Showing papers on "Psychotropic drug published in 1986"

Postpartum psychiatric disorders

Abstract: Postpartum blues, postpartum neurotic depression and puerperal psychoses have distinct clinical features; they affect women in all social classes and in all cultures, and despite numerous studies they have not been linked definitively with any biologic or psychosocial variables. The only possible exception is puerperal psychosis, which emerges much more often in women with a personal or family history of a bipolar affective disorder than in women without, a finding that probably explains the reluctance of some researchers to recognize puerperal psychotic episodes as distinct from psychotic episodes at other times. If postpartum blues last longer than 2 weeks and are disabling they are classified as neurotic depression and warrant treatment, often requiring both psychosocial approaches and psychotropic drug therapy. Antidepressants, major tranquillizers, electroconvulsive therapy and lithium have proved effective in the treatment of postpartum psychoses, depending on the symptoms. Both lithium and diazepam have been reported to cause deleterious side effects on breast-fed infants, and as the side effects of other psychotropic drugs given to a nursing mother are imperfectly understood, bottle feeding seems prudent.

Pharmacotherapy for patients with borderline personality disorder.

Abstract: In the early 1970s, when studies on borderline patients began in earnest, most inpatients received either an inadequate trial on any psychotropic drug or none at all. The literature of that period warned about the ineffectiveness 1,2 or actual harmfulness 3-7 of pharmacologic treatment for borderline patients. A decade later, it had become rare for any inpatient with borderline personality disorder to be discharged without a vigorous trial of at least one psychotropic agent. Even in outpatient settings, the majority of patients had prior exposure to psychotropic medications. 8 This proliferation of drug treatments for borderline patients had taken place despite the absence of any controlled evaluations. In fact, the additions to the literature largely consisted of case series from which claims were made for the usefulness of monoamine oxidase inhibitors, 9 tricyclic antidepressants, 10 and low-dose phenothiazines. 11 The greatly expanded awareness of the potential value of such pharmacotherapies

Fast and slow chemical signalling in the nervous system

Abstract: L L Iversen: Introduction AMINO ACIDS AS FAST SIGNALS: K Krnjevi 'c: Amino acid transmitters: 30 years' progress in research J L Barker, B Dufy & R N McBurney: Amino acid and peptide signals in cultured CNS neurons and clonal pituitary cells J S Kelly, V Crunelli, S Forda, N Leresche & M Pirchio: Fast synaptic responses in the hippocampus and dorsal lateral geniculate nucleus of the rat A M Sillito: Fast and slow chemical signalling in the visual cortex: an evaluation of GABA- and neuropeptide-mediated influences P Krogsgaard-Larsen, L Nielsen, U Madsen & E Nielsen: GABA and glutamic acid agonists of pharmacological interest J C Watkins: Selective antagonists define sub-classes of excitatory amino acid receptors S H Snyder: Multiple benzodiazepine and related receptors as targets for psychotropic drug action E H F Wong & J Kemp: Amino acids as fast signals: discussion NEUROPEPTIDES AND MONOAMINES AS SLOW SIGNALS: G N Woodruff: Receptors and second messengers for neuropeptides and monoamines D A Brown: Voltage-sensitive ion channels mediating modulatory effects of acetylcholine, amines, and peptides S I Walaas, J K-T Wang & P Greengard: First messengers, second messengers, and protein phosphorylation in CNS T M Jessell & C E Jahr: Synaptic interactions between dorsal root ganglion and dorsal horn neurons in cell culture: amino acids, nucleotides, and peptides as possible fast and slow excitatory transmitters R F Irvine & M J Berridge: Inositude metabolism in the brain: its potential role in complex neuronal pathways T H "okfelt et al: Coexistence of peptides and other active molecules in neurons: diversity of chemical signalling potential S Freedman & K Watling: Neuropeptides and monoamines as slow signals: discussion CHEMICALLY ADDRESSED NEURAL COMMUNICATIONS: F O Schmitt: Chemical information processing in the brain: prospect from retrospect E A Kravitz: Serotonin, octopamine, and proctolin: two amines and a peptide, and aspects of lobster behaviour W Sossin, T Kreiner & R H Scheller: Aplysia neurosecretory cells: multiple populations of dense core vesicles D E Koshland Jr: Molecular mechanisms for memory F E Bloom: Chemical signalling in the spatial, temporal continuum J D Salamone & N G Bowery: Chemically addressed neural communications: discussion Index.

Treatment of mental disorders in pregnancy. A review of psychotropic drug risks and benefits.

Abstract: Pregnancy can be complicated by affective or psychotic illnesses severe enough to threaten the health and life of both mother and fetus. In many cases, nonbiological interventions like psychotherapy or hospitalization in a supportive milieu will be insufficient, and use of a psychotropic drug will be indicated. This paper outlines the characteristics of maternal and fetal physiology that influence drug risks and then reviews the specific risks and benefits associated with antipsychotics, antidepressants, and lithium.

Computed tomographic scans in ECT-patients.

Abstract: Although the safety and efficacy of electroconvulsive therapy (ECT) is acknowledged by most, concern has repeatedly been expressed that the treatment may have some lasting effects on the brain. To study potential morphological changes, 22 patients with a history of ECT were submitted to a detailed clinical evaluation and a brain CT scan examination. Age- and sex-matched control subjects comprised a group of comparable patients, none of whom had received ECT, and a second control group of healthy volunteers. Patients had larger ventricle brain ratios and cortical “atrophy” scores than normal controls, but no association was found between these radiological measures and a previous history of ECT. Hence, the present data are consistent with recent reports that affective disorders may be associated with enlarged brain ventricles, although the clinical significance of such findings remains unclear. In line with previous investigations age correlated significantly with cortical “atrophy” scores and ventricle/brain ratios for all subjects. Statistical tests of correlations between duration of illness, previous psychotropic drug exposure and CT scan appearances were mainly inconclusive.

Clinical and social characteristics of male parasuicides: variation by employment status and duration of unemployment.

Abstract: In this study employed and unemployed male parasuicides were compared on a number of clinical, sociodemographic and other characteristics in order to establish which, if any, were significantly related to employment status. A further analysis examined variation in personal attributes by duration of unemployment. The unemployed group was found to contain a higher proportion of individuals who were unmarried, living outside the family, of lower social class, given a diagnosis of abnormal personality, misusing drugs habitually, in trouble with the police and with a criminal record. Comparisons within the unemployed group showed that age and civil state varied significantly by duration of unemployment, but no linear trend was evident. Longer durations of unemployment were associated significantly with personality diagnosis and receipt of psychotropic drug treatment. Within the limits dictated by the study design (cross-sectional, without general population controls), the findings are discussed in terms of their compatibility with the causal or self-selection models of the unemployment-parasuicide relationship.

Psychotropic drug use in Italy: national trends and regional differences.

Abstract: Psychotropic drug sales data for Italy were examined for the years 1975-84. The principal findings were of more-or-less consistent annual increases in sales of antidepressants, minor tranquillizers and, to a lesser extent, of neuroleptics. These trends are interpreted in the context of the characteristics of the Italian National Health Service (NHS), and in relation to findings from psychotropic drug utilization studies in other Western countries. Regional differences in psychotropic drug sales for 1983/4 were also examined. Marked differences were found and, in general, levels of use were higher in North/Central Italy than in the South. Factors influencing regional differences were explored using regression analysis. Regional NHS expenditure (excluding that on drugs) was found to influence strongly the sales of all categories of psychotropic drug, whereas there was also a marked urban greater than rural difference in the sales of tranquillizers.

Psychotropic Drugs in Pregnancy

Abstract: Pregnancy is frequently complicated by the development or recurrence of a serious mental disorder; neurotic, major affective, and psychotic illnesses have all been observed1–4. When a major mental disorder arises in a pregnant woman and threatens her life, health, or that of the fetus, it should be treated early and aggressively to minimize complications and forestall the advance of the disease. Nonbiologic methods like individual psychotherapy, couples or family therapy, social casework, and hospitalization in a supportive, structured milieu should form the first line of treatment. If the illness persists in spite of nonbiological interventions, and if the risks of the inadequately treated disease outweigh the risks associated with a potentially useful medication, then a trial of that medication is clearly indicated.

Differences Between Female and Male Children in the Receipt of Prescribed Psychotropic and Controlled-analgesic Drugs

Abstract: This study describes the differences between male and female children in the receipt of prescriptions for psychotropic and controlled-analgesic drugs in office practice. The study encompassed 341,422 children of ages 0 through 17 years enrolled in the Tennessee Medicaid program during the 5 years 1977-1981. These children made 1,342,573 office visits and received 1,636,127 prescriptions during the study. There were 18,023 (5.3%) children who received prescriptions for psychotropic drugs and 18,744 (5.5%) who received prescriptions for combination products containing psychotropic drugs. There were 26,071 (7.6%) children who were prescribed controlled analgesics and 50,240 (14.7%) who received prescriptions for these substances as fixed combination medications. In this population, proportions of male and female children who received prescriptions for psychotropic and controlled-analgesic drugs were similar through age 11. After age 11, females were increasingly more likely to receive prescriptions for drugs from both categories than were males of the same age. By age 17, the rate of psychotropic drug prescription receipt for female children (6.3%) was nearly twice that for males (3.3%), a ratio consistent with numerous studies in adults. These differences were consistent over diagnostic categories and were only partially explained by differences in office-visit rates. These findings suggest that the known greater rates of psychotropic drug use among adult females are the result of factors whose influence begins at puberty, not before.

Psychological treatment in general practice: its effect on patients and their families.

Abstract: Rates of consultations and prescriptions for patients referred to clinical psychologists, and for these patients' immediate families, were investigated for three-year periods both before and after referral. Patients and their children consulted more and had more medication prescribed before referral than control groups, this tendency being particularly prevalent in the year before referral. After the contact with the psychologist there was a decrease in all these indices in the short term, and there were long-term decreases in psychotropic drug prescriptions for patients and in both consultations and prescriptions for their children.

The use of hypnotics and anxiolytics in the elderly.

Abstract: Anxiety and insomnia are prevalent conditions in the elderly, and anxiolytics and hypnotic drugs are commonly used. Pharmacokinetic variables--absorption, distribution, metabolism and elimination--are all altered to a greater or lesser extent. As a general rule, the elderly are more sensitive to psychotropic drug actions than younger patients. This is particularly so in the over 80s. The elderly tend to suffer from physical conditions which may cause insomnia and anxiety, and medication for those physical complaints may interact with psychotropic medication. In the treatment of insomnia, short- or intermediate-acting benzodiazepines are preferable to long-acting compounds which tend to accumulate and produce confusional states and ataxia. Similarly, the benefit/risk ratio for anxiolytics is least in the elderly. Compounds of intermediate half-life and no active metabolites, such as oxazepam, are preferable. Anxiety syndromes occurring in other contexts, e.g. dementia may be better treated with low doses of antipsychotic drugs.

The Symptom-Rating Test

Abstract: The Symptom-Rating Test (SRT) was originally designed to measure changes in the symptoms of neurotic adults and in experiments in therapeutics, such as drug trials. After several stages of research, new versions were designed to make the scale more economical and sensitive to discriminate between the effects of psychotropic drugs and placebo, or between two drugs in double-blind drug trials. It has been found to be a measure of distress and it has been used effectively with depressed patients [5, 10,19, 20, 24], in psychosomatic disorders [9-11, 21], in schizophrenics [15, 16], and in epidemiological studies [6, 7].

Induction of a heat shock protein in the isolated mammalian retina

Abstract: The effects of elevated ambient temperature and addition of the psychotropic drug LSD on protein synthesis in the isolated rabbit retina were investigated. Two dimensional gel electrophoresis followed by fluorography of proteins synthesized in vitro demonstrated that synthesis of a heat shock protein of molecular weight 74,000 (74K) was induced by the elevation of temperature and not by the addition of LSD. The appearance of this heat shock protein was shown to be dependent upon the synthesis of new RNA as shown by the addition of actinomycin-D to the incubation medium. The newly synthesized heat shock protein was associated with both nuclear and cytoplasmic fractions.

Psychotrope and alcohol use by women: one or two populations?

Abstract: From a telephone survey of 1,673 Montreal women, all consenting psychotrope users and randomly selected controls (N = 179) then were interviewed in their homes as to psychotropic drug and alcohol use. The results presented are based on these in-depth interviews. In the first phase of the analysis, the respondents were grouped according to whether they abstained from both alcohol and psychotropes, used alcohol alone, psychotropes alone, or both. The variables that distinguished these groups were determined by use of one-way analysis of variance. Some of these factors included age, level of education, anxiety, nervous tension, depression, subjective ratings of health, and responses to emotional upset. The second series of results involved correlation procedures to determine the covariates of alcohol and psychotrope use. Most significant of these findings were that psychotrope use was associated with anxiety, depression, and nervous tension, while alcohol use was not. Further, unlike alcohol use, psychotrope use was associated with a variety of coping techniques for dealing with emotional upset. The findings were interpreted to mean that there are two distinct populations.

The treatment of psychiatric disorders in pregnancy and the puerperium.

Abstract: Although few psychotropic drugs are known to be teratogenic or to have adverse effects on the developing fetus or neonate, no psychotropic drug is of proven safety. It is therefore very important that psychotropic medication should not be prescribed lightly during pregnancy or lactation and that such drugs should be prescribed only where there are positive indications for their use. Close collaboration between obstetrician and psychiatrist is recommended before treatment of a mental illness with psychotropic medication. Breast feeding should not routinely be suspended in mothers who require psychotropic medication. There is an adequate range of psychotropic drugs available to safely treat the pregnant or lactating woman who is mentally ill.

Psychotropic drugs and epilepsy

Abstract: Psychotropic drug use in epileptics requires special considerations, since many such drugs lower the seizure threshold. Stress associated with epilepsy often produces psychiatric problems, so that psychotropic drug therapy may be required. Side-effects of the anticonvulsant drugs themselves must also be considered, as must psychotropic-anticonvulsant interactions. Other seizure risk factors must be taken into account, but nevertheless psychotropic drug therapy should not be denied to the epileptic when it is specifically indicated. This paper outlines the precautions that need to be taken under such circumstances.

Activity of oxiracetam in patients with organic brain syndrome: a neuropsychological study.

Abstract: Oxiracetam is a new psychotropic drug that has been shown to positively affect processes both in animals and in patients with impaired brain function. The aim of this study was the evaluation of the effects of oxiracetam treatment on clinical symptoms in 43 patients with organic brain syndrome (OBS). After a 2-week washout period, patients were assigned to either oxiracetam or placebo, according to a randomized, double-blind, between-patients design. Both oxiracetam and placebo were orally given bid for 8 weeks; daily dose of oxiracetam was 2 X 800 mg. In OBS patients with a mild to moderate degree of cognitive impairment, oxiracetam showed to improve cognitive functions, logical performance, and attention. Other behavioral and functional parameters were also positively modified.

Psychotropic Drug-users and Non-users in General Practice: I. A Three-year Retrospective Study from an Island Community in Northern Norway

Abstract: In an island community in Northern-Norway 18.7 % of the population received one or more prescriptions of psychotropic drugs during a three-year period. This is the first of two articles that describe the general practitioner's prescribing of psychotropic drugs in this municipality (1). This article compares the psychotropic drug-users and non-users in order to identify and define the characteristics of local risk groups. Socio-demographic data and use of health services are analysed. The aim is to get a baseline for prevention of mental problems in the local community. The study indicates that high risk groups regarding psychotropic drug-use in this defined community were men≥65 years, females≥45 years, previously married/unmarried, disabled pensioners, young wives (25–44 years) with fulltime occupation outside the home, and middle-aged wives (45–64 years) without fulltime occupation outside the home. Thus suggestions and advice for prevention of mental problems can be listed and presented for local autho...

Spectrophotometric Study of Acid-Base Equilibrium of a Thienotriazolodiazepine, Brotizolam, Determination in Pharmaceutical Formulations

Abstract: Brotizolam is a psychotropic drug, derived from the Thieno-triazolodiazepine family, which has sedative and hypnotic properties. In this work, a spectrophotometric study has been carried out to determine the acid-base equilibrium, the pka value being obtained, as well as to develop a method for the determination of this compound in pharmaceutical formulations.

Neuropeptide-Dopamine Interactions: Focus on Neurotensin

Abstract: The emphasis of this chapter is on the mechanisms and functional significance of the interaction of neuropeptides with the putative neurotransmitter dopamine in the central nervous system (CNS). Accumulating evidence supports the contention that these interactions are of physiological importance and have added a novel dimension to our concepts of the pathophysiology of psychiatric disorders and the mechanisms of psychotropic drug action. Primary emphasis has been placed on findings from our laboratories and those of others concerning interactions between the tridecapeptide neurotensin (NT) and dopamine neurons. Where appropriate, the influence of other neuropeptides on dopamine mechanisms are discussed. We (Nemeroff et al., 1982a, 1983a, 1984) and others (Goedert, 1984) have previously reviewed the neuropharmacological, neuroanatomical and neurochemical literature supporting a functional interaction between NT-containing and dopamine-containing cells in the CNS and the interested reader is referred to these articles for a more comprehensive review than is intended here. The major objective of this chapter is to integrate recent data concerning the molecular basis of NT-dopamine interactions into the developing concept of the functional significance of such interactions.

Trends in psychotropic prescribing in general practice and general medical patients.

Abstract: Psychotropic drug prescribing in 1280 medical inpatients between 1973-75 was compared with that in 1200 similar patients during 1982-83. Three benzodiazepines accounted for 64% of prescriptions in 1973-75 and nine benzodiazepines for 82% of prescriptions in 1982-83. Over the decade, use of psychotropic drugs fell from 56% to 38% (P less than 0.001), primarily due to a reduction in patients treated only in hospital (34% vs 16%, P less than 0.001). Before admission, the proportions of patients receiving these drugs were similar (17% vs 18%). During admission, concomitant administration of similar drugs declined from 22% of patients in 1973-75 to 11% in 1982-83 (P less than 0.001), while concurrent prescribing before admission increased from 13 to 19%. The marked fall in psychotropic drug use and in inappropriate concomitant therapy indicates an encouraging trend towards more rational drug use at least in hospital. This was achieved without fiscal control and further rationalization of prescribing habits may be achieved by self-audit within the profession without legislative action.

Psychotropic Drug Prescribing in General Practice: II. A Three Year Retrospective Study from an Island Community in Northern Norway

Abstract: In a rural community in the northern part of Norway, the prescribing of psychotropic drugs has been recorded. The total prescribing during three years amounted to 60 defined daily doses per thousand inhabitants per day. Hypnotics and sedatives comprised together with antihistamines, 50 % of the total amount of defined daily doses. Neurosis was the dominating indication for prescribing. The majority of the patients (59 %) received less than 50 defined daily doses per year, indicating that most patients have a moderate consumption of psychotropic drugs. One of five users were prescribed more than 180 defined daily doses per year (71 % of all DDD), representing a probable risk-group for chronic use.

A survey of psychotropic drug prescribing.

Abstract: Psychotropic drug prescribing in a group practice was studied retrospectively. Approximately two-thirds of patients considered to have psychosocial problems were being treated with psychotropic drugs. Compared with the remaining patients with psychosocial problems not prescribed psychotropic medication these patients were more likely to be older, to have no children in the household and to have a past history of physical illness but were less likely to have an acute physical problem or to have a social factor contributing to their mental problem. Sedative and antidepressant drugs were prescribed with similar frequency for all age groups but 75% of hypnotic drugs were prescribed for the elderly.The study provides evidence that while a high proportion of patients with psychosocial problems receive a prescription for a psychotropic drug, general practitioners are discriminating in their prescribing.

Pharmacokinetic mechanisms of ethanol-psychotropic drug interactions.

Abstract: Acute and chronic ethanol consumption alters psychotropic drug pharmacokinetics. An understanding of the processes of drug absorption, distribution, biotransformation, and elimination provide a rational basis for predicting and evaluating drug interactions. Careful application of clinical pharmacokinetic models describing these physiological processes are particularly appropriate for the task of understanding drug and alcohol interactions. Absorption: Acute alcohol inhibits first-pass effect increasing systemic bioavailability. Ethanol inhibits gastric emptying and may delay drug absorption (increase lag time of absorption) and decrease the rate of absorption. The effects of chronic alcohol intake are unknown. Distribution: Hypoalbuminemia may be present in alcoholics with liver disease. Fluctuations in free fractions of drugs may occur in the alcohol withdrawal period. The clinical effects of protein binding changes are dependent on degree of binding, hepatic extraction ratio, and binding protein. Acute low-dose ethanol increases hepatic blood flow while high doses decrease it. The effects of chronic alcohol intake on liver blood flow are unknown. Hepatic blood flow changes show the greatest effects on drugs with high extraction ratios. Metabolism: Acute alcohol ingestion usually inhibits drug metabolism and chronic intake (in the absence of severe liver disease) enhances metabolism. Cirrhosis impairs oxidative metabolism, but spares glucuronidation. Although these generalizations may serve as useful guidelines for predicting alcohol and psychotropic drug interactions, they should be applied with caution as exceptions do exist.

Pharmacoendocrine Studies in Healthy Subjects and Depressed Patients

Abstract: On the assumption that psychotropic drugs can influence the functioning of aminergic neurons, and that aminergic neurons influence secretion of anterior pituitary (AP) hormones, the effect of various psychotropic drugs on AP hormone secretion was studied in healthy subjects and depressed patients.