摘要:

Alzheimer's disease is an age-related progressive neurodegenerative disorder leading to dementia. Numerous markers of inflammation, including major histocompatibility glycoproteins, cytokines and their receptors, classical pathway complement proteins and mRNAs, complement receptors and complement regulatory proteins, have been identified in brain samples taken from patients with Alzheimer's disease. In contrast, such markers are not detected or are significantly reduced in the brains of nondemented elderly control patients.Several retrospective studies suggest that an anti-inflammatory drug history may correlate with reduced frequencies of Alzheimer's disease, although there are many caveats. A small clinical trial of the nonsteroidal anti-inflammatory agent, indomethacin, has recently been conducted in patients with Alzheimer's disease, with generally encouraging results.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

In the last few years, several advances have been made in the area of migraine. Characterisation of the serotonin (5-hydroxytryptamine; 5-HT) receptor that belongs to the 5-HT1class and mediates selective cranial vessel vasoconstriction has provided the impetus for mechanistic, clinical and therapeutic studies in migraine. The interest in migraine mechanisms has resulted in considerable clinical development, particularly in the field of diagnosis, with the advent of a set of diagnostic criteria that are widely accepted. The criteria of the International Headache Society are easily applied and provide a useful practical tool in headache diagnosis.Prophylactic therapy of migraine still depends on old, clinically useful but largely systematically unproven drugs such as propranolol, flunarizine, methysergide, pizotifen and amitriptyline. In contrast, substantial advances have been made recently in the treatment of acute attacks of migraine, with the introduction of the 5-HT1-like receptor agonist, sumatriptan. This drug is both effective and rapid in its onset of effect and is associated with minimal adverse effects. Many patients with migraine are equally well treated by older drugs such as aspirin (acetylsalicylic acid), nonsteroidal anti-inflammatory agents or ergotamine derivatives.The future development of drugs in neurology will hopefully follow that of migraine, so that advances in therapeutics will be paralleled by an increased understanding of a condition and/or better diagnosis.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

This article discusses therapeutic strategies for the treatment of schizophrenia on an outpatient basis. Using the World Health Organization classification of patient impairment and the criteria of chronicity and degree of disability involved, patients with psychiatric disorders can be said to be disabled at 3 levels - psychological impairment, social disability and social handicaps.Treatment of schizophrenia, prevention of relapse and patient rehabilitation demand long term strategies, with an individually adjusted and integrated approach. This should involve combined use of pharmacological and nonpharmacological treatments.Antipsychotic drugs play a central role in the treatment of patients with schizophrenia, and their effectiveness has been clearly demonstrated. Guidelines for the pharmacological treatment of schizophrenia have been established. However, in practice, antipsychotic treatment of acute schizophrenic illness and prevention of relapse varies greatly.Several types of psychosocial therapy have been shown to be successful in treating schizophrenia, including social skills training based on complex learning theories, and family intervention strategies. In addition, training the patient for specific employment is of great importance in the process of rehabilitation.To provide optimal outpatient management and rehabilitation, pharmacological and psychosocial therapies must be complemented by a suitable institutional and organisational framework, such as that of community-based psychiatriccare.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Stuttering is increasingly being recognised as a neurodevelopmental disorder. This has stimulated new interest in pharmacological approaches to the treatment of the condition. Psychosocial factors are also regarded as important to the course of the condition. Therefore, psychosocial interventions, such as psychotherapy and speech retraining, are important components of a comprehensive treatment programme.A wide range of pharmacological agents are effective in reducing stuttering in selected patients. These include haloperidol, verapamil, bethanechol and some antidepressants. The agents are presumed to work through different mechanisms. Unilateral injection of botulinum toxin directly into the vocal folds is another promising treatment.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

During the last 20 years, research has indicated that antiepileptic drugs such as carbamazepine, valproic acid (sodium valproate) and clonazepam have therapeutic effects in disorders other than epilepsy. These agents are beneficial in patients with manic and depressive disorders, and have a mood-stabilising effect in schizophrenic and schizoaffective disorders that present with comorbid affective symptoms, such as excitation and aggression. Furthermore, a prophylactic effect on the recurrence of mood disorders is also observed.Many schizophrenic and schizoaffective patients do not respond or only partially respond to antipsychotics. Antiepileptic drugs may have an important clinical role as adjuncts to antipsychotics in the treatment of these patients. Carbamazepine has been studied most extensively, and therapeutic effect has been reported in many studies. Valproic acid has also been shown to have a similar effect.The response of a patient to different mood-stabilising drugs, such as lithium, carbamazepine, valproic acid or clonazepam, is not necessarily the same. Therefore, a clinical strategy of rotating trials in a sequential fashion may be useful for the treatment of nonresponders or partial responders to antipsychotics. An appropriate strategy may include starting treatment with lithium or carbamazepine followed by valproic acid and then clonazepam. If no individual agent is effective, a combination of 2 or 3 agents may be useful.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Evidence is available regarding the relationship between the specificity of antidepressants in modulating neurotransmitter systems and their therapeutic activity. All antidepressant treatments initiate adaptive changes in central serotonin (5-hydroxytryptamine; 5-HT) neurotransmission. This involves a desensitisation of postsynaptic serotonergic 5-HT1Areceptors and an enhanced responsiveness of 5-HT2receptors that are located postsynaptically. Antidepressants also induce changes in central noradrenergic transmission. This effect possibly arises as a consequence of alteration in serotonin heteroceptors that are located on noradrenergic terminals.There are several different classes of antidepressants available at present that modulate biogenic amine neurotransmitters, e.g. reversible monoamine oxidase A inhibitors, selective serotonin reuptake inhibitors, &agr;2-adrenoceptor antagonists, atypical benzodiazepines and 5-HT1Apartial agonists.The next generation of antidepressant drugs may be developed based on their ability to modify signal transductors (G proteins), or possibly to act at sites distal to receptors, such as second messenger complexes.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Anxiety disorders are common psychiatric problems and the cause of considerable morbidity. Following the demise of the barbiturates, the mainstay of drug treatment for these disorders has been the benzodiazepines.These agents are very effective at producing anxiolysis. However, the disadvantages of their use, including sedation, ataxia and memory impairment, have caused considerable concern to health professionals and the public alike. The other main disadvantage of benzodiazepines is the development of tolerance with continuing use, and subsequent withdrawal symptoms on treatment cessation.In recent years, knowledge of benzodiazepine receptors has increased, and with it the hope that some of the above problems can be addressed by using non-benzodiazepine ligands, subtype specific ligands or partial agonists. The latter bind to benzodiazepine receptor but have lower maximal effects than full agonists, such as diazepam. Thus, they are less efficacious than full agonists and cannot fully potentiate the inhibitory effect of &ggr;-aminobutyric acid (GABA), even at full receptor occupancy.Animal studies suggest that partial agonists have less propensity to cause adverse effects, although they still retain anxiolytic properties. Importantly, they do not appear to cause significant tolerance and dependence.Several compounds are being developed and, although experience with them is limited, early clinical results appear promising.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS