Tuanthon Boonlue

Background/Objectives: Antipsychotic-induced hyperprolactinemia may adversely affect skeletal health through suppression of the hypothalamic–pituitary–gonadal axis; however, the independent association between circulating prolactin and bone mineral density (BMD) remains uncertain. Methods: This cross-sectional study examined the association between serum prolactin concentration and BMD Z-scores among women with schizophrenia receiving prolactin-raising antipsychotics. Sixty-eight women underwent serum prolactin measurement and dual-energy X-ray absorptiometry at the lumbar spine, femoral neck, and total hip. Because prolactin concentrations were right-skewed, natural-log-transformed prolactin was used in linear regression analyses. Multivariable models adjusted for age, body mass index (BMI), duration of prolactin-raising antipsychotic exposure, chlorpromazine-equivalent dose, and physical activity, with heteroskedasticity-robust standard errors. Results: Median serum prolactin concentration was 44.51 ng/mL (IQR 16.36–78.37). Serum prolactin was not independently associated with BMD Z-score at the lumbar spine (adjusted β = 0.196, 95% CI −0.212 to 0.605; p = 0.340), femoral neck (β = 0.157, 95% CI −0.142 to 0.456; p = 0.298), or total hip (β = −0.224, 95% CI −0.587 to 0.139; p = 0.221). Higher BMI was positively associated with femoral neck and total hip Z-scores, while physical activity was positively associated with BMD Z-scores at all three sites. In a sensitivity analysis restricted to risperidone-treated participants (n = 60), serum prolactin remained unassociated with BMD Z-scores at all sites. Conclusions: In this cohort, contemporaneous serum prolactin concentration was not independently associated with BMD Z-scores. These findings support a multifactorial approach to skeletal health and warrant confirmation in larger longitudinal studies incorporating cumulative prolactin exposure and endocrine and bone-turnover markers.

Introduction: E-cigarettes are increasingly popular among university students, raising significant public health concerns. This study aimed to assess the prevalence of e-cigarette use, as well as knowledge, and attitudes toward e-cigarettes among health and non-health science undergraduate...

Dolutegravir (DTG) is widely used in antiretroviral therapy (ART) for its high efficacy and favorable tolerability. However, emerging evidence has raised concerns regarding weight gain and potential metabolic consequences associated with DTG use, with limited longitudinal data from Asian populations. This study aimed to evaluate longitudinal weight changes among people living with HIV (PLWH) receiving DTG‐containing regimens and to determine whether weight trajectories differ across key demographic and clinical subgroups. We conducted a retrospective cohort study of adult PLWH who initiated DTG‐based ART at a tertiary referral center between January 2020 and June 2022, with follow‐up through June 2024. Participants with complete weight data at baseline, 6, 12, 18, and 24 months were included. Weight trajectories were analyzed using repeated‐measures ANCOVA, adjusting for sex, age group, ART backbone (TDF‐based vs. non–TDF‐based), baseline body mass index (BMI), baseline weight, and baseline CD4 cell count. A total of 157 participants (59.2% male; mean age 50.4 years) were included. Mean body weight increased significantly over 24 months in both sexes. Greater numerical weight gain was observed among participants aged ≥ 50 years and those receiving non–TDF‐based regimens. However, only ART backbone demonstrated a significant time‐by‐subgroup interaction. Participants with baseline CD4 counts < 200 cells/mm ³ and lower baseline BMI demonstrated numerically greater weight increases over time. No significant time‐by‐sex, time‐by‐age, time‐by‐BMI, or time‐by‐CD4 interactions were observed, indicating broadly similar longitudinal trajectories across these subgroups after adjustment. DTG‐containing ART was associated with modest but significant weight gain over 24 months in this Thai cohort. ART backbone, differences between TDF‐based and non–TDF‐based regimens, was the primary factor associated with differential weight trajectories. These findings support monitoring of routine weight and metabolic parameters and highlight the importance of individualized ART selection to optimize long‐term metabolic health.

To evaluate the effects of different management strategies (watchful waiting, dose reduction, switching and adjunctive treatments) on prolactin levels and clinical outcomes in patients with antipsychotic-induced hyperprolactinaemia. A prospective cohort study was conducted with 135 adult patients diagnosed with hyperprolactinaemia due to antipsychotic use. Patients were assigned to four management groups: watchful waiting, dose reduction, switching and adjunctive treatment (with aripiprazole). Prolactin levels and clinical symptoms (e.g. galactorrhea, gynaecomastia, menstrual irregularities) were assessed before and after intervention. Baseline prolactin levels were comparable across groups. Post-intervention, all groups exhibited significant reductions in prolactin levels, with the largest decrease observed in the switching and adjunctive treatment group (mean change: -68.3 and -67.1 ng/mL, respectively). Clinical outcomes also improved, with a notable reduction in galactorrhea (p = 0.04), gynaecomastia (p = 0.004) and menstrual irregularities across all groups (p = 0.02). No significant changes were observed in sexual dysfunction, hirsutism or acne. Management strategies for antipsychotic-induced hyperprolactinaemia, particularly switching or adjunctive treatments, effectively reduce prolactin levels and improve related symptoms.

Background: Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine and sertraline, are widely prescribed for depression due to their favorable safety profiles compared to older anti-depressants. However, these medications are associated with various adverse drug reactions (ADRs) that may affect patient adherence and treatment outcomes. Objectives: This study evaluates the prevalence and characteristics of ADRs in outpatients treated with fluoxetine and sertraline, comparing ADR rates in real-world clinical settings. Materials and Methods: A prospective cross-sectional study was conducted at a tertiary care psychiatric hospital from July to December 2018, involving 65 outpatients with depression who had been on fluoxetine ( n = 47) or sertraline ( n = 18) for at least 4 weeks. Data on ADRs were collected using a validated questionnaire, and comparisons were performed using chi-square and Fisher’s exact tests. Results: The mean age of participants was 47.55 ± 16.14 years for fluoxetine and 45.16 ± 19.47 years for sertraline, with no significant differences in gender or treatment duration. Common ADRs included sedation, insomnia, and gastrointestinal symptoms. Anorexia was significantly more frequent in the fluoxetine group (21.28%, p = .05), while nausea/vomiting was higher in the sertraline group (27.78%, p = .001). Other ADRs, including sexual dysfunction and cardiovascular effects, were similar between the groups. Conclusion: These findings underscore the importance of recognizing distinct ADR profiles to optimize treatment decisions for outpatients with depression.

Background: Risperidone is an atypical antipsychotic commonly used in the treatment of schizophrenia. Despite its effectiveness, several adverse drug reactions can be bothersome to patients. Objective: This study aimed to examine the prevalence and characteristics of adverse effects in outpatients with schizophrenia treated with low (<4 mg/day) and standard (≥4 mg/day) doses of risperidone. Method: A cross-sectional study was conducted with 64 patients at a tertiary psychiatric hospital. Data on adverse effects were collected through a self-report questionnaire, and causality was assessed using Naranjo’s Algorithm. Descriptive statistics and chi-square tests were employed for data analysis. Results: The participants comprised 51.56% females, with a mean age of 45.16±14.32 years. Significant gender differences were observed between dose groups, with more females in the low-- dose group (63.16%) than in the standard-dose group (34.62%) (P = 0.02). A total of 221 adverse effects were confirmed after assessment. The most common effects were weight gain (57.81%), increased appetite (48.44%), and dystonia (32.81%). Weight gain was more prevalent in the low-- dose group (68.42%) than the standard-dose group (42.31%; Cohen's h = 0.53, 95% CI: 2.0%–50.2%), while insomnia was higher in the standard-dose group (23.08%) compared to the low-dose group (5.26%; Cohen's h = 0.54, 95% CI: 0.1%–35.5%). Other ADRs, such as dystonia and gastrointestinal symptoms, showed no significant differences between groups. Conclusion: Weight gain was the most prevalent adverse effect associated with risperidone use, particularly at lower doses, while insomnia was more frequent at standard doses, emphasizing the need for careful monitoring and personalized dose adjustments to optimize patient safety. Future studies with larger, longitudinal cohort designs are warranted to confirm these findings and evaluate long-term safety outcomes.

Methamphetamine use disorder (MUD) poses a severe global health challenge, characterized by high addiction potential, neurotoxicity, and significant societal impacts. Despite the rising prevalence of methamphetamine consumption and its intersection with the opioid crisis, effective treatment options remain limited. Current therapies focus on behavioral interventions such as cognitive-behavioral therapy and contingency management, yet retention and long-term success are challenging. Emerging pharmacological treatments, including dopaminergic agents and glutamatergic modulators, offer promise but require further investigation. Neurostimulation techniques, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, have shown potential in reducing cravings and improving cognitive control. Novel strategies like immunotherapy and personalized interventions guided by neuroimaging and epigenetic insights represent future directions. This chapter highlights the need for integrated, multimodal approaches combining pharmacological, behavioral, and neurostimulation therapies to address the complex neurobiological and psychosocial dimensions of MUD. Advances in research, coupled with policy and healthcare collaborations, are essential to mitigate the impact of this pervasive disorder.

Purpose/Background: Clozapine-induced hypersalivation is one of the most common bothersome adverse reactions of clozapine. The management strategies for this condition remain inadequately studied and understood. The objective of the study is to compare the effectiveness and tolerability of (1) trihexyphenidyl 5 mg/d, (2) clonidine 0.15 mg/d, or (3) a reduction of clozapine dosage by 25 to 50 mg/d for managing clozapine-induced hypersalivation Methods/Procedures: A randomized, open-label, non–placebo-controlled clinical trial was conducted from December 2023 to May 2024. Eligible patients were randomly assigned to 1 of 3 groups. Primary outcomes were assessed using the Drooling Severity and Frequency Scale (DSFS) and the Nocturnal Hypersalivation Rating Scale (NHRS) at baseline, week 4, and week 8. Quality of life assessed using the pharmaceutical therapy for quality of life short version and adverse drug reactions were recorded as secondary outcomes. Findings/Results: A total of 67 patients were randomly assigned to 1 of 3 treatment groups. By week 8, significant reductions in DSFS and NHRS scores were observed in all groups, with clonidine showing the greatest improvement. Trihexyphenidyl was also effective, whereas reducing clozapine dose resulted in more modest improvements. Quality of life improved significantly across all groups, with the greatest improvement observed in the clonidine group. The most common adverse effects were dry mouth, constipation, drowsiness, and dizziness. Implications/Conclusions: Clonidine and trihexyphenidyl appear to be more effective options for managing clozapine-induced hypersalivation compared to clozapine dose reduction.

Background: Hypersalivation, or excessive production and secretion of saliva, can result from associated disorders or adverse drug reactions. It significantly impacts physical health, psychosocial well-being, and quality of life. Clozapine, a gold standard for treatment-resistant schizophrenia, is known to cause hypersalivation in some patients. Objectives: This study aimed to determine the prevalence of hypersalivation and identify factors associated with its occurrence in patients with schizophrenia treated with clozapine, either as monotherapy or in combination with other antipsychotics. Methods: This retrospective cohort study was conducted using medical records from inpatients diagnosed with schizophrenia at a tertiary psychiatric hospital. Data were collected from patients treated with clozapine between June 1, 2020, and December 31, 2020. Descriptive statistics were used to describe the prevalence of hypersalivation, and multiple logistic regression was performed to assess the association between hypersalivation and patient characteristics. Results: A total of 96 patients were included in the study, with a mean age of 44.03 years (SD = 13.27); 72.9% of the patients were male. The overall prevalence of hypersalivation was 14.6%, with 19.51% of patients on clozapine monotherapy and 10.91% of those on clozapine combined with other antipsychotics experiencing hypersalivation. Male sex appeared to reduce the risk for hypersalivation (adjusted OR: 0.36, 95% CI: 0.10-1.33, P = .13), while the use of electroconvulsive therapy (ECT) significantly increased the risk of hypersalivation (adjusted OR: 5.40, 95% CI: 1.22-24.02, P = .03). Other variables, including age, Body Mass Index (BMI), smoking status, alcohol consumption, clozapine dosage, and use of anticholinergics, were not significantly associated with hypersalivation. Conclusion: The prevalence of hypersalivation in schizophrenia inpatients treated with clozapine was 14.6%. Male sex was associated with a reduced risk of hypersalivation, while ECT use significantly increased the risk. These findings provide valuable insights for clinicians managing patients on clozapine, highlighting the need for careful monitoring, particularly in patients undergoing ECT.