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1. |
Drug Interactions With Grapefruit Juice: An Update |
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Journal of Clinical Psychopharmacology,
Volume 21,
Issue 4,
2001,
Page 357-359
David Greenblatt,
Kiran Patki,
Lisa von Moltke,
Richard Shader,
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ISSN:0271-0749
出版商:OVID
年代:2001
数据来源: OVID
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2. |
A Double-Blind, Randomized, Prospective Evaluation of the Efficacy and Safety of Risperidone Versus Haloperidol in the Treatment of Schizoaffective Disorder |
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Journal of Clinical Psychopharmacology,
Volume 21,
Issue 4,
2001,
Page 360-368
Philip Janicak,
Paul Keck,
John Davis,
John Kasckow,
Karen Tugrul,
Sheila Dowd,
Jane Strong,
Rajiv Sharma,
Stephen Strakowski,
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摘要:
The relative efficacy and safety of risperidone versus haloperidol in the treatment of schizoaffective disorder was studied. Sixty-two patients (29 depressed type; 33 bipolar type) entered a three-site, randomized, double-blind, 6-week trial of risperidone (up to 10 mg/day) or haloperidol (up to 20 mg/day). Trained raters assessed baseline, weekly, and end-of-study levels of psychopathology with the Positive and Negative Syndrome Scale (PANSS), the 24-item Hamilton Rating Scale for Depression (HAM-D-24) and the Clinician-Administered Rating Scale for Mania (CARS-M). The authors were unable to statistically distinguish between risperidone and haloperidol in the amelioration of psychotic and manic symptoms. In addition, there was no difference in worsening of mania between the two agents in either subgroup (i.e., depressed or bipolar subgroups). For the total PANSS, risperidone produced a mean decrease of 16 points from baseline compared with a 14-point decrease with haloperidol. For the total CARS-M scale, risperidone and haloperidol produced mean change scores of 5 and 8 points, respectively, and for the CARS-M Mania subscale, 3 and 7 points, respectively. Additionally, risperidone produced a mean decrease of 13 points from the baseline 24-item HAM-D, compared with an 8-point decrease with haloperidol. In those patients who had more severe depressive symptoms (i.e., HAM-D baseline score >20), risperidone produced at least a 50% mean improvement in 12 (75%) of 16 patients in comparison to 8 (38%) of 21 patients receiving haloperidol. Haloperidol produced significantly more extrapyramidal side effects and resulted in more dropouts caused by any side effect. There was no difference between risperidone and haloperidol in reducing both psychotic and manic symptoms in this group of patients with schizoaffective disorder. Risperidone did not demonstrate a propensity to precipitate mania and was better tolerated than haloperidol. In those subjects with higher baseline HAM-D scores (i.e., >20), risperidone produced a greater improvement in depressive symptoms than haloperidol.
ISSN:0271-0749
出版商:OVID
年代:2001
数据来源: OVID
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3. |
Novel Antipsychotics and Severe Hyperlipidemia |
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Journal of Clinical Psychopharmacology,
Volume 21,
Issue 4,
2001,
Page 369-374
Jonathan Meyer,
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摘要:
Newer atypical antipsychotics demonstrate superior effectiveness, with a diminished incidence of extrapyramidal side effects compared with older typical antipsychotics, but they have been associated with the development of obesity and new-onset diabetes. A small number of reports documenting modest hypertriglyceridemia related to newer antipsychotics have implicated fluperlapine, clozapine, and, most recently, olanzapine. This study summarizes the results of 14 cases of severe hypertriglyceridemia (>600 mg/dL) associated with olanzapine and quetiapine therapy occurring among inpatients at Oregon State Hospital, including 7 patients whose serum triglyceride levels exceeded 1,000 mg/ dL. Four of these patients also developed new-onset diabetes. Nine cases occurred during the first 8 months of treatment, with three cases identified within 3 months of commencing olanzapine or quetiapine therapy. Weight gain in olanzapine and quetiapine groups was modest (12.3 lb and 8.5 lb, respectively) and did not correlate with the severity of hypertriglyceridemia. Biochemical causes for severe hypertriglyceridemia associated with novel antipsychotics are unclear, but clinical monitoring of serum lipids must be added to the concerns about the metabolic consequences of therapy with certain newer antipsychotic agents.
ISSN:0271-0749
出版商:OVID
年代:2001
数据来源: OVID
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4. |
Olanzapine as Alternative Therapy for Patients With Haloperidol-Induced Extrapyramidal Symptoms: Results of a Multicenter, Collaborative Trial in Latin America |
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Journal of Clinical Psychopharmacology,
Volume 21,
Issue 4,
2001,
Page 375-381
Jorge Costa e Silva,
Nelson Alvarez,
Guido Mazzotti,
Wagner Gattaz,
Jorge Ospina,
Veronica Larach,
Sergio Starkstein,
Daniel Oliva,
Lynne Cousins,
Mauricio Tohen,
Cindy Taylor,
Jeff Wang,
Pierre Tran,
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摘要:
Conventional antipsychotic agents can induce extrapyramidal symptoms (EPS) that may be alleviated by switching patients to novel agents such as olanzapine. Patients with schizophrenia and related disorders (ICD-10) who were taking haloperidol (N = 94; mean dose = 12.7 mg/day) and had EPS (Simpson-Angus Scale [SAS] > 3) were directly switched to 6 weeks of open-label olanzapine treatment (mean dose = 11.4 mg/day). There were significant mean improvements (p<0.001 for all measurements) from baseline to endpoint on the SAS (−9.69 ± 5.33; percentage change, 87.2%), the Barnes Akathisia Scale (−1.00 ± 1.19; percentage change, 82.5%), and the Abnormal Involuntary Movement Scale (−1.48 ± 2.89; percentage change, 81.1%), and anticholinergic use decreased from 47.9% to 12.8% (mean baseline to endpoint change: −1.52 ± 1.91-mg equivalents of benztropine;p< 0.001). Significant mean baseline to endpoint improvements (p< 0.001 for all measurements) were observed on the Positive and Negative Syndrome Scale (PANSS; −25.28 ± 18.67; percentage change, 30.3%), the PANSS-extracted Brief Psychiatric Rating Scale (0–6 scale, −13.41 ± 10.16; percent-age change, 54.4%), and the Clinical Global Impressions Severity scale (−1.16 ± 1.19; percentage change, 26.4%). Spontaneously reported treatment-emergent adverse events with a greater than 5% incidence were somnolence (16.0%), increased appetite (14.9%), weight gain (11.7%), headache (8.5%), anxiety (7.4%), dizziness (6.4%), and insomnia (5.3%). Criteria for a successful switch were met by 90.5% of patients. Psychotic symptom exacerbation was experienced by 30.9% of patients at any time during the study and by 11.7% of patients at endpoint. Results suggest that a direct switch to olanzapine is a therapeutic option when patients with haloperidol-induced EPS are unable to tolerate a more gradual switch.
ISSN:0271-0749
出版商:OVID
年代:2001
数据来源: OVID
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5. |
Myocarditis Related to Clozapine Treatment |
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Journal of Clinical Psychopharmacology,
Volume 21,
Issue 4,
2001,
Page 382-388
Staffan Hägg,
Olav Spigset,
Andrew BAHons,
Torbjörn Söderström,
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摘要:
Myocarditis has in several case reports been associated with use of clozapine. Eight cases of myocarditis during treatment with clozapine that were submitted to the Swedish Adverse Drug Reaction Advisory Committee and 18 cases that were reported in the literature are summarized. As part of the routine signal detection process on the World Health Organization (WHO) Program on International Drug Monitoring database, which contains more than two million case reports of spontaneously reported suspected adverse drug reactions, a Bayesian confidence propagation neural network (BCPNN) is used. This article also shows the retrospective output of the BCPNN over time for clozapine and myocarditis and discusses its implications. In 19 (79%; duration of treatment not stated for 2 patients) of 24 patients with myocarditis, the symptoms occurred within the first 6 weeks of clozapine treatment. Many patients shared a similar clinical course, with symptoms such as an influenza-like illness, fever, sinus tachycardia, hypotension, chest discomfort, and heart failure. The reaction was fatal in 12 (46%) of these patients. The other patients generally had a prompt recovery. By using the BCPNN technique, a quantitative association between clozapine and myocarditis was demonstrated, and the association might have been highlighted for clinical review in 1994 had this BCPNN method been in use at the WHO center at the time. Myocarditis seems to be a rare and potentially lethal adverse effect of clozapine. Admittance for observation, interruption of the clozapine treatment, and treatment with corticosteroids should be considered for patients in whom this reaction is suspected.
ISSN:0271-0749
出版商:OVID
年代:2001
数据来源: OVID
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6. |
A Double-Blind, Randomized Comparison of the Efficacy and Safety of Intramuscular Injections of Olanzapine, Lorazepam, or Placebo in Treating Acutely Agitated Patients Diagnosed With Bipolar Mania |
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Journal of Clinical Psychopharmacology,
Volume 21,
Issue 4,
2001,
Page 389-397
Karena Meehan,
Fan Zhang,
Stacy David,
Mauricio Tohen,
Philip Janicak,
Joyce Small,
Kimberly Koch,
Rosemary Rizk,
Daniel Walker,
Pierre Tran,
Alan Breier,
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摘要:
There are no rapid-acting intramuscular formulations of atypical antipsychotics available for quickly calming an agitated patient with bipolar disorder. In this study, 201 agitated patients with bipolar mania were randomly assigned to receive one to three injections of the atypical antipsychotic olanzapine (10 mg, first two injections; 5 mg, third injection), the benzodiazepine lorazepam (2 mg, first two injections; 1 mg, third injection), or placebo (placebo, first two injections; olanzapine, 10 mg, third injection) within a 24-hour period. Agitation was measured at baseline, every 30 minutes for the first 2 hours, and at 24 hours after the first injection using the Positive and Negative Syndrome Scale–Excited Component subscale and two additional agitation scales. At 2 hours after the first injection, patients treated with olanzapine showed a significantly greater reduction in scores on all agitation scales compared with patients treated with either placebo or lorazepam. At 24 hours after the first injection, olanzapine remained statistically superior to placebo in reducing agitation in patients with acute mania, whereas patients treated with lorazepam were not significantly different from those treated with placebo or olanzapine. Furthermore, no significant differences among the three treatment groups were observed in safety measures, including treatment-emergent extrapyramidal symptoms, the incidence of acute dystonia, or QTc interval changes. These findings suggest that intramuscular olanzapine is a safe and effective treatment for reducing acute agitation in patients with bipolar mania.
ISSN:0271-0749
出版商:OVID
年代:2001
数据来源: OVID
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7. |
CYP1A2 Activity as Measured by a Caffeine Test Predicts Clozapine and Active Metabolite Norclozapine Steady-State Concentration in Patients With Schizophrenia |
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Journal of Clinical Psychopharmacology,
Volume 21,
Issue 4,
2001,
Page 398-407
Vural Özdemir,
Werner Kalow,
Paul Posner,
Evan Collins,
James Kennedy,
Bing-Kou Tang,
Lawrence Albers,
Christopher Reist,
Rochelle Roy,
Winston Walkes,
Pegah Afra,
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摘要:
Clozapine is an atypical antipsychotic drug and displays efficacy in 30% to 60% of patients with schizophrenia who do not respond to traditional antipsychotics. A clozapine concentration greater than 1,150 nmol/L increases the probability of antipsychotic efficacy. However, plasma clozapine concentration can vary more than 45-fold during long-term treatment. The aim of this study was to assess the contribution of CYP1A2 to variability in steady-state concentration of clozapine and its active metabolite norclozapine. Patients with schizo-phrenia or schizoaffective disorder were prospectively monitored during clozapine treatment (N = 18). Thein vivoCYP1A2 activity was measured using the caffeine metabolic ratio (CMR) in overnight urine. Trough plasma samples were drawn after at least 5 days of treatment with a constant regimen of clozapine. A significant negative association was found between the CMR and the dose-corrected clozapine (rs= −0.87,p< 0.01) and norclozapine (rs= −0.76,p< 0.01) concentrations. Nonsmokers displayed a higher clozapine (3.2-fold) and norclozapine (2.3-fold) concentration than smokers (p< 0.05). Furthermore, there was marked person-to-person variation in CYP1A2 activity during multiple-dose clozapine treatment (coefficient of variation = 60%). Age, weight, serum creatinine, and grapefruit juice consumption did not significantly contribute to variability in clozapine and norclozapine concentration (p> 0.05). In conclusion, CYP1A2 is one of the important contributors to disposition of clozapine during multiple-dose treatment. Although furtherin vitroexperiments are necessary, the precise metabolic pathways catalyzed by CYP1A2 seem to be subsequent to the formation of norclozapine, hitherto less recognized quantitatively important alternate disposition routes, or both. From a clinical perspective, an environmentally induced or constitutively highCYP1A2expression can lead to a decrease in steady-state concentration of clozapine as well as its active metabolite norclozapine. Thus, interindividual variability in CYP1A2 activity may potentially explain treatment resistance to clozapine in some patients. CYP1A2 phenotyping with a simple caffeine test may contribute to individualization of clozapine dosage and differentiate between treat ment noncompliance and high CYP1A2 activity.
ISSN:0271-0749
出版商:OVID
年代:2001
数据来源: OVID
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8. |
An Evaluation of Risperidone Drug Interactions |
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Journal of Clinical Psychopharmacology,
Volume 21,
Issue 4,
2001,
Page 408-416
C. DeVane,
Charles Nemeroff,
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摘要:
Risperidone, an atypical antipsychotic drug, is widely used in the treatment of psychoses associated with schizophrenia, Alzheimer’s disease, and other psychiatric disorders. Polypharmacology is a necessary condition for the optimal treatment of many patients with comorbid psychiatric and medical illness. One concern raised by the widespread use of multiple concurrent pharmacotherapies is the potential for drug-drug interactions to adversely affect patient outcome. Accordingly, the biomedical literature was reviewed for reports of drug interactions involving risperidone, and the clinical significance of each report was evaluated. Additionally, the potential for risperidone to participate in drug interactions was evaluated by considering the drug’s pharmacokinetic properties. Controlled studies and case reports indicate that risperidone has a low potential for metabolic drug interactions. Drugs that inhibit cytochrome P450 (CYP) 2D6 or induce or inhibit CYP3A4 may alter risperidone plasma concentrations, but the clinical significance of such interactions seems to be minimal. Adherence to a few guidelines for the design of dosage regimens should limit the effect of drug-drug interactions on patient status and contribute to optimal pharmacotherapy with risperidone.
ISSN:0271-0749
出版商:OVID
年代:2001
数据来源: OVID
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9. |
Fluoxetine in the Prevention of Depressive Recurrences: A Double-Blind Study |
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Journal of Clinical Psychopharmacology,
Volume 21,
Issue 4,
2001,
Page 417-424
Inmaculada Gilaberte,
Angel Montejo,
Jesus de la Gandara,
Victor Perez-Sola,
Miguel Bernardo,
Joan Massana,
Rocio Martin-Santos,
Alfonso Santiso,
Ramon Noguera,
Leonardo Casais,
Valero Perez-Camo,
Manuel Arias,
Rajinder Judge,
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摘要:
Optimal outcomes from depression treatment are long-term recovery and, in the case of recurrent depression, prevention of new episodes. However, few data are available concerning the long-term efficacy of antidepressants in prophylactic treatment to prevent recurrences of depression. The efficacy and safety of fluoxetine 20 mg/day was evaluated in reducing the number of depressive episodes and in extending the time free of symptoms in patients with recurrent unipolar major depression. Patients with recurrent unipolar major depression according to DSM-III-R criteria and who responded to 32 weeks of open-label fluoxetine were randomly assigned to receive fluoxetine 20 mg/day (N = 70) or placebo (N = 70) for 48 weeks of double-blind maintenance treatment. Outcome measures were the percentage of recurrences and time to recurrence. Safety assessments included treatment-emergent adverse events, reasons for discontinuation, vital signs, and laboratory measures. Fluoxetine was associated with a statistically significantly smaller percentage of patients who had a recurrence compared with placebo (20% vs. 40%; χ2analysis,p= 0.010). The symptom-free period was significantly longer for patients treated with fluoxetine versus placebo (295 vs. 192 days; Kaplan-Meier estimates, log-rank test,p= 0.002). Treatments were well tolerated during maintenance treatment. The only statistically significant difference in adverse events between treatment groups was anxiety, which was more frequent in the placebo group (fluoxetine, 12.9% vs. placebo, 30%; χ2analysis,p= 0.013). Two placebo-treated patients and no fluoxetine-treated patients were withdrawn because of adverse events. In conclusion, fluoxetine at 20 mg/ day was effective and well tolerated for the prophylactic treatment of recurrent unipolar major depression.
ISSN:0271-0749
出版商:OVID
年代:2001
数据来源: OVID
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10. |
Mirtazapine Versus Venlafaxine in Hospitalized Severely Depressed Patients With Melancholic Features |
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Journal of Clinical Psychopharmacology,
Volume 21,
Issue 4,
2001,
Page 425-431
Julien Guelfi,
Marc Ansseau,
L. Timmerman,
S. Kørsgaard,
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摘要:
The aim of this multicenter, randomized, double-blind, 8-week study was to compare the antidepressant efficacy and tolerability of mirtazapine and venlafaxine in the treatment of hospitalized patients with DSM-IV diagnosis of severe depressive episode with melancholic features. Patients with a baseline score of ≥ 25 on the 17-item Hamilton Rating Scale for Depression (HAM-D-17) were randomly assigned to receive treatment with either mirtazapine (N = 78, 15–60 mg/day) or venlafaxine (N = 79, 75–375 mg/day, twice a day) in a rapid up-titration schedule. Efficacy was assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS), HAM-D-17, and Clinical Global Impression scale, and quality of life was assessed with the Quality of Life, Enjoyment, and Satisfaction Questionnaire and Quality of Life in Depression Scale. Tolerability was assessed with the Utvalg for Kliniske Undersogelser (UKU) side effect scale and by reporting adverse events. Both drugs were effective in reducing overall symptoms of depression, showing substantial reductions in group mean MADRS scores (−20.1 for mirtazapine and −17.5 for venlafaxine) and HAM-D-17 scores (−17.1 for mirtazapine and −14.6 for venlafaxine) at the end of the treatment. Although not statistically significant, at all assessment times higher percentages of patients treated with mirtazapine were classified as responders (≥50% reduction) on the HAM-D (at endpoint, 62% vs. 52%) and MADRS (at endpoint: 64% vs. 58%). Likewise were the percentages of remitters (HAM-D score ≤7; MADRS score ≤12) also higher in the mirtazapine group. A statistically significant difference favoring mirtazapine was found on the HAM-D Sleep Disturbance factor at all assessment points (p≤ 0.03). Both treatments were well tolerated. Although slightly more subjects treated with mirtazapine reported at least one adverse event, a statistically significantly higher percentage of patients treated with venlafaxine (15.3%) than mirtazapine (5.1%) dropped out because of adverse events (p= 0.037). Quality of life improved in both treatment groups. In this study, treatment with mirtazapine resulted in a trend toward more responders and remitters than treatment with venlafaxine and in significantly fewer dropouts as a result of adverse events.
ISSN:0271-0749
出版商:OVID
年代:2001
数据来源: OVID
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