ISSN:0271-0749    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

An attempt was made to determine whether an algorithm for lithium dose prediction allows earlier or more economical attainment of a therapeutic steady state than does the usual “clinical titration.” Twelve patients were treated using an algorithm developed by Zetin and associates and compared with 21 patients treated by clinical titration. Ten of the 12 algorithm-treated patients (83% ) had reached the desired lithium blood level by the seventh day, whereas only 8 of the 21 clinical titration patients (38% ) had done so. This difference is significant. In addition, the Zetin algorithm performed safely: the 2 dose prediction errors led to underdosing. Some of the relevant literature is reviewed.

ISSN:0271-0749    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We have examined the effects of two monoamine oxidase (MAO) inhibitors with different mechanisms of action—phenelzine and brofaromine—on peripheral serotonergic (5-hydroxytryptamine [5-HT]) measures, sensitive to the inhibition of MAO-A (intra- and extracellular 5-HT and related metabolites in blood). Both drugs increased the concentration of 5-HT in platelet-free plasma (254%, p < 0.001) in patients with depressive illness (DSM-III-R) after 6 weeks of daily treatment. Platelet 5-HT was also increased significantly in both drug treatment groups but more marked in the patient group treated with phenelzine. The acid/amine ratio at 6 weeks was 30% of pretreat-ment values (p < 0.000) and individual variability correlated significantly with the Hamilton Rating Scale for Depression. Plasma 5-HT increased more markedly in responders than in nonresponders and a significant inverse relationship surfaced between plasma 5-HT and the Hamilton Rating Scale for Depression. The results support other reports of comparable antidepressant efficacy for brofaromine and phenelzine, both inhibitors of MAO-A in humans. The consistent relationship we found between the biochemical and clinical changes again suggests and supports a key role of 5-HT in the antidepressant effect of these MAO inhibitors.

ISSN:0271-0749    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The widespread use of benzodiazepines remains a source of concern to the medical profession and the general public, especially as newer compounds come on the market. Our goal was to characterize long-term alprazolam users in the community and to determine whether such use represented abuse or behavioural dependence. We conducted three community surveys to learn about the natural history of long-term alprazolam use. Current long-term alprazolam users (those using the drug for 3 months or longer) were recruited on three separate occasions 1 year apart by identical newspaper advertisements in the metropolitan Toronto area. All respondents were mailed a questionnaire with a stamped, addressed return envelope. Our data from 312 respondents show that: (1) the majority of patients have a substantial history of prior medication use for symptom control (65%), (2) dose escalation is not a characteristic of long-term use, (3) patients change their initial pattern of regular use to one of symptom control only when required, (4) most physicians do not discuss discontinuation of the drug with their patients, (5) patients frequently try to stop their drug use (with a median of 2 attempts) and often report symptoms upon discontinuation, and (6) patients perceive a need for medication use and indicate that alprazolam is effective (75%). We conclude that some patients persistently use alprazolam but that this use does not represent abuse or behavioral dependence.

ISSN:0271-0749    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Many autistic children have associated problems of inattention, impulsivity, and hyperactivity that limit the effectiveness of educational and behavioral interventions. Few controlled psyehophar-macologic trials have been conducted in autistic children to determine which agents may be effective for these associated features. Eight male children (8.1 ± 2.8 years) with autistic disorder, diagnosed by DSM-III-R criteria, completed a placebo-controlled, double-blind crossover trial of clonidine. Subjects were included in the study if they had inattention, impulsivity, and hyperactivity that was excessive for their developmental level. Subjects had not tolerated or responded to other psychopharmacologic treatments (neuroleptics, methylphenidate, or desipramine). Teacher ratings on the Aberrant Behavior Checklist irritability, stereotypy, hyperactivity, and inappropriate speech factors were lower during treatment with clonidine than during treatment with placebo. Attention deficit disorder with hyperactivity: Comprehensive Teacher's Rating Scale ratings were not significantly improved during the study, except for oppositional behavior. Parent Conners Abbreviated Parent-Teacher Questionnaire ratings significantly improved during clonidine treatment. Clonidine led to increased ratings of the side effects of drowsiness and decreased activity. Clinician ratings (Children's Psychiatric Rating Scale Autism, Hyperactivity, Anger and Speech Deviance factors; Children's Global Assessment Scale; Clinical Global Impressions efficacy) of videotaped sessions were not significantly different between clonidine and placebo. Clonidine was modestly effective in the short-term treatment of irritability and hyperactivity in some children with autistic disorder.

ISSN:0271-0749    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Serotonin uptake inhibitors are generally considered activating antidepressants. To assess rates and temporal patterns of activation and sedation as well as dose-effect relationships, adverse event data were evaluated from a fixed-dose study comparing placebo and fluoxetine 5, 20, and 40 mg/day in the treatment of major depressive disorder (N = 363) and two fixed-dose studies pooled together comparing placebo and fluoxetine 20, 40, and 60 mg/day in the treatment of major depressive disorder (N = 746). The adverse events nervousness, anxiety, agitation, and insomnia were considered indicative of activation; somnolence and asthenia were considered indicative of sedation. Activation and sedation were both statistically significant (p ≤ 0.05) treatment-emergent phenomena, but dose-effect relationships differed. Activation rates were relatively stable between 5 and 40 mg/day, and then increased at 60 mg/day. Sedation rates increased linearly to 40 mg/day and then were comparable at 40 and 60 mg/day. Discontinuations for either phenomenon were uncommon. The temporal patterns of first occurrences and persistence of activation and sedation differed. First occurrences of activation peaked early and declined over time with all doses. First occurrences of sedation also peaked early with all doses, but there may have been greater variability in first occurrences of sedation over time with lower doses. Persistent occurrences of sedation may decline less over time than persistent occurrences of activation.

ISSN:0271-0749    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A 75 mg/day clomipramine treatment was prescribed for 4 weeks to 92 outpatients with major depression at the Neuropsychiatric Clinic of the National University Hospital of Cotonou in Benin, West Africa. Among them, only 42 followed the treatment during the 4 weeks and had a clomipramine and desmethylclomipramine plasma level measure (gas chromatography technique). The rate of noncompliance appeared high: 10 patients had no trace and another 2 had only traces of anti-depressant in their plasma. For the remaining 29, a comparison with 29 Caucasian patients treated by clomipramine (the two samples are matched for sex and age, and the variables of weight, dosage and drug association are controlled) shows no significantly higher plasma levels in the Beninese sample.

ISSN:0271-0749    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A double-blind, placebo-controlled, randomized study was performed to determine whether proglumide added to ongoing neuroleptic medication was efficacious in the treatment of 32 patients with persistent positive and negative schizophrenic symptoms. Patients treated with both proglumide and placebo showed a significant improvement over the 8 weeks of the study, but no significant difference between the patients taking proglumide and those taking placebo could be demonstrated. In addition, proglumide had no effect on plasma homovanillic acid concentrations or neuroleptic drug activity. The results suggest that, at least for the dose of proglumide used in this study (15 mg/day), the addition of this particular cholecystokinin antagonist does not potentiate the antipsychotic efficacy of neuroleptic medication in patients with persistent schizophrenic symptoms.

ISSN:0271-0749    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Tandospirone is an azaspirodecanedione derivative under investigation as an antidepressant. Metabolism of tandospirone in humans and rodents leads to l-(2-pyrimidinyl)-piperazine (1-PP), presumed to have pharmacologic activity. To determine the relative contributions of tandospirone and 1-PP after tandospirone administration, we evaluated open-field activity, pharmacokinetics, and receptor binding of tandospirone and 1-PP in a mouse model. Tandospirone significantly reduced open-field activity during 30 minutes at doses of 1–20 mg/kg. 1-PP had no significant effect on activity except for a trend toward reduction at 20 mg/kg. At 30 minutes after administration, plasma and cortex concentrations of tandospirone and 1-PP increased in proportion to dose. Plasma protein binding (free fraction) for tandospirone was 30.4%, and for 1-PP, 87.5%. Receptor binding studies indicated that tandospirone bound with high affinity to serotonin1Asites, and with low affinity to serotonin2, α1α2, and benzodiazepine sites. 1-PP bound with high affinity to α2sites and with low affinity to the other sites evaluated. A “receptor occupancy index” of tandospirone cortex concentrations divided by receptor affinity suggests that after acute administration of tandospirone, effects are likely to be due to the parent compound rather than to the metabolite. Similar conclusions are likely to be correct for other azaspirodecane-diones, including buspirone.

ISSN:0271-0749    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We report the results of an open trial of trazodone in the treatment of severe behavioral disturbances in a sample of 22 hospitalized children previously found to be unresponsive to other treatments. Response to treatment was assessed by overall clinical criteria and improvements in individual symptom dimensions during the inpatient hospitalization. Thirteen children (67%) were found to benefit from the introduction of trazodone. Aggressive, impulsive behaviors were symptoms most frequently improved by this agent. Three of those found to be nonresponders actually worsened in symptomatology. A follow-up interview of the parents was conducted 3–14 months after discharge from the inpatient unit, for those children who initially responded to trazodone administration. The results of this interview suggest that the effect of trazodone was persistent for a prolonged period of time after the initial inpatient trial. Trazodone appears to be of value in the management of severe behavioral disturbances in children. The possible mechanism of action of trazodone is discussed.

ISSN:0271-0749    

出版商:OVID    

年代:1992

数据来源: OVID