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Faria CGF, de Matos UMA, Llado-Medina L, Pereira-Sanchez V, Freire R, Nardi AE. Understanding and addressing COVID-19 vaccine hesitancy in low and middle income countries and in people with severe mental illness: Overview and recommendations for Latin America and the Caribbean. Front Psychiatry 2022; 13:910410. [PMID: 36177216 PMCID: PMC9513790 DOI: 10.3389/fpsyt.2022.910410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022] Open
Abstract
Despite the speedy development of vaccines for COVID-19, their rollout has posed a major public health challenge, as vaccine hesitancy (VH) and refusal are high. Addressing vaccine hesitancy is a multifactorial and context-dependent challenge. This perspective focuses on VH in the world region of Latin America and the Caribbean (LAC) and includes people suffering from severe mental illness, therefore covering populations and subpopulations often neglected in scientific literature. We present an overview of VH in LAC countries, discussing its global and historical context. Vaccine uptake has shown to widely vary across different subregions of LAC. Current data points to a possible correlation between societal polarization and vaccination, especially in countries going through political crises such as Brazil, Colombia, and Venezuela. Poor accessibility remains an additional important factor decreasing vaccination rollout in LAC countries and even further, in the whole Global South. Regarding patients with severe mental illness in LAC, and worldwide, it is paramount to include them in priority groups for immunization and monitor their vaccination coverage through public health indicators.
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Affiliation(s)
- Clara Gitahy Falcão Faria
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | - Victor Pereira-Sanchez
- Department of Psychiatry, Columbia University, New York, NY, United States.,Division of Translational Epidemiology and Mental Health Equity, New York State Psychiatric Institute, New York, NY, United States.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry, Amoud University, Borama, Somalia
| | - Rafael Freire
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Department of Psychiatry and Center for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Javelot H, Meyer G, Becker G, Post G, Runge V, Pospieszynski P, Schneiderlin T, Armand-Branger S, Michel B, Weiner L, Faria CGF, Drapier D, Fakra E, Fossati P, Haffen E, Yrondi A, Hingray C. [Anticholinergic scales: Use in psychiatry and update of the anticholinergic impregnation scale]. Encephale 2021; 48:313-324. [PMID: 34876278 DOI: 10.1016/j.encep.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
Anticholinergic properties are well known to prescribers, notably in mental health, as a therapeutic strategy for i.e. extrapyramidal syndrome but also as a source of numerous adverse side effects. Herein, we propose a narrative literature review describing: (i) cholinergic pharmacology and anticholinergic properties; (ii) the importance of anticholinergic therapeutic properties in psychiatry; (iii) the existing anticholinergic drug scales and their usage limitations in Psychiatry and; last (iv) an update to the anticholinergic drug impregnation scale, designed for the French psychiatry practice. The anticholinergic side effects can appear both in the peripheral level (dry mouth, constipation, etc.) and in the central level (especially as cognitive deficits). Many of the so called « anticholinergic » drugs are in fact entirely or mostly antimuscarinic and act essentially as parasympathetic system antagonists. Overall, anticholinergic/antimuscarinic side effects are usually attributed to psychotropic medications: to certain antipsychotics, notably classical neuroleptics such as phenothiazine and also to tricyclic antidepressants. In practice, the impact of anticholinergic toxicity treatments is often highlighted due to their excessively prolonged use in patients on antipsychotics. Interestingly, these antipsychotic treatments are better known for their anticholinergic side effects, especially cognitive ones, with an early onset specially in elder patients and/or in the case of polymedication. In order to evaluate anticholinergic side effects, metrics known as anticholinergic burden scales were created in the last few decades. Nowadays, 13 different scales are documented and accepted by the international academic community, but only three of them are commonly used: the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Burden Scale (ACB). All of them are based on a similar principle, consisting of grading treatments individually, and they are normally scored from 0 - no presence of side effects - to 3 - anticholinergic effects considered to be strong or very strong. Using these scales enables the calculation of the so-called "anticholinergic burden", which corresponds to the cumulative effect of using multiple medications with anticholinergic properties simultaneously. The application of anticholinergic scales to patients with psychiatric disorders has revealed that schizophrenic patients seem to be especially sensitive to anticholinergic cognitive side effects, while elder and depressed patients were more likely to show symptoms of dementia when exposed to higher anticholinergic burden. Unfortunately, these tools appear to have a low parallel reliability, and so they might induce large differences when assessing side effects predictability. In addition, the capacity of these scales to predict central adverse effects is limited due to the fact they poorly or do not differentiate, the ability of treatments to cross the blood-brain barrier. Finally, one last limitation on the validity of these scales is prescription posology is not accounted for side effects considered to be dose dependent. Recently, the MARANTE (Muscarinic Acetylcholine Receptor ANTagonist Exposure) scale has incorporated an anticholinergic burden weighting by posology. Nevertheless, this new model can be criticized, due to the limited number of medications included and due to testing a limited number of potency ranges and dosages for each treatment. Herein, we propose an update to the Anticholinergic Impregnation Scale, developed specifically for the French Psychiatry practice. The scale validation was based on an evaluation of the prescriptions correcting anticholinergic peripheral side effects (constipation, xerostomia and xeropthalmia). This indirect evaluation allowed us to show patients with an anticholinergic impregnation score higher than 5 received significantly more treatments for constipation and xerostomia. This strategy bypasses the bias of a cognitive evaluation in patients with severe mental health disorders. Moreover, the relevance of a tool developed specifically for French psychiatry is justified by the fact that some highly prescribed treatments for mental illness in France (cyamemazine and tropatemine) are strong anticholinergics, and also by the fact they are rarely included in the existing anticholinergic scales. This update of the original scale, published in 2017, includes information whether prescribed drugs cross the blood-brain barrier and thus makes possible a more accurate assessment when evaluating anticholinergic central side effects. Finally, the anticholinergic impregnation scale will soon be integrated into a prescription help software, which is currently being developed to take into consideration dose dependent adverse effects.
