ISSN:0271-0749    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Standard and more recent advances in treatment of acute mania are reviewed with special emphasis oncontrolledstudies. Lithium is still the drug of choice and the most common treatment for mania, but some of its limitations have become more apparent, and specific indications for its use are defined. Alternatives to lithium are recommended for psychotic, rapid cycling, severely manic, and lithium-refractory patients. Neuroleptics are effective and used commonly but carry risks of long term side effects. Substantial reduction in neuroleptic dose and duration of exposure is probably feasible in many patients. Neuroleptic-lithium combinations are popular but do not have clear advantages over treatment with a single drug in the initial treatment of acute mania. These combinations have also been associated with increased neurotoxicity. Carbamazepine, both alone and in combination with lithium, has been used increasingly over recent years. Its efficacy is comparable to lithium, but clinical features predicting responsiveness may be different for these two drugs. Carbamazepine-neuroleptic combinations offer little advantage over neuroleptics alone. Valproic acid, verapamil, clonazepam, lorazepam, benzodiazepine-neuroleptic combinations, clonidine, tryptophan, propranolol, and electroconvulsive therapy are also popular, but their effectiveness has not yet been adequately confirmed by controlled studies.

ISSN:0271-0749    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

As a probe of the noradrenergic system in depression, single oral doses of the tricyclic antidepressant desipramine (100 mg) and placebo were administered to unipolar and bipolar depressed patients and healthy volunteers. Plasma concentrations of norepinephrine (NE) were determined 2–3 hours after dosing, with subjects in supine and upright positions. On the placebo day plasma NE was low in a subset of bipolar patients; both groups of depressives demonstrated an exaggerated increase in plasma NE upon standing. After desipramine dosing, the orthostatic procedure resulted in even greater relative increments in plasma NE in both patient groups, with no change in volunteers. These data are consistent with noradrenergic dysregulation in depression.

ISSN:0271-0749    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The authors review the development and the controversies of the neuroleptic threshold theory. According to this theory, the minimum effective antipsychotic dose of a neuroleptic (“threshold dose”) correlates with the appearance of “fine motor” symptoms (micrography) as opposed to the appearance of manifest or “coarse motor” extrapyramidal side effects. About half of the acutely exacerbated schizophrenic patients respond to threshold doses, but no predictors are known to characterize the responders. The neuroleptic threshold doses were found to be low, and the low dose treatment strategy is supported by the results of current PET and neuroleptic plasma level studies.

ISSN:0271-0749    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A total of 2250 subjects from psychiatric and geriatric settings was examined for abnormal involuntary movements by the same team of trained raters employing a standard examination technique and rating scale. “Spontaneous” dyskinesia rates were 1.3% among 400 healthy elderly people surveyed at senior citizens centers, 4.8% among medical geriatric inpatients and ranged from 0 to 2% among psychiatric patients never exposed to neuroleptics. For samples of neuroleptic-treated patients, prevalence rates ranged from 13.3% among patients at a voluntary psychiatric hospital to 36.1% among state hospital patients. Logistic regression analyses revealed a large effect of age on tardive dyskinesia prevalence and an interaction of age with sex. Among younger subjects, men had higher rates; among subjects over age 40, rates were higher for women. Edentulousness and presence of other neurological disorders were possible contributors to high rates for the elderly. Even with control for age, sex and duration of neuroleptic exposure, prevalence differed markedly across study site.

ISSN:0271-0749    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In an open label study, two fixed doses of nifedipine (30 mg and 60 mg daily) were added to the usual antipsychotic drug treatments of 10 patients suffering from chronic schizophrenia. While no patient experienced significant improvements, statistically significant falls in Brief Psychiatric Rating Scale scores were observed. A significant reduction in Abnormal Involuntary Movement Scale scores was observed in those patients with tardive dyskinesia. After the addition of nifedipine, four of the 10 patients showed large increases in plasma neuroleptic activity (radioreceptor assay) that decreased to baseline levels within two weeks. The possibility that this represents competitive inhibition and subsequent induction of the liver metabolism of the antipsychotic drugs is discussed. Adverse effects encountered are also discussed.

ISSN:0271-0749    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Fifty-five young adult patients completed a study comparing alprazolam, propranolol, and placebo in the treatment of panic disorder and agoraphobia with panic attacks. Twenty completed 5 weeks of treatment with alprazolam. No concomitant psychological treatment was administered. Plasma alprazolam levels were determined at baseline and at the end of the trial by means of automated gas chromatography. These levels were significantly correlated with dose (p= 0.001). Dividing the data into quartiles based on alprazolam concentration, no direct, linear relationship was found between alprazolam levels and response (as defined by a criterion of zero panic attacks). However, analysis of the combined middle two quartiles versus the combined upper and lower quartiles showed a positive trend toward a curvilinear relationship; i.e., there was a greater response rate within the 18–62 ng/ml concentration range than in the combined 0–17 plus 63–107 ng/ml range, (x2= 2.4;p= 0.12). The findings are very preliminary in nature. It remains to be seen if the results will reach significance with a larger sample size and a more tightly controlled study design.

ISSN:0271-0749    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We have previously reported on the familial aggregation of bipolar II affective disorder and have speculated that new treatment approaches might be required for this difficult disorder. Based on Reimherr's report that fluoxetine responders were more likely to have poor prior responses to tricyclics and to have chronic depressions with “atypical” clinical features, we used fluoxetine to treat the chronic atypical depression in selected bipolar II outpatients. The 16 bipolar II patients in our series had been depressed for an average of 5.3 years prior to starting fluoxetine and had had poor responses to tricyclics, MAOIs, and lithium. All but one have had some response to fluoxetine. Ten of the 13 patients who have been taking fluoxetine for 10 or more months have had a good to very good response and the other 3 have had a fair response. Only one patient discontinued fluoxetine because of side effects. These findings should encourage further treatment research using fluoxetine and other serotonin reuptake blockers as well as research into the pathophysiologic identity of bipolar II as a possible distinct form of affective disorder.

ISSN:0271-0749    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0271-0749    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0271-0749    

出版商:OVID    

年代:1991

数据来源: OVID