AUCTORES
Globalize your Research
Chat with us
Research Article | DOI: https://doi.org/10.31579/2690-1919/249
* Emeritus Professor of Psychiatry, New York, USA.
*Corresponding Author: Saeed Shoja Shafti, Emeritus Professor of Psychiatry, New York, USA.
Citation: S. S. Shafti. (2022). Evaluation of Abnormal Movements among Senior Schizophrenics: A Local Study with Reference to Tardive Dyskinesia. J Clinical Research and Reports, 11(2); DOI:10.31579/2690-1919/249
Copyright: © 2022, Saeed Shoja Shafti. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 12 April 2022 | Accepted: 25 April 2022 | Published: 07 May 2022
Keywords: schizophrenia; typical antipsychotic drug; atypical antipsychotic drug; extrapyramidal symptoms; tardive dyskinesia; medication induced movement disorder
Introduction: Tardive dyskinesia (TD) includes involuntary choreiform or athetoid movements of the jaw, lower face, tongue, and extremities, developing in association with the use of an antipsychotic medication, and may develop in about 20 to 40 percent of patients who require long-lasting hospitalization. In the present study, the prevalence of this condition has been measured among an elderly group of schizophrenic patients.
Methods: One hundred and one elderly schizophrenic patients, who were hospitalized in the chronic section of a community psychiatric hospital, were selected for the present cross-sectional study. Abnormal Involuntary Movement Scale (AIMS) was employed to screen for patients with schizophrenia who also had TD. Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, Schedule for Assessment of Insight, and Clinical Global Impressions – Severity of illness, as well, had been used as ancillary scales for evaluation of severity of general psychopathology of schizophrenia, and comparing the TD patients with the group of patients without TD, for probing the intervening parameters.
Results: While abnormal movements were clear in 38.61% (n=39) of elderly schizophrenic patients, only seven of them (6.93 %) could be diagnosed as TD, based on the above-mentioned criteria. All of them were using conventional antipsychotic medications, accompanied with anticholinergic medications. Among TD patients, three cases had only abnormal facial and oral movements, one patient had atypical facial and oral movements as well as anomalous extremity movements, one patient had irregular facial and oral movements in addition to unusual trunk movements, and lastly, two patients had nonstandard extremity movements. In addition, around 71% of patients with TD were aware of their unusual movements. Between-group analysis did not show any significant difference between patients with TD and patients without TD in age, duration of illness, positive symptoms, negative symptoms, insight, and general psychopathology.
Conclusion: According to the findings of the present study, the prevalence of Tardive Dyskinesia among elderly schizophrenic patients, who were using typical antipsychotic medications, is very lower than what has been indicated thus far.
Tardive dyskinesia (TD) includes involuntary choreiform or athetoid movements of the jaw, lower face, tongue, and extremities, developing in association with the use of an antipsychotic medication for at least a few months, though symptoms may appear after a shorter period in older persons. In some patients, movements of this kind may appear after cessation, or after alteration or decrease in dosage of antipsychotic drugs. Tardive syndrome includes other forms of movement complications, such as akathisia or dystonia, which are distinguished by their late appearance in the course of management and their potential perseverance for months to years, even despite antipsychotic discontinuation or dosage lessening [1]. TD can appear in various ways. Initial clinical symptoms are primarily messy movements in the facial areas, mouth and tongue, which seem uncontrollable and repetitive. Also, TD symptoms can affect movement of the torso, limbs, head and neck, and patients with severe disorders may also suffer from vague speech, abnormal postures and problematic swallowing [2]. The severity of the movements may range from slight to obviously incapacitating. TD is worsened by stress and vanishes during sleep [3]. TD develops in about 10 - 20 percent of patients who are treated for more than a year. About 20 - 40 percent of patients who require long-standing hospitalization have TD [4, 5]. The occurrence of TD can also depend on whether the antipsychotic drug is atypical or typical, with around 13.1% incidence with atypical antipsychotic medications and about 32.4% rate with typical antipsychotic drugs [6, 7]. Females, children, patients who are more than fifty years of age, and patients with brain injury or affective disorders are at higher risk [3,9]. Increased antipsychotic medication exposure (particularly typical antipsychotics), African-American ethnicity, cognitive disturbance, alcohol or substance abuse, early occurrence of drug-induced parkinsonism, diabetes, and HIV, as well, have been accounted as other risk factors for the development of TD [10,11]. Moreover, drugs used to treat Parkinson's disease can cause TD [12, 13] (Table 1). Up to now, sustained D2 receptor blockade resulting in receptor hypersensitivity is the most common theory explaining the development of TD. Besides, genetic studies have indicated a possible relationship with polymorphisms in the DA2 receptor, DA3 receptor, dopamine transporter (DAT1), and the serotonin 2A receptor genes. Oxidative stress and cell demise secondary to augmented glutamatergic neurotransmission triggered by blockade of presynaptic dopamine receptors is also hypothesized [14-18]. Although proof proposes a genetic susceptibility to TD [19], evidence suggests that a genetic protection against TD exists [20]. Furthermore, some studies suggest that D3, D4, and D5 receptors are also involved in the pathogenesis of TD [22]. Since anticholinergic agents are also associated with TD, an imbalance of acetylcholine and dopamine is likely involved in TD pathogenesis [23]. While usage of adjunctive agents, like vitamin B6, procholinergic agents (e.g., donepezil [Aricept]), Ondansetron (Zofran), a selective 5-HT3 receptor antagonist, cyproheptadine (Periactin), a 5-HT and histamine antagonist, and levetiracetam (Keppra) is of limited benefit [24] (Table 1), the use of deep brain stimulation for severe and refractory TD offers hope to those who are rigorously incapacitated [24]. Among patients with schizophrenia, the life quality of patients with TD may drop radically [25], and leads to a decline in patients’ social functioning, and may affect quality of life and treatment compliance meaningfully [26]. Additionally, TD can increase the difficulty in handling the primary disorder, thus increasing the economic burden on the patient’s family (27). Currently, appropriate proof for effectiveness exists for two Vesicular monoamine transporter 2 (VMAT2) inhibitors, valbenazine and deutetrabenazine [28,29]. Among them, Valbenazine was the first drug that has been approved for TD in the United States [30, 31].
Medications That Can Induce TD | Medications and Supplements Used to Treat TD |
Antipsychotic Drugs Anticholinergic Agents Antidepressants (Trazodone, doxepin, clomipramine, and amitriptyline, Fluoxetine, sertraline, Selegiline, Rasagiline, Phenelzine) Antiemetics Anticonvulsants (Phenytoin carbamazepine and lamotrigine) Antihistamines Decongestants (Phenylpropanolamine) Antimalarials Antiparkinson Agents Anxiolytics (Barbiturates, meprobamate benzodiazepines) Biogenic Amines (Tyramine) Mood Stabilizers (Lithium) Stimulants | Cholingergic Agents Clozapine, Quetiapine, Olanzapine Apomorphine Vesicular monoamine transporter 2 (VMAT2) inhibitor [Tetrabenazine, Tetrabenazine Analogs (Valbenazine and Deutetrabenazine)] Clonazepam. Propranolol. Amantadine. Branched-Chain Amino Acids Ginkgo Biloba Antioxidant Medications and Supplements (zonisamide, yi gan san (a Chinese herb), levetiracetam, melatonin, omega-3 fatty acids, piracetam, resveratrol, vitamin B6, and vitamin E) |
Table 1: Medications that may induce or alleviate TD.
One hundred and one elderly patients (≥ 55 years old), who received a diagnosis of schizophrenia, according to the ‘Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)’ (1), and were hospitalized in the chronic section of a community psychiatric hospital in south of Tehran, had been selected for the present cross-sectional study, which had been performed in June 2006. While the study was carried out consistent with the ‘Declaration of Helsinki and Ethical Principles for Medical Research Involving Human Subjects’ [32], the patients were informed about the procedure, and a signed informed consent was received from those who were interested in participating in the study or from a legal guardian or representative. Abnormal Involuntary Movement Scale (AIMS) was employed to screen for patients with schizophrenia who also had TD. AIMS is a 12-item tool developed at the National Institute of Mental Health (NIMH) and has been utilized by clinicians to give a numeric measure to the observed atypical movements in various sections of the body [33,34]. The AIMS has a global rating of severity, a rating of incapacitation because of the irregular movements, and an evaluation of the patient's attentiveness to the atypical movements. Moreover, it can be used to measure anomalous movements in different types of patients, including adults, children, and adolescents. The entire test can be completed in about 10-15 minutes. These items are rated on a five-point scale of severity from [0-4]. The scale is rated between 0 (none), 1 (minimal), 2 (mild), 3 (moderate), and 4 (severe). Two of the 12 items denote dental care. The remaining 10 items denote body movements. Test-retest reliability at 6-8 weeks ranges from 0.40-0.82 for each item and is 0.71 for overall severity. The scale can be done as part of a physical-neurological examination by a trained clinician. The AIMS do not make the diagnosis of the disorder causing the movement abnormality unless some criteria have been established already to ease the diagnostic process. The Schooler–Kane research criteria are commonly used to find probable antipsychotic-induced TD, and need those three criteria are met: [1] symptoms occur after at least 3 months of treatment with an antipsychotic, [2] abnormal, involuntary movements must occur in 2 or more body regions if mild, or 1 body region if moderate to severe, as determined by a rating scale such as the AIMS, and [3] there are no other conditions that may have caused the abnormal movement patterns [35]. So, in the present appraisal, patients whose abnormal involuntary movements were induced by medical or neurological diseases were excluded. Scale for Assessment of Positive Symptoms (SAPS) [36], Scale for Assessment of Negative Symptoms (SANS) [37], Schedule for Assessment of Insight (SAI) [38], and Clinical Global Impressions – Severity of illness (CGI-S) [39], as well, had been used as ancillary scales for evaluation of severity of general psychopathology of schizophrenia, and comparing the TD patients with the group of patients without TD, for probing the intervening parameters.
Baseline characteristics were compared by ‘t tests’ for continuous variables. Between-group analysis, too, with respect to ancillary scales, like SANS, SAPS, SAI, and CGI-S, was performed by ‘t-tests’. Statistical significance is defined as P-value ≤0.05. ‘Med-Calc’ statistical software, version 15.2, was the statistical software tool for analysis.
While abnormal movements were clear in 38.61% (n=39) of elderly schizophrenic patients, only seven of them (6.93 %) could be diagnosed as TD, based on the above-mentioned criteria. Medication induced Extrapyramidal adverse effects, like Parkinsonism or tremor, and other abnormal movements like Tic, Chorea, Myoclonus, Ballismus and rigidity, which were present either before initiation of illness or in advance of prescription of neuroleptic, or were generated later due to comorbid medical or neurological ailments, constituted the rest of abnormal movements in the present sample of aged schizophrenic patients. Among the said group with TD, and based on the assessment by AIMS, three patients had only abnormal facial and oral movements with minimal to mild severity (code: 1-2), one patient had atypical facial and oral movements in addition to odd extremity movements with mild to moderate (code: 2-3) and minimal to mild severity (code: 1-2), respectively, one patient had anomalous facial and oral movements in addition to irregular trunk movements with minimal to mild (code: 1-2) and mild to moderate severity (code: 2-3), respectively, and lastly two patients had unusual extremity movements with minimal to moderate severity (code: 1-3). While two of them, one patient with abnormal extremity movements and the other patient with atypical facial and oral movements, had problems with teeth, the rest of the patients usually wore dentures. In addition, in the present survey, around 71% of patients with TD were aware of their unusual movements. In this regard, while two patients with only anomalous facial and oral movements had no awareness of their odd movements (code: 0), one of the patients in the said cluster was aware of mild distress (code: 2). Two patients with irregular extremity movements were aware of the uniqueness of their atypical movements, with mild distress in one of them (code: 2) and no distress in the other one (code: 1). The patient with abnormal facial and oral movements plus atypical trunk movements was aware of moderate distress (code: 3). The same was applicable, as well, for the patient with nonstandard facial and oral movements in addition to strange extremity movements. Nevertheless, none of them could be considered as severely incapacitated due to the said abnormal movements. All of them were using conventional antipsychotic medications, like chlorpromazine, haloperidol, perphenazine and trifluoperazine [Mean ± SD mg/d Chlorpromazine equivalent = 464.28 ± 118.66], in companion with anticholinegic medications (biperiden or trihexyphenidyl). While between-group analysis did not show any significant difference between patients with TD and patients without TD about some demographic parameters, like age and duration of illness, no significant difference, as well, was evident between them with respect to measuring positive symptoms, negative symptoms, insight, and general psychopathology, which had been assessed by the said ancillary scales (Table 2).
Variables | Patients with TD (n=7) | Patients without TD (n=94) | T | P | CI |
Age (y/o) | 66.14±4.99 | 66.01±7.36 | 0.046 | 0.96 | -5.50, 5.76 |
Duration of illness (years) | 33.57± 3.06
| 31.79± 6.93 | 0.672 | 0.50 | -3.47, 7.03 |
Mean (sd) mg/d Chlorpromazine equivalent | 464.28 ± 118.66
| 431.96 ± 159.03
| 0.526 | 0.60 | -89.64, 154.28 |
SAPS | 63.71±9.62
| 57.44±10.16 | 1.580 | 0.11 | -1.60, 14.14 |
SANS | 55.38±6.40 | 49.96±8.37
| 1.674 | 0.09 | -1.00, 11.84 |
SAI | 7.61±2.97
| 8.83±3.11
| 1.004 | 0.31 | -3.63, 1.19 |
CGI-S | 4.10±2.35
| 3.22±1.16
| 1.776 | 0.07 | -0.10, 1.86 |
Abbreviations: SAPS = Scale for Assessment of Positive Symptoms; SANS = Scale for Assessment of Negative Symptoms; SAI = Schedule for Assessment of Insight; CGI-S = Clinical Global Impressions – Severity of illness; TD = Tardive Dyskinesia
Table 2: Comparative Analysis of Demographic and Psychopathologic Parameters
Medication-induced TD is a complex and distinctive neurologic condition [40]. While the reported incidence of TD seems to be reduced with the usage of atypical antipsychotic drugs, the risk of developing TD remains with these medications. Furthermore, several other medication classes have a high prevalence of TD and yet are not commonly considered to be TD-inducing (41). Drug-induced Parkinsonism and TD are stigmatizing movement disorders linked with exposure to dopamine receptor blocking agents such as antipsychotic drugs, but they differ in their pathophysiology and clinical management. Treatment for one may exacerbate the other, and there are important diagnostic signs that help in making a precise evaluation and founding a sensible treatment strategy. On the other hand, since the presentation differs greatly among people, it often goes undiagnosed or can be easily misdiagnosed [27]. Though movement disorders were once thought to be associated with conventional antipsychotic medications, increasing attention is being given to the possibility of induction of movement disorders by most atypical antipsychotics [44]. On the other hand, some researchers believe that published prevalence rates of TD may be falsely low [45]. This is probably due to the insidious development of TD [46]. Back to our discussion and along with the findings of the current evaluation, the frequency of TD among our sample was lesser than what had been indicated by Koning et al. [4], Waln et al. [5], Kim et al. [6], Carbon et al. [7], Ward et al. [25], Saltz et al. [47], and Huang et al. [27], though it was slightly comparable to the finding of the last study [27]. Findings of Kim et al. [6], as well, were a bit comparable with the outcomes of the present assessment, though it was about atypical antipsychotic medications. On the other hand, maybe the presence of only male patients in the current estimation has altered the results adversely, which could be greater by the addition of female patients, especially when it has been declared that women are more likely to be affected than men [3, 5]. Also, while the elderly schizophrenic patients shaped the present sample and increasing age is known as a risk factor for the development of TD [7], other similar studies are mostly about the prevalence of TD among adult patients aged between 20 and 70 [27]. Nevertheless, once more, the present outcome is remarkably less than the indicated measurements [3]. But the present conclusion is somewhat similar to the findings of Go et al. [48], who found that patients of Filipino and Asian descent had a lower frequency of TD compared to patients of Caucasian descent, even though the Filipino and Asian patients consistently took a daily dose of 700 mg chlorpromazine for at least 5 years. Moreover, in contrary to the findings of Huang et al. [27], in the present survey no significant relationship was clear between TD and dosage of antipsychotic medication, scores of negative symptoms, and severity of symptoms or age. But in the current survey, too, the occurrence of movement disorders in the facial and oral areas of chronic schizophrenic patients with TD was the most frequent finding [2, 27]. This outcome is consistent with the earlier reports that the anomalous involuntary movements in head and facial zones, whose classic symptom is the mouth-tongue-cheek triple sign, are seen the most in patients with TD [49]. Also, in the existing appraisal, abnormal extremity movements were more prevalent than abnormal trunk movements, and the proportion of TD patients with multiple affected areas in comparison with TD patients with a single affected area was higher, outcomes which were comparable to the conclusions of Huang et al. [27]. But, the proportion of TD patients with self-awareness about their abnormal movements in the present assessment was remarkably higher than what has been recounted by Huang et al. [27]. Anyway, as said by some scholars, we do not have a deep understanding of this disorder due to its vague etiology, various clinical symptoms, many affected areas and wide variation in demonstration by patients [27]. So, the uncertain pathophysiology of TD remains to be a problem for the effective treatment of this ailment [40], particularly, by taking into consideration that TD may also occur in never-medicated patients with schizophrenia [3]. Accordingly, the best strategy against TD is prevention. Prevention of drug-induced TD is focused around clinical considerations for pharmacologic physiognomy [40]. Therefore, healthcare staff are liable for teaching themselves and their patients about the risks associated with antipsychotic drugs and other TD-inducing prescriptions and following up the patients’ compliance, and only allow patients to stay on these drugs for long periods if absolutely compulsory [40]. On the other hand, in many low- and middle-income countries there is also a lack of mental health resources, which results in a poorer ratio of medical staff to patients. In clinical practice, this may cause less time obtainable for each patient and hence a later recognition and diagnosis of TD [27]. Consequently, the APA has recommended monitoring patients with schizophrenia for the development of TD every [3-12] months, depending on the patient’s risk factors and the class of antipsychotic drug. Principles include every six months for patients on a typical antipsychotic drug to every twelve months for patients on an atypical antipsychotic medication [50]. Though implementation of the study in the senior group of schizophrenic patients could be accounted for as an advantage on behalf of the present valuation, small sample size, male gender, and lack of control group were among the weaknesses of the current appraisal, which could prevent generalization of the conclusion and thus confirm it as a pilot study. Further methodical studies in future with larger sample sizes and a broader spectrum of oldness may bring about more apposite results and will probably make the existing state of affairs brighter.
According to the finding of the present study, prevalence of Tardive Dyskinesia among elderly schizophrenic patients, who were using typical antipsychotic medications, is very lower than what has been indicated thus far.
The author appreciates colleagues and personnel of ‘Razi Psychiatric Hospital’ for their valuable support and assistance.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
