摘要:

Tricyclic antidepressants have a useful role as a first-line treatment in children and adolescents with obsessive-compulsive disorder, and as a second-line treatment in attention deficit hyperactivity disorder, enuresis, Gilles de la Tourette's syndrome and some anxiety disorders. There is little evidence of efficacy in childhood depression, and clinicians may well consider using alternative treatments such as psychotherapy or one of the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors. Clinicians prescribing tricyclic antidepressants to children need to be aware of the differing pharmacokinetics compared with adults, and the risk of toxicity. Treatment should be carefully and regularly monitored.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

The development of targeted maintenance treatment with antipsychotics arose out of the recognition that, despite its efficacy for preventing relapses of schizophrenia, standard maintenance treatment was associated with a number of actual and potential disadvantages. Targeted treatment was designed to circumvent these disadvantages by decreasing total antipsychotic exposure while maintaining the prophylactic benefit of standard maintenance treatment. Targeted treatment has been shown to be effective in reducing total antipsychotic exposure and may be effective in reducing negative symptoms. However, its use is associated with an increase in relapse and hospitalisation rates. These increased rates limit the recommended use of the targeted approach to selected patient populations.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Previously a rare diagnosis, cryptococcal meningitis has emerged as the most common fungal meningitis in the US because of the AIDS epidemic. Due to the profound and prolonged immunosuppression seen in patients with AIDS, the clinical presentation and course of the disease differ from those previously seen in non-HIV-infected patients.Accordingly, previous ‘standard’ treatment strategies have undergone reevaluation in a number of retrospective and prospective clinical studies. In addition, the availability of triazole compounds has changed the management of the disorder. A strategy of aggressive initial treatment with amphotericin B followed by lifelong suppressive therapy with fluconazole has become the accepted approach. Although several clinical studies addressing treatment have been completed, a number of important questions remain about optimal management of this disease.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

The use of drug treatments in patients with personality disorders remains controversial. The target for treatment is symptoms that arise from underlying biological vulnerabilities rather than the personality disorder itself.In antisocial personality disorder (ASPD), the trait symptoms that may respond to drugs are impulsive and violent behaviour. As there have been no specific placebo-controlled treatment studies of patients with ASPD, no specific drug treatment recommendations can be made. However, there is limited evidence based on trials of patients with antisocial behaviours that antipsychotics, mood stabilisers and antidepressants may sometimes be helpful in patients with ASPD. Well designed drug treatment studies are urgently needed.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

The current management of patients with aneurysmal subarachnoid haemorrhage (SAH) begins with early diagnosis using cranial computed tomography and cerebral angiography. In general, rebleeding is best prevented by early surgery and aneurysm clipping, with antifibrinolytics reserved for patients at low risk of vasospasm in whom early surgery is impossible. Anticonvulsants to prevent or treat seizures, and the maintenance of normal serum sodium levels and intracranial pressure are advisable in the immediate period after haemorrhage. Patients should be maintained with normo- or hypervolaemia.Nimodipine is indicated to prevent vasospasm, one of the causes of delayed neurological deficits associated with SAH. Deterioration due to vasospasm, and possibly patients at high risk for vasospasm, should be treated with induced hypervolaemia (to maximise cardiac output) and induced hypertension, and, possibly, haemodilution. Transluminal angioplasty and intra-arterial papaverine are other options in the setting of delayed ischaemia that is unresponsive to the above measures. Intracisternal fibrinolysis with alteplase should be considered in patients with thick SAHs.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Withdrawal from tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs) and selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) can produce somatic and psychological distress. Influenza-like syndromes, gastrointestinal adverse effects, arrhythmias, anxiety, sleep disturbances, movement disorders, mania or hypomania, panic attacks and delirium may follow antidepressant withdrawal. At present, the aetiology of withdrawal symptoms is not fully known.Withdrawal phenomena are usually prevented by gradually reducing the total daily dosage of the drug in question rather than abruptly discontinuing it. Antimuscarinic agents can be prescribed in order to alleviate the symptoms produced by the withdrawal of TCAs and MAOIs. To date, no drugs have been shown to be useful in the treatment of SSRI-associated withdrawal symptoms. The withdrawal syndrome associated with MAOIs may constitute a medical emergency.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

The actions of the endothelins (endothelin-1, endothelin-2 and endothelin-3) are mediated via endothelin-A (ETA) and endothelin-B (ETB) receptors, the former generally mediating vasoconstriction and the latter vasodilation.Peptide antagonists selective for either receptor subtype [e.g. BQ 123 (ETA) and BQ 788 (ETB)] and combined ETA/ETBreceptor antagonists (e.g. PD 145065 and TAK 044) have been developed. More recently, small molecule non-peptide antagonists have also been synthesised. ETAreceptor-selective agents include PD 155080 and BMS 182874, while Ro 46-2005 and bosentan are combined ETA/ETBreceptor antagonists.The role of the endothelin family of vasoconstrictor peptides in the pathophysiology of cerebrovascular disease has been speculated upon. Increases in plasma and CSF levels of endothelin-1 in delayed vasospasm following subarachnoid haemorrhage and acute ischaemic stroke have implicated the endothelins in these cerebrovascular diseases. The development of non-peptide endothelin receptor antagonists has facilitated investigations into the role of the endothelins in cerebrovascular disease.The endothelin receptor antagonists have been demonstrated to attenuate cerebral vasospasm following experimental subarachnoid haemorrhage in a variety of species. Additionally, the endothelin receptor antagonists ameliorate neuronal damage following experimental focal and global cerebral ischaemia. These actions have highlighted the therapeutic potential of endothelin receptor antagonists in cerebrovascular disease.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS