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Showing papers on "Psychotropic drug published in 1995"


Journal ArticleDOI
TL;DR: The attributable risk of recurrent falls for regular psychotropic drug users was 36%, which suggests optimal management of psychopharmacotherapy is an essential component of fall prevention programs for ambulatory nursing home residents.
Abstract: Although psychotropic drug use has been associated with increased risk of falls in long-term care settings; this association may be confounded by the high prevalence of dementia and depression and other fall risk factors. This question was addressed in a prospective cohort study of recurrent falls among 282 ambulatory residents of 12 Tennessee nursing homes during 1991-1992. Eligible subjects were > or = 65 years of age, ambulatory, able to provide study data, and expected to remain in the nursing home for > or = 3 months. Baseline data collected for each cohort member included symptoms of dementia (cognitive impairment and behavior problems) and depression, medication use, and other potential fall risk factors. Falls were ascertained from facility incident reports and nursing home charts. During follow-up, 111 residents had > or = 2 falls, an incidence rate of 54.9 recurrent falls per 100 person-years. With the use of Cox proportional hazards modeling, the authors found incidence density ratios (95% confidence intervals (Cl)) showing that the following risk factors were independently associated with recurrent falls: age > or = 75 years (1.66 (1.01-2.72)); > or = 4 assisted activities of daily living (1.94 (1.09-3.47)); middle (2.08 (1.20-3.61)) and upper (2.54 (1.44-4.49)) tertiles of balance impairment; fall in the 90 days preceding assessment (2.01 (1.32-3.06)); and upper tertile of behavior problems (1.65 (1.03-2.64)). The rate of recurrent falls increased tenfold as the number of these risk factors increased from 0 to 5 (21.4 to 231.5 per 100 person-years, p 2 factors) group. The attributable risk of recurrent falls for regular psychotropic drug users was 36%, which suggests optimal management of psychopharmacotherapy is an essential component of fall prevention programs for ambulatory nursing home residents. Language: en

198 citations


Journal ArticleDOI
TL;DR: SUDEP incidence increased with male sex, number of AEDs ever prescribed, and prescription of psychotropic drugs and was highest in males with a history of treatment with three or more AEDS and four or more psychotropic drug prescriptions.
Abstract: Summary: To measure the incidence of sudden unexplained death in treated persons with epilepsy (SUDEP) and to identify risk factors for SUDEP, a cohort of 6,044 persons aged 15–49 years with more than four prescriptions for antiepileptic drugs (AEDs) was identified from the Saskatchewan Health prescription drug file. To exclude subjects whose sudden deaths (SUDs) might be misattributed to another chronic underlying disease, subjects with hospitalizations for cancer or heart problems were excluded. To exclude subjects without epilepsy, subjects with >2-year AED treatment followed by AED-free time and subjects receiving < 1 U/day were excluded. The final cohort consisted of 3,688 subjects. Follow-up was started at the first AED prescription listed in the prescription drug file and ended at the earliest of the following: age 50 years, death, or last registration in the Saskatchewan Health. For 153 of 163 deaths occurring in the cohort, copies of anonymized death certificates were obtained and copies of anonymized autopsy reports of potential SUDEP cases were examined. There were 18 definite/probable SUDs and 21 possible SUDEPs, yielding a minimum incidence of 0.54 SUDEP per 1,000 person-years and a maximum of 1.35 SUDEP per 1,000 person-years. SUDEP incidence increased with male sex, number of AEDs ever prescribed, and prescription of psychotropic drugs and was highest in males with a history of treatment with three or more AEDs and four or more psychotropic drug prescriptions. Poisson regression showed a 1.7-fold increase in risk of SUDEP for each increment in maximum number of AEDs administered, a likely surrogate for severity and persistence of seizures.

