Some of the selective serotonin reuptake inhibitors (SSRI)-induced motor side effects are mediated by stimulating 5-HT2 receptors in the basal ganglia, probably because serotonin inhibits the subsequent neuronal dopamine release. We hypothesized that nefazodone, a serotonin 2 antagonist/reuptake inhibitor (SARI) that selectively blocks 5-HT2 receptors, could disrupt the aforementioned inhibitory pathway. Therefore, increased dopamine levels in the postsynaptic milieu and an improvement in the motor symptoms in depressed patients with Parkinson disease (PD) should be observed. This study was designed to determine whether nefazodone has a dual activity as an antidepressant and as an agent capable of reducing the extrapyramidal symptoms in depressed parkinsonian patients. Depressed patients with PD were randomly assigned to 2 therapeutic groups: nefazodone or fluoxetine. Patients were evaluated by a psychiatrist and were blindly assessed by a neurologist with an array of scales. Patients on nefazodone (n = 9) showed a significant improvement over time in the total Unified Parkinson Disease Rating Scale score (UPDRS) (part II + part III) (P = 0.004) and in the UPDRS subscore part III (P = 0.003). None of these scores changed over time in the fluoxetine group (n = 7). Both, nefazodone and fluoxetine were equally effective as antidepressants: Beck Depression Inventory scores significantly improved (P < 0.001), with no significant differences between treatment groups (P = 0.97). If our results can be confirmed in a larger clinical trial, nefazodone ought to be considered over fluoxetine given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms in depressed PD patients.

Depression and sleep disorders are among the most prevalent nonmotor symptoms of Parkinson disease (PD). Because agomelatine acts as a MT1 and MT2 agonist and as a 5HT2c antagonist, this study was designed to assess the efficacy of agomelatine in treating depressive symptoms in PD patients, and the potential changes both in sleep quality and motor symptoms. Depressed patients with PD were treated with agomelatine for 6 months, and they were evaluated with an array of scales. Completed nocturnal video-polysomnography was performed at baseline and week 12. The efficacy analysis population included 24 patients (12 men). The mean (SD) age was 75.2 (8.3) years. The mean (SD) daily dose of agomelatine was 25.00 (10.43) mg at 24 weeks. No changes in dopamine replacement therapy were made. There was a significant decrease in the 17-item Hamilton Depression Scale score over the course of the study (P < 0.0005). The Scales for Outcomes in Parkinson disease Sleep Questionnaire showed a statistically significant improvement over time in each of its subscales: nighttime sleep (P < 0.005), last month nighttime sleep (P < 0.0005), and daytime sleepiness (P < 0.0005). Surprisingly, changes over time in the motor subscale of Unified Parkinson Disease Rating Scale were statistically significant (P < 0.0005). Periodic limb movements and awakenings measured by polysomnography improved significantly (P < 0.005 and P < 0.05, respectively). We concluded that the use of agomelatine in PD depressed patients may have a considerable therapeutic potential because of its dual action for treating both symptoms of depression and disturbed sleep given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms.

In ischaemic stroke patients, systolic BP over 180 mmHg in the first 6 h and a decrease of diastolic BP during the 6-24 h from stroke onset were independent predictors of a poor functional recovery.

BackgroundThe rheumatoid arthritis (RA), as known, causes inability in various performance areas mostly in the musculoskeletal, but few is known about psychological, sleep and sexual problems.ObjectivesThe aim of this study is to describe the socio-demographic profile of patients with RA in specialized RA clinic in Colombia, where we identified disorders in areas besides the physical or musculoskletal, like psychological, sexual and sleep.MethodsA descriptive study was performed in a specialized clinic dedicated to care patients with RA. 1298 RA patients were included in the study, which were seen by the area of psychology; information was collected through semi-structured interviews and non-probability sampling, also using classificatory criteria of pathologies described in CIE 10 diagnostic manual, applying descriptive epidemiology for continuous variables, measure of central tendency and dispersion for qualitative and categorical variables through percentages and averages.ResultsTotal sample of patients was 1298, 1048 (80%) were women and 250 (19%) were men. Patients had a DAS28 2.6 in average ± 1.1; mean age was 55.1 ± 8.8 years; 58% of patients were medium socio-economical level and the 34% were low socio-economical level; 59% were married, 18% were divorced, 14% is single and 6% were widowed. Related with the occupation, 25% were retired because age and 10% had handicap retirement pay; 24% were dedicated to housekeeping and 35% were working. Related to education 6% were illiterate, 44% had elementary school, 33% high school, 8% had a technical degree and only 7% had college level. According to CIE-10 739 patients (57%) had psychological disorders, 279 patients (21%) had sexual and 373 (28%) had sleep disorders.ConclusionsAccording to these findings there is a high prevalence of patients with low-medium socio-economical levels in RA which shows a possible correlation of a socio-demographic unfavorable situation with presence of disease. Also there are high rates of psychological, sexual and sleep comorbidities, which implies that measures must be implemented in order to improve these areas of performance in patients with RA.Disclosure of InterestNone declared