摘要:

Recent and ongoing advances in mapping and isolating human epilepsy genes will: (i) modify the classification of the epilepsies; (ii) base antiepileptic drug development on defined epilepsy mutations; and (iii) spur the development of somatic cell and/or germ line therapy for the fatal progressive myoclonus epilepsies and, eventually, the chronic generalised and partial epilepsies.In the next century, advances in these 3 areas will dramatically change the diagnostic, therapeutic and prognostic approach to patients with epilepsy, and will probably eliminate some genetic epilepsies within 2 or 3 generations.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Central post-stroke pain (CPSP) follows stroke in up to 8% of patients. The pain is usually burning in character and is accompanied by a sensory deficit, particularly for nonpainful temperature and for pinprick (sharpness) sensations. About one-half of patients exhibit allodynia. The pain is not experienced until some months after the stroke in two-thirds of patients, so it is frequently the family doctor who is responsible for determining the diagnosis.Conventional analgesics (including morphine) are largely ineffective, and precious time should not be wasted ‘trying’ them. The most effective treatment is with adrenergically active antidepressants (e.g. amitriptyline, nortriptyline, desipramine and maprotiline), in dosages increasing gradually from 10 or 25 to 50 or 75 mg/day. The sooner such treatment is commenced after pain onset, the better the prognosis.In patients who do not respond to antidepressants, benefit may be obtained by the addition of mexiletine. Transcutaneous nerve stimulation or surgically implanted stimulators may help in recalcitrant cases.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Drug-induced psychosis represents one of the more serious adverse effects of therapy for Parkinson's disease. Risk factors include dementia, a history of psychiatric illness, advancing age, and the dose and duration of treatment with dopamine-enhancing agents.The pathophysiological basis of drug-induced psychosis has not been established. Chronic changes in both the dopaminergic and serotonergic systems have been implicated in producing these symptoms.Management options include the reduction and/or elimination of medications used for symptomatic control of the illness. However, with the attendant risks of an unacceptable reduction in mobility and, in rare cases, life-threatening complications, therapeutic alternatives are required. Treatment with atypical antipsychotic agents, such as clozapine and risperidone, presents such an avenue. Nonpharmacological treatments, including electroconvulsive therapy (ECT), may also play a role in the management of these patients.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Depressive symptoms are highly prevalent in the medically ill, and may affect quality of life, social functioning, and compliance and the outcome of treatments for medical illness.There is evidence that depression in medical patients is frequently unrecognised and untreated. Its evaluation requires both the assessment of severity (whether it reaches the clinical threshold of a major depressive disorder) and determination of aetiology (symptomatic or organic mood disorders).Treatment of symptomatic depression follows the treatment. whenever it is feasible. of the underlying medical condition. Antidepressant drugs are the treatment of choice for major depressive disorders in the medically ill, and are well tolerated in patients with a number of medical conditions. provided that specific precautions are heeded.In the medically ill, tricyclic antidepressants appear to still present considerable advantages over second generation antidepressants. such as selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors. Psychotherapeutic interventions have considerable potential, currently largely unexplored in controlled studies, for the treatment of depression in the medically ill. Electroconvulsive therapy (ECT) remains an effective modality for refractory depression and can be used safely in a number of medical conditions.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Abuse of the centrally acting anticholinergic agents is a phenomenon occasionally reported in the medical literature. Anticholinergics, most often used in psychiatry to treat antipsychotic-induced extrapyramidal symptoms, are also used by some patients for their mood altering and psychedelic effects. The changes in sensorium can range from mild euphoria and increased sociability to hallucinations and toxic psychosis.In this article, we have reviewed 110 cases of reported anticholinergic abuse and identified 3 distinct groups of abusers: (i) those individuals who have no valid medical need for the medication and consume it only for its mind-altering effects; (ii) those with a valid indication for the use of anticholinergics who also abuse the agents for their mind-altering effects; and (iii) those who have an appropriate medical indication for the agents and appear to be using anticholinergics to relieve chronic or subclinical extrapyramidal symptoms, depression or negative schizophrenic symptoms. True abusers (i.e. those individuals in the first 2 groups) can be recognised because they feign extrapyramidal symptoms, repeatedly ‘lose’ their medications or request unnecessary dose increases.In order to reduce the risk of abuse, exposure to anticholinergics should be minimised in patients at risk. Patients who are reluctant to have their anticholinergics discontinued should be carefully evaluated to identify potential risks and benefits of continued use before prolonged therapy is instituted. Anticholinergics should not be abruptly discontinued, but instead tapered over a 2-week period in patients receiving high doses or long term treatment.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Plasma drug concentrations and response to drugs vary considerably between patients during treatment with psychotropic drugs. Many antidepressant and antipsychotic drugs are metabolised by the polymorphic debrisoquine/sparteine hydroxylase, i.e. cytochrome P450 (CYP) 2D6, which is absent in 7% of Caucasians [these individuals are termed ‘poor metabolisers’ (PM)]. Such PM might develop adverse drug reactions while receiving usual dosages of drugs due to high plasma drug concentrations. In contrast, ultrarapid metabolisers with multipleCYP2D6genes might require high doses of such drugs for optimal therapy.The mean CYP2D6 activity is lower in Oriental than in Caucasian populations, because of a frequent mutation in exon 1 ofCYP2D6, causing decreased enzyme activity. This may partly explain the use of lower doses of antidepressants and antipsychotics in Oriental than in Caucasian individuals. In contrast to other antipsychotics, clozapine is not metabolised by CYP2D6 to a major extent, but by CYP1A2. This latter isozyme is induced by tobacco smoking.The hydroxylation ofS-mephenytoin is catalysed by the polymorphic CYP2C19 isozyme. About 3% of Caucasians, but as many as 12 to 20% of Oriental persons, are PM of S-mephenytoin and of omeprazole, another CYP2C19 substrate. Among psychotropic drugs, tertiary amine antidepressants (amitriptyline, citalopram, clomipramine and imipramine) areN-demethylated by CYP2C19. Both diazepam and its demethyl metabolite are partly metabolised by this polymorphic enzyme. The high incidence of PM (and of heterozygous extensive metabolisers) ofS-mephenytoin in Asia might be the reason for the reported higher sensitivity of Orientals to diazepam compared with Caucasians.Various probe drugs may be used for phenotyping of CYP2D6 (debrisoquine, dextromethorphan and sparteine) and CYP2C19 (mephenytoin and omeprazole). Allele-specific polymerase chain reaction (PCR)-based methods are now available for genotyping using leucocyte DNA. A major advantage of genotyping over phenotyping is that the former may be performed using blood samples from patients irrespective of treatment with psychotropic drugs.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

▴ Sertindole is a novel and atypical antipsychotic compound.▴ The drug selectively inhibits limbic dopamine function and is notable for its highin vitroaffinity for dopamine D2receptors, serotonin 5-HT2receptors and &agr;1-adrenergic receptors.▴ Sertindole shows marked antipsychotic activity in various animal models while lacking marked cataleptogenic, anticholinergic and autonomic activity.▴ Results of phase II and III clinical studies have shown sertindole to be effective in alleviating the positive and negative symptoms of schizophrenia.▴ Sertindole was not associated with disturbed motor function (including extrapyramidal symptoms) in phase II and III clinical studies.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS