ISSN:0271-0749    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The antidepressant efficacy of alprazolam (ALP) was tested in a double-blind controlled comparison with desipramine (DMI) and an ALP-DMI combination in outpatients diagnosed with major depressive disorder by Research Diagnostic Criteria (90% met criteria for endogenous subtype). Following a placebo period of at least 1 week, subjects who continued to meet severity criteria defined by Hamilton Depression Rating Scale (HDRS) scores were administered oral doses of the active medication (N = 79), in a dose ratio of 1 mg ALP:50 mg DMI:1 mg ALP + 50 mg DMI. Treatment continued for 6 weeks, and all subjects who completed at least 2 weeks (N = 69) were included in endpoint analyses. Following the placebo baseline, symptoms were rated again at day 5 and at the end of weeks 1, 2, 4, and 6. Final doses averaged 4.6 ± 1.3 mg for the ALP group, 230 ± 61 mg for the DMI group, and 4.6 ± 1.2 mg ALP + 229.5 ± 1.2 mg DMI for the combination group. The final outcome was a comparable degree of improvement at the end-point among the three treatment groups on measures of depression (HDRS and Beck Depression Inventory), anxiety (Hamilton Anxiety Rating Scale), and global improvement (Global Assessment Scale, and Physician and Patient Global Impressions). A similar outcome was found for the subgroup of patients who completed all 6 weeks (N = 56). Endpoint analyses also showed that ALP-treated subjects responded sooner and continued to show improvement throughout the course of the study on measures of depression, anxiety, and global status. These results suggest that ALP alone is as effective as a standard tricyclic for the acute treatment of patients with major depressive disorder and that significant improvement may occur within the first week of medication. Side effect profiles were compared among treatment groups and are discussed, as are other clinical studies that have investigated ALP's potential antidepressant efficacy. (J Clin Psychopharmacol 1987;7:295—310)

ISSN:0271-0749    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Individual daily dosages of nortriptyline (NT) can be predicted from administration of a 50-mg or 100-mg single test dose, with a determination of the plasma level 24 hours later. Because the 50-mg or 100-mg test dose used in previous studies may cause unmanageable acute side effects in elderly patients, a 25-mg NT test dose was used to establish a 24-hour plasma level in 18 physically healthy, moderately depressed, geriatric outpatients. Correlations between the 24-hour test dose plasma level and steady state levels were done for maintenance dosages of 50, 75, and 100 mg/day. A nomo-gram was made from the regression equations to predict the dosage required to achieve a steady state concentration within a 50 to 150 ng/ml range. The importance of the ability to predict NT dosage requirements in geriatric patients is indicated by findings that at daily NT doses of 50 and 100 mg, nearly one-half of subjects had steady state levels below or above 50 or 150 ng/ml, respectively. (J Clin Psychopharmacol 1987;7:311–314)

ISSN:0271-0749    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Caffene, in addition to being a food constituent, is also a common analgesic adjuvant that is used in combination with aspirin in certain over-the-counter preparations. Caffeine has previously been shown to significantly improve certain aspects of human performance, particularly sustained vigilance, when administered in low and moderate doses (32 to 256 mg). We therefore attempted to determine whether caffeine, in the dose (64 mg) found in some over-the-counter drugs, retains this beneficial property when combined with aspirin. We also measured self-reported mood state, using various standardized questionnaires, since caffeine has been reported to have both beneficial and adverse effects on alertness and anxiety. We observed that caffeine (64 mg), when added to aspirin (800 mg), significantly improves vigilance performance and increases self-reported efficiency when compared with either placebo or aspirin alone. As previously reported, this caffeine dose alone significantly increased vigilance and decreased reaction time. No adverse effects of caffeine were detected on any of the parameters that were assessed. This study therefore demonstrated that the addition of caffeine to aspirin, in a dose commonly employed in over-the-counter drugs, has significant beneficial consequences with respect to mood and performance. (J Clin Psychopharmacol 1987;7:315–320)

ISSN:0271-0749    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This is the final report of a study of single dose pharmacokinetic parameters of nortriptyline in children and adolescents 5 to 16 years old (N = 64). The data were analyzed separately for the 5− to 12-year-olds (N = 41) and for the 13− to 16-year-olds (N = 32). The results confirm the preliminary findings of the similarity of the pharmacology of nortriptyline between the pediatric and adult age groups with respect to a logarithmically linear rate of elimination and a wide interindividual rate of metabolism. The 5− to 12-year-olds had a significantly shorter mean half-life and a significantly greater mean apparent oral clearance than the 13-to 16-year-olds. The mean half-life in the 5− to 12-year-olds was 20.8 ± 7.2 (range, 11.2 to 42.5) hours and in the 13− to 16-year-olds was 31.1 ± 19.8 (range, 14.2 to 89.4) hours. A twice a day dosage regimen is recommended for the entire 5− to 16-year-old group based on their range of half-lives. (J Clin Psychopharmacol 1987;7:321–323)

ISSN:0271-0749    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Piquindone (RO22–1319), a new “atypical” neuroleptic, was administered for 2 weeks to 37 schizophrenic patients, and the effects of treatment were examined in a double-blind, placebo-controlled trial. “Atypical” neuroleptics are those that block animal behaviors that model antipsychotic actions in humans at doses lower than those necessary to block animal behaviors that model extrapyramidal actions. Our results demonstrate that piquindone led to moderate but significant improvements in the positive symptoms of schizophrenia and to improvements in negative symptoms just below the level of statistical significance. This supports the notion that neuroleptics categorized as “atypical” in preclinical experiments may prove to be clinically efficacious in humans. In addition, our anecdotal observations were that piquindone caused minimal extrapyramidal symptoms. This is consistent with the preclinical data and suggests that atypical neuroleptics may be associated with fewer extrapyramidal side effects in humans than conventional neuroleptics. However, this must be substantiated by further research. (J Clin Psychopharmacol 1987;7:324–329)

ISSN:0271-0749    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Fluoxetine is a new antidepressant with pharmacologic effects apparently limited to blockade of neuronal serotonin reuptake. We entered 20 patients who met DSM-III criteria for either panic disorder or agoraphobia with panic attacks into an open, uncontrolled pilot study of fluoxetine. Four responded to placebo in the week before fluoxetine administration and were dropped from the study. Of the remaining 16 patients, nine were nonresponders and seven were responders, with complete cessation of their panic attacks. Eight of the nine nonresponders were unable to tolerate the side effects of fluoxetine. In contrast, all of the responders (and one nonresponder) experienced minimal side effects. Fluoxetine may be effective in the treatment of panic attacks, perhaps implicating the serotonergic system in the pathophysiology of panic disorder. Future studies should use very low doses of fluoxetine to initiate treatment. (J Clin Psychopharmacol 1987;7:329–332)

ISSN:0271-0749    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Thirteen healthy volunteers received 1 mg of alprazolam, as the commercially available oral tablet, by sublingual and oral routes on two occasions in random sequence. Plasma alprazolam concentrations during 48 hours after each dose were measured by electron-capture gas-liquid chromatography. The peak plasma concentration after sublingual dosage was higher than after oral administration (17.3 vs. 14.9 ng/ml), and the time of peak concentration following sublingual administration was reached (1.17 vs. 1.73 hours after dose). However, these differences did not reach statistical significance. The mean total area under the plasma concentration curve for sublingual administration was slightly but not significantly larger than that following oral dosage (203.7 vs. 194.4 hr. ng/ml) and no significant differences between sublingual and oral dosage were found for elimination half-life (11.7 vs. 11.8 hours) or for clearance (86.4 vs. 92.4 ml/min). Thus, alprazolam absorption following sublingual administration is as rapid as after oral dosage on an empty stomach, and completeness of absorption is comparable. In clinical terms, sublingual and oral dosages of alprazolam are likely to be therapeutically equivalent. The sublingual route may be a useful alternative for panic disorder patients who cannot swallow pills or for those who do not have access to a liquid at the time of dosing. (J Clin Psychopharmacol 1987;7:332–334)

ISSN:0271-0749    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Although the electrocardiographic effects of the tricyclic antidepressants have been extensively investigated, there are fewer data on the effects of monoamine oxidase inhibitors and tetracyclics on cardiac conduction. This study used high speed recordings of the electrocardiogram to investigate the cardiographic effects of phenelzine and mianserin and to compare these to the effects of imipramine, amitriptyline, and placebo. Phenelzine caused significant slowing of the heart rate, while mianserin showed little effect on heart rate compared to the increases in rate seen with tricyclics. In clinically effective doses, neither phenelzine nor mianserin caused changes in conduction, while both tricyclics studied caused the expected prolongation of conduction. These data suggest that phenelzine and mianserin deserve further study in patients with disease of the cardiac system as they may be less likely to cause heart block in these patients. (J Clin Psychopharmacol 1987;7:335–339)

ISSN:0271-0749    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The psychopharmacologic management of psychotic patients who have had neuroleptic malignant syndrome poses a dilemma for clinicians. Neuroleptic malignant syndrome can recur when neuroleptics are readministered, but there are equal numbers of reports of safe resumption of neuroleptic treatment in patients who have had the syndrome. In an effort to avoid reexposure to neuroleptics, the authors treated two bipolar patients who were clinically recovered from episodes of neuroleptic malignant syndrome with lithium alone. Both patients rapidly developed recurrent neuroleptic malignant syndrome after only 300 and 1,200 mg of lithium, respectively. Possible pathogenetic mechanisms are reviewed, although a definitive explanation for such a sudden and dramatic toxic effect is not available. (J Clin Psychopharmacol 1987;7:339–341)

ISSN:0271-0749    

出版商:OVID    

年代:1987

数据来源: OVID