Cyberduck 2nd transfer stopped first

// Опубликовано: 30.06.2021 автор: Tulrajas

cyberduck 2nd transfer stopped first

This is my first post. I tried to transfer a big file (1,8 GB) to my (e.g.: Cyberduck) and the transfer has completed without stopping. Cyberduck is a libre server and cloud storage browser for Mac and Windows with clients' FTP's in Cyberduck allows for more effortless transfer of files. Feature Provide URL references to Office documents in browser (OneDrive); Feature Disable Bonjour notifications; Bugfix Transfer progress stops updating. CYBERDUCK SHOW HIDDEN FOLDERS Cyberduck 2nd transfer stopped first antique industrial workbench

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For patients who require long-term treatment, switching to another antipsychotic may be needed if their response to treatment has been inadequate, or unacceptable adverse effects have occurred. For patients with serious psychiatric illness, stopping or switching antipsychotics requires referral to a specialist if possible.

However, for patients on small off-label doses of antipsychotics for behavioural disturbance in dementia or for sleep problems, it may be reasonable for the GP to taper the dose and stop treatment with careful monitoring. There are many drugs with antipsychotic efficacy available, including both oral and depot formulations. They differ in their adverse effects and effectiveness Table 1. Historically, antipsychotics have been divided into typical or conventional and atypical or novel types.

However, this simple dichotomisation cannot account for the heterogeneity in a range of characteristics with antipsychotic drugs old or new. This includes their likelihood of causing extrapyramidal effects, hyperprolactinaemia, weight gain and metabolic syndrome, sedation versus activation, and cardiac effects Table 1.

EPS extrapyramidal symptoms dystonia, akathisia, pseudo-parkinsonism, tardive dyskinesia. Some antipsychotics are more effective for psychosis than others — clozapine has been recognised as the most effective antipsychotic drug, followed by a mid-efficacy group of amisulpride, olanzapine, risperidone and paliperidone, then the remaining novel and old antipsychotics such as haloperidol and chlorpromazine.

Psychiatrists also use some antipsychotics such as olanzapine, quetiapine and risperidone for off-label indications. An example would be adjunctive initial treatment of severe major depression when rapid relief of agitation, insomnia and suicidality is needed while waiting for antidepressants to take effect.

As a consequence, GPs are seeing a broad spectrum of patients not merely those with schizophrenia who have been started on antipsychotics, often in combination with other psychotropic drugs. It has been common practice to continue these antipsychotics long term, especially when treatment of an acute episode has been reasonably successful. However, long-term antipsychotic use can have serious consequences including tardive dyskinesia, weight gain, metabolic syndrome, diabetes and cardiovascular complications.

If possible, antipsychotics should be stopped very slowly under close medical observation. Abrupt discontinuation can result in rebound psychosis which can be more severe than before treatment was started. This is not uncommon when stopping clozapine as a result of complications such as agranulocytosis or myocarditis. Some antipsychotics particularly depot injections have long half-lives and are unlikely to be associated with significant withdrawal symptoms Table 1.

After a first episode of psychosis in schizophrenia and related disorders, stopping antipsychotics is considered when the patient has made a full recovery and been well for at least 12 months. If there have been a number of episodes of psychosis, or recovery is incomplete, ongoing antipsychotic treatment is usually recommended as the chance of exacerbation or relapse is high if the drug is stopped.

In patients who have experienced more than one episode but have fully recovered and been well for at least 12 months with antipsychotics, gradual dose reduction accompanied by close observation can be considered. Illness severity, treatment complications e. Repeated episodes of psychosis worsen longer term prognosis. As the risk of relapse after a second episode is high, most clinicians would recommend long-term treatment.

Patients who have experienced psychotic depression and have responded to a combination of antidepressants and antipsychotics with or without electroconvulsive therapy, can often be continued on antidepressant drugs alone. There are no clear guidelines for when antipsychotics can be withdrawn in these patients.

Patients who have been started on sedating antipsychotics for severe agitated depression, anxiety or insomnia can often be taken off them, especially if there has been significant clinical improvement. Antipsychotics for behavioural disturbance associated with dementia and other brain diseases should be reviewed and deprescribing should be considered due to the serious adverse effects and lack of evidence for long-term use.

There are a number of clinical situations in which switching from one antipsychotic to another is considered. Review by a psychiatrist is indicated before switching, particularly in complex clinical situations or when urgent switching is necessary Box 2. When choosing a drug to switch to, it helps to know which antipsychotics have a lower risk of the common adverse effects associated with long-term therapy.

Table 3 lists antipsychotics that have lower risks of adverse effects such as extrapyramidal and anticholinergic symptoms, weight gain, postural hypotension and hyperprolactinaemia. Consider switching to an antipsychotic with a lower risk for the adverse effect. Source: references 1 and 8. Switching is not necessarily a panacea. Illness exacerbation may occur during the switch, and new adverse effects may emerge. When switching is being undertaken due to an inadequate response, it is important to ensure the dose of the first antipsychotic has been optimised, the patient has been treated for an adequate amount of time, and that they are adhering to treatment.

The choice of the new drug will be partly determined by the reasons for the switch, but probable efficacy, adverse effects, dosing regimen and patient or carer preferences also need to be taken into account. Broad characteristics of antipsychotics are given in Table 1 , but more details may be necessary and expert advice could be valuable in making drug choices. Depending on the pharmacology of the antipsychotic, switching may result in withdrawal syndromes, particularly anticholinergic withdrawal with drugs such as quetiapine, clozapine, chlopromazine and olanzapine.

Changing from one antipsychotic to another when, for example, seeking a drug with a lower risk of weight gain can result in loss of efficacy and withdrawal symptoms. It is essential for patients and carers to be informed about the possible consequences of switching, and an action plan for how to deal with any difficulties should be formulated.

When a patient is being switched from clozapine to another antipsychotic, rebound psychosis and other serious withdrawal effects may occur irrespective of which drug is substituted. Clozapine discontinuation should be done under the guidance of a psychiatrist. The dose should be gradually tapered, not stopped suddenly. In contrast to switching antidepressants, a drug-free period between stopping the first antipsychotic and starting the second is not recommended due to the risk of relapse.

Table 4 lists the different methods of changing from one antipsychotic or formulation to another. Whether switching from an oral to a depot antipsychotic, depot to depot, or depot to oral, specific instructions need to be followed Table 4. While it is possible to stop the first drug and start the second drug the next day, this may result in withdrawal symptoms and possible drug interactions. When the first antipsychotic is aripiprazole or brexpiprazole, a direct switch can be made as both these drugs have very long half-lives and no anticholinergic effects.

Evidence indicates there may be little difference in the risk of relapse with immediate and gradual antipsychotic stopping or switching. This involves a reduction of the first antipsychotic while introducing the second drug. A slower approach to titration is to continue the first antipsychotic for a period at its usual dose while gradually increasing the therapeutic dose of the second antipsychotic.

The first antipsychotic can then be gradually reduced and stopped. The risk of relapse is minimised with this approach, but there may well be additive adverse effects during the process. An interactive tool provides specific switching guidelines for different antipsychotics, including from one oral antipsychotic to another and from one depot antipsychotic to another.

There are a variety of clinical circumstances in which stopping an antipsychotic should be considered and undertaken if appropriate. When it is necessary to switch from one antipsychotic to another during the course of treating psychoses, clinicians need to have some understanding of the pharmacokinetics and dynamics of antipsychotic drugs in order to plan and carefully monitor a switching regimen.

This usually involves a period of both drugs being used simultaneously. Stopping and switching antipsychotics can result in serious consequences, particularly a relapse of psychosis which may entail serious risks and worsen long-term prognosis. Withdrawal syndromes related to cholinergic and dopaminergic effects may occur depending on the characteristics of the antipsychotics involved.

Conflict of interest: none declared. Aust Prescr. Published online Oct 1. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. SUMMARY In general, specialist advice should be sought when stopping or switching antipsychotics While antipsychotics are often needed long term, there are circumstances when clinicians, patients and families should reconsider the benefits versus the harms of continuing treatment Withdrawal syndromes, relapse and rebound can occur if antipsychotics are discontinued, especially if they are stopped abruptly.

Generally, they should be reduced and stopped slowly, ideally over weeks to months Relapse of psychosis and exacerbation occur in most patients with psychotic disorders, occasionally with drastic consequences. Sometimes this occurs many months after stopping antipsychotics Switching from one antipsychotic to another is frequently indicated due to an inadequate treatment response or unacceptable adverse effects. Keywords: antipsychotics, psychosis, drug withdrawal syndrome.

Introduction Stopping antipsychotic drug therapy is feasible and appropriate in a number of clinical circumstances. Antipsychotics in Australia There are many drugs with antipsychotic efficacy available, including both oral and depot formulations. Table 1 Antipsychotic drugs available in Australia. Open in a separate window. Off-label use Psychiatrists also use some antipsychotics such as olanzapine, quetiapine and risperidone for off-label indications.

Box 1 When to consider stopping antipsychotics. Table 2 Withdrawal syndromes associated with antipsychotic drugs. Type of withdrawal syndrome Causative antipsychotics Clinical manifestations Cholinergic syndrome Chlopromazine, clozapine, olanzapine, quetiapine Nausea, vomiting, headache, restlessness, anxiety, insomnia, fatigue, malaise, myalgia, diaphoresis, rhinitis, paraesthesia, loose bowels Dopaminergic syndrome All antipsychotics in Table 1 Withdrawal dyskinesia, akathisia, dystonia, tardive dyskinesia Rebound psychosis Clozapine Psychosis above pre-treatment levels, illusions, hallucinations, catatonia.

Switching antipsychotics There are a number of clinical situations in which switching from one antipsychotic to another is considered. Table 3 Switching antipsychotics based on risk of adverse effects. Clozapine When a patient is being switched from clozapine to another antipsychotic, rebound psychosis and other serious withdrawal effects may occur irrespective of which drug is substituted. Switching strategies In contrast to switching antidepressants, a drug-free period between stopping the first antipsychotic and starting the second is not recommended due to the risk of relapse.

Table 4 Techniques for changing from one antipsychotic or formulation to another psychiatrist review required. Change Comment Direct switch: First antipsychotic is stopped and next antipsychotic is started on the following day Simplest strategy but expertise is required and may be best carried out in an inpatient setting.

Risk of discontinuation symptoms from first antipsychotic may be substantial. There may be a significant risk of drug interactions depending on individual drug characteristics. Should be avoided if possible when switching from clozapine. Cross titration: First antipsychotic is gradually reduced while second antipsychotic is gradually increased to therapeutic dose Most common strategy used in clinical practice.

Provides some balance between minimising risk of relapse and minimising risk of adverse effects during overlap. Expertise required due to differing pharmacokinetics and possibility of drug interactions. Continuation with slower titration and subsequent discontinuation: First antipsychotic is continued at usual dose, second antipsychotic is gradually titrated up to near therapeutic dose, then first antipsychotic is gradually reduced and stopped, while dose of second antipsychotic is increased to its therapeutic dose Most conservative strategy suitable for patients with a high risk of relapse.

However, there will be significant overlap of the two antipsychotics with a likelihood of adverse effects during switch. There is also the risk that the planned discontinuation of the first antipsychotic never takes place or therapeutic dose of second antipsychotic is not reached. Formulations Oral to depot Specific instructions need to be followed for each particular depot.

Continuation of oral antipsychotic may be required for some time after injecting depot depending on the characteristics of depot drug. Depot to depot Need to follow instructions with new depot for changing from previous depot drug. This is most commonly undertaken as a direct switch but, because of the long half-lives, it is in effect a cross titration.

Depot to oral Because of the long half-lives, depot formulations can be stopped immediately. For all oral antipsychotics except clozapine, the oral drug should be started on the date that the depot antipsychotic was due. Clozapine requires a very slow titration at the start of therapy. As the effective dose of clozapine varies so much between patients, it is common to continue the depot antipsychotic until clozapine has reached therapeutic plasma concentrations or has shown significant clinical effect.

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