191 citations


Journal ArticleDOI
TL;DR: Knowing the substrates, inhibitors, and inducers of CYP3A3/ and other cytochrome P450 isoforms may help clinicians to anticipate and avoid pharmacokinetic drug interactions and improve rational prescribing practices.
Abstract: Recent advances in molecular pharmacology have allowed the characterization of the specific isoforms that mediate the metabolism of various medications. This information can be integrated with older clinical observations to begin to develop specific mechanistic and predictive models of psychotropic drug interactions. The polymorphic cytochrome P450 2D6 has gained much attention, because competition for this isoform is responsible for serotonin reuptake inhibitor-induced increases in tricyclic antidepressant concentrations in plasma. However, the cytochrome P450 3A subfamily and the 3A3 and 3A4 isoforms (CYP3A3/4) in particular are becoming increasingly important in psychopharmacology as a result of their central involvement in the metabolism of a wide range of steroids and medications, including antidepressants, benzodiazepines, calcium channel blockers, and carbamazepine. The inhibition of CYP3A3/4 by medications such as certain newer antidepressants, calcium channel blockers, and antibiotics can increase the concentrations of CYP3A3/4 substrates, yielding toxicity. The induction of CYP3A3/4 by medications such as carbamazepine can decrease the concentrations of CYP3A3/4 substrates, yielding inefficiency. Thus, knowledge of the substrates, inhibitors, and inducers of CYP3A3/ and other cytochrome P450 isoforms may help clinicians to anticipate and avoid pharmacokinetic drug interactions and improve rational prescribing practices.

169 citations


Journal ArticleDOI
TL;DR: As in the often related clinical population of mental retardation, psychotropic medication appears to be heavily used in patients with autism.
Abstract: Objective To survey the prevalence and patterns of psychotropic and anticonvulsant medication and vitamin treatments in patients with autism. Method Caregivers of 1,595 index cases were sent survey questionnaires by mail, and repeat questionnaires were sent twice if no reply was received. Results A total of 838 care providers (53%) responded to the survey. In all, 33.8% of the sample was taking some psychotropic drug or vitamin for autism or associated behavioral/psychiatric problems. A total of 19.2% reported having epilepsy, but only 13.2% were taking anticonvulsant drugs. More than 50% of the sample was taking some psychotropic, antiepileptic, vitamin, or “medical” agent. Of the agents taken, care providers were most satisfied with anticonvulsants, antidepressants, and stimulants. The use of each drug group was analyzed with respect to subject and demographic variables to evaluate medication patterns within this population. Conclusion As in the often related clinical population of mental retardation, psychotropic medication appears to be heavily used in patients with autism.

118 citations


Journal ArticleDOI
TL;DR: The acute treatment of SIADH induced by a psychotropic drug includes discontinuation of the drug as well as restriction of fluid intake, and concomitant treatment with demeclocycline may reduce the tendency of hyponatraemia.
Abstract: The use of psychotropic drugs has been associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in a number of case reports. SIADH is characterised by the sustained release of antidiuretic hormone (ADH) from the posterior pituitary. The patients have a reduced ability to excrete diluted urine, ingested fluid is retained, and the extracellular fluid expands and becomes hypo-osmolar. The cardinal signs are hyponatraemia, serum hypoosmolality and a less than maximally diluted urine. Common symptoms include weakness, lethargy, headache, anorexia and weight gain. These symptoms may be followed by confusion, convulsions, coma and death. The early symptoms are vague and nonspecific, and they may even mimic the symptoms of the psychiatric disorder itself. For antidepressants, the risk of SIADH seems to be highest during the first weeks of treatment. For antipsychotics, the risk seems to be more spread out in time. The causative role of the drug may sometimes be difficult to estimate, as even drug-free psychiatric patients, mostly those with schizophrenia, develop SIADH on the basis of psychogenic polydipsia. Smoking is another factor associated with the development of SIADH, and the risk may also increase with age. The acute treatment of SIADH induced by a psychotropic drug includes discontinuation of the drug as well as restriction of fluid intake. In cases with significant clinical symptoms, infusion of sodium chloride is recommended. After the acute management, it is useful to evaluate the causative role of the drug by performing a water loading test and/or drug rechallenge. If continued treatment with an antidepressant or antipsychotic is indicated, a drug with a different pharmacological profile should be chosen, and the serum sodium levels should be monitored closely. If treatment with the drug that caused SIADH must be continued, concomitant treatment with demeclocycline may reduce the tendency of hyponatraemia.

107 citations


Journal Article
TL;DR: Patients with a co-existent psychiatric illness and chronic HCV can be treated successfully with interferon-alpha with the active participation of a psychiatrist and the maintenance of psychotropic drug therapy during interferons treatment.
Abstract: Objective To determine whether individuals with concurrent active psychiatric disease and chronic hepatitis C virus (HCV) can be treated safely and effectively with interferon-alpha. Design Prospective, open label study. Setting Tertiary referral hospital. Patients Thirty-one consecutive patients with co-existent chronic HCV and a psychiatric illness. Interventions Interferon-alpha was administered at doses of either 5 MU three times per week for 6 months (n = 17) or 5 MU daily for 6 months (n = 14). Methods HCV-RNA in serum was measured using reverse transcriptase polymerase chain reaction. Serum alanine aminotransferase levels were assessed and liver biopsy was performed before and after 6 months of treatment and again after 6 months of follow-up. Results Twenty-nine of the 31 patients completed 6 months of therapy. Two patients discontinued therapy after 2 and 3 months of treatment. Serum alanine aminotransferase levels returned to normal in 22 (71%) patients. Fifteen (48%) of the 31 patients cleared HCV-RNA from their serum. Only four patients experienced a worsening of their psychiatric illness during treatment. Interferon therapy was discontinued in two of these patients. Conclusions Patients with a co-existent psychiatric illness and chronic HCV can be treated successfully with interferon-alpha with the active participation of a psychiatrist and the maintenance of psychotropic drug therapy during interferon treatment.

107 citations


Journal ArticleDOI
TL;DR: It appears that the utilization of psychotropic drugs does not increase the quality of sleep when consumers are compared to non treated insomniacs (NUSD) on parameters of sleep satisfaction.
Abstract: 1. 1. During an epidemiological study conducted by telephone on sleep disorders in the metropolitan area of Montreal (Quebec, Canada), the authors found that 5% of subjects used psychotropic drugs. These drugs were usually prescribed by a general practitioner (72.9%). 2. 2. From this population, the authors drew three groups of subjects: users with sleeping difficulties (USD); non users with sleeping difficulties (NUSD) and, non users without sleeping difficulties (NUWSD). 3. 3. Results showed that the utilization of psychotropics was usually chronic and more frequent among the elderly and women. 4. 4. In multivariate models, when users were compared to NUWSD, the authors found eight variables significantly associated with psychotropic consumption: age ( ≥ 55), sex (female), presence of physical illness, medical consultation, dissatisfaction with sleep onset period and sleep quantity, sleep onset period greater than 15 minutes, and to never or rarely dream. 5. 5. When users were compared to NUSD, three variables were found to be associated with psychotropic consumption: age, to be formerly married, and to experience regular nighttime awakenings. 6. 6. It appears that the utilization of psychotropic drugs does not increase the quality of sleep when consumers are compared to non treated insomniacs (NUSD) on parameters of sleep satisfaction.

55 citations


Journal Article
TL;DR: The degree of variation in prescribing volumes of psychotropic drugs between practices raises serious concerns and progress will be hampered until there is more clarity over the effectiveness and appropriateness of using these substances in the various illness, symptom and life-stress presentations seen in primary care.
Abstract: BACKGROUND Although the desirability of reducing prescribing of hypnotics and anxiolytics has long been recognized, variation between practices in patterns of psychotropic drug prescribing has received little attention; factors underlying such variation are poorly understood AIM The study aimed to describe the extent of variation between general practices in the prescribing of hypnotics, anxiolytics and antidepressants; it also aimed to analyse the influence of measures of practice population and general practice and general practitioner characteristics on any variation in prescribing volumes METHOD Routinely collected prescribing data and practice population data, from April 1992 to March 1993, from all 61 practices in the Cambridge and Huntingdon Health Commission were analysed Prescribing was measured as annual defined daily doses per 1000 practice population for each drug class Data on variables relating to practice structure and general practitioner characteristics were obtained and analysed Potentially influencing variables were investigated by multiple regression RESULTS Between the highest and lowest prescribing practices there was an 11-fold difference, a 13-fold difference and an eightfold difference in the annual defined daily doses per 1000 practice population prescribed for hypnotics, for anxiolytics and for antidepressants, respectively Strong positive correlations existed between volumes of prescribing of each drug class The drugs prescribed in the greatest volumes were hypnotics Practice population structure had some influence on psychotropic drug prescribing with high prescribing being associated with the proportions of temporary residents and women aged 65 years and over in the practice for all three classes of drug Other factors, including presence of a practice counsellor, were not found to have a significant influence on psychotropic drug prescribing CONCLUSION The degree of variation in prescribing volumes of psychotropic drugs between practices raises serious concerns Further study is needed, but progress will be hampered until there is more clarity over the effectiveness and appropriateness of using these substances in the various illness, symptom and life-stress presentations seen in primary care

