Showing papers on "Psychotropic drug published in 1993"

CNS signal transduction in the pathophysiology and pharmacotherapy of affective disorders and schizophrenia

Abstract: Until recently, research on the neurochemical basis of affective disorders (AD) and schizophrenia (SCZ) focused on detecting postulated disturbances in presynaptic neurotransmitter release and metabolism, or postsynaptic receptor function. New insights into the molecular mechanisms involved in the propagation of neurotransmitter signals across biological membranes and in the regulation of neuronal responses have allowed the development of novel hypotheses, which may explain the altered postsynaptic neuroreceptor responsivity thought to be integral to the pathophysiology of these disorders. In this review we evaluate evidence from both basic science and clinical research implicating disturbances in postreceptor signal transduction in the pathophysiology and pharmacotherapy of AD and SCZ. Specific findings regarding potential postreceptor sites of pathophysiology are highlighted in each of these disorders, together with the growing body of data on the possible postreceptor loci of psychotropic drug action, especially lithium and antidepressants.

Mental Disorders and the Use of Psychotropic Drugs in an 85-Year-Old Urban Population

Abstract: The prevalence of mental disorders was studied in a representative sample of 85-year-olds living in Gothenburg, Sweden, (n = 494). All subjects were examined by a psychiatrist, whose diagnoses were defined according to the DSM-III-R criteria. In the sample, the prevalence of dementia was 29.8%, and of any other mental disorder was 24.3%. Psychotic disorders were present in 4.7%, depressive disorders in 12.6%, and anxiety disorders in 10.5%. Anxiety disorders were more common in women than in men. Of all subjects, 42.5% used a psychotropic drug (men 30.1%, women 47.6%, p < 0.001), 34.2% used anxiolytic-sedatives, 14.0% used antidepressants, and 5.7% used neuroleptics. Women used significantly more anxiolytic-sedatives and antidepressants than did men. Of those with no mental disorders, 29.1% used a psychotropic drug. Although the prescription of psychotropic drugs was high, only one fifth of those with depressive disorders received antidepressant drug therapy and one tenth of those with psychotic disorders received neuroleptics.

How sound is the double-blind design for evaluating psychotropic drugs?

Abstract: Sufficient data have accumulated to raise serious doubts about the integrity of the double-blind design that is presumed to shield psychotropic drug trials from bias and expectations. A major deficit in most drug trials has been the use of inert rather than active placebos. The deficiencies of the d

Relaxation of supercoiled DNA associated with induction of heat shock proteins in Escherichia coli.

Abstract: Heat treatment of wild-type Escherichia coli cells led to a transient relaxation of negatively supercoiled plasmid DNA and there was no recovery of DNA torsional strain in the DNA in gyrA mutant cells. After heat treatment, DnaK and GroEL proteins were synthesized continuously in the gyrA mutant cells, whereas they were synthesized only transiently in wild-type cells. Thus, change in superhelical density of the DNA correlated with the temperature-induced expression of heat shock proteins. Inhibitors of DNA gyrase (nalidixic acid, novobiocin), an organic solvent (ethanol) and a psychotropic drug (chlorpromazine) all stimulated relaxation of cellular DNA over the same concentration range that induces heat shock proteins. As DNA relaxation was induced by heat treatment or chemicals in an rpoH mutant, the process is not the result of induced synthesis of heat shock proteins.

De novo absence status epilepticus as a benzodiazepine withdrawal syndrome.

Abstract: Summary: A 67-year-old woman with a history of psychotropic drug abuse developed confusion. EEG was consistent with absence status epilepticus (AS). Intravenous (i.v.) flumazenil 1 mg, a benzodiazepine antagonist with anticonvulsant properties, increased both confusion and paroxysmal activity. Complete resolution was obtained after diazepam was administered i.v., and the patient then admitted that she had abruptly discontinued long-standing treatment with carpipramine, amitryptiline, bromazepam, and flunitrazepam. The aggravating effect of flumazenil indicates that benzodiazepine withdrawal was probably the elective triggering factor of this de novo absence status epilepticus. ReSUMe Une femme âgee de 67 ans qui presentait des antecedents d'abus en medicaments psychotropes fut hospitalisee pour confusion mentale. L'EEG montrait un etat d'absence. L'injection de 1 mg de flumazenil, tedicament antagoniste des benzodiazepines possedant egalement des proprietes antiepileptiques aggrava la confusion et augmenta la distribution spatio-temporelle des anomalies paroxystiques. La resolution de l'etat d'absence fut obtenue aprCs diazepam IV. La patiente avoua alors avoir brutalement suspendu un traitement chronique associant carpipramine, amitryptiline, bromazepam et flunitrazepam. L'effet aggravant du flumazenil indique que le sevrage en benzodiazepines fut probablement le facteur declenchant electif de cet etat d'absence survenu de novo. ZUSAMMENFASSUNG Eine 67 Jahre alte Frau mit bekanntem Abusus psychotroper Medikamente entwickelte einen Verwirrtheitszustand. Das EEG zeigte einen Absence-Status. Intravenose Gabe von einem 1 mg Flumazenil, einem Benzodiazepin-Antagonistenmit antikonvulsiven Eigenschaften, verstarkte sowohl die Verwirrtheit als auch die paroxysmale Aktivitat. Erst nach intravenoser Gabe von Diazepam stellte sich die Besserung ein. Die Patientin gab an, die Langzeitmedikation mit Carpipramin, Amitryptilin, Bromazepam und Flunitrazepam abrupt abgebrochen zu haben. Die verstarkende Wirkung von Flumazenil weist daraufhin, daβ der Benzodiazepin-Entzug wahrscheinlich Trigger fur den AbsenceStatus war.

Pharmacologic treatment of depression in the elderly.

Abstract: Depressive illness is the most common emotional disorder in those of advanced age, occurring in approximately one seventh of those over 65 years old. Despite its high prevalence, depression in the elderly is more complicated to diagnose and treat than depression in younger adults. Successful pharmacotherapy for depression in the elderly requires careful consideration of the pharmacodynamics and pharmacokinetics of antidepressant medications of various classes to balance the therapeutic effects and side effect profiles of these agents. The heterocyclic antidepressants are effective in the elderly, but their use in this population may be limited by anticholinergic and/or cardiovascular side effects. The monoamine oxidase inhibitors also are effective, but compliance problems limit their usefulness in older persons. The serotonin selective reuptake inhibitors have been shown to be effective in the elderly, and their side effect profiles are generally milder than those of the older agents. Elderly patients receiving psychotropic drug therapy must be monitored carefully because treatment failure due to undermedication and drug toxicity due to overmedication may have more severe consequences in older than in younger adults.

Pathways to psychiatric care in Cantabria.

Abstract: This article delineates the pathways taken in different health areas of Cantabria (Spain) by a series of newly referred patients to the mental health services and explores the influence of sociodemographic, medical and service-related factors on the delays in referral. The work forms part of an ongoing World Health Organization multicentre research programme aimed at exploring and optimizing the quality of mental health care in different centres of the world. We found that, in a rural health area, the majority of newly referred patients establishe first contact with the general practitioner and to a lesser extent with the hospital doctor and from there directly progress to the psychiatric services; in the urban health area there is a greater tendency to contact specialized medical and psychiatric services. Delays in these health areas are remarkably short and are comparable to the ones in other European centres. Our data also show that somatic symptoms are the main presenting problem both at the primary care and at the mental health level; and that, in general, psychotropic drug prescriptions are high both in hospital and in general medical settings, and that women were more often prescribed psychotropic medication than men.

Frequent attenders in general practice: A study from slovenia

Abstract: To compare frequent with infrequent attenders at GPs' surgeries in a rural area in Slovenia with respect to morbidity, type of contact with the GP, referral pattern and the prescriptions given, a random sample of 623 records from a population-based register was analysed retrospectively. The frequent attenders had a higher proportion of contacts for malignant disease, mental disorder, and gastrointestinal disease. They also had a greater probability for a “superficial contact”, were more likely to be referred to a specialist, were less likely to receive a psychotropic drug, and were more likely to receive a prescription for an antibiotic. We conclude that there are differences in morbidity between the two groups. The high referring pattern and the high proportion of “superficial contacts” of the frequent attenders may reflect poor doctor/patient relationship of this group.

[Pro and contra: psychotherapy and psychopharmacotherapy attitude of the public].

Abstract: As shown by the results of a representative survey carried out in the FRG in 1990, psychotherapy is much favoured over psychotropic drug treatment by the lay public. This holds similarly for the treatment of schizophrenia, depression, and panic disorder. The decision in favour of psychotherapy is primarily motivated by the assumption that this treatment modality provides an opportunity for personal exchange and that it will be carried out by a competent therapist. The lays' beliefs about psychotherapy are rather global. They are very much influenced by the social representations of psychoanalysis as a method that treats the cause of the problem. The knowledge of psychotropic drugs, as well, is rather unprecise. Their image is mostly determined by that of the tranquilizers as drugs with a high risk of dependency and a primarily sedative effect.

Caffeine During Pregnancy: Grounds for Concern?

Abstract: Is caffeine consumption safe during pregnancy? Caffeine, the most widely used psychotropic drug, is consumed by at least 75% of pregnant women via caffeinated beverages. 1 In spite of its widespread use, the safety of this habit during pregnancy is unresolved. See also p 2940. In the last year, JAMA has published two excellent studies that assessed the safety of caffeine consumption during pregnancy. The conclusions of these studies somewhat conflict. In February, Mills and colleagues, 2 in a prospective cohort study of 431 pregnant women, reported that moderate caffeine consumption of less than 300 mg/d (or about three cups of coffee) did not increase the risk for spontaneous abortion (SAB), intrauterine growth retardation (IUGR), or microcephaly. Although the heavy consumption group was small and the power limited, caffeine consumption above 300 mg/d did appear to be related to IUGR. 3,4 In this issue of JAMA , Infante-Rivard and colleagues 5

International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: I. Current concerns

Abstract: Although clinical experience influences psychotropic drug treatment world-wide, it has been underutilized because it has not been systematically gathered and widely disseminated. An international survey was conducted to help remedy this situation. One of the major objectives was to develop a representative body of expert judgment and opinion on the clinical use of benzodiazepines in relation to other psychotherapeutic medications that might be used for the same purposes. A select international panel of psychiatric experts on the pharmacotherapy of the anxiety and depressive disorders (N = 73) was constituted on the basis of progressive peer nominations. The peer selection process began with primary nominators from 44 countries. Judgments and opinions about psychotherapeutic medications were elicited from the Expert Panel via a self-administered questionnaire. Completion rate: 90 per cent (66/73). Outcomes bear directly on current therapeutic and regulatory concerns. Topics addressed include: special indications for use, abuse liability, dependence potential, duration of treatment, high-risk treatments, and adverse effects. Although sometimes divided, agreement was generally high and indicative of a good benefit to risk ratio for the benzodiazepines. Expert judgments were more positive than would have been anticipated from media reports, public concern, and recent regulatory postures. The following inferences can be drawn from this body of expert judgment and opinion: (1) qualitative differences in abuse liability among the benzodiazepines are minimal; (2) physical dependence at therapeutic doses is not a major clinical problem; (3) when physical dependence occurs, it can be readily managed clinically by the treating physician; (4) the relative abuse liability of the benzodiazepines as a class is low. These expert evaluations do not support or justify the imposition of stronger or differential restrictions on the benzodiazepines. The data help define the reasonable limits within which clinical guidelines and regulatory mandates can be meaningfully promulgated.

Computer-based prediction of psychotropic drug classes based on a discriminant analysis of drug effects on rat sleep.

Abstract: The goal of the present study was to classify psychotropic drugs on the basis of EEG-defined rat sleep-waking behaviour. Using an automated sleep classification system it was found that some of the drug-induced changes in sleep-waking behaviour were specific for the pharmacotherapeutic treatment class to which the drug belonged. In several preliminary experiments we further found that drugs may have effects on rat EEG independent of their effects on rat sleep-waking behaviour and that these pharmaco-EEG effects may be different for the various sleep and waking stages. By analysing sleep class-independent EEG-spectral parameters a single drug effect score can, moreover, be obtained giving information on drug pharmacodynamics. The drug-induced changes in sleep-waking behaviour were used to classify a large number of drugs into several therapy classes by means of a discriminant analysis procedure. Antidepressants, antipsychotics and stimulants were discriminated successfully from each other and from placebo by this system, whereas nootropics classified as placebo. Anxiolytics, hypnotics and anticonvulsants classified poorly. Their classification is hampered by the lack of specific compounds. Assigned drug class and assignment probability were dose dependent. In the discussion of the present study it is suggested that animal pharmaco-sleep and pharmaco-EEG studies are not mutually exclusive approaches, but that they may complement each other.

Benzodiazepine dependence: a shadowy diagnosis.

Abstract: When benzodiazepines were introduced into clinical practice in the 1950s they were hailed as efficacious minor tranquillizers, largely devoid of unwanted side effects, in contrast to the barbiturates and similar drugs that they largely superseded. It was 30 years before the phenomenon of low-dose dependence on benzodiazepines was recognized. Benzodiazepine dependence differs from other psychotropic drug addictions because the benzodiazepines do not produce either euphoria or drug-seeking behaviour (except in those who are already addicted to other drugs). However, benzodiazepine use is associated in some individuals with a marked withdrawal (abstinence) syndrome that provides the best evidence of dependence. Just over half the people prescribed long-term benzodiazepines do not develop any sign of a withdrawal reaction (Fig. 1): this reflects factors including the type of benzodiazepine prescribed, the dosage and duration of treatment, as well as characteristics of the patient. Individuals with passive-dependent personalities appear to be more likely to experience withdrawal symptoms than other patients, although this remains a controversial issue. Therefore benzodiazepine use should follow certain guidelines, and if these are adhered to the benzodiazepines will continue to be valuable drugs in clinical practice.

Three-year Follow-Up of Patients With Panic Disorder After Short-Term Treatment With Alprazolam and Imipramine

Abstract: Fifty-five patients with moderate to sever panic disorder were treated for 9 weeks with alprazolam or imipramine and were then, except for one patient who had committed suicide, re-examined after on average 3 years of treatment. At follow-up most patients (74%) did not suffer from panic attacks at all. In the beginning of the study 87% exhibited phobic avoidance behaviour but after 3 years 68% no longer revealed phobic behaviour. At follow-up 28% of the patients were no longer having psychotropic drug treatment and 20% were completely free of overt psychopathology. No tolerance phenomena were associated with the long-term medication applied in the study.

A community survey of psychotropic drug consumption in South Verona: prevalence and associated variables.

Abstract: A cross-sectional community survey was undertaken to investigate the pattern of psychotropic drug consumption in 453 community residents of South Verona. Overall, 15.0% of the subjects were taking psychotropics (benzodiazepines 13.5%, antidepressants 2.2%, neuroleptics 1.1%). Prevalence was higher in females (20.0%), in those over 45 years (25%), in high General Health Questionnaire (GHQ) scorers (26.2%), and in subjects with physical ill-health (27.0%), with social problems (20.0%), with distressing events (22.0%) and with alcohol abuse (32.3%). Logistic regression analysis showed that age, sex, GHQ score, physical ill-health and life events were all significantly and independently associated with psychotropic drug consumption.

Implementation of an Interdisciplinary Psychotropic Drug Review Process for Community-Based Facilities.

Abstract: A continuing psychotropic drug review process developed and implemented in 1986 by a community-based agency serving individuals with mental retardation was described. This process has proven to be a feasible and effective system that has taken into account the practical realities of integration into the community and the use of community-based resources. The goals of establishing data-based interdisciplinary team review, utilizing concurrent alternative treatments, and prescribing psychotropic medication at the lowest effective dosage only to those individuals for whom it proves to make a positive difference have been met. For the residents of the agency's facilities, this process has led to a low psychotropic utilization rate of 17%. Dosage levels have been reduced for 75% of the individuals who have been prescribed psychotropic medication.

Effect of Patient and Physician Gender on Prescriptions for Psychotropic Drugs

Abstract: This study compared prescription-writing practices of male and female physicians for all classes of psychotropic drugs to see if previously documented patterns of differential prescribing still exist. The medical records of 108 patients of an academically affiliated family practice in the southeastern United States were examined. Subjects were eligible for selection if they were diagnosed as having a primary or secondary mental disorder other than tobacco abuse, alcoholic intoxication, alcohol abuse, and alcoholic psychosis. Records of 7 male and 7 female physicians were reviewed. There were 27 subjects in each of the following categories: female patient/female physician, male patient/female physician, male patient/male physician, and female patient/male physician. Female patients received significantly more first-time prescriptions for a psychotropic drug than did male patients (p = 0.003). Both male and female physicians prescribed psychotropic drugs at a higher rate for female than male patien...

Prevalence of Drug Therapy

Abstract: This book is a guide to psychotropic drug therapy for children and adolescents. But just how common is the medical prescription of such drugs at the moment? Is it too little or too much? Does clinical application precede scientific verification of safety and efficacy? Are recommendations for patient management generally followed in everyday clinical settings? This chapter examines these and related issues to the extent that available data will allow.

Adverse psychic reactions to psychotropic drugs--a report from the AMUP study.

Abstract: The AMUP study (AMUP = Arzneimitteluberwachung in der Psychiatrie (Drug Monitoring in Psychiatry)) was conducted from 1979 to 1989 in order to provide for a systematic and standardized assessment of all adverse reactions to psychotropic drugs under the conditions of routine clinical treatment at two psychiatric hospitals. This paper presents data from the AMUP study on the type and frequency of adverse psychic reactions to psychotropic drug groups and relevant single drugs. Psychic ADR leading to drug discontinuation were observed in 4.5% of 15,264 inpatients monitored over an eight-year period. Only neurological ADR were more frequent (4.9%). Neuroleptics and antidepressants were involved with similar frequencies in ADR that were at least "probably" drug-related (3.3 and 3.5%). Lithium salts and benzodiazepines were only rarely involved in psychic ADR. Toxic delirium (1.0%), agitation (0.9%), and sedation (0.8%) were the most frequent single events, usually rated as "probably" drug-related. Depression and psychotic states were next in frequency, but judged as only "possibly" drug-related in a considerable proportion of cases. Haloperidol, the most common high-potency neuroleptic, was imputed mainly for depression, sedation, agitation, and (malignant) neuroleptic syndrome; with medium-potency perazine, toxic delirium and sedation prevailed; among the most common antidepressants, amitriptyline was above all connected with toxic delirium, while with clomipramine agitation predominated. The paper discusses the particular difficulties encountered in the field of psychic ADR in psychiatric patients regarding causality assessment, and emphasizes the need for continuous ADR assessment studies including state hospitals.

Effects of etoperidone on sympathetic and pituitary-adrenal responses to diverse stressors in humans

Abstract: The effects of the psychotropic drug etoperidone on the response to laboratory stressors was investigated in a controlled study. Cardiovascular and hormonal (catecholamines, corticotropin, and cortisol) measurements were made in a group of young, healthy volunteers during a cold pressor test (CPT), a mental arithmetic test (MAT), and insulin-induced hypoglycaemia (ITT). One-week treatment with etoperidone (ETO) (150 mg/day, orally) reduced basal and stress-induced values of systolic and diastolic blood pressure (BP) on CPT, while it did not alter catecholamine output in response to the stressor. Cardiovascular response was also attenuated after ETO on MAT, in the absence of any hormone changes. Adrenocorticotropic hormone (ACTH) and cortisol secretions were markedly reduced on ITT after ETO, whereas catecholamine outflow and cardiovascular parameters were substantially unaffected. These findings on ITT suggest that the anti-serotoninergic and anti-alpha 1-adrenergic activities of ETO may be used in the pharmacological control of the potentially detrimental consequences of the stress response.

Ill-health and social predictors of psychotropic drug prescription in general practice.

Abstract: Prescriptions of psychotropic drugs among 505 consecutive attenders on a single day at 32 general practices were recorded. For 404 of them the results of a screening for psychiatric morbidity conducted by means of the General Health Questionnaire (GHQ) were available. Among attenders recognised as psychiatric cases by their general practitioners the presence of concurrent somatic problems exerted a significant effect in reducing the relative odds of prescription. A very strong and significant interaction effect between male sex and high GHQ score was detected: men scoring over the threshold on the questionnaire had a risk of receiving a psychotropic drug prescription 49 times higher than the general sample. Social problems-related factors did not show significant effects when included in multivariate models comprising ill-health risk factors.

Idiopathic unconjugated hyperbilirubinemia (Gilbert's Syndrome) and concurrent psychotropic drug administration

Abstract: Gilbert's Syndrome is a benign familial condition in which unconjugated hyperbilirubinemia occurs in the absence of structural liver disease or hemolysis. Phenothiazines and tricyclic medications are often withheld in patients with preexisting liver disease. The authors present four patients with Gilbert's Syndrome and concurrent psychiatric illness. Administration of phenothiazine antipsychotics or tricyclic antidepressants proved beneficial and produced no adverse effects on hepatic function. The authors discuss clinical aspects of Gilbert's Syndrome in psychiatric patients and conclude that phenothiazine antipsychotic medication should not necessarily be withheld from these patients.

Relevance of 5-HT autoreceptors for psychotropic drug action.

Abstract: Psychiatric disorders such as psychosis, depression, and anxiety have been related to changes in the activity of the serotoninergic system in the brain. Accordingly, drugs influencing this system either have been found to be of therapeutic value in these disorders or they are developed systematically as new classes of psychotropic agents. Evidence for the heterogeneity of serotonin (5-hydroxytryptamine; 5-HT) receptors and recent progress in their classification (reviewed by Bradley et al. 1986; Peroutka 1988; Frazer et al. 1990; Gothert 1990a) have promoted the development of selective agonists and antagonists directed at certain 5-HT receptor classes and subclasses. Some of these drugs are considered as potentially useful for the treatment of psychiatric disorders, for example, 5-HT1A receptor agonists, which act as anxiolytics and antidepressants, and 5-HT3 receptor antagonists, which appear to possess antipsychotic properties.

The right to refuse psychotropic drugs.

Abstract: The right to refuse medical treatment has been accepted by the courts, health care personnel and consumers throughout Canada and the United States. Yet for some situations, the right to refuse medical treatment remains a matter of serious public debate. One of the most complex of these circumstances occurs when an institutionalized person is to be treated with a psychotropic drug.