ISSN:1172-7047    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

The involvement of tachykinin neuropeptides, such as substance P and the neurokinins, in pain transmission is supported by a wealth of evidence. At present, the therapeutic potential of manipulating tachykinin-mediated effects is being investigated and has been assisted by the discovery of several non-peptide, metabolically stable compounds that are antagonists at neurokinin (NK) receptors. Since multiple neurotransmitters or neuromodulators are involved in nociception in primary afferents, drugs that are antagonists at both tachykinin NK1and NK2receptors could be clinically more useful than receptor-selective drugs in the treatment of pain syndromes. NK1receptor antagonists that are also opioid receptor agonists or the combination of neurokinin receptor antagonists with opioids may also be promising approaches to treating pain.

ISSN:1172-7047    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Substance abuse in women of childbearing age is a global public health problem. The most common drugs of abuse are cocaine, diamorphine (heroin) and alcohol. Fetal drug exposure can be identified by maternal history (which is not always reliable), maternal and infant urine toxicology screening, and meconium and infant and maternal hair analysis.The opioids most commonly associated with withdrawal in neonates are diamorphine, morphine and methadone. Neonatal withdrawal or abstinence syndrome (NAS) occurs in 50 to 80% of infants exposed to opioidsin utero,usually within the first 24 to 72 hours after birth. Only 5 to 20% of these infants will have severe symptoms and need pharmacotherapy.Signs of withdrawal include effects arising from the central nervous, vasomotor, respiratory and gastrointestinal systems. The most serious problems are vomiting and diarrhoea resulting in dehydration, electrolyte imbalance, bodyweight loss, aspiration pneumonia, respiratory alkalosis from tachypnoea, and seizures. There are a number of scales that can be used for assessing the need for pharmacotherapy in NAS. The goal of treatment is for the infant to be comfortable and able to sleep between feeds without being deeply sedated.Pharmacological agents used for treating opioid NAS include both opioid and non-opioid drugs. The most commonly used drugs are paregoric, diluted tincture of opium, and phenobarbital (phenobarbitone). Paregoric, a solution of opium alkaloids - morphine and codeine (analgesics), narcotine and papaverine (antispasmodics) - is used in doses of 3 to 6 drops every 4 to 6 hours. Tincture of opium alkaloids, for use in the neonate, must be reconstituted (25-fold dilution) by the hospital pharmacy to a concentration of 0.4% to reduce the content of morphine to that in paregoric (0.4 mg/ml). This avoids the adverse effects associated with the presence of other ingredients in paregoric. Phenobarbital is an analgesic and anticonvulsant. It has a prolonged half-life and is especially useful in reducing the hyperactive behaviour associated with NAS. It is important to closely monitor the efficacy of therapy by assessing patient response through the use of objective measures.The psychosocial aspects of drug abuse are important to keep in mind, as the infant continues to be at high risk for neglect, abuse and foster care placement.

ISSN:1172-7047    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Psychotic depression, although considered in DSM-IV to be a subtype of major depression, has many features of a separate disorder, including its own distinct phenomenology, epidemiology, family history, course of illness, biology and treatment. When evaluating patients with both depressive and psychotic symptoms, it is important to always consider psychotic depression as a possible diagnosis, as well as other diagnoses which may resemble it, such as bipolar disorder, schizoaffective disorder, schizophrenia with superimposed depression, delusional disorder and obsessive-compulsive disorder with poor insight and comorbid depression.Although patients with psychotic depression and those with depression without psychotic symptoms appear to respond equally well to electroconvulsive therapy (ECT), numerous studies have shown a significant lack of response to tricyclic antidepressants (TCAs) in the former group of patients compared with the latter. However, patients with psychotic depression appear to respond significantly better to combinations of antidepressants and antipsychotics. There is disagreement as to whether ECT is superior to combined TCA-antipsychotic treatment. Most researchers agree, however, that both are effective first-line treatments for psychotic depression. Amoxapine, selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor (SSRI) monotherapy, and combination treatment with an SSRI and an antipsychotic, are promising as possible additional first-line treatments. Atypical antipsychotics and the addition of lithium or other mood stabilisers to an antidepressant-antipsychotic regimen are potential treatments for patients with refractory psychotic depression.Psychotic depression is a recurrent disorder with a high rate of relapse after successful initial treatment with medications or ECT. The rate of relapse appears to be especially high when no maintenance therapy is used or when the antipsychotic drug of an antidepressant-antipsychotic combination is tapered off prematurely. Maintenance ECT is a promising tool for preventing relapse after initial ECT treatment.Additional studies of psychotic depression are needed to better determine the effectiveness of new treatments as well as to help resolve how to most effectively prevent relapse after acute treatment of this disorder.