36 citations



Journal ArticleDOI
TL;DR: The most important predictor for prescribing psychotropic drugs was recognition of mental problems at the initial survey, but age and marital status also had an association with the prescription.
Abstract: We followed the prescription of psychotropic drugs by primary health care physicians over a 3-year period. The material consisted of 1000 randomly selected adult primary health care patients. At least one psychotropic drug was prescribed to one third (n = 307) of the sample during the follow-up period. The most commonly used drug category was that of benzodiazepines, which was prescribed to 24% of the sample. An antidepressive was prescribed to 8%, a neuroleptic to 2% and "other psychotropic drugs" to 10% of the sample. The most important predictor for prescribing psychotropic drugs was recognition of mental problems at the initial survey, but age and marital status also had an association with the prescription. No gender difference was found after controlling for mental problems. Psychotropic medication was also prescribed to 13% of the patients who had no sign of mental disorder.

33 citations


Book
25 Sep 1995
TL;DR: Gendered Moods as mentioned in this paper offers the first feminist analysis of the gendered character of psychotropic drug use, based on studies of long-term psychotrop drug users and the content of drug advertising.
Abstract: Tranquillisers are prescribed to almost twice as many women as men, yet very little gender-based research has been carried out on the social context of their use. Gendered Moods offers the first feminist analysis of the gendered character of psychotropic drug use, based on studies of long-term psychotropic drug users and the content of drug advertising. The authors argue that gender differences in psychotropic drug use are manifestations of the gendered construction of society as a whole, and that, as a result, women are particularly susceptible to being channelled into a state of dependency on prescribed drugs. Exploring current social scientific debates relating to drug users and providers, Gendered Moods also provides a critical review of previous research. It is a much needed introduction to a neglected area of study.

Patent
06 Nov 1995
TL;DR: In this paper, a lactam derivative represented by general formula (A) or an acid-addition salt thereof, having excellent characteristics as a psychotropic drug, and being useful as a remedy for schizophrenia, senile psychosis, manic-depressive psychosis, neurosis, and so forth, wherein R?1, R2, R3 and R4? represent each hydrogen or lower alkyl, provided a pair of R? 1 and R 2, R 3 and R 4, R 2 and R 3, R 4 and R 5 may form a hydrocarbon
Abstract: A lactam derivative represented by general formula (A) or an acid-addition salt thereof, having excellent characteristics as a psychotropic drug, and being useful as a remedy for schizophrenia, senile psychosis, manic-depressive psychosis, neurosis, and so forth, wherein R?1, R2, R3 and R4? represent each hydrogen or lower alkyl, provided a pair of R?1 and R2, R3 and R4, R1 and R3, or R2 and R4? may form a hydrocarbon ring which may be bridged with lower alkylene or oxygen, and the lower alkylene and the hydrocarbon ring may be substituted by at least one alkyl group; n represents 0 or 1; A represents lower alkylene, lower alkenylene or a hydrocarbon ring which may be bridged with lower alkylene (which may be substituted by at least one alkyl or hydroxy group) or oxygen, and the lower alkylene, the lower alkenylene and the hydrocarbon ring may be each substituted by at least one alkyl or hydroxy group; p and q represent each 0, 1 or 2; and G represents N or CH and Ar represents a heteroaryl or aromatic hydrocarbon group, or alternatively G represents CH and Ar represents phenoxy, provided the heteroaryl group, the aromatic hydrocarbon group and the phenoxy group may be each substituted by at least one lower alkyl, lower alkoxy or halogeno.

