摘要:

Drug dependence involves the repetitive use of substances that produce reinforcing effects in the CNS. Drug dependence disorders can often be more effectively and less expensively treated than the consequences of dependence (e.g. HIV infection, liver cirrhosis, lung cancer). Systematic psychotherapy or behavioural intervention is the most widely studied and used treatment for drug dependence. Medications can be used to treat aspects of drug dependence by reducing withdrawal symptoms, blocking the addicting effects of the drugs, and by protracting episodes of remission.We conclude that insofar as a critical therapeutic goal is a change of behaviour, some form of behavioural intervention is the cornerstone of all therapies for drug dependence, and that a comprehensive drug dependence treatment programme should include the option to administer medications as indicated. Additionally, the most cost-effective approaches to treating drug dependence in large populations may be those that integrate psychotherapeutic and medication-based approaches as per the needs of the individual patients.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Adrenoleukodystrophy (ALD) is a neurodegenerative disorder characterised by progressive demyelination of the CNS, and adrenal insufficiency. The disorder is associated with an accumulation of saturated very long-chain fatty acids (VLCFAs) in neural white matter, adrenal glands, fibroblasts and plasma. This effect is related to an impairment of &bgr;-oxidation of VLCFAs in peroxisomes of these tissues and fluids.The administration of oleic and erucic acids (Lorenzo's oil) inhibits the synthesis of VLCFAs and can normalise the levels of VLCFAs in the plasma of patients with ALD. Such dietary treatment has been widely publicised as a possible cure for the disease. However, there is no evidence of clinically relevant benefit in children with the lethal cerebral form of ALD or in adults with the less severe adrenomyelopathy form, which affects mainly the spinal cord. Although there is still some hope that this dietary treatment might have a partial preventative effect, this effect is yet unproven.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

A clear understanding of the scope of alcohol (ethanol)-related problems is important for effective diagnosis and treatment of alcoholism. The focus of medical treatment has long been on patients with severe alcohol dependence. These patients constitute only 5 to 6% of the adult population. However, approximately 20% of the adult population can be classified as ‘problem drinkers’, who are not alcohol dependent and yet consume alcohol at levels that may result in hazardous medical and psychosocial sequelae.Evaluation of alcohol-related problems should be viewed as an integral part of a medical assessment in all patients. The ideal strategy should incorporate the findings of clinical interviews, physical examinations, questionnaires and laboratory tests.There has been important progress in the pharmacotherapy of alcoholism, particularly for alcohol withdrawal and reduction of alcohol consumption. Benzodiazepines are currently the first-line therapy for the treatment of the alcohol withdrawal syndrome. Pharmacotherapy has been improved and simplified with the use of long-acting benzodiazepines via a loading dose technique.Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) and other agents modulating serotonergic function are currently the most promising agents for the reduction of alcohol consumption. In short term clinical trials, SSRIs, such as zimeldine, viqualine, citalopram and fluoxetine, decreased alcohol consumption by averages of 14 to 20% from baseline. Reductions of up to 60% were observed in some patients. Citalopram and fluoxetine also decreased the desire for alcohol, and may be useful for prevention of relapse after detoxification. The combination of SSRIs and psychosocial interventions may be more beneficial than either therapy alone.Future developments in understanding the neurobiological mechanisms of alcohol dependence may further improve the pharmacological treatment of alcoholism.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Antidepressants lead to improvement in about 70% of unselected patients with a depressive syndrome. However, many of these patients would also improve with the passage of time alone or with support and counselling. Although antidepressants are generally well tolerated, they can be expensive and are not devoid of adverse effects. Accordingly, it is worthwhile considering which patients are most likely to benefit from these drugs.Patients who are likely to require antidepressants include those with a depression of relatively long duration, a depression of moderate or greater severity, and a depression that has melancholic or psychotic features. Patients with a history of previous depressive or manic episodes, and those showing suicidal ideation are also candidates for antidepressant treatment. Patients who show the sleep electroencephalographic (EEG) changes characteristic of depression and those with enhanced pituitary-adrenocortical activity usually require antidepressant treatment.Once a depressed patient has responded to antidepressant treatment, further treatment for about 6 months is recommended to minimise the risk of relapse. Patients who are particularly vulnerable to recurrences may benefit from continuing antidepressant treatment beyond 6 months.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Chronic fatigue syndrome (CFS) is an illness characterised by incapacitating fatigue and a pattern of somatic complaints without known cause. It is a controversial illness in that symptoms are subjective and overlap with symptoms of primary emotional disturbance.The natural history of this illness is often characterised by spontaneous improvement, and a significant placebo response is frequently present. Therefore, results from poorly controlled trials may be misleading. Few adequate treatment trials have been done in patients with CFS, due to difficulties in case definition and the lack of definitive biological markers. However, numerous treatment regimens have been proposed over the last 30 years, the majority emphasising either psychotropic, immunological or antimicrobial therapy. While no single agent has been curative, benefit has been claimed for many agents. These include tricyclic antidepressants, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors fluoxetine and sertraline, amfebutamone (bupropion), immunoglobulin G, mismatched double-stranded RNA [Poly(I):Poly(C12U); ‘ampligen’] and essential fatty acids.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

