ISSN:0271-0749    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We compared desipramine with phenelzine in a double-blind, parallel-groups study of 43 outpatients with recurrent unipolar depression. Response to the two drugs was similar, with an overall average reduction in scores on the Hamilton Rating Scale for Depression of about 50% over 6 weeks. Improvement was negatively correlated with initial severity of depression, especially in patients treated with desipramine. Response to desipramine was better in patients with moderate to severe stressors and no previous hospitalizations. Response to either treatment was better in patients whose course consisted of recurrent depressions with a stable baseline, even if the baseline was dysthymic. (J Clin Psychopharmacol 1997;17:78-83).

ISSN:0271-0749    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The aim of this study was to determine if the severity of paranoid/belligerence was a major determinant of neuroleptic dosage in newly admitted patients with acute or exacerbated schizophrenia.Two clinical psychiatrists, who had no clinical responsibility for drug treatment and were blind to neuroleptic dosage regimens, jointly interviewed 155 patients who were cooperative enough to be carefully interviewed with the Structured Clinical Interview for the DSM-III-R, Positive and Negative Syndrome Scale (PANSS) Edition. The large majority of the patients were receiving moderate dosages of neuroleptics (mean peak dosage: 500 mg/day of chlorpromazine equivalents). There was a positive correlation between the score on the PANSS paranoid/belligerence cluster and the daily dosage of neuroleptic treatment. Splitting the sample by gender, the correlations remained highly significant. In a multivariate analysis controlling for the effects of other clinical variables, paranoid/belligerence and gender emerged as significant predictors of neuroleptic dosage. Clinicians prescribed lower doses of neuroleptics for female patients and higher doses for patients with higher ratings on the PANSS paranoid/belligerence cluster. These findings suggest that clinicians' strategy of increasing neuroleptic dosage at the manifestation of hostility is not limited to assaultive or uncooperative schizophrenic patients who are on very high dosages of neuroleptics. (J Clin Psychopharmacol 1997;17:84-87).

ISSN:0271-0749    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

An 18-week, double-blind, crossover study of amantadine and neuroleptics in the treatment of tardive dyskinesia (TD) is described. A fixed-dose regimen was used, and objective rating scales for TD, extrapyramidal symptoms, and mental state were employed. The results indicate that amantadine is significantly better than placebo in the management of TD and that there is little risk of exacerbating psychosis. Further investigation of this potentially useful medication is warranted. (J Clin Psychopharmacol 1997;17:88-91).

ISSN:0271-0749    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Twenty-two patients affected by bipolar or schizoaffective disorder, in whom carbamazepine was added to lithium after recurrence when on maintenance with lithium alone, were followed up prospectively for 2 to 13 years. The number of episodes, hospitalizations, and cumulative affective morbidity was markedly reduced after carbamazepine augmentation. Seventeen patients presented a better course during combined treatment than during lithium alone, and of these 15 had no further recurrences. Four patients did not appear to improve after carbamazepine augmentation, whereas one featured reemergence of affective episodes after having derived satisfactory benefit from combination for 7 years (delayed tolerance). Carbamazepine augmentation was associated with a reduction of lithium doses in some patients, including a subgroup who had not tolerated lithium at usual therapeutic levels. Carbamazepine significantly reduced serum thyrotropin concentrations, which were abnormally high in approximately one half of patients when on lithium alone. Total serum thyroxine concentrations were also decreased after carbamazepine augmentation, but free thyroid hormone concentrations did not change. Other significant carbamazepine-induced changes in laboratory tests included increases in total cholesterol concentrations and decreases in white blood cell counts. (J Clin Psychopharmacol 1997;17:92-96).

ISSN:0271-0749    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The effects of short treatment (7 days) with the tricyclic antidepressant imipramine and the two selective serotonin reuptake inhibitors paroxetine and sertraline on the reactivity to inhalation of 35% CO2/65% O2were compared in 70 panic patients who had positive responses to 35% CO2inhalations.A double-blind, random, placebo-controlled design was applied. Each patient was given the 35% CO (2) challenge on days 0 (before starting the treatment), 3, and 7. In the placebo group, there were no significant changes in the reactivity to 35% CO2in the three sessions whereas there were significant similar reductions of reactivity to 35% CO2in all three drug-treated groups. These results confirm the good reproducibility of 35% CO2reactivity and the negligible effects of placebo on reactivity to CO2and suggest that short treatments with imipramine, paroxetine, and sertraline decrease reactivity to 35% CO2, possibly as an expression of their antipanic properties. (J Clin Psychopharmacol 1997;17:97-101).

ISSN:0271-0749    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Sertraline, a selective serotonin reuptake inhibitor used to treat depression, inhibits CYP2D6 in vitro (Ki = 1.2 micro Meter) less potently than fluoxetine (Ki = 0.15 micro Meter). To determine the extent and time course of CYP2D6 inhibition in patients, six males (mean age: 40 years, range: 29-64 years), who were starting treatment for depression with sertraline, were phenotyped on five occasions (once before treatment and approximately 3, 7, 14, and 21 days later). Phenotype status was determined using oral dextromethorphan (30 mg) by calculating the urinary ratio of O-demethylated metabolites to parent drug (i.e., log ODMR). CYP2D6 genotype was determined by leukocyte DNA analysis using polymerase chain reaction amplification. Compliance was confirmed by sertraline plasma levels. Daily sertraline dosages ranged from 50 to 150 mg. Genotype results indicated all subjects were extensive metabolizers (four homozygous wild type [wt], two heterozygous wt/B mutation). Phenotype results showed that CYP2D6 inhibition in patients treated with sertraline appeared to be related to baseline CYP2D6 activity and sertraline dosage. Some patients with high CYP2D6 activity can demonstrate inhibition with sertraline dosages as low as 50 mg. (J Clin Psychopharmacol 1997;17:102-106).

ISSN:0271-0749    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The hepatic cytochrome P450 enzyme system is involved in the metabolism of numerous drugs.Specific enzymes are associated with the metabolism of specific drugs. The potential for drug interactions arises when one drug inhibits or induces the enzyme(s) responsible for metabolism of another drug given concurrently. Most psychotropics are metabolized by these enzymes. Clinically significant drug interactions are reported between the selective serotonin reuptake inhibitors and other psychotropics. Specifically, interactions between fluoxetine and phenytoin are reported with substantial elevations of phenytoin concentrations. Phenytoin is metabolized by the CYP2C subfamily, and fluoxetine is known to inhibit this subfamily. Similarly, sertraline also inhibits the CYP2C subfamily, but no case reports to date have been identified. To minimize and prevent these interactions, one must be aware of the P450 enzymes involved in drug metabolism. The significance of these interactions seems to rely both on the concentration of the drug at the enzyme and its potency for inhibiting the enzyme. Frequent monitoring of serum concentrations of drugs with a narrow therapeutic range would be appropriate when a potential inhibitor is added. This article describes an apparently similar interaction between sertraline and phenytoin in two elderly patients, which resulted in elevated phenytoin concentrations without symptoms of toxicity. (J Clin Psychopharmacol 1997;17:107-109).

ISSN:0271-0749    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The purpose of this study was to assess the effect of fluoxetine on the hypoprothrombinemic response of warfarin in patients chronically anticoagulated.Patients receiving low-intensity anticoagulation with warfarin were recruited. All patients were taking stable dosages of warfarin and had two baseline prothrombin times (PTs) within 10% of each other. Each patient received fluoxetine (20 mg daily) for 21 days. PTs were measured on days 2, 5, 8, 12, 15, 19, and 22 of fluoxetine administration. Six patients completed the study. There was no significant difference in mean PTs before and during fluoxetine administration. Fluoxetine at the dosage studied does not predictably effect the hypoprothrombinemic response of warfarin. (J Clin Psychopharmacol 1997;17:110-112).

ISSN:0271-0749    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Six and seven addicts treated with racemic methadone (MTD) were comedicated with fluvoxamine (FLV) and fluoxetine (FLX), respectively.The plasma concentrations of both (R)- (the active enantiomer) and (S)-MTD were increased by FLV, whereas only (R)-MTD concentrations were increased by the addition of FLX. This suggests that cytochrome P450IID6 (CYP2D6), an enzyme that is strongly inhibited by FLX, preferentially metabolizes (R)-MTD, whereas CYP1A2, which is strongly inhibited by FLV, metabolizes both enantiomers. The choice of a selective serotonin reuptake inhibitor in depressive addicted patients treated with MTD and the possible use of FLX or FLV to potentiate the effects of MTD in some cases of therapeutic failure are discussed. (J Clin Psychopharmacol 1997;17:113-117).

ISSN:0271-0749    

出版商:OVID    

年代:1997

数据来源: OVID