Objective. To identify the frequency of obesity and metabolic complications in child and adolescent users of risperidone. Potential associations with clinical parameters and SNPs of the HTR2C, DRD2, LEP, LEPR, MC4R, and CYP2D6 genes were analyzed. Methods. Samples from 120 risperidone users (8–20 years old) were collected and SNPs were analyzed, alongside assessment of chronological and bone ages, prescribed and weight-adjusted doses, use of other psychotropic drugs, waist circumference, BMI z-scores, blood pressure, HOMA-IR index, fasting levels of serum glucose, insulin, cholesterol, triglycerides, transaminases, and leptin. Results. Thirty-two (26.7%) patients were overweight and 5 (4.2%) obese. Hypertension was recorded in 8 patients (6.7%), metabolic syndrome in 6 (5%), and increased waist circumference in 20 (16.7%). The HOMA-IR was high for 22 patients (18.3%), while total cholesterol and triglycerides were high in 20 (16.7%) and 41 (34.2%) patients, respectively. SNP associations were found for LEP, HTR2C, and CYP2D6 with BMI; CYP2D6 with blood pressure, ALT, and HOMA-IR; HTR2C and LEPR with leptin levels; MC4R and DRD2 with HOMA-IR; HTR2C with WC; and LEP with ALT. Conclusions. Although not higher than in the general pediatric population, a high frequency of patients was overweight/obese, with abnormalities in metabolic parameters and some pharmacogenetic associations.

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Modelo do Estudo: Estudo de prevalência. Objetivo: Descrever o perfil sócio demográfico e clínico de pacientes com transtornos relacionados ao uso de substâncias psicoativas (SPA) atendidos pela Psiquiatria da Unidade de Emergência Referenciada (UER) do Hospital de Clínicas (HC) da UNICAMP. Métodos e casuística: Estudo descritivo e quantitativo, que avaliou os pacientes com transtornos relacionados ao uso de SPA atendidos pela Psiquiatria da UER do HC-UNICAMP no período de 12 meses a partir de maio de 2010. Resultados: Foram avaliados 350 pacientes com transtornos por uso de SPA, representando 23.8% do total dos que procuraram atendimento psiquiátrico. Maioria do sexo masculino e mais jovens do que os demais pacientes. O principal motivo de atendimento foi queixa psiquiátrica outra que não o uso de SPA (23,1%), seguido do desejo de se tratar/internar (20,8%) e intoxicação (12,5%). 38,5% tinham diagnóstico de dependência de múltiplas SPA e 34,8% dependência exclusiva de álcool; 36% apresentavam comorbidade psiquiátrica. Quando comparados com os demais pacientes avaliados pela Psiquiatria, receberam mais medicações no atendimento e foram menos encaminhados à atenção primária. Conclusão: Há elevada taxa de atendimento de pessoas com problemas relacionados ao uso de SPA na emergência psiquiátrica. Dados sobre o perfil dos atendidos podem contribuir para a melhoria da assistência a esta população

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This report aims at raising clinical awareness for the diagnosis of atypical presentations of neuroleptic malignant syndrome (NMS). We describe the case of a female patient with NMS symptoms, except fever, after starting the use of chlorpromazine. The afebrile condition delayed the consideration of NMS by the emergency clinicians who provided her initial assessment. Before this consideration, an anticholinergic agent, not recommended at this condition, was inadvertently prescribed. This might have contributed to the worsening of symptoms. NMS is a life-threatening idiosyncratic reaction most often seen as complication of antipsychotic treatment. Its clinical spectrum is broad and its diagnosis should be considered even if the patients do not fulfill all the possible described symptoms.