Journal ArticleDOI
TL;DR: To determine whether gender bias exists in recent drug advertisements, a frequency analysis was performed of all psychotropic drug advertisements appearing in American Journal of Psychiatry and American Family Physician between 1986 and 1989.
Abstract: Differences in patterns of prescribing psychotropic drugs for men and women have been well documented, especially in antidepressants and anxiolitics. One explanation offered is that physicians are influenced by gender stereotyping in pharmaceutical drug advertisements. It is argued that if drug ads display disproportionately more women than men, or if they portray women only as helpless, depressed, and incompetent, cultural stereotypes are reinforced, so that physicians may be likely to diagnose and treat women differently from men. To determine whether gender bias exists in recent drug advertisements, a frequency analysis was performed of all psychotropic drug advertisements appearing in American Journal of Psychiatry (AJP) and American Family Physician (AFP) between 1986 and 1989. Since females are depressed twice as commonly as males in the general population, it was expected that twice as many antidepressant ads would depict females. The study found that the actual ratio of females to males in antidep...

Journal ArticleDOI
TL;DR: To determine the current prevalence of psychotropic drug use by women and any association between use and demographic variables, a cross‐sectional, questionnaire‐based survey is conducted.
Abstract: OBJECTIVE To determine the current prevalence of psychotropic drug use by women and any association between use and demographic variables. DESIGN A cross-sectional, questionnaire-based survey. SETTING Metropolitan Melbourne between November 1993 and February 1994. SUBJECTS Consecutive women aged over 18, attending 15 randomly selected general practices for a consultation. OUTCOME MEASURES Psychotropic drugs taken in the last year and duration of their use, reported by the doctor from the patients' clinical notes and patient interview. Patient demographic characteristics. RESULTS The questionnaire was returned complete for 2048/3026 women. Of these, 20.4% had taken at least one psychotropic drug for at least a month in the past year. Most of these women had taken the drug for longer than 12 months and a quarter had taken more than one psychotropic drug in the past year. Psychotropic drug use by women was significantly associated with increasing age, having been married, parity, lower educational attainment, manual occupation, unemployment and being supported by a government pension. CONCLUSIONS Psychotropic drug use by women is common and mostly long term. Psychotropic drugs should be prescribed carefully and judiciously, with continual review of the indications for their use and with an awareness of the association with social situation.

Journal Article
01 Mar 1995-in Vivo
TL;DR: In the present in vivo study the psychotropic drug clomipramine was used as chemosensitizer in the doxorubicin (DOX)-resistant L 1210 cell line growing as solid tumors in mice, and a significant reduction in the growth of DOX-resistant tumors was observed after treatment with clomine and DOX.
Abstract: Resistance to cytotoxic treatment is a major obstacle to more successful cancer treatment, and approaches to overcome the drug resistance of tumors have received much attention in recent years. In the present in vivo study the psychotropic drug clomipramine was used as chemosensitizer in the doxorubicin (DOX)-resistant L 1210 cell line growing as solid tumors in mice. A significant reduction in the growth of DOX-resistant tumors was observed after treatment with clomipramine and DOX (p = 0.014, Kruskal Wallis-test; p = 0.006, Wilcoxon rank sum test). Thus, clomipramine might be useful in reversing DOX-resistance in solid tumors.


Journal ArticleDOI
TL;DR: CEEG can assist the physician in confirming clinical diagnoses, selecting psychotropic drugs for treatment, and drug treatment monitoring by utilizing the more economical telephonic services.
Abstract: Quantification of standard electroencephalogram (EEG) by digital computers [computer-analyzed EEG (CEEG)] has transformed the subjective analog EEG into an objective scientific method. Until a few years ago, CEEG was only used to assist in the development of psychotropic drugs by means of the quantitative pharmaco EEG. Thanks to the computer revolution and the accompanying reductions in cost of quantification, CEEG can now also be applied in psychiatric practice. CEEG can assist the physician in confirming clinical diagnoses, selecting psychotropic drugs for treatment, and drug treatment monitoring. Advancements in communications technology allow physicians and researchers to reduce the costs of acquiring a high-technology CEEG brain mapping system by utilizing the more economical telephonic services.

