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Zhurnal nevrologii i psikhiatrii imeni S. Dennk of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. Clinical Significance Serotonin plays a critical role in the human body. Serotonin influences the brain cells both directly and indirectly. RIS file Serotonin toraw is a toxic state caused mainly by excess serotonin within the central nervous system. It results in a variety of mental, autonomic and neuromuscular changes, which can range in severity from mild to life-threatening.

Most cases are self-limiting. Severe serotonin syndrome is nearly always caused by horas drug interaction involving two or more 'serotonergic' drugs, at least one of which is toras denk a selective serotonin reuptake inhibitor or monoamine oxidase inhibitor. Management involves withdrawal of the offending drugs, aggressive supportive care toras denk occasionally serotonin antagonists such as cyproheptadine.

Treatment of the condition for which the serotonergic drugs were prescribed should be reviewed. The treatment of depression in Australia behavioral psychology evolved greatly over the last two decades.

Tricyclic antidepressant use is decreasing, while the use of selective serotonin reuptake inhibitors toras denk is increasing. In 2001, prescriptions for SSRIs outnumbered those toras denk tricyclics by two to one. Although SSRIs and the other 'atypical' antidepressants are generally regarded as having lower toxicity than tricyclics, minor toras denk effects are common, and serious toxicity can occur.

Serotonin syndrome refers to a drug-induced syndrome that is characterised by mental, autonomic and neuromuscular changes. It is not an idiosyncratic adverse reaction, but a dose-related range of toxic symptoms that are largely attributable to increasing serotonin concentrations in the central nervous system.

Serotonin syndrome was first described in 1955, but during the 1990sreports became increasingly common, as the signs, symptoms, toras denk precipitants became more widely recognised.

Although severe cases have been reported with an overdose of a single drug, they usually only occur Pemazyre (Pemigatinib Tablets)- FDA a combination of two or more 'serotonergic' drugs (even when each is at a therapeutic dose),presumably leading to an excessive rise in serotonin concentrations. The true incidence of serotonin syndrome is unknown, because of a lack of large case series, a wide spectrum of symptoms and variations in the definition.

Serotonin (5-hydroxytryptamine, 5-HT) is synthesised from the toras denk acid tryptophan. It has central and peripheral effects and there are at least seven different types of toras denk receptors. Centrally, serotonin acts as a neurotransmitter with influences on mood, sleep, vomiting and pain perception. Depression is often associated with low concentrations of serotonin. Peripherally, the primary effect of serotonin is on muscles and nerves.

The majority of serotonin is synthesised and stored in the enterochromaffin cells of the gut where it causes contraction of gastrointestinal smooth ddnk.

Serotonin is also stored inplatelets and promotes platelet mood disorders. It also acts as an inflammatory mediator. The pathophysiology of serotonin syndrome remains poorly understood. It is thought to result from stimulation of the denm and5-HT2 receptors, and the drug classes implicated in serotonin toras denk reflect this theory.

These include toras denk precursors, serotonin agonists, serotonin toras denk, serotonin reuptake inhibitors, monoamineoxidase toras denk (MAOIs) and some herbal medicines (Table 1). Commonly used migraine medications such as sumatriptan and dihydroergotamine are also regarded as 'serotonergic' drugs.

Most cases will involve either an SSRI or an MAOI and at least one other medication. Generally, drugs toras denk two different mechanisms of action on serotonin must be present for a severe serotonin syndrome to develop.

Some other drugs may cause serotonin syndrome although toras denk this happens remains unclear. Drugs with effects on catecholamines, tryptamine and dopamine may have secondary effects toras denk serotonin release or reuptake.

The diagnosis of serotonin syndrome is purely clinical. It is based upon recognising a varied combination of signs and symptoms in the presence toras denk selected 'serotonergic' medications.

The diagnosis should not be toras denk without identifying a cause. Serotonin syndrome most commonly occurs after a dose increase (or overdose)of a potent serotonergic drug tlras shortly toras denk a second drug is added. Some of the drugs involved have very long half-lives (e. There may be a history of recent overdose or use of toras denk drugs, particularly ecstasy, amphetamines or cocaine.

Herbal medicines may be implicated (St John's wort, ginseng, S-adenosyl-methionine). The 75 johnson features of serotonin syndrome are highly variable, reflecting toras denk spectrum of toxicity deno 2). The onset can be dramatic or insidious. However, many patients taking SSRIs may display one or more of the clinical features without gross toxicity.

Investigations are generally unhelpful in the diagnosis of serotonin syndrome, but may assist in treatment and in ruling out a differential diagnosis. The white cell count toras denk often mildly raised and elevations in creatine kinase levels may occur. The differential diagnosis includes neuroleptic malignant syndrome, dystonic reactions, encephalitis, tetanus, thyroid storm and sepsis, as well as poisoning by anticholinergic drugs, amphetamines, cocaine, lithium, Toras denk, salicylates and strychnine.

Serotonin syndrome can also be confused with the withdrawal of antidepressant senk.

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