirium, and improve the quality of rehabilitation of patients.
Aged ; Analgesia ; Female ; Hip Fractures/surgery* ; Humans ; Isoxazoles ; Male ; Pain ; Prospective Studies ; Treatment Outcome

The Community Mental Health Program (CMHP) of the Center for Health Development Calabarzon is an initiative that aims to integrate mental health into primary care to facilitate person-centered and holistic services. At the core of CMHP is a referral pathway between health centers and tertiary-level mental health services for the diagnosis and continuing management of persons with mental health conditions, as well as the use of an innovative medication (specifically for schizophrenia). This commentary presents lessons learned from a one-year implementation of CMHP in four pilot sites in the provinces of Rizal and Laguna, which stakeholders in mental health may consider in the design of community-based mental health programs to further the mandate of the Mental Health Act.
Schizophrenia ; Mental Health Services ; Program Evaluation ; Paliperidone Palmitate

OBJECTIVE: To explore the effect of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative pain management in patients undergoing pancreaticoduodenectomy. METHODS: This randomized controlled trial was conducted among 98 patients undergoing pancreaticoduodenectomy in the Department of Biliary Surgery of West China Hospital between March, 2017 and August, 2018. The patients were randomized to receive perioperative analgesia with local infiltration anesthesia with ropivacaine combined with multimodal analgesia with parecoxib (experimental group, =50) or postoperative analgesia with dizosin (control group, =48). The regimens for intraoperative anesthesia and postoperative pain relief were identical in the two groups. The differences in NRS pain score, use of pain relief agents, the incidences of adverse reactions to analgesia and wound infection, and the time to first ambulation and first flatus passage after the operation were compared between the two groups. RESULTS: At 12, 24 h, 48 h, 72 h and 7 days after the operation, the patients in the experimental group had significantly lower NRS scores ( < 0.05) than those in the control group. The rate of use of rescue analgesics was significantly lower in the experimental group than in the control group (32% 66.67%, < 0.05); the rate of tramadol hydrochloride use was also significantly lower in the experimental group ( < 0.05). Compared with those in the control group, the patients in the experimental group showed a significantly lower total incidence of adverse reactions (22% 54.17%, < 0.05) as well as a lower incidence of nausea and vomiting ( < 0.05), an earlier time of first ambulation and first flatus passage after the operation ( < 0.05), and a shorter postoperative hospital stay ( < 0.05). CONCLUSIONS In patients undergoing pancreaticoduodenectomy, local infiltration of ropivacaine combined with multimodal analgesia with ropivacaine can effectively relieve perioperative pain, reduce the use of relief analgesics, lower the incidence of adverse reactions, and promote the recovery after the surgery.
Analgesia, Patient-Controlled ; Analgesics, Opioid ; Anesthetics, Local ; China ; Double-Blind Method ; Humans ; Isoxazoles ; Pain Management ; Pain Measurement ; Pain, Postoperative ; Pancreaticoduodenectomy ; Ropivacaine

OBJECTIVE: To observe and evaluate the clinical effect of intra-articular injection of parecoxib in patients with early knee osteoarthritis. METHODS: From September 2016 to August 2017, 107 patients with early knee osteoarthritis were treated, including 50 males and 57 females, aged 45 to 64 (51.9±4.2) years. They were divided into basic therapy+oral glucosamine group(group A) 36 cases, oral celecoxib+basic therapy+oral glucosamine group(group B) 36 cases, intra-articular injection of parecoxib+basic therapy+oral glucosamine group(group C) 35 cases. There was no significant difference in gender, age, BMI and clinical stage(Kellgren-Lawrence classification) between the three groups before treatment. VAS score, HSS score and patient satisfaction were compared before and after treatment in the three groups. The levels of inflammatory cytokines in synovial fluid were measured before and after treatment in the three groups. RESULTS: All cases were followed up for(15.2±2.6) months on average. The VAS score and HSS score of each group were improved after treatment(<0.001). There were significant differences in VAS and HSS scores among the three groups after treatment(<0.001). The clinical efficacy of group C was better than that of group A and B(<0.001), group B was better than that of group A(<0.001), and group C had the highest satisfaction(<0.001). After treatment, the concentration of proinflammatory factor TNF-α and IL-6 in the synovial fluid of each group decreased(<0.001) and the concentration of anti-inflammatory factor IL-10 increased(<0.001). After treatment, the concentrations of TNF-α, IL-6 and IL-10 in the synovial fluid of the three groups were significantly different(<0.001). CONCLUSIONS For patients with early knee osteoarthritis, intra-articular injection of parecoxib can significantly improve clinical symptoms and avoid adverse reactions of long-term oral NSAIDs, which is an effective treatment.
Adult ; Aged ; Female ; Humans ; Injections, Intra-Articular ; Isoxazoles ; therapeutic use ; Male ; Middle Aged ; Osteoarthritis, Knee ; drug therapy

Cordycepin exerts neuroprotective effects against excitotoxic neuronal death. However, its direct electrophysiological evidence in Alzheimer's disease (AD) remains unclear. This study aimed to explore the electrophysiological mechanisms underlying the protective effect of cordycepin against the excitotoxic neuronal insult in AD using whole-cell patch clamp techniques. β-Amyloid (Aβ) and ibotenic acid (IBO)-induced injury model in cultured hippocampal neurons was used for the purpose. The results revealed that cordycepin significantly delayed Aβ + IBO-induced excessive neuronal membrane depolarization. It increased the onset time/latency, extended the duration, and reduced the slope in both slow and rapid depolarization. Additionally, cordycepin reversed the neuronal hyperactivity in Aβ + IBO-induced evoked action potential (AP) firing, including increase in repetitive firing frequency, shortening of evoked AP latency, decrease in the amplitude of fast afterhyperpolarization, and increase in membrane depolarization. Further, the suppressive effect of cordycepin against Aβ + IBO-induced excessive neuronal membrane depolarization and neuronal hyperactivity was blocked by DPCPX (8-cyclopentyl-1,3-dipropylxanthine, an adenosine A₁ receptor-specific blocker). Collectively, these results revealed the suppressive effect of cordycepin against the Aβ + IBO-induced excitotoxic neuronal insult by attenuating excessive neuronal activity and membrane depolarization, and the mechanism through the activation of A₁R is strongly recommended, thus highlighting the therapeutic potential of cordycepin in AD.
Action Potentials ; Adenosine ; Alzheimer Disease ; Fires ; Ibotenic Acid ; Membranes ; Neurons ; Neuroprotection ; Neuroprotective Agents ; Patch-Clamp Techniques ; Pyramidal Cells

The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2018 (KMAP-BP 2018) with other recently published guidelines for treating bipolar disorder. We reviewed a total of five recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2018 with those of other guidelines. For initial treatment of mania, there were no significant differences across treatment guidelines. All guidelines recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or a combination of an MS with an AAP as a first-line treatment strategy for mania. However, the KMAP-BP 2018 did not prefer monotherapy with MS or AAP for psychotic mania. Quetiapine, olanzapine and aripiprazole were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Most guidelines advocated newer AAPs as first-line treatment options for all phases while lamotrigine was recommended for depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. As research evidence accumulated over time, recommendations of newer AAPs (such as asenapine, cariprazine, paliperidone, lurasidine, long-acting injectable risperidone and aripiprazole once monthly) became prominent. KMAP-BP 2018 guidelines were similar to other guidelines, reflecting current changes in prescription patterns for bipolar disorder based on accumulated research data. Strong preference for combination therapy was characteristic of KMAP-BP 2018, predominantly in the treatment of psychotic mania and severe depression. Further studies were needed to address several issues identified in our review.
Aripiprazole ; Bipolar Disorder ; Depression ; Drug Therapy ; Lithium ; Paliperidone Palmitate ; Prescriptions ; Quetiapine Fumarate ; Risperidone ; Valproic Acid

Aripiprazole is an atypical antipsychotic that acts as a partial agonist of dopamine type 2 receptors as well as 5-HT1A receptors. It is used in the treatment of schizophrenia and in type 1 bipolar disorder for mania. Because aripiprazole is well tolerated with few side effects it is used off-label in other psychotic disorders. The prevalence of abnormal liver function tests with antipsychotic use is 32%, with clinically significant effects in 4% of cases. No cases of aripiprazole-induced liver injury have been published. We report a 28-year-old female who presented with non-affective first-episode psychosis and who was treated with aripiprazole. Initially she was medicated with 10 mg per day, with an increase to 20 mg per day on the 12th day of hospitalization. Nine days after she became icteric, with nausea and had a vomiting episode. Laboratory analysis revealed a very high level of alanine aminotransferase, and minor to moderately high levels of aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, and bilirubin. Aripiprazole was tapered and paliperidone was started with the improvement of clinical and laboratory findings.
Adult ; Alanine Transaminase ; Alkaline Phosphatase ; Aripiprazole ; Aspartate Aminotransferases ; Bilirubin ; Bipolar Disorder ; Dopamine ; Female ; Hepatitis ; Hospitalization ; Humans ; Liver ; Liver Function Tests ; Nausea ; Paliperidone Palmitate ; Prevalence ; Psychotic Disorders ; Receptor, Serotonin, 5-HT1A ; Schizophrenia ; Transaminases ; Transferases ; Vomiting

OBJECTIVE: Whether long-acting injectable antipsychotics (LAI) are superior to oral antipsychotics remains a controversial question, and results vary depending on the study design. Our study was performed to compare outcomes of oral anti-psychotics and paliperidone palmitate (PP) in clinical practice by investigating the numbers of admissions and bed days. METHODS: We performed a retrospective observational mirror-image study at a single medical center, reviewing medical charts to obtain the clinical data. Forty-six patients with a diagnosis of schizophrenia or schizoaffective disorder who had received at least two doses of PP were included in the analysis. The Wilcoxon signed-rank test was used to compare the numbers of bed days and admissions 1 year before starting PP with those numbers at 1 year after. RESULTS: The mean number of admissions fell from 0.83 to 0.17 per patient (p < 0.0002), and the median fell from 1 to 0. The mean number of bed days decreased significantly, from 24.85 to 8.74 days (p < 0.006). The outcomes remained similar in sensitivity analyses set up with different mirror points. CONCLUSION: Our results indicate that initiating PP reduced the mean numbers of hospital admissions and bed days compared with prior oral medication. LAIs may thus be cost effective in practice; its use bringing about cost reductions greater than its purchase cost.
Antipsychotic Agents ; Diagnosis ; Hospitalization ; Humans ; Paliperidone Palmitate ; Psychotic Disorders ; Retrospective Studies ; Schizophrenia