摘要:

AbstractLithium is highly valued for the treatment of mania and depression. Resistance may occur to one of its two main indications: firstly for thetreatmentof acute episodes of mania, and secondly for theprevention of relapseeither of bipolar affective disorder (manic depression) or of unipolar affective disorder (recurrent depression).For the management of manic episodes, alternative possibilities include neuroleptics, carbamazepine, electroconvulsive therapy (ECT) and sodium valproate. Neuroleptics are effective, but may precipitate depression. Carbamazepine is effective either alone or as a supplement to the lithium. ECT is an impressively powerful treatment for mania. Valproate appears to be effective but more studies are desirable.Alternatives to lithium in the prevention of relapse of recurrent affective disorders include antidepressants, carbamazepine and ECT. For the prevention of relapses of bipolar affective disorder antidepressants have the disadvantage of increasing the frequency of manic episodes. In unipolar disorder they are a valid alternative to lithium but with some disadvantages. Carbamazepine is effective in the prophylaxis of bipolar affective disorder and should be considered especially in patients with rapid cycling or those with psychotic features.Only open studies are available on ECT and valproate as prophylactic agents. Preliminary work has been carried out on verapamil, flupenthixol, clonazepam, methylene blue, clorgyline, clonidine, tryptophan and 5‐hydroxy tryptamin

ISSN:0885-6222    

DOI:10.1002/hup.470090501

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractA multicentre study compared the antidepressant efficacy and the tolerance of two selective serotonin reuptake inhibitors, paroxetine (20–30 mg/d) and fluvoxamine (50–200 mg/d) in two parallel groups of respectively 56 and 64 patients with major depression, as defined by DSM‐III‐R criteria. The duration of the study was six weeks, with assessments at baseline and at the end of weeks 1, 2, 4, and 6. For efficacy the Hamilton depression, the Hamilton anxiety scales and the clinical global impressions were used; adverse events were assessed by means of a non‐leading question. Results showed a similar improvement in both groups on all rating instruments. The total number of patients reporting adverse events did not significantly differ between paroxetine (52 per cent) and fluvoxamine (64 per cent); severe adverse events were however significantly less frequently reported with paroxetine than with fluvoxamine (13 per cent versus 28 per cent), and resulted less frequently in the discontinuation of treatment (5 per cent versus 17

ISSN:0885-6222    

DOI:10.1002/hup.470090502

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractNineteen patients with mania were compared to a group of 15 schizophrenic patients and age, sex matched controls with respect to changes in 5HT‐induced platelet aggregation. In the manic patients aggregation rates were monitored immediately before the commencement of standard neuroleptic treatment (chlorpromazine, haloperidol), on days 4, 8, 15 and following discharge from hospital. The 5HT‐induced aggregation rate was increased in the manic patients compared with their controls and the schizophrenics and did not return to control levels at the end of the study period when the patients were apparently well. There was no correlation between the increased 5HT‐induced aggregation and the Young Manic Score. No change occurred in the aggregation rate to noradrenaline and adrenaline in either the manic or schizophrenia patients.The results suggest that increased 5HT‐induced platelet aggregation may be a trait marker o

ISSN:0885-6222    

DOI:10.1002/hup.470090503

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractDespite its early promise as ‘the chemical key to schizophrenia’, and its manifest properties as a psychotomimetic, LSD failed to catch on as a drug model for human psychosis. The reasons for this and the longstanding preference, instead, for the amphetamine model are examined. It is argued that the rejection of LSD was not just a scientific decision, but was influenced by increasing disaffection in psychiatry and society at large with psychological (existentialist) interpretations of schizophrenia with which LSD, as a recreational drug, was associated. The proscription of LSD and the shift towards a strongly organic view of schizophrenia created a climate where it was easier to accept the simpler amphetamine (dopamine) model. Flaws in the latter, its further recent undermining as an exclusive theory, and challenges to an overly organic psychiatry by a more psychobiological approach, are all discussed in the light of the perceived need for a more elaborated neurochemical account of schizophrenia; this includes a rǒle for central serotonergic influences in the disorder, removing much of the previous objection to LSD as a drug model. Several ways are suggested in which data about LSD could still usefully be drawn upon in schizophrenia research; including, in animal experimentation, its direct use to test the viability of the various biological models of schizophrenia on offer. Some examples of the latter are given, including a study of LSD from the author's own past

ISSN:0885-6222    

DOI:10.1002/hup.470090504

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractA number of important neurotransmitter deficiencies have been described in Alzheimer's disease, the commonest cause of dementia in people at all ages. Particularly marked is the depletion of acetylcholine, and a number of treatments have been developed which are aimed at correcting this biochemical deficiency, so far with varying success. An alternative strategy involves the use of neurotrophic compounds to try and prevent or retard the loss of cholinergic cells, reducing the magnitude of acetylcholine depletion. A number of different neurotrophic compounds are exciting interest in this context, especially Nerve Growth Factor (NGF). Animal and tissue culture studies support a neuroprotective role for NGF in relation to cholinergic neurons and human recombinant NGF is being produced with a view to small scale clinical trials in the not too distant future. The ‘active’ parts of the NGF molecule are being identified to enable the development of simpler molecules with biological activity that may more easily penetrate the blood‐brain barrier. Other members of the neurotrophin family are also under investigation as potential treatments for a range of neurodegenerative disorders, including Alzheimer's di

ISSN:0885-6222    

DOI:10.1002/hup.470090505

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractFunctional neuroimaging with SPET and PET offers the opportunity to visualize brain function either in terms of blood flow and metabolism or receptor function using specific ligands. SPET is a more widely available and cheaper technology than PET. Continuously developing and being refined, this technology will help the understanding of brain function generally and of brain dysfunction in psychiatric disorders specifically. SPET may also be used to study how these measures of brain function change with pharmacological intervention. Receptor imaging allows the study of drug‐receptor interactionsin vivo.As yet, the precise role and value of these techniques have not been established, but they do provide complementary tools to structural imaging and may ultimately provide prognostic information and facilitate refinement of the pharmacotherapeutic rationale underlying clinical practic

ISSN:0885-6222    

DOI:10.1002/hup.470090506

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

ISSN:0885-6222    

DOI:10.1002/hup.470090507

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

ISSN:0885-6222    

DOI:10.1002/hup.470090508

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractAdministration of l‐tryptophan (TRP), the amino acid precursor of 5‐hydroxytryptamine (5‐HT), to animals increases brain 5‐HT synthesis and in some circumstances, the release of 5‐HT in terminal fields. TRP also appears to increase brain 5‐HT neurotransmission in humans because neuroendocrine studies have shown that intravenous TRP produces a dose‐related increase in plasma prolactin concentration, probably via indirect stimulation of postsynaptic 5‐HT1Areceptors. The effect of TRP on prolactin release in humans is enhanced by several effective antidepressant treatments including tricyclic antidepressants, selective 5‐HT re‐uptake inhibitors, monoamine oxidase inhibitors and lithium. The ability of these drugs to augment the effect of TRP on brain 5‐HT function may represent the pharmacological mechanism that underpins the utility of TRP in combination drug treatments of

ISSN:0885-6222    

DOI:10.1002/hup.470090509

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

ISSN:0885-6222    

DOI:10.1002/hup.470090510

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY