Showing papers on "Psychotropic drug published in 1992"

Child and adolescent (early onset) schizophrenia: a review in light of DSM-III-R.

Abstract: Early onset schizophrenia (EOS) is defined as that beginning in childhood or adolescence (under 16 or 17). Studies of EOS are infrequent, and comparative adult figures not always available, but tentative conclusions may be drawn. EOS is more common in males; symptomatology is often undifferentiated; frequencies of homotypic family disorder, premorbid schizotypal personality, and neurodevelopmental abnormalities high; outcome poor but only slightly worse than in adults; response to psychotropic drug treatment probably similar though not properly tested; and confusion with psychotic bipolar disorder particularly common. Onset before language is developed presents special diagnostic difficulties. There are a few reports of autistic children developing schizophrenia but this requires replication. Differences from adult schizophrenia are more marked when onset is in childhood than in adolescence but all are quantitative rather than qualitative suggesting that the disorders are the same and that there should be no separate category for children or adolescents.

The impact of antipsychotic drug regulations on psychotropic prescribing practices in nursing homes.

Abstract: The authors prospectively studied psychotropic prescribing practices and quality assurance data in 17 nursing homes in the Baltimore area to assess the impact of federal antipsychotic drug regulations. There was a 36% reduction in prescriptions for neuroleptics over 6 months, no increase in prescriptions for sedative/hypnotics, and a small increase in prescriptions for antidepressants. The authors conclude that psychotropic drug prescribing practices and patient outcomes remain important areas of study in nursing homes.

Dextromethorphan and mephenytoin phenotyping of patients treated with thioridazine or amitriptyline.

Abstract: The metabolism of most tricyclic antidepressants and some phenothiazine neuroleptics is under the genetic control of hepatic cytochrome P-450IID6, which also regulates the metabolism of dextromethorphan. This study investigated the effect of treatment with amitriptyline or thioridazine on testing for genetically regulated efficiency of the metabolism of dextromethorphan and mephenytoin. One group of 33 patients was treated with 150 mg amitriptyline a day (the AMI group); 25 other patients received a daily dose of thioridazine, either 200 mg (200-THD group; n = 7) or 400 mg (400-THD group; n = 18). Before and after 10 days of this treatment, all patients were tested with 25 mg dextromethorphan and 100 mg mephenytoin to determine their pharmacogenetic status with respect to their hepatic drug oxidizing systems (cytochrome P-450IID6 and P-450 MP). Two patients were poor metabolizers (PMs) of dextromethorphan and three of mephenytoin. Treatment with either psychotropic drug was without significant effect on the metabolism of mephenytoin, but both amitriptyline and thioridazine increased significantly the metabolic ratio of dextromethorphan/dextrorphan. Thioridazine had the effect of changing the pharmacogenetic status of 15 efficient metabolizers of dextromethorphan to poor metabolizers; amitriptyline did not have such an effect. There was no significant correlation between day-11 plasma levels of thioridazine, mesoridazine, or sulforidazine and the metabolism of dextromethorphan, but there was a correlation between the metabolism of dextromethorphan and plasma levels of amitriptyline and nortriptyline. Amitriptyline (p less than 0.05), but not thioridazine, decreases the ratio of conjugated/total dextrorphan in urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychodermatology: an overview.

Abstract: As the skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli, dermatological practice involves a psychosomatic dimension. It is, however, the high visibility of dermatoses and their easy accessibility which make the skin a direct target for behavioural problems. Furthermore, self-destructive tendencies and hypochondriacal features often express themselves through dermatological symptoms: dermatitis artefacta and skin hypochondriasis are among the specific psychocutaneous disorders discussed here. In view of the clinical interface between dermatology and psychiatry, general guidelines are formulated and specific aspects of psychotherapy, behavioural treatment and psychotropic drug treatment are discussed.

Neurodevelopment in late infancy after prenatal exposure to benzodiazepines--a prospective study.

Abstract: Growth and neurodevelopment at 6, 10 and 18 months of age have been studied prospectively and longitudinally in a series of 17 children born to mothers who used benzodiazepines (BZD) in therapeutic doses as their only psychotropic drug throughout pregnancy. The results were compared with a group of 29 children born to mothers without any known use of psychotropic drugs. The BZD-exposed children caught up their low mean birth-weight, at an early stage, whereas the slightly decreased head circumference at birth remained at the same low level. In five infants, a pattern of craniofacial anomalies was found. Deviating neurodevelopmental and clinical symptoms and signs were common. The gross motor development was retarded at 6 and 10 months, but was nearly normal at 18 months. Impaired fine motor functions were found on all follow-up occasions. At 18 months, the most prominent finding was a delayed development of pincer grasp. The BZD-exposed children showed deviations in muscle tone and pattern of movements more frequently than children in the reference group. The study suggests that the use of BZD in therapeutic doses throughout pregnancy can have negative effects on the development of children up to 18 months of age. The long-term hazards cannot be evaluated from these results. A further follow-up at early school age is needed and is in progress.

Impact of Triplicate Prescription Program on Psychotropic Prescribing Patterns in Long-Term Care Facilities

Abstract: OBJECTIVE:To assess the impact of the effect of the New York state triplicate prescription program on psychotropic prescribing patterns in selected long-term care facilities over a one-year period.DESIGN:Retrospective study for changes in psychotropic drug use patterns before and after implementation of the triplicate prescription program.SETTING:Eight private and two public long-term care facilities in the western New York area.PATIENTS:All residents in the long-term care facilities with complete medical records for a one-year period were reviewed.OUTCOME MEASUREMENTS:Charts were reviewed for changes in psychotropic drug patterns and incidence in adverse events such as falls, hip fractures, hospital admission, signs or symptoms of benzodiazepine (BZD) withdrawal syndrome, or behavioral outburst.MAIN RESULTS:BZD use declined precipitously from 25 percent of psychotropic drug orders to 10 percent six months after implementation of the program. The decline in BZD use was accompanied by an increase in the nu...

Stress and Psychotropic Drug Use among the Elderly: An Exploratory Model

Abstract: The aim of the present study was to examine the effect of stressors and other factors on psychotropic drug consumption among the elderly, with an emphasis on individual rather than social factors. Respondents were recipients of a home care program that focusses on personal care rather than health-related care. Data were derived from two in-home interviews (one week apart) of 99 users of psychotropic drugs residing in a socially deprived suburb of a major Canadian city. The initial path-analytic model explained a significant amount (19%) of variance in the amount of drug use. Age, sex, attitudes towards psychotropic drug use, and life events were the predictors which remained in our trimmed model of drug use which explained 17 per cent of the variance. The results suggest that younger individuals reported greater drug use than older respondents. Positive attitudes towards psychotropics and being female were associated with the highest level of drug use. Path analysis did not support our hypothesis of a stress-related mental health model of drug use and, instead, raised important questions regarding social factors. Several explanations for the results are discussed. Suggestions for future study and clinical implications are offered.

Psychogenic periodic fever

Abstract: The present report concerns a 35-yr-old Caucasian male who had suffered from episodic fever of unknown origin over a period of 13 yr. Extensive investigation covering all the known causes of fever of unknown origin did not yield a diagnosis. Finally, a psychogenic cause was considered, and treatment with a psychotropic drug and relaxation therapy led to complete disappearance of the febrile periods.

Psychotropic drug-related rhabdomyolysis

Abstract: OBJECTIVE:The objective of this review is to discuss the pathophysiology and potential etiologies of rhabdomyolysis in psychiatric patients, with an emphasis on psychotropic drug-induced rhabdomyolysis.DATA SOURCES:References were obtained through an on-line search of MEDLINE, using English-language and human literature only.STUDY SELECTION:Because the topic is a potential drug-induced adverse effect, no controlled studies are available. Most of the literature are case reports and series of case reports.DATA EXTRACTION:The quality of case reports was assessed using the Food and Drug Administration guidelines for assessing the causality of a potential adverse drug reaction.DATA SYNTHESIS:The results of this review are based on qualitative data and indicate that rhabdomyolysis in psychiatric patients can be from multiple etiologies, including agitation, dehydration, and intramuscular injections, as well as an adverse effect of psychotropic medications. Although the deficiencies of this type of data are reco...

Effect of psychotropic drugs on excitatory amino acids in patients undergoing psychosurgery for depression.

Abstract: Samples of ventricular CSF were taken from 52 consecutive patients admitted for psychosurgery for intractable depression. Concentrations of asparagine, aspartate, glutamine, glutamic acid, and serine were determined. Glutamate and aspartate concentrations, implicated in excitotoxic brain damage, were not affected by various types of psychotropic drug treatment. Serine, a modulator of glutamate responses, was significantly elevated in samples from subjects receiving antidepressants. These subjects responded poorly to the operation. Psychotropic drugs are unlikely to be neurotoxic. Nevertheless, antidepressants may influence excitatory neurotransmission.

Longitudinal study of psychotropic drug use by elderly nursing home residents.

Abstract: In this longitudinal study of patterns of use of psychotropic drugs by a cohort of elderly nursing home residents (N = 5,752), drug use was examined upon admission, 3 months later, and at discharge/end of study. At each time point, 17% of the cohort used neuroleptics. Half of the subjects discontinued neuroleptics at each time point; however, a similar number were initiated on the drug. Benzodiazepines were used by 21%, 15%, and 15% at each of the three time points, respectively. Twice as many people were taken off benzodiazepines as initiated on them following admission. The 5% rate of antidepressant use was constant across the three time periods, although only half of those who took antidepressants upon admission were also taking them upon discharge/end of study. The amount of change due to discontinuation of these drugs and adjustment in dosage levels challenges the stereotype of the "neglected psychotropic drug user" in nursing homes.

The efficacy of psychotropic drugs: Implications for power analysis

Abstract: The estimation of the correct sample size to successfully test a hypothesis has become critical. A common approach to this problem is for the investigating team to complete a pilot study of a few patients to establish the "active drug-placebo" difference, using this "effect size" to perform the power analysis for sample size estimation. Given the variability evident in the effect size from completed and published studies, the pilot study approach may not be entirely dependable. The authors propose a method to obtain this initial "active drug-placebo" difference, in the field of psychotropic drug research. They apply meta-analysis to statistically summarize effect sizes obtained from an exhaustive review of the literature for a specific psychotropic drug in a given clinical condition. All double-blind, random assignment studies are used to calculate the effect size; therefore, no selection bias exists. These literature-based effect sizes are then used to perform the traditional power analysis for sample size estimation. The authors propose these estimations as a convenient reference source for future clinical investigators.

Integration of medical and psychiatric management in self-mutilation

Abstract: The traditional management of factitious patients with self-inflicted injuries consists of medical/surgical treatment of the physical lesions, followed by psychiatric referral. The former is assigned to the dermatologist, the surgeon, or the primary care physician. More often than not, the subsequent psychiatric referral for treatment of the psychiatric disorder underlying and actually causing the self-mutilation fails because of self-mutilators' notorious resistance to psychiatric help. The integration of a psychiatric strategy into the medical management is more effective than a sequential division of medical/surgical and psychiatric treatment. This integrated treatment strategy is based on three key issues: education of the medical team in understanding the self-mutilation as a morbid form of help-seeking behavior, the judicious use of confrontation as a therapeutic tool, and the combination of psychotropic drug treatment with psychotherapeutic techniques.

The Use of Psychotropic Medications in Persons with Prader-Willi Syndrome

Abstract: Prader-Willi Syndrome (PWS) is an unusual and multifacted birth defect characterized by severe hypotonia, hypogenitalism, delayed development, and mental retardation (Prader et al, 1956; Zellweger and Schneider, 1968; Zellweger 1988) Hyperphagia becomes evident early in childhood and is accompanied by predisposition to increasingly unstable emotions and behavior Problems that intensify over time (Sulzbacher, 1988) If the insatiable appetite is left unmanaged, affected individuals may become morbidly obese and die of complications of obesity A no less important component of the Syndrome is the evolution over time of inappropriate and often bizarre behaviors that escalate in frequency and intensity with age, necessitating ongoing management and Intervention (Greenswag, 1987) Anecdotal reports of chemical management of these behaviors, accompanied by conflicting opinions regarding their appropriateness and effectiveness, are emerging No data exists to guide clinicians’ choice of medication, dosage, Potential side effects, and time frame for administration Moreover, information comparing the effectiveness of psychotropic medications with non-drug behavioral Intervention is not available

Withdrawal syndrome from antidepressive drugs. Report of 5 cases

Abstract: Antidepressant withdrawal symptoms, following abrupt or gradual discontinuation of antidepressants, include general somatic distress (flu-like syndromes, gastro-intestinal disturbances, myalgias, headache, chills, weakness and rhinorrhea), anxiety, agitation, sleep disturbances, movement disorders, cardiac arrhythmias, delirium and manic reactions. Two cases of delirium, an hypomanic reaction and two general distress and movement disorders are reported. Cases 1 and 2 required admission to a general hospital. The etiology of the delirium was difficult to assess as long as the clinicians did not know that patients were taking antidepressants. Case 3 corresponds to the paradoxical activation following antidepressant interruption. Cases 4 and 5 constitutes light withdrawal syndromes. Most of cases are probably unrecognized. These cases reflect the importance in daily practice of the phenomena. It can be concluded from our study that: antidepressants must not be abruptly discontinued when a somatic disease appears. When a patient treated with a psychotropic drug develops delirium, the withdrawal of antidepressant must be suspected and the prescribing physician contacted to know what kind of psychoactive medication was prescribed.

[A computer-assisted EEG study on psychotropic properties of antiparkinsonian drugs].

Abstract: For the purpose of determining psychotropic properties of antiparkinsonian substances, the author has carried out a quantitative analytic study on EEG changes induced by six marketed antiparkinsonian drugs in young normal volunteers. The drugs were six antiparkinsonian agents, l-dopa (LDP) 100 mg, trihexyphenidyl (THP) 2 mg, 4 mg, biperiden (BPD) 1 mg, 2 mg, 5 mg, mazaticol (MZC) 4 mg, 8 mg, amantadine (AMD) 100 mg, bromocriptine (BMC) 1.25 mg, 2.5 mg, and amitriptyline (ATP) 25 mg, haloperidol (HPD) 3 mg, diazepam (DZP) 3 mg, inert placebo (PLB) as active and inactive controls. They were orally given to six healthy male volunteers respectively with two weeks interval and pre-drug, one, three, six hour post-drug EEGs were recorded and analyzed using our computer system with the periodgram technique. Placebo-controlled differences between pre- and post-drug EEGs were statistically treated with the principal component analysis. THP, BPD and MZC produced a marked decrease of alpha frequency associated with increases of slow and fast activities. In addition, MZC induced a slight delirious state with visual and auditory hallucinations at 8 mg in five of six subjects. EEG profiles of these drugs appeared very close to those of thymoleptics but the clinical observations suggest some psychodysleptic property of MZC at a higher dose. LDP provoked a decrease of lower alpha frequency and an increase of lower fast activity that may suggest central stimulant or mood elevating effects. BMC and AMD induced a decrease of slow activity associated with increases of higher alpha activity and lower fast activity in EEG and suggested their vigilance enhancing effects. Based on the current experience, it would be appropriate to use six EEG bands classification (delta, theta, lower alpha, higher alpha, lower beta, higher beta) instead of the fundamental four bands (delta, theta, alpha and beta) in pharmaco-EEG, as far as multivariate analysis of psychotropic drug profile is concerned. It must be noted that the higher part of alpha frequency present a completely different response from the lower part to the centrally effective drugs. Furthermore, psychiatrists should be as prudent as possible when prescribing antiparkinsonian drugs for prevention and treatment of drug induced extrapyramidalism.

26 – Psychopharmacologic Treatment

Abstract: Publisher Summary To meet the needs of increasing numbers of older patients, the field of geriatric psychopharmacology has developed from a fledgling area of inquiry into a major subspecialty within the field of general psychopharmacology during the past dozen years. Both research and clinical experience have vastly increased the knowledge database on the specific use of psychotropic drugs for older people and on nondrug factors that influence the effects of psychotropic drugs in this population. Psychotropic drug treatment for geriatric patients requires an understanding of several age-related factors that influence the effects of these drugs. Diagnosis, variable treatment response, and increased predisposition to drug side-effects provide the essential foundation. This chapter presents four additional areas of information that bear directly and indirectly upon appropriate and successful psychotropic drug use for this population. They are: (1) high prevalence of concomitant physical illness; (2) increased likelihood of the use of multiple drugs and the consequent potential for harmful drug interactions; (3) increased sensitivity of the aging central nervous system to the effects of psychotropic drugs; and (4) alterations in the aging body's ability to bind, distribute, and dispose of psychotropic drugs. Some clinical emphases governing the clinician's rational use of psychotropic drugs become evident: (1) choosing drug treatment when all other treatment modes prove ineffective; (2) being familiar with age-related changes intrinsic to psychotropic side effects; (3) appreciating the great diversity of the elderly population; and (4) recognizing the cautions necessary for safe psychotropic drug use when it is needed.