The occurrence of mental changes in patients with hyperthyroidism and hypothyroidism is well known. In contrast, the role of thyroid function in patients with depression is still controversial. However, it is certain that some depressed patients have a tendency towards hypothyroidism.Thyroid function should be carefully checked in depressed patients, especially in those who are elderly or in the postpartum period. The thyrotrophin-releasing hormone (TRH; protirelin) test is a useful psychoendocrine test.Thyroid hormones augment the effect of tricyclic antidepressants, and large dosages of these hormones influence the periodic recurrence of mood disorders. Therefore, thyroid hormones can be used as adjunctive therapy in patients with refractory depression. They may also be considered as candidate therapy for the treatment of intractable cycling psychoses.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Clinical experience indicates that the concurrent use of electroconvulsive therapy (ECT) and some psychoactive drugs is safe. With the exception of caffeine to prolong ECT seizure duration, no agent reliably enhances the efficacy of ECT.Despite the paucity of adequate prospective studies, antipsychotic drugs (including clozapine) may be safely combined with ECT. Furthermore, this combination is probably more effective in relieving psychoses than either treatment alone. Similarly, there is no evidence of an antagonism of efficacy or a loss of safety during the use of ECT and antidepressants, such as tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) or lithium. However, prolongation of seizures may be a concern with a combination of SSRIs and ECT, and enhanced confusion a concern with lithium and ECT.In contrast, benzodiazepines inhibit the efficacy of ECT and, therefore, combined use should be avoided. Where such use is deemed necessary, the administration of flumazenil (a benzodiazepine antagonist) before ECT may be considered. The continued use of other anticonvulsants during ECT depends on their effect on ECT-induced seizure adequacy, which remains ill-defined. There are special risks associated with administering ECT to patients who have therapeutic plasma concentrations of theophylline or lidocaine (lignocaine).During the evaluation of new psychoactive drugs, studies of possible interactions with ECT are rarely performed. Therefore, the data available are inferred from case literature alone. Such data are notoriously deficient, and attention to premarketing testing of such interactions is warranted.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

The benefits and risks of the benzodiazepines when used to treat generalised anxiety disorder, panic disorder and insomnia are important considerations. In discussing these parameters a distinction must be drawn between short term (of up to 28 days) and long term use.Benzodiazepine anxiolytics and hypnotics have undoubted efficacy, although it can be difficult to distinguish between a substantial nonspecific (placebo) effect and true pharmacodynamic drug effects. Response to benzodiazepines is prompt. However, in the long term, efficacy wanes and becomes difficult to disentangle from the suppression of rebound or withdrawal.The risks of benzodiazepines are well known, and comprise those associated with drug use and those that occur following discontinuation. Benzodiazepines have effects on psychological function, such as cognition and memory, and psychomotor performance. This translates into some interference with real-life functioning. Tolerance occurs to many but not all of these effects. Benzodiazepines have few effects on physical function, few drug interactions and are fairly safe in overdose.On discontinuation after short term use, some rebound of the disorder for which the agents were prescribed may occur. After long term use, up to a third of patients will show a characteristic and clinically troublesome withdrawal syndrome.Anxiety, panic and insomnia are unpleasant conditions that, especially in their severest forms, are associated with appreciable mortality. Alternative treatments to benzodiazepines are being developed, but are most efficacious in milder conditions. Therefore, the use of benzodiazepines can be justified in the short term management of anxiety, panic disorder and insomnia. However, in the long term, the risks of these agents probably outweigh their benefits.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Gepirone is an azapirone derivative with partial agonist activity at the postsynaptic serotonin (5-hydroxytryptamine) 5-HT1A receptor. In contrast to buspirone, gepirone lacks appreciablein vitroaffinity for the dopamine D2receptor, and exhibits only limited dopaminergic activityin vivo.The drug is active in several animal models considered predictive of antidepressant and anxiolytic activity, and is currently under development as a potential treatment for affective and anxiety disorders. The limited number of controlled clinical trials performed to date indicate that gepirone is of superior therapeutic efficacy to placebo on short term (≤ 10 weeks) administration to outpatients with generalised anxiety disorder (dosage range ≤ 60 mg/day) and major depressive disorder or atypical depression (dosage range ≤ 90 mg/day). The antidepressant effect of gepirone appears to be additional to its anxiolytic effect. As with buspirone, onset of the anxiolytic effect of gepirone appears to be delayed (≈ 2 to 4 weeks) relative to that of the benzodiazepines. The tolerability profile of gepirone mirrors that of buspirone: gepirone is nonsedating, lacks anticholinergic effects, and appears to be of low abuse potential. Gepirone has a possible role in the treatment of major depression, particularly that of the milder, non-endogenous or non-melancholic subtype, major depression associated with generalised anxiety, atypical depression, and chronic generalised anxiety disorder.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS