Psicofarmaci e disturbi cognitivi Mar Mario Amore Dipartimento di Neuroscienze Università di Parma Parma, 23 ottobre 2009 Given that depot antipsychotics can reduce the time spent in hospital, they should also be expected to reduce costs. In a pharmacoeconomic model of costs associated with depot medication in ‘revolving door’ patients (i.e. those needing frequent rehospitalization), the total direct treatment cost for a patient receiving a conventional oral antipsychotic was estimated to be US$5752. Switching the patient to a depot antipsychotic reduced this cost to $4595. In a 24-week naturalistic study of patients attending an out-patient clinic in Moscow followed by an analytical study of the same patient cohort over a hypothetical 5-year period, economic analysis showed that there was a 50% saving in total direct costs with depot medication, despite the higher acquisition costs. 1
Transcript
Psicofarmaci e disturbi cognitivi
MarMario AmoreDipartimento di Neuroscienze
Università di Parma
Parma, 23 ottobre 2009
Given that depot antipsychotics can reduce the time spent in hospital, they should also be expected to reduce costs. In a pharmacoeconomic model of costs associated with depot medication in ‘revolving door’ patients (i.e. those needing frequent rehospitalization), the total direct treatment cost for a patient receiving a conventional oral antipsychotic was estimated to be US$5752. Switching the patient to a depot antipsychotic reduced this cost to $4595. In a 24-week naturalistic study of patients attending an out-patient clinic in Moscow followed by an analytical study of the same patient cohort over a hypothetical 5-year period, economic analysis showed that there was a 50% saving in total direct costs with depot medication, despite the higher acquisition costs.
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Mood depression
Mood depression
In this way the pathogenesis of mood depression is to be considered
not only related to a cerebral neurotransmission imbalance, but also to other CNS modifications (such as neurotrophic,
neurosteroidal, hormonal alterations) and diffuse somatic changes (related to autonomic, immunological,
metabolic systems).
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Locus coeruleus
mood
Frontal cortex
cognition
limbic
driveagitationemotivity cerebellum
tremors
heartheart
tachycardiatachycardiabladderbladder
urinaryurinary hesitancyhesitancy
stemstem and and vesselsvessels
bloodblood pressionpression
NORADRENERGIC PATHWAYSNORADRENERGIC PATHWAYS
The same considerations have to be applied to all other somaticmanifestations,
particularly for noradrenergic antidepressants.
Noradrenergic system is actually linked to stress stimuli.
In depressed patients the reduced function of noradrenergicneurons
is related to the individual hypersensitivity to environmentalstressors
that causes an inadequate behavioural and somatic responce tostress
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rostralrostral rapheraphe nucleinuclei
caudal caudal rapheraphenucleinuclei
NeocortexNeocortex
HypothalamusHypothalamus
MedullaMedulla
HyppocampusHyppocampus
Limbic areasLimbic areas
BasalBasal GangliaGanglia
sexualsexual and and eatingeatingbehaviourbehaviour
CytoplasmaticCytoplasmatictransduction controltransduction control
Gene expression controlGene expression control
Antidepressants EffectsAntidepressants Effectsafter chronic after chronic somministrationsomministration
Le alterazioni osservate dopo trattamento con antidepressivi indicano inequivocabilmente un effetto regolatorio sui sistemi serotoninergici e adrenergici, che comprendono, oltre alle azioni sui recettori, anche un aumento della quantità del secondo messaggero cAMP, pur in presenza di un ridotto numero di recettori beta-adrenergici, e la conseguente attivazione di sistemi enzimatici che possono regolare la funzione cellulare attraverso la fosforilazione di specifiche proteine. Grazie anche all’affinarsi delle tecniche di indagine neurochimica, è stato osservato che un trattamento prolungato con farmaci antidepressivi è in grado di potenziare il processo della fosforilazione proteica mediata dalla proteino-kinasi cAMP dipendente di tipo II (PKA). Una delle proteine fosforilate dalla PK cAMP-dipendente è il fattore di trascrizione CREB (cAMP response element-binding protein) che media molte azioni intracellulari del cAMP a livello dell’espressione genica. Il fattore di trascrizione nucleare CREB è stato proposto come target postrecettoriale candidato a mediare le risposte adattative che si verificherebbero in seguito a trattamento prolungato con diverse classi di farmaci antidepressivi. Questo anche sulla base del fatto che CREB risulta essere regolato sia da 5-HT che da NA, neurotrasmettitori sicuramente coinvolti nella fisiopatologia e terapia della depressione.
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More recently some studies investigate the effect of antidepressantson hippocampal neurogenesis in the adult rat,using the thymidine analog bromodeoxyuridine (BrdU) as a marker for dividing cells.