Dealing with sadness, madness and hostility. New psychotropic drug remedies for the future.

Abstract: The objective of this article is to present an overview of new forms of psychotropic drug therapy that may be expected to play a role in psychiatric practice in the 1990s. In predicting these future developments, three lines of approach have been followed. Firstly, progress in elucidating basic neuronal mechanisms is described. The radioligand receptor binding technique has proved to be an especially powerful tool in the search for novel psychoactive compounds. Secondly, those mental health problems most likely to undergo intensive study are discussed. It is likely that special attention will be devoted to organic mental disorders related to aging (dementia) or chronic exposure to toxic substances. In addition, research will be aimed at explaining and reducing the occurrence of auto-aggressive and hetero-aggressive behaviour. Thirdly, the types of newly designed agents and treatment strategies currently under investigation are outlined. In particular, the development of pharmacological agents that interfere with serotonergic molecular mechanisms has opened the way to improving existing psychotropic drugs, to inventing drugs that achieve known clinical effects via different mechanisms of action, and even to discovering entirely new categories of psychotropic drugs.

Drug washout issues in studies of cerebral metabolism by positron emission tomography in psychiatric patients.

Abstract: Many studies of brain glucose utilization by positron emission tomography attempt to describe the modifications of the brain activity during psychiatric diseases. A major difficulty in such studies is the necessity to assess patients free of pharmacological treatment, in order to relate the measured changes in glucose utilization to the pathopsychology, and not to a drug effect. In this paper are reviewed the arguments from the literature allowing to estimate the drug washout time for considering the patients as drug-free. The review is focussed on the known effects of the psychotrops on brain glucose utilization. This time is approximatively six months for the neuroleptics given orally, one month for antidepressants, and five and a half half-lives for benzodiazepines. Alternative research strategies for avoiding a long drug washout are mentioned, and ethical limitations are considered.

A case of neuroleptic malignant syndrome with a history of general anesthesia

Abstract: Antidepressant was given to treat a patient with manic-depressive psychosis, depressed type (ICD-9). Following the treatment, she manifested the alteration of the consciousness, autonomic dysfunction, extrapyramidal sign, muscular hypertonicity, hyperthermia, and elevated serum CPK levels. This condition was consistent with the neuroleptic malignant syndrome. Then, along with interruption of medication she was treated with supportive measures and improved progressively. In her past history, she underwent general anesthesia for operation of mitral valve replacement and at that time she manifested tachycardia, hyperthermia, elevated CPK levels, etc. In the case of patients who manifest a malignant hyperthermia-like state or neuroleptic malignant syndrome-like state, special care is required in selecting anesthetics and psychotropic drugs.

Investigation of psychotropic drug-induced blood agranulocytosis

Abstract: Psychotropic drugs frequently cause agranulocytosis. It is therefore important that patients on these drugs who develop symptoms or signs of infection should have a full blood count performed, and if the neutrophil count is reduced, prompt withdrawal of the drug and, if necessary, immediate supportive care should be given to reduce the incidence of mortality. Once the patient has recovered, investigations can be performed to confirm the diagnosis and incriminate the responsible drug. It is imperative, in order that these tests may be performed, that serum samples are taken at the time of diagnosis of the neutropenic episode, throughout its course and during the recovery period.

New psychotropic drug remedies for the future

Abstract: The objective of this article is to present an overview of new forms of psychotropic drug therapy that may be expected to play a role in psychiatric practice in the 1990s. In predicting these future developments, three lines of approach have been followed. Firstly, progress in elucidating basic neuronal mechanisms is described. The radioligand receptor binding technique has proved to be an especially powerful tool in the search for novel psychoactive compounds. Secondly, those mental health problems most likely to undergo intensive study are discussed. It is likely that special attention will be devoted to organic mental disorders related to aging (dementia) or chronic exposure to toxic substances. In addition, research will be aimed at explaining and reducing the occurrence of auto-aggressive and hetero-aggressive behaviour. Thirdly, the types of newly designed agents and treatment strategies currently under investigation are outlined. In particular, the development of pharmacological agents that interfere with serotonergic molecular mechanisms has opened the way to improving existing psychotropic drugs, to inventing drugs that achieve known clinical effects via different mechanisms of action, and even to discovering entirely new categories of psychotropic drugs.