ISSN:0271-0749    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0271-0749    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The effects of alprazolam (0.125 mg) taken twice a day on several cognitive and performance tasks (Pictures test, Digit-Symbol Substitution Test, Choice Reaction Time [CRT], Critical Flicker Fusion [CFF]) were investigated in healthy students. A double-blind, independent group design was used to compare placebo with alprazolam (32 volunteers in each group). After random assignment, all subjects received placebo for 3 days (D) followed by 14 days of treatment with either alprazolam or placebo. Subjects completed a battery of tests at D0, D3, D7, D10, and D14.D3performance was poorer in the alprazolam group except for CFF values (ascending values and total values), and the only significant improvement was in total reaction time on the CRT test.However, a significant improvement in performance (except in recognition reaction time) was shown at D7, D10, and D14in the alprazolam group compared with the control group results. This study shows that repeated low doses of alprazolam produce small improvements in some aspects of psychomotor and cognitive functions. Training effect, tolerance effect, anxiolytic effect, and changes in receptor function and/or number are discussed to explain the performance improvement. (J Clin Psychopharmacol 1998;18:364-372)

ISSN:0271-0749    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Patients with social phobia who responded well to 6 months of open-label treatment with clonazepam were assigned to receive either continuation treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate of 0.25 mg every 2 weeks, with double-blind placebo substitution. Clinical efficacy was compared between the CT and DT groups using three different social phobia scales. Benzodiazepine withdrawal symptoms were also measured. Relapse rates were 0 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorable clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% for DT) with no real evidence suggesting significant withdrawal difficulties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therapy with clonazepam in the treatment of social phobia is safe and effective, producing a somewhat greater clinical benefit than a slow-taper discontinuation regime. However, even in the DT group, withdrawal symptoms were not found to be a major problem. The study can be taken as supportive of benefit for long-term clonazepam treatment in social phobia, as well as being compatible with a reasonably good outcome after short-term treatment and slow taper. (J Clin Psychopharmacol 1998;18:373-378)

ISSN:0271-0749    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study was designed to investigate the efficacy of the antidepressant drug bupropion in the treatment of posttraumatic stress disorder (PTSD).Seventeen male combat veterans with chronic PTSD were treated with bupropion in an open-label fashion for 6 weeks. Patients were evaluated with the Clinical Global Impressions Scale for Improvement (CGI-I) at follow-up and rated blindly at baseline and posttreatment with the Clinician Administered PTSD Scale (CAPS), the Hamilton Rating Scale for Depression (HAM-D), and the Hamilton Rating Scale for Anxiety. Three patients discontinued bupropion prematurely because of side effects. Of the remaining 14 patients, 10 were classified as treatment responders by the CGI-I. HAM-D scores decreased significantly from baseline to follow-up. The improvement seen in hyperarousal symptoms was significant but was less significant than the change in depressive symptoms. There was no significant change in Intrusion, Avoidance, or total CAPS scores. It was concluded that bupropion was well tolerated. Patients who had experienced sexual dysfunction with selective serotonin reuptake inhibitors reported no complaints during bupropion treatment. Bupropion decreased depressive symptoms and most patients reported global improvement, although PTSD symptoms remained mostly unchanged. Controlled trials should further clarify the role of bupropion in the treatment of PTSD. (J Clin Psychopharmacol 1998;18:379-383)

ISSN:0271-0749    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

One hundred patients who had attempted suicide before commencing lithium prophylaxis were followed up.Outcome was analyzed in terms of attempted or completed suicide after a mean of 10 years since admission to the lithium clinics. Of 10 patients who committed suicide, 9 had discontinued adequate lithium prophylaxis for a period ranging from 2 weeks to 7 years before death. Having discontinued lithium therapy was associated with suicide also in the subgroup of patients for whom lithium had not completely prevented episodes during lithium treatment. Suicide risk was 24 times as high during periods off compared with periods on adequate lithium prophylaxis. Incidence of attempting suicide was similar during the periods before receiving or after discontinuing lithium treatment, whereas it was 5 to 6 times lower during prophylaxis. Continuous and adequate lithium prophylaxis should be considered in the presence of high suicide risk, even if the prophylactic effect on the underlying mood disorder may be incomplete. (J Clin Psychopharmacol 1998;18:384-389)

ISSN:0271-0749    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In a double-blind trial, the selective serotonin reuptake inhibitor citalopram was administered to women with severe irritability and/or depressed mood in the luteal but not in the follicular phase of the menstrual cycle (premenstrual dysphoria). Treatment continued for three consecutive menstrual cycles. One group (N = 17 completers) was administered citalopram continuously at a constant dosage (20 +/- 10 mg/day) throughout the menstrual cycle. A second group (N = 17) also received citalopram continuously throughout the cycle, but at a lower dosage in the follicular phases (5 mg/day) than in the luteal phases (20 +/- 10 mg/day) (semi-intermittent treatment). A third group (N = 18) received citalopram (20 +/- 10 mg/day) in the luteal phase only and placebo during the follicular phase (intermittent treatment). A fourth group (N = 17) received placebo throughout the cycles. The side effects of active treatment were generally mild and transient. Intermittent administration of citalopram was clearly more effective than placebo with respect to both reduction in self-rated irritability and self-rated global improvement; it is of interest that intermittent treatment with citalopram also seemed more effective than continuous or semi-intermittent administration of the drug. (J Clin Psychopharmacol 1998;18:390-398)

ISSN:0271-0749    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We conducted a placebo-controlled, randomized, double-blind, 8-week trial of sertraline added to haloperidol treatment in patients with schizophrenia to evaluate changes in clinical measures and pharmacokinetic interactions with haloperidol. In addition to their haloperidol regimen, 36 inpatients with chronic schizophrenia were randomly assigned to receive capsulized sertraline (50 mg/day; N = 18) or identically capsulized placebo (N = 18) for 8 weeks. The results from the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression (CGI) Scale, Simpson-Angus Extrapyramidal Effects (S-A) Scale, and plasma concentration levels of haloperidol and reduced haloperidol were examined at baseline and 2, 4, 6, and 8 weeks of treatment. No significant differences between the three PANSS factors (positive, negative, general psychopathology) scores, CGI Scale scores, or S-A Scale scores were recorded at any point during sertraline and placebo treatment. Neither plasma haloperidol or reduced haloperidol concentrations was changed significantly at any point during the sertraline and placebo treatments. In this study, the addition of sertraline 50 mg to the treatment regimen of inpatients did not differ significantly from the placebo effect on positive and negative symptoms and extrapyramidal side effects. The results further indicate that the pharmacokinetics of haloperidol are seemingly unaffected by sertraline. (J Clin Psychopharmacol 1998;18:399-403)

ISSN:0271-0749    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Of 30 patients with treatment-refractory affective illness, 10 showed a moderate to marked response to blind nimodipine monotherapy compared with placebo on the Clinical Global Impressions Scale. Fourteen inadequately responsive patients (3 unipolar [UP], 11 bipolar [BP]) were treated with the blind addition of carbamazepine. Carbamazepine augmentation of nimodipine converted four (29%) of the partial responders to more robust responders. Patients who showed an excellent response to the nimodipine-carbamazepine combination included individual patients with patterns of rapid cycling, ultradian cycling, UP recurrent brief depression, and one with BP type II depression. When verapamil was blindly substituted for nimodipine, two BP patients failed to maintain improvement but responded again to nimodipine and remained well with a blind transition to another dihydropyridine L-type calcium channel blocker (CCB), isradipine. Mechanistic implications of the response to the dihydropyridine L-type CCB nimodipine alone and in combination with carbamazepine are discussed. (J Clin Psychopharmacol 1998;18:404-413)

ISSN:0271-0749    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

As many as 45% of patients with major depression also meet diagnostic criteria for bipolar (BP) II disorder.Although the use of a concurrent mood-stabilizing drug has been suggested in treating BP II depression, antidepressant monotherapy has received less attention. The efficacy and safety of venlafaxine were examined in 17 BP II (mean +/- SD; age, 41 +/- 14 years) versus 31 unipolar (UP) (45 +/- 14 years) patients with major depression. Minimum pretreatment Hamilton Rating Scale for Depression (HAM-D21or=to 20. After a 1-week placebo lead-in, patients were randomly assigned to receive double-blind treatment with once- versus twice-daily venlafaxine dosing starting at 37.5 mg daily and increasing up to 225 mg daily. Patients were evaluated weekly for efficacy using the HAM-D21, the Montgomery-Asberg Depression Rating Scale (MADRS), and the Clinical Global Impression (CGI) Scale. We observed a similar overall efficacy in BP and UP patients by 6 weeks of treatment (p = not significant). However, we also observed a more rapid reduction of HAM-D (21) (p < 0.03) and MADRS (p < 0.02) scores by week 2 of treatment in BP patients who completed the entire trial. No episodes of venlafaxine-induced "manic switch" were observed in either patient group. In conclusion, our preliminary findings suggest that short-term, 6-week venlafaxine treatment may be a safe and effective antidepressant monotherapy for BP II major depression. (J Clin Psychopharmacol 1998; 18:414-417)

ISSN:0271-0749    

出版商:OVID    

年代:1998

数据来源: OVID