ISSN:0271-0749    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This review surveys the literature in the area of predictors of response to antipsychotic drugs. Four general categories are presented and discussed: diagnosis as a predictor, clinical predictors, biological predictors, and pharmacological predictors. No single consistent predictor of response could be discerned; it appears that a variety of factors affect outcome and that several variables must be considered simultaneously. Based on the findings of this review, suggestions for improvements in clinical research design are made.

ISSN:0271-0749    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Centrally active antimuscarinic agents are generally used in psychiatry to treat the extrapyramidal side effects of antipsychotic medications. However, these agents may have antidepressant and mood-elevating properties, and the literature suggests they are liable to abuse. The author reviews this literature and discusses its implication.

ISSN:0271-0749    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The authors have previously reported mild improvement of behavior and cognition in a group of 17 nondepressed patients with dementia of the Alzheimer type (DAT) treated with two doses of L-deprenyl (10 and 40 mg/day). Seven of these patients subsequently received double-blind, placebo-controlled treatment with tranylcypromine. The patients experienced significant side effects, particularly orthostatic hypotension without compensatory pulse increase, during tranylcypromine treatment. These effects were more severe than those occurring during L-deprenyl treatment, and they occurred at substantially lower doses (mean dose, 16 mg/day). These data support the role of the inhibition of monoamine oxidase type A in the development of orthostatic hypotension in patients treated with monoamine oxidase inhibitors. They also raise the question of whether the observed sensitivity to monoamine oxidase inhibition is a function of age or disease. In either case, the greater toxicity of tranylcypromine makes inferences difficult regarding the relative efficacies of these drugs in treating patients with dementia of the Alzheimer type and may limit the potential usefulness of tranylcypromine in ameliorating some symptoms of this disease.

ISSN:0271-0749    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Tricyclic antidepressants (TCAs) have been occasionally reported to cause delirium, probably via a central antimuscarinic action. Nine of 16 patients with plasma TCA levels greater than 450 ng/ ml developed cognitive or behavioral toxicity, compared with only one of 15 patients in a control group with plasma TCA levels between 150 and 450 ng/ml. The clinician should be aware of this potential adverse effect of TCA therapy, which may be easily preventable through the combination of careful clinical monitoring and liberal use of plasma TCA levels.

ISSN:0271-0749    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

High potency neuroleptics have been advocated for acute mania because their side effect profile may allow for a more rapid dose escalation and symptom resolution. Low potency neuroleptics have also been advocated because their sedative properties might better calm the acutely agitated manic patient. The authors tested these hypotheses using a double-blind design comparing thiothixene with chlorpromazine in 29 manic patients on a standard dose of lithium. They found that thiothixene and chlorpromazine produced identical rates and degree of improvement, that side effect profiles differed for each drug but did not affect overall clinical response, and that most patients had a good response on much lower than expected doses. The implications for less aggressive use of neuroleptics to treat mania are discussed.

ISSN:0271-0749    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Data from pharmacokinetics studies that examined the relationship of haloperidol serum concentrations and therapeutic response in schizophrenic patients were reexamined utilizing the method of logistic regression analysis. A linear rather than a curvilinear relationship was obvious between serum haloperidol concentration and therapeutic response according to both the regression analysis and inspection of the distribution of the data. It was concluded that a serum haloperidol concentration in the range of 9 to 15 ng/ml was associated with a 30% decrease in the total Brief Psychiatric Rating Scale (BPRS) score. Haloperidol concentrations above these appear unlikely in the majority of patients to produce any additional reduction of symptoms. The BPRS psychosis factor finding suggested an analogous finding for serum haloperidol concentrations between 12 and 17 ng/ml. The analyses suggest that the probability of response to haloperidol seems to reach a point of diminishing return at concentrations of approximately 9 to 17 ng/ml. Serum concentrations above this limit do not appear to either decrease or increase the probability of response.

ISSN:0271-0749    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Patients with Alzheimer's disease (AD) have an apparent abnormality possibly representing an increase in the average fluidity of their cell membranes. Changes in membrane fluidity of similar magnitude to those observed in AD have been noted to lead to marked alterations in cell function. Therefore, the changes in fluidity observed in AD may be related to the symptoms of that disorder, representing either an underlying cause of dysfunction or cellular attempts to compensate for dysfunction in AD. To test these possibilities, we administered S-adenosyl-L-methionine (SAMe), an agent shown to increase membrane fluidity in animals, to patients with AD. Treatment with SAMe led to marked increases in membrane fluidity.

ISSN:0271-0749    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Imipramine (IMI) and its active metabolites, desipramine (DMI), 2-hydroxyimipramine (2-OH-IMI), and 2-hydroxydesipramine (2-OH-DMI), were assayed by high pressure liquid chromatography in the serum and urine of 14 depressed patients after 1 week of twice-daily treatment with 100 mg of IMI. The concentrations of the glucuronide conjugates of 2-hydroxyimipramine (GA-O-IMI) and 2-hydroxydesipramine (GA-O-DMI) were assessed via enzyme hydrolysis. The range of serum concentrations of IMI and DMI was 65 to 1,064 ng/ml with slight elevation in total active components caused by inclusion of the unconjugated hydroxy metabolites. The average of total active compounds in smokers (239 ng/ml) was less (p< 0.1) than in non-smokers (524 ng/ml). The mean serum concentration ratios were 0.24 for 2-OH-IMI/IMI and 0.50 for 2-OH-DMI/DMI ratios, whereas the DMI/IMI ratio was 1.88, indicating more extensive accumulation of DMI. Appreciable glucuronide conjugate accumulation occurred with average serum concentration ratios of 8.13 for GA-O-IMI/2-OH-IMI and 6.22 for GA-O-DMI/2-OH-DMI. Covariance occurred in metabolite/precursor ratios indicating intrapatient similarities in formation/disposition rates of the hydroxy pairs and the conjugate metabolite pairs. Renal clearances of 2-OH-DMI were 35 to 267 ml/min, whereas those of the conjugates were only 10 to 110 ml/min. Total urinary recovery of these metabolites was similar to that reported previously for single IMI doses. The data indicate accumulation of substantial serum concentrations of glucuronide conjugates after therapeutic doses of IMI in depressed patients and similarities within patients in disposition of metabolite pairs.

ISSN:0271-0749    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We discontinued fluphenazine decanoate using a double-blind, crossover random order design, in 12 recent onset clinically stable schizophrenics who had been given fluphenazine decanoate 12.5 mg intramuscularly every 2 weeks for at least 1 year prior to drug withdrawal. Each condition (drug or placebo) lasted 12 weeks. Using a radioimmunoassay verified by comparison to a gas chromatographic-mass spectrometric method, plasma fluphenazine levels were measured every 2 weeks during drug continuation and drug withdrawal conditions. No patient relapsed over the 24-week period of the study. Mean fluphenazine levels between drug continuation and withdrawal conditions showed a progressively larger difference over time, although significant differences were not seen until week 8. By week 12 after drug withdrawal, 33% of subjects still showed notable plasma fluphenazine levels. On the basis of our preliminary findings, we suggest that 2-week intervals between injections may be too short and that wider intervals may achieve similar clinical results.

ISSN:0271-0749    

出版商:OVID    

年代:1988

数据来源: OVID