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Affiliation(s)
- H Javelot
- Établissement public de santé Alsace Nord, 67170 Brumath, France; Laboratoire de toxicologie et pharmacologie neuro cardiovasculaire, université de Strasbourg, 67084 Strasbourg cedex, France.
| | - G Meyer
- Établissement public de santé Alsace Nord, 67170 Brumath, France
| | - G Becker
- Laboratoire de toxicologie et pharmacologie neuro cardiovasculaire, université de Strasbourg, 67084 Strasbourg cedex, France
| | - G Post
- Centre hospitalier de Rouffach, 68250 Rouffach, France; GIP Symaris, 68250 Rouffach, France
| | - V Runge
- Laboratoire de mathématiques et modélisation d'Evry (LaMME), UEVE - université Paris-Saclay, 91037 Evry cedex, France
| | | | | | - S Armand-Branger
- ServicePharmacie, Centre de santé mentale Angevin (CESAME), 49130 Sainte-Gemmes-sur-Loire, France
| | - B Michel
- ServicePharmacie, CHU de Strasbourg, 67000 Strasbourg, France
| | - L Weiner
- Clinique de psychiatrie, CHU de Strasbourg, 67000 Strasbourg, France; Laboratoire de psychologie des cognitions, université de Strasbourg, 67000 Strasbourg, France
| | - C G F Faria
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brésil
| | - D Drapier
- Pôle hospitalo-universitaire de psychiatrie adulte, centre hospitalier Guillaume-Régnier, 35700 Rennes, France; EA 4712, comportements et noyaux gris centraux, université de Rennes 1, 35000 Rennes, France
| | - E Fakra
- Pôle universitaire de psychiatrie, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - P Fossati
- Inserm U1127, ICM, service de psychiatrie adultes, groupe hospitalier pitié Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France
| | - E Haffen
- CIC-1431 Inserm, service de psychiatrie, CHU de Besançon, 25000 Besançon, France; Laboratoire de Neurosciences, université de Franche-Comté, 25000 Besançon, France
| | - A Yrondi
- Service de Psychiatrie et de Psychologie Médicale, CHU de Toulouse, Hôpital Purpan, 31059 Toulouse, France; Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, 31059 Toulouse, France; ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 31024 Toulouse, France
| | - C Hingray
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand Nancy, Centre psychothérapique de Nancy, 54520 Laxou, France; Département de neurologie, CHU de Nancy, 54000 Nancy, France
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Faria CGF, Fidry M, do Cabo MC, Quagliato LA, Nardi AE, Zaman R, Freire R. A Brazilian Case of Treatment-Resistant Generalized Anxiety Disorder Successfully Treated with Monoamine Oxidase Inhibitor (MAOI). Psychiatr Danub 2020; 32:139-141. [PMID: 32890377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this brief report we present the case of a 53 year old man with a very debilitating Generalized Anxiety Disorder successfully treated with tranylcypromine. After several failed treatment attempts following international guidelines recommendations over the course of one year and a half, tranylcypromine was prescribed which led to effective and sustained remission of anxiety symptoms for this patient. We also briefly explore treatment options for resistant cases of generalized anxiety disorder, given the major negative impacts of untreated GAD in a person's daily functioning and quality of life.
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Affiliation(s)
- Clara Gitahy Falcão Faria
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), School of Medicine Venceslau Brás Avenue, 71, Rio de Janeiro, Brazil,
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Ferreira-Garcia R, Gitahy Falcão Faria C, Nardi AE, da Rocha Freire RC. Negative Affect Mediates Impulsivity in Generalized Anxiety Disorder. Psychopathology 2019; 52:327-333. [PMID: 31968352 DOI: 10.1159/000503395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/13/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although anxiety and impulsivity are intuitively thought to be inversely correlated, increased impulsivity has been associated both with generalized anxiety disorder (GAD) diagnosis and GAD symptoms in non-clinical samples. The emotional dysregulation model of GAD posits that patients experience more frequent and intense negative emotions while having poor regulatory control over emotional states and greater negative reactivity to their emotions. We hypothesized that poor regulatory control in the presence of negative emotions might explain the increased impulsivity found in GAD patients. In this study, we examined if negative affect mediates the relationship between GAD and impulsivity. METHODS Thirty-four GAD patients and 35 healthy controls were included, and evaluated with measurements of impulsivity, negative and positive emotions, the severity of worrying and GAD symptoms, depression, and 5-factor personality traits. RESULTS Global impulsivity scores and the attentional facet of impulsivity were higher in the patient group when compared to the controls. Negative affect was correlated with global impulsivity in the patient group only and explained impulsivity in our regression model while worrying and depressive symptoms did not. An indirect relationship was found between diagnosis and impulsivity through negative affect. CONCLUSION Our study showed that the cardinal symptom of GAD - worrying - was not independently related to impulsivity in our sample. Increased impulsivity in GAD seems to be mediated by the increased presence of negative emotions, as it is common in mood and impulse-control disorders, indicating an unspecific shared vulnerability factor to psychopathology.
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Affiliation(s)
- Rafael Ferreira-Garcia
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil,
| | | | - Antonio Egídio Nardi
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Christophe da Rocha Freire
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychiatry, School of Medicine, Queen's University, Kingston, Ontario, Canada
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