Journal ArticleDOI
TL;DR: Community‐living persons with Alzheimer's disease are frequently prescribed psychotropic drugs; however, more than 50% of patients with a psychiatric symptom did not report taking one of these agents, which suggests that alternative therapies and no treatment are also prevalent.
Abstract: We attempted to determine the relationship between psychiatric symptoms and psychotropic drug use in persons with Alzheimer's disease based on a multicenter patient registry of 671 community-living persons diagnosed with the disease by published criteria. Logistic regression was performed to determine which symptoms were associated psychotropic use after controlling for age, sex, and Mini-Mental Status Examination (MMSE) score. At least one psychotropic drug was reported by 31% of patients, and 66% had at least one psychiatric symptom. Antipsychotics were associated with a lower MMSE score (odds ratio = 0.92, 95% confidence interval 0.88-0.97), emotional lability (OR = 4.52, 95% CI 1.69-11.94), and hallucinations (OR = 6.54, 95% CI 2.99-14.26). Antidepressants were associated with depressive symptoms (OR = 5.8, 95% CI 2.61-13.46), and benzodiazepines with a lower MMSE score (OR = 0.93, 95% CI 0.90-0.97). Community-living persons with Alzheimer's disease are frequently prescribed psychotropic drugs; however, more than 50% of patients with a psychiatric symptom did not report taking one of these agents. This suggests that alternative therapies and no treatment are also prevalent.

Journal Article
TL;DR: With regard to a low therapeutic index of psychotropics, interindividual differences in the rate of their metabolism, genetic polymorphism of their main metabolic pathways and metabolic interactions in clinical drug combinations, the phenotyping of patients at the beginning of therapy and a control of drug concentrations at a steady state and during coadministration of another drug, may increase the efficiency and safety of the pharmacotherapy of psychiatric disorders.
Abstract: Cytochrome P-450 (CYP) catalyzes phase I metabolic reactions of psychotropic drugs. The main isoenzymes responsible for their biotransformation are CYP1A2, CYP2D6, CYP3A4 and these of the subfamily CYP2C. The majority of metabolites of psychotropic drugs are biologically active. Some of them retain pharmacological properties of parent compounds (eg. selective serotonin reuptake inhibitors, risperidone, carbamazepine, benzodiazepines), but others display quite different (eg. amitriptyline, buspirone) or even opposite (trazodone) profiles. They are present in vivo in concentrations high enough to contribute to pharmacological and clinical effects of the administrated drugs. Active metabolites of psychotropics are also characterized by pharmacokinetic properties different from their parent compounds, e.g. half-life time, plasma protein binding, blood-brain-barrier penetration, the cerebrospinal fluid (CSF) protein binding and tissue binding. These properties lead, in turn, to differences in the brain/plasma and the CSF/plasma concentration ratios between a drug and its metabolites. Therefore studies relating a pharmacological or therapeutic response of psychotropic drug to its plasma concentrations should not disregard the presence of its active metabolites, considering their distinct pharmacological and pharmacokinetic properties. With regard to a low therapeutic index of psychotropics, interindividual differences in the rate of their metabolism, genetic polymorphism of their main metabolic pathways and metabolic interactions in clinical drug combinations, the phenotyping of patients at the beginning of therapy and a control of drug concentrations (and its active metabolites) at a steady state and during coadministration of another drug, may increase the efficiency and safety of the pharmacotherapy of psychiatric disorders.

Journal ArticleDOI
TL;DR: Diagnostic characteristics of the disorder are reviewed, how these show up in behavior during office visits, and tips for treating these challenging patients in the primary care setting are reviewed.
Abstract: Patients with borderline personality disorder may be the most psychologically challenging patients a primary care physician ever encounters. Early diagnosis is important to avoid interpersonal enmeshment and personalization in dealings with these patients, who often appear intact initially. The acronym PISIA is useful in recalling the major characteristics of the disorder: psychotic episodes, impulsivity, superficially intact social adaptation, interpersonal-relationship problems, and affective disorders. Specific techniques (eg, setting limits, separating medical and psychological issues, consulting a psychiatrist to determine a psychotropic drug regimen) promote effective treatment of these difficult patients.

Journal Article
TL;DR: Whether the scope of differences in the EEG recordings and the N1/P1 amplitude increase of the SSEP may be used as an additional diagnostic criterion to determine the risk of epileptic seizures, should depend on the type of myoclonus chiefly induced.
Abstract: Based on five case studies, the suggestion is that, if physiological myoclonus can be excluded, antidepressant - or neuroleptic-induced myoclonus must as a rule be presumed to be a most subtle indication of increased cerebral exitability, an epileptic fragment or, in some instances, a myoclonus epilepsy. In each of the reported cases EEG recordings reflected epilepsy-specific potentials. Whether, however, the scope of differences in the EEG recordings and the N1/P1 amplitude increase of the SSEP may be used as an additional diagnostic criterion to determine the risk of epileptic seizures, should depend on the type of myoclonus chiefly induced. This would require more extensive neurophysiological examinations which should mainly include the back-averaging to permit, beside the EEG, a better evaluation of the relatively easily obtainable SSEP findings.


Journal Article
TL;DR: It is suggested that minaprine has memory-impairment-prevention and neuroprotective effects against short-term ischemia in gerbils.
Abstract: This study examines the effect of the psychotropic drug minaprine on memory impairment in Mongolian gerbils subjected to a 5-min bilateral common carotid artery occlusion, as assessed by their performance in an 8-arm radial maze task. Gerbils were initially trained on the 8-arm radial maze until their mean error was 0-1 for 5 days. This task was repeated before the ischemia was performed and again 7 days after it. Then the animals were immediately sacrificed for histopathological examination. Severe memory impairment occurred in the control gerbils; whereas when minaprine 75 mg/kg was given orally 30 min before the 5-min occlusion, memory impairment was significantly reduced. Histopathological analysis of the control gerbils showed nearly complete loss of the pyramidal neurons in the CA1 region of the hippocampus, whereas the minaprine-treated gerbils showed complete preservation of the pyramidal neurons. These findings suggest that minaprine has memory-impairment-prevention and neuroprotective effects against short-term ischemia in gerbils.

Journal ArticleDOI
TL;DR: Geriatric medicine, particularly the management of psychiatric symptoms, is practiced far from this model, and suboptimal utilization of psychotropic drugs is an important, but imperfect, indicator of this deeper problem-that psychiatric symptoms in older adults are misinterpreted and mismanaged.
Abstract: n the ideal world, older patients with psychiatric symptoms I present to a provider who is knowledgeable in geriatric medicine, geriatric psychiatry, and psychopharmacology. After careful consideration, the symptoms are addressed with a pharmacological (or nonpharmacological) intervention as part of an individualized treatment plan. Because drug costs and formulary restrictions are immaterial in an ideal setting, such concerns never enter into the decision-making process. Furthermore, because this is the ideal world, the drug alleviates the symptom-never requiring the empiric addition of a second or third agent. Geriatric medicine, particularly the management of psychiatric symptoms, is practiced far from this model. Sometimes, atypical presentations frustrate the development of a reasonable diagnosis and treatment plan. However, it is evident that some providers do not have the time, interest, or knowledge base to implement a rational strategy for the management of psychiatric symptoms in older patients. Suboptimal utilization of psychotropic drugs is an important, but imperfect, indicator of this deeper problem-that psychiatric symptoms in older adults are misinterpreted and mismanaged.

Book ChapterDOI
TL;DR: Preclinical investigation of the effects of a variety of drugs on alcohol consumption has increasingly set the stage for clinical trials in alcoholism, and this evolution is apparent with the opioidergic, serotonergic, and GABAergic compounds that are the focus of recent clinical investigation in alcoholism.
Abstract: “Historically, psychotropic drug discoveries have been made, for the most part, by observant and experienced clinicians making serendipitous findings in the course of trying a candidate drug molecule on patients suffering from a variety of clinical complaints and using traditional interview and observational techniques rather than studying homogeneous groups of patients with formal assessment instruments” (LASAGNA 1991, p. 263). In addition to serendipity, developments in the pharmacotherapy of alcoholism have also depended on the availability of medications for other clinical uses, rather than on a particular theoretical rationale or compelling preclinical data. However, in recent years preclinical investigation of the effects of a variety of drugs on alcohol consumption has increasingly set the stage for clinical trials in alcoholism. This evolution is apparent with the opioidergic, serotonergic, and GABAergic compounds that are the focus of recent clinical investigation in alcoholism. Future clinical developments are likely to be informed also by molecular investigation. A promising approach might involve the identification of agents that act selectively in those precise regions of the brain that control alcohol consumption and dependence formation. Molecular neurobiologic techniques are likely to be instrumental both in the identification of these regions and in the testing of agents that modify subcellular responses to alcohol.

01 Jan 1995
TL;DR: Most psychotropic agents can be used safely in patients with respiratory disease, and careful use of selected drugs should always be employed if indicated for treating distressful conditions that may be benefitted.
Abstract: Respiratory patients require psychotropic drug administration to treat pain, cough and respiratory distress or to treat insomnia, anxiety, depression or psychosis. Terminal patients require thoughtful and compassionate use of these drugs, even when there is an expectation that such therapy may lead to an earlier death. Most psychotropic agents can be used safely in patients with respiratory disease, and careful use of selected drugs should always be employed if indicated for treating distressful conditions that may be benefitted. Guidelines to appropriate choices and doses are provided.

Journal ArticleDOI
TL;DR: The types of interactions that may occur, levels at which the interactions arise, and specific drug interactions of importance are described.
Abstract: Chittaranjan Andrade, M. D. Associate Professor Department of Psychopharmacology National Institute of Mental Health and Neurosciences, Bangalore 650 029 Psycho tropic drugs are frequently prescribed in combination with other psychotropic preparations or with drugs for medical disorders. Drug interactions in such circumstances are important but neglected domain in psychiatric and general medical practice. This article describes the types of interactions that may occur, levels at which the interactions arise, and specific drug interactions of importance. Neuroleptics, antidepressant drugs, anxiolytic drugs and lithium are specifically considered, as also ECT-drug interactions. It is hoped that greater awareness of interactions will improve the quality of patient care.

Journal ArticleDOI
TL;DR: This review examines the rationale for using such drugs, and critically, but constructively, appraises published therapeutic trials of psychotropic agents in the treatment of fibromyalgia.
Abstract: Fibromyalgia (FM) is a relatively common chronic painful condition predominately affecting women. A variety of pathogenic mechanisms have been proposed and several central and peripheral neurochemical abnormalities observed. Based on their multiple effects on both central and peripheral mechanisms, psychotropic drugs have been used to treat FM patients. This review examines the rationale for using such drugs, and critically, but constructively, appraises published therapeutic trials of psychotropic agents in the treatment of fibromyalgia.

Journal ArticleDOI
01 Feb 1995
TL;DR: It is suggested in the article that the Nordic tendencies to have a paternalistic “health” regulatory system will be replaced by a “market” organized system, emphasizing free competition, consumer rigths, legal decisions and industry interests.
Abstract: The complicated balance, including the formal system, that regulates patterns of psychotropic drug usage in the Nordic countries is under rapid change. The European Union is the main agent of chang...

Journal ArticleDOI
TL;DR: The findings in these studies revealed that the endocrine morphologic changes due to a psychotropic drug occurred soon after dosing, and electron microscopy and immunohistochemical techniques were useful for these investigations.
Abstract: Morphologic changes occurring in the endocrine organs and tissues of rats in single doss multiple doses, or primed estradiol study of a psychotropic drug were examined light and electro microscopically, or immunohistochemically. When a single dose of a psychotropic drug was given to female rats, prolactin mRNA contents in the pituitary gland was increased immediately after dosing of the drug. Ultrastructurally, fewer and smaller secretory granules of lactotrophs in the pituitary anterior lobe were observed 2 hours after dosing, and morphologic activation of rough endoplasmic reticulum and Golgi apparatus followed after its initial changes. In light microscopic examination, however, sligl changes in the pituitary anterior lobe and mammary glands were observed only 24 hours after dosing. When multiple doses of the drug were given to female and male rats, the pituitary changes and mammar development were seen light and electron microscopically. The pituitary changes were evidenced by immunohistochemistry using anti-BrdU or anti-PCNA monoclonal antibody, and AgNORs stain as indication of proliferating tissue. In the primed estradiol study, although microscopic changes in the pituitary gland and mammary glands due to hormonal effects could be advanced, there were no apparent differences between estradiol and estradiol/psychotropic drug treated animals. The findings in these studies revealed that the endocrine morphologic changes due to a psychotropic drug occurred soon after dosing, and electron microscopy and immunohistochemical techniques were useful for these investigations.