摘要:

The clinical significance and neurobiological basis of normal age-related cognitive decline remains controversial. Terms such as ‘benign senescent forgetfulness’, ‘age-associated memory impairment’ (AAMI) and, more recently, ‘age-associated cognitive decline’ have been proposed to describe memory loss in non-demented individuals as they age. This editorial considers to what extent such terms, particularly AAMI, should be accepted as clinically meaningful. It is concluded that, in the current state of knowledge about the natural history of AAMI and similar entities, widespread treatment with pharmacotherapy is premature.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Attention deficit hyperactivity disorder (ADHD) is a heterogeneous disorder of unknown aetiology. It usually affects school-aged children with an estimated prevalence of 3 to 6%. ADHD is characterised by a core of symptoms that include short attention span, easy distractibility and social impulsivity.Stimulants continue to be the most efficacious and least toxic agents used to treat the disorder in the majority of children, and are the drugs of choice in children in whom cardiovascular status is questioned. Tricyclic antidepressants are also effective and are especially beneficial in individuals who are resistant to stimulants or in whom ADHD is accompanied by comorbid depression, anxiety, enuresis, tic disorders, substance abuse or sleep disturbance. Other antidepressants such as clorgiline (clorgyline), nortriptyline, fluoxetine and monoamine oxidase inhibitors have also been shown to reduce ADHD symptomatology. These agents may provide therapeutic options in the future.Adverse effects associated with stimulants include decreased appetite, insomnia, gastrointestinal upset, headache and potential growth suppression. Tricyclic antidepressants may cause drowsiness, anticholinergic effects and cardiovascular changes. Tolerance does not development with stimulants but may occur with tricyclic antidepressants.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

The history of negative symptoms of schizophrenia, also known as fundamental Bleulerian, Type 2 and deficit symptoms, is nearly as old as the concept of schizophrenia itself.Negative symptoms include alogia, flattened affect, anhedonia, asociality, avolition/apathy and attentional impairment. These symptoms can be assessed using various scales, such as the Andreasen's Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative Symptom scale (PANSS), and the Negative Symptom Rating Scale (NSRS). The differential diagnosis of negative symptoms requires exclusion of akinesia secondary to antipsychotic-induced extrapyramidal effects, and depression.The issue of whether and to what extent negative symptoms of schizophrenia respond to traditional antipsychotic agents remains a controversial one. The atypical antipsychotic, clozapine, appears to be an important agent in the treatment of negative symptoms, and initial data on several newly developed drugs suggest that they may prove to be useful. Psychological treatments are also a promising avenue for future research.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Depression and anxiety disorders are under-recognised in clinical practice. They are relatively common psychiatric disorders, affecting 2 to 5% of the population per year.Symptoms of depression and anxiety frequently co-exist in a given patient. Recent diagnostic criteria allow a differential diagnosis to be made based on the history of the symptomatology in the current psychiatric episode. The Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), although not the only diagnostic scheme available, has become widely used, particularly for the diagnosis of anxiety states. Despite the relatively clear-cut diagnostic criteria of the DSM-III-R, the problem of comorbidity of diagnoses remains.Pragmatically, the differentiation of major depression and anxiety may not be very important, since pharmacological treatment of both disorders is heavily reliant on the use of antidepressant drugs.Tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs) and selective serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitors (SSRIs) are all effective in the treatment of major depression and panic disorder. SSRIs and the tricyclic antidepressant clomipramine are effective in the treatment of obsessivecompulsive disorder, while MAOIs are effective in social phobia.Although their use has declined in recent years, due to concerns about tolerance and dependence, benzodiazepines have proven efficacy in the treatment of generalised anxiety disorder. At higher dosages, these agents are also effective in panic disorder.Some general guidelines on drug treatment for these disorders is presented.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Ischaemic stroke is a major cause of death in industrialised nations. Many survivors of stroke bear a burden of permanent disability. This very often involves extreme individual suffering and puts great financial strain on healthcare systems.It is beyond doubt that ischaemic stroke can partly be avoided. In order to reduce the incidence of stroke, 2 approaches to prevention are necessary. First, avoidable risk factors must be avoided by patients themselves. Secondly, treatable risk factors must be treated by physicians. However, efficient preventive strategies depend on the reliable definition and recognition of risk factors and their competent management.In the last few decades, scientific research has identified certain disorders and conditions as definite risk factors and has meticulously assessed their significance for the causation of stroke. The significance of various other potential risk factors, however, remains elusive. The most important treatable risk factors for ischaemic stroke are cardiac disease, arterial hypertension, diabetes mellitus, hyperlipidaemia, increased fibrinogen level, elevated haematocrit, and selected haematological disorders and coagulopathies. The most important avoidable risk factors include cigarette smoking, alcohol consumption, abuse of other drugs, intake of oral contraceptives, excessive bodyweight and low physical activity. Implications for the prevention of ischaemic stroke, in particular with respect to underlying cardiac disease, are outlined.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS

摘要:

Alzheimer's disease is the most prevalent late-onset neurodegenerative disorder of unknown origin.The cholinergic hypothesis of Alzheimer's disease attributes the cognitive deficits of the disease and their severity to the degeneration of cholinergic pathways running from the nucleus basalis of Meynert to the hippocampus. Five basic strategies have been pursued to treat the disorder: precursor loading, increasing the release of acetylcholine, decreasing the degradation of acetylcholine, activating cholinergic receptors and stimulating intracellular second messengers.Based on the strategy of reducing the degradation of acetylcholine, cholinesterase inhibitors were developed. By inhibiting acetylcholinesterase, the enzyme that degrades acetylcholine, these agents make more acetylcholine available to postsynaptic neurons. It was suggested that cholinesterase inhibitors could reverse memory impairment, and they are now being investigated and/or used to restore acetylcholine deficits at synaptic sites in the brain.A number of cholinesterase inhibitors have been shown to be moderately effective in mild to moderate Alzheimer's disease. Among their adverse effects, reversible increases in liver transaminase levels cause the most concern. The drugs also will, in a dose-dependent manner, cause typical cholinergic adverse effects, affecting mainly the gastrointestinal system.

ISSN:1172-7047    

出版商:ADIS    

年代:1994

数据来源: ADIS