摘要:

A review of the published literature over the past 30 years provides evidence that antidepressants are rarely associated with substance abuse and substance dependence as described by DSM-IV criteria.Reported data do not support the designation of antidepressants as substances of abuse or their general regulation by control acts or schedules. However, the data do support the recommendation that they be used with caution among people who have concurrent substance use disorders or personality disorders (e.g. antisocial personality disorder), who have a high proclivity toward substance abuse or dependence.As with other drugs, all people who use antidepressants require appropriate information regarding the associated risks and benefits of their drug therapy, and instruction regarding correct therapeutic use. They should also be monitored to ensure optimal therapeutic benefit with minimal adverse drug effects.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

A small number of cases in the literature over the past 30 years suggest the possibility of abuse of antidepressant medications. However, this number is minuscule compared with the vast population of individuals who have received antidepressant treatment. Consequently, any possible benefit of routinely warning patients of the possibility that antidepressants might be abusable substances would be more than offset by the negative effect of this warning. It is likely that such a warning would influence patients-who need the short term or maintenance effects of antidepressant medication - to become noncompliant with a therapy that would otherwise be beneficial.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Aggression is found in many patients with psychiatric disorders. However, the aetiology of aggression and an appropriate treatment for this behaviour has yet to be elucidated. Antipsychotics, hypnotics and benzodiazepines have been used to treat aggression because of their sedative properties, but with only moderate success. Antiepileptic agents and &bgr;-adrenoceptor blockers are the mainstays of treatment, but are often ineffective or induce significant adverse effects.A new class of psychoactive drugs, the serenics, has been developed as selective anti-aggressive medications. These agents are serotonin 5-HT1A/1B-receptor agonists. They reduce aggressive behaviour without inducing severe adverse effects or diminishing social relationships. While further research is required, the serenics seem to represent a new and effective treatment for aggression.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Most major affective disorders are, from a longitudinal perspective, recurrent conditions. This article reviews the rationale for longer term models of antidepressant treatment, including strategies for the prevention of relapse (defined as an increase of symptoms back to a syndromal level after an initial treatment response) and recurrence (defined as the onset of a distinctly new episode of affective illness).To prevent relapse, it is recommended that all patients whose symptoms remit during pharmacotherapy receive 4 to 6 months of continuation therapy. Those patients at increased risk for subsequent recurrent depressive episodes should be considered for an extended course of maintenance pharmacotherapy. The efficacy of tricyelic antidepressants, lithium and the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors for the prevention of recurrent depression has been established, with the latter class having a clinical advantage in terms of common adverse effects and safety in overdose.With each new episode of depressive illness, the risk of illness becoming more autonomous, severe and potentially refractory may increase. Thus, prophylactic treatment of patients at risk of recurrent depression remains the best way to optimise their long term outcome.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Tardive dyskinesia is an important adverse effect of antipsychotic drug treatment. It is a complex neurological syndrome, consisting of hyperkinetic, involuntary movements, mainly choreoathetoid (but also dystonic) in nature. The movements involve several body areas, and affected patients are usually unaware of the presence of the movements.Tardive dyskinesia affects about one-fifth of patients treated with antipsychotics. Epidemiological studies show that some factors such as age, institutionalisation, a psychiatric diagnosis of mood disorders and a history of acute extrapyramidal syndromes increase the risk of developing tardive dyskinesia. Treatment variables are less clearly correlated with risk, but lower doses seem to reduce the risk and new atypical antipsychotics, in particular clozapine, seem to have a reduced risk of inducing the syndrome. As the greatest factor for risk is patient vulnerability, the best way to reduce the risk of tardive dyskinesia is to use antipsychotic drugs in a conservative manner.Recognising and treating tardive dyskinesia is of paramount importance and results in a more favourable course of the disorder. Reducing antipsychotic exposure to the minimum clinically effective dose and duration increases the possibility of improvement and remission. Active treatment is required for patients with severe tardive dyskinesia, but to date no treatment has been demonstrated to be significantly effective in the majority of patients, except for the suppressive effects of antipsychotics themselves. Benzodiazepines, in particular clonazepam, and atypical antipsychotics, especially clozapine, provide some benefits. The neuroprotective effects of tocopherol (vitamin E) seem useful in some patients. Other treatments may be limited by severe adverse effects and have little proven efficacy. Nevertheless, subgroups of patients may respond to a particular treatment, suggesting the heterogeneity of this condition.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

Felbamate is one of a new generation of antiepileptic agents that has recently reached the market. In July 1993, it was approved for use in the US as an adjunctive and monotherapy in adults with partial seizures, with or without generalisation, and as adjunctive therapy in children with Lennox-Gastaut syndrome. However, the unexpected development of aplastic anaemia prompted the US Food and Drug Administration and the manufacturer, Carter Wallace, to issue a strong warning on 1 August 1994 regarding continued use of felbamate. Shortly thereafter, reports of felbamate-associated hepatic failure engendered further concern. As a result, felbamate is not indicated as a first-line treatment, but should be used only in those patients who respond inadequately to alternative treatments and whose epilepsy is severe enough that the risk of aplastic anaemia and/or liver failure is deemed acceptable by the patient compared with the benefits conferred by its use. Because of the effectiveness of this drug in many patients, felbamate will remain on the market in the US and may be available in certain situations in other countries.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS

摘要:

In the last 5 years, there has been considerable progress in the molecular characterisation of multiple neurotransmitter reuptake mechanisms (or neurotransporters). Neurotransporters are high affinity reuptake proteins located in the plasma membrane of both presynaptic nerve and glial cells. They mediate the removal of the neurotransmitter from the synaptic cleft or represent intracellular transport systems that concentrate neurotransmitters in synaptic vesicles.Based on subcellular distribution and pharmacological properties, neurotransporters have been placed into 3 main subgroups: (i) Na+/Cl−-or (ii) Na+/K+-dependent cell surface transporters, and (iii) H+-dependent transporters associated with synaptic vesicles.The new insights into neurotransporter diversity provide the means for novel approaches of studying reuptake processes at the molecular level. Current research strategies are focusing on functional mechanisms of substrate translocation and antagonist binding, as well as on molecular regulation of neurotransporter gene expression and on post-translational modification at the neurotransporter protein level. Interesting information will also be derived from the analysis of genomic regulatory elements, as well as from modelling neurotransporter-related disorders and novel therapeutic strategies in genetically engineered animals.Through an improved understanding of the modulation of the function of neurotransporters in the brain, it may be possible to identify the molecular factors underlying both the predisposition to, and the pathogenesis of, psychiatric, neurological and neurodegenerative disorders. Neurotransporters have long been regarded as primary sites of action for tri- and heterocyclic antidepressant drugs in the treatment of a variety of neuropsychiatric conditions. Nevertheless, due to their increasingly appreciated heterogeneity, as well as their specificity for distinct neuronal systems, we are currently witnessing a renaissance of various neurotransmitter reuptake mechanisms as potential targets for novel therapeutic strategies.

ISSN:1172-7047    

出版商:ADIS    

年代:1995

数据来源: ADIS