Use of rauwolfia serpentina benth. in neuropsychiatric conditions
01 Apr 1954-Annals of the New York Academy of Sciences (John Wiley & Sons, Ltd)-Vol. 59, Iss: 1, pp 107-132
About: This article is published in Annals of the New York Academy of Sciences.The article was published on 1954-04-01. It has received 173 citations till now.
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TL;DR: A hypothesis is proposed wherein psychosis is a state of aberrantSalience of stimuli and ideas, and antipsychotics, via modulation of the mesolimbic dopamine system, dampen the salience of these symptoms, ensuring the resolution of symptoms.
Abstract: A review of the history of antipsychotics reveals that while the therapeutic effects of chlorpromazine and reserpine were discovered and actively researched almost concurrently, subsequent drug development has been restricted to drugs acting on postsynaptic receptors rather than modulation of dopamine release. The fundamental property of atypical antipsychotics is their ability to produce an antipsychotic effect in the absence of extrapyramidal side effects (EPS) or prolactin elevation. Modulation of the dopamine D2 receptor remains both necessary and sufficient for antipsychotic drug action, with affinity to the D2-receptor being the single most important discriminator between a typical and atypical drug profile. Most antipsychotics, including atypical antipsychotics, show a dose-dependent threshold of D2 receptor occupancy for their therapeutic effects, although the precise threshold is different for different drugs. Some atypical antipsychotics do not appear to reach the threshold for EPS and prolactin elevation, possibly accounting for their atypical nature. To link the biological theories of antipsychotics to their psychological effects, a hypothesis is proposed wherein psychosis is a state of aberrant salience of stimuli and ideas, and antipsychotics, via modulation of the mesolimbic dopamine system, dampen the salience of these symptoms. Thus, antipsychotics do not excise psychosis: they provide the neurochemical platform for the resolution of symptoms. Future generations of antipsychotics may need to move away from a "one-size-fits-all polypharmacy-in-a-pill" approach to treat all the different aspects of schizophrenia. At least in theory a preferred approach would be the development of specific treatments for the different dimensions of schizophrenia (e.g., positive, negative, cognitive, and affective) that can be flexibly used and titrated in the service of patients' presenting psychopathology.
627 citations
TL;DR: The discovery of the antipsychotic properties of chlorpromazine in the 1950s was a fundamental event for the practice of psychiatry and for the genesis of the so-called "psychopharmacological revolution."
Abstract: Background. The historical process of discovery and clinical introduction of chlorpromazine, one of the greatest advances of 20th century medicine and history of psychiatry, is analyzed.Methods. In this review, we have studied the original works of pioneers in the discovery and clinical use of chlorpromazine, as well as the contributions of prestigious researchers (historians, pharmacologists, psychiatrists, etc.) about this topic.Results. The discovery of phenothiazines, the first family of antipsychotic agents has its origin in the development of German dye industry, at the end of the 19th century (Graebe, Liebermann, Bernthsen). Up to 1940 they were employed as antiseptics, antihelminthics and antimalarials (Ehrlich, Schulemann, Gilman). Finally, in the context of research on antihistaminic substances in France after World War II (Bovet, Halpern, Ducrot) the chlorpromazine was synthesized at Rhone-Poulenc Laboratories (Charpentier, Courvoisier, Koetschet) in December 1950. Its introduction in anaesthes...
290 citations
TL;DR: The purpose of this report is to describe the development of psychiatric complications in hypertensive patients treated with large doses of reserpine for long periods.
Abstract: THE introduction of Rauwolfia serpentina into this country by Wilkins and Judson1 and the purification of an active alkaloid, reserpine (Serpasil), has led to the widespread clinical use of the latter drug not only in hypertension2 , 3 but also in neuropsychiatric conditions.4 The purpose of this report is to describe the development of psychiatric complications in hypertensive patients treated with large doses of reserpine for long periods. Case Reports Case 1. Mrs. I.K., a 54-year-old widow, had mild hypertension for 1 year associated with headache and substernal pain. Since the death of her husband 2 years previously she had been more . . .
288 citations
TL;DR: The evidence that alterations in glutamatergic neurotransmission, especially focusing on the N‐methyl‐d‐aspartate receptor (NMDAR) function, may be a critical causative feature of schizophrenia is reviewed, how this contributes to pathologic circuit function in the brain, and how these insights are revealing whole new avenues for treatment development that could reduce treatment‐resistant symptoms.
Abstract: Schizophrenia is a chronic and severe psychiatric disorder that has profound impact on an individual's life and on society. Thus, developing more effective therapeutic interventions is essential. Over the past quarter-century, an abundance of evidence from pharmacologic challenges, post-mortem studies, brain imaging, and genetic studies supports the role of glutamatergic dysregulation in the pathophysiology of schizophrenia, and the results of recent randomized clinical trials based on this evidence have yielded promising results. In this article, we review the evidence that alterations in glutamatergic neurotransmission, especially focusing on the N-methyl-d-aspartate receptor (NMDAR) function, may be a critical causative feature of schizophrenia, how this contributes to pathologic circuit function in the brain, and how these insights are revealing whole new avenues for treatment development that could reduce treatment-resistant symptoms, which account for persistent disability.
187 citations
TL;DR: The multiple hit hypothesis of PD—that is, the effect of more then one risk factor—may be the start of new era in animal models of PD that is one step closer to mimicking the pathology of PD in humans.
147 citations
References
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TL;DR: The level of the figures generally accepted as indicative of hypertension should be raised for persons over 40 years of age, which would result in a decrease in the reported incidence of hypertension.
Abstract: Hypertension is a common diagnosis in medical practice and is usually considered to bear a serious connotation. Arterial hypertension has been described as the most common and important of all types of heart diseases.1Yet the levels which constitute abnormally high blood pressure at various ages have not been accurately determined. The various figures now in use—140, 150 or 160 mm. of mercury systolic and 90 to 100 mm. of mercury diastolic—are arbitrary, particularly when age is concerned. The observation that many persons with high blood pressure live to old age suggests that undue significance is frequently attached to the degree of hypertension.2 In a report made several years ago we pointed out that the level of the figures generally accepted as indicative of hypertension should be raised for persons over 40 years of age.3This would result in a decrease in the reported incidence of hypertension
202 citations
TL;DR: The sedative principle of Rauwolfia serpentina Benth has been isolated in pure crystalline form and its chemistry and pharmacology has been studied as discussed by the authors, and its properties and properties have been investigated.
Abstract: The sedative principle ofRauwolfia serpentina Benth. has been isolated in pure crystalline form and its chemistry and pharmacology has been studied.
199 citations
TL;DR: Evans and Loughnan, after a critical analysis and trial of thirty three different preparations in seventy cases of high blood pressure (essential hypertension), were forced to admit the uselessness of them all.
Abstract: In view of the persistently high mortality from hypertension in spite of the large number of measures recommended in the treatment of this disease one is forced to admit the futility or helplessness of the situation. In Ayman’s opinion, the “proper treatment is still unknown.” Evans and Loughnan, after a critical analysis and trial of thirty three different preparations in seventy cases of high blood pressure (essential hypertension), were forced to admit the uselessness of them all. In their opinion, simple sedative measures are often more effective than the much more expensive and fashionable products extensively displayed on the market.
149 citations
TL;DR: Rauwolfia serpentina has been used in India for many years to treat a variety of diseases that at first thought appear to bear little similarity to one another, but on reflection these various diseases could have a common denominator if they were all relieved symptomatically by a sedative or a "relaxing" drug such as Rau wolfia.
Abstract: RAUWOLFIA serpentina (Ophioxylon serpentinum) has been used in India for many years to treat a variety of diseases that at first thought appear to bear little similarity to one another. These include insanity, epilepsy, insomnia, hysteria, eclampsia and hypertension. On reflection, however, these various diseases could have a common denominator if they were all relieved symptomatically by a sedative or a "relaxing" drug such as Rauwolfia. Our attention was drawn to the drug because reports of its hypotensive effects seemed to be fairly well documented; indeed, the conservative claims made for it by several authors increased rather than . . .
113 citations
TL;DR: There is evidence, that central portions of the sympathetic system are inhibited by Reserpin, a new, highly active alcaloid from Rauwolfia serpentina benth.
Abstract: Reserpin, a new, highly active alcaloid fromRauwolfia serpentina benth., shows a very marked hypnotic effect and lowers the blood pressure.
110 citations