ISSN:1172-7047    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

The development of ischaemic brain damage depends on the severity and duration of the focal disturbance in cerebral blood flow. Several flow thresholds exist; if flow is decreased to a certain threshold there can be functional but potentially reversible impairment, while a decrease to lower thresholds results in morphological and therefore permanent damage. Tissue perfused at a value between these thresholds is termed the ‘penumbra’. This tissue has the potential for functional recovery if blood flow is re-established to a sufficient level within a limited time period, i.e. the ‘therapeutic window’.The existence of a therapeutic window for the restoration of blood flow is evident from experimental studies and clinical experience. It has formed the basis for the success of thrombolytic therapy (e.g. with alteplase) in ischaemic stroke if treatment is initiated within a short period (approximately 3 hours) after the onset of symptoms. Despite the success of thrombolytic therapy, additional strategies need to be developed for the treatment of ischaemic stroke. In particular, therapies that interrupt the molecular and biochemical alterations triggered during the ischaemic period and that continue after reperfusion would be beneficial. These biochemical changes may propagate ischaemic damage and contribute to the enlargement of infarcts.State-of-the-art imaging modalities, such as positron emission tomography and diffusion- and perfusion-weighted magnetic resonance imaging, demonstrate the presence of ischaemically compromised but viable tissue in patients who have had a stroke (and in animal models of focal ischaemia, in which the transient changes can be followed until the final state of infarction or recovery is reached). In selected groups of patients, therapeutic strategies, such as acute thrombolysis or the interruption of biochemical changes, can be evaluated using these imaging techniques, and the clinical course analysed in relation to effects on impaired perfusion and altered metabolism within ischaemic tissue.

ISSN:1172-7047    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Some anticonvulsants have been reported to be associated with psychiatric adverse reactions, such as behavioural disorders, depression, mania and psychosis. However, few systematic pharmacoepidemiological studies have investigated adverse reactions to anticonvulsant drugs, which makes accurate assessment of the incidence rate of adverse drug reactions, including psychiatric adverse reactions, very difficult. Nevertheless, by reviewing clinical trials, observational studies and case reports, it can be concluded that patients exposed to vigabatrin or phenobarbital (phenobarbitone) are at the highest risk of developing psychiatric adverse drug reactions, those exposed to phenytoin probably at medium risk, while patients exposed to carbamazepine, valproic acid (sodium valproate) and benzodiazepines are at the lowest risk. Based on the available evidence, psychiatric adverse drug reactions attributable to lamotrigine and gabapentin are relatively infrequent, although further evidence is required to confirm this. Topiramate has only been marketed for 2 years and felbamate has only had limited use because of its propensity to cause serious nonpsychiatric adverse effects; with the relative lack of peer-reviewed reports it is very difficult to comment further on the risk of psychiatric adverse reactions to these drugs.Rational prescribing using: (i) monotherapy, instead of polytherapy, whenever possible; (ii) the minimal effective dosage; and (iii) escalating the dosage slowly, can reduce the risk of the patient developing psychiatric adverse drug reactions. Pre-existing psychiatric/behavioural disorders and organic brain damage are believed to predispose patients to these reactions, and such patients should be carefully monitored.The ideal treatment of a psychiatric adverse drug reaction is discontinuation of the offending drug; however, this may not be possible for all patients with epilepsy. In cases where it is necessary to continue anticonvulsant medication to obtain satisfactory seizure control, the psychiatric disorder should be treated concurrently with psychosocial interventions and psychotropic medication, as appropriate.

ISSN:1172-7047    

出版商:ADIS    

年代:1997

数据来源: ADIS