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Biomedical subjects

A C Altamura

Publications and source records attributed to A C Altamura.

At least 37 records · Page 2Linked to original sources
PubMed1995

Medically unexplained somatic symptoms in different cultures. A preliminary report from phase I of the World Health Organization International Study of Somatoform Disorders.

The World Health Organization has recently launched an international study of somatoform disorders in different cultures. Five centres representing distinct cultures participated in phase I of the project, the main objective of which was to test the cross-cultural applicability and reliability of instruments for the assessment of somatoform disorders. The analysis of the assessed somatic symptoms showed that various aches and pains in different parts of the body represented cross-culturally the most frequent symptoms for which there was no medical explanation. Such symptoms may indicate the presence of an underlying mental disorder but can also represent a means for culture-specific expression of psychosocial distress. This bears particular significance for health professionals in primary and general medical care, who are most likely to encounter patients presenting with multiple, persistent and medically unexplained somatic symptoms.

Adult↗
PubMed1994

Prediction of response to haloperidol in schizophrenia: neuroendocrine, neuromorphological and clinical variables.

Prediction of response to neuroleptics is a crucial topic since drug resistance phenomena can make the management of schizophrenia problematic and further deteriorate the outcome. Cerebral atrophy and enlarged ventricles have been suggested as the structural changes underlying negative symptoms and poor response to neuroleptic treatment. A higher percentage of non-suppressors to the dexamethasone suppression test (DST) among negative schizophrenics has been reported. Twenty-four schizophrenic in-patients, of both sexes, mean age 26.62 +/- 5.26 years, diagnosed according to DSM-III-R, with a mean duration of illness of 4.86 +/- 3.99 years, were treated with haloperidol 4-20 mg/day p.o. for 4 weeks. Clinical picture and extrapyramidal side effects were evaluated using BPRS and Simpson and Angus Scale at the beginning and end of the study. Ventricular brain ratio and basal and post-DST cortisol levels were evaluated at admission. The severity of the psychopathological picture, particularly positive symptoms at admission, were correlated to a higher amelioration at BPRS. Patients with ventricular enlargement and non-suppressors to DST showed higher variability of BPRS at baseline and more unpredictable clinical outcome than patients with normal ventricular brain ratio (VBR) and suppressors, even if a real difference in clinical outcome between patients characterized by normal or pathological parameters cannot be defined.

Adolescent↗
PubMed1994

Clinical pharmacokinetics of fluoxetine.

Fluoxetine is well absorbed after oral intake, is highly protein bound, and has a large volume of distribution. The elimination half-life of fluoxetine is about 1 to 4 days, while that of its metabolite norfluoxetine ranges from 7 to 15 days. Fluoxetine has a nonlinear pharmacokinetic profile. Therefore, the drug should be used with caution in patients with a reduced metabolic capability (i.e. hepatic dysfunction). In contrast with its effect on the pharmacokinetics of other antidepressants, age does not affect fluoxetine pharmacokinetics. This finding together with the better tolerability profile of fluoxetine (compared with tricyclic antidepressants) makes this drug particularly suitable for use in elderly patients with depression. Furthermore, the pharmacokinetics of fluoxetine are not affected by either obesity or renal impairment. On the basis of results of plasma concentration-clinical response relationship studies, there appears to be a therapeutic window for fluoxetine. Concentrations of fluoxetine plus norfluoxetine above 500 micrograms/L appear to be associated with a poorer clinical response than lower concentrations. Fluoxetine interacts with some other drugs. Concomitant administration of fluoxetine increased the blood concentrations of antipsychotics or antidepressants. The interactions between fluoxetine and lithium, tryptophan and monoamine oxidase inhibitors, in particular, are potentially serious, and can lead to the 'serotonergic syndrome'. This is because of synergistic pharmacodynamic effects and the influence of fluoxetine on the bioavailability of these compounds.

Administration, Oral↗
PubMed1994

[Multinational validation of the Composite International Diagnostic Interview (CIDI)].

The Composite International Diagnostic Interview (CIDI) is a fully structured diagnostic interview developed by the "Joint Project of World Health Organization (WHO) and Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) on Diagnosis and Classification of Mental Disorders and Alcohol and Drug Related Problems". Its main features are: it is devised for use in epidemiological and trans-cultural fields, can be used also by non-medical staff, has a modular structure, and gives diagnoses simultaneously according to ICD-10 and DSM-III-R, covering respectively 39 and 32 diagnoses on Axis I. This paper explains the validation study which was performed simultaneously in 20 different Countries under the competence of WHO applying a traditional interviewer-observer protocol. The reliability indexes which were obtained are among the highest reported in the current literature for similar instruments, and good levels of trans-cultural applicability and feasibility were demonstrated. CIDI therefore proved to be a very precise and reliable diagnostic instrument.

Cross-Cultural Comparison↗
PubMed1993

A multidimensional (pharmacokinetic and clinical-biological) approach to neuroleptic response in schizophrenia. With particular reference to drug resistance.

Despite the undisputable effectiveness of the available neuroleptic medications (NDs), short and long term outcome of schizophrenic disorders is often unsatisfactory and drug resistance phenomena are not uncommon. The causes of variability in the response seem to be primarily due to the heterogeneity of schizophrenic syndromes in terms of clinical history, symptoms, and biological patterns. The high non-compliance rate is an important source of therapeutic failure particularly during long-term treatment. The lacking or poor response to NDs can be linked to peculiar drug disposition patterns, which lead generally to inadequate plasma concentrations (too low or too high). To deal with pharmacokinetic aspects two main topics are discussed in this paper: (A) the interindividual differences in bioavailability and metabolism and (B) the plasma level-clinical response relationship. The knowledge of these aspects can significantly contribute to reducing some pseudo-drug resistance phenomena. Moreover, the need to combine these data with the new acquisitions on the pathophysiology of these disorders is emphasized, to deal properly with the complexity of drug response mechanisms during therapy with NDs. New heuristic paradigms for schizophrenic disorders, stemming from the evidences of their heterogeneity, in terms of clinical course, outcome and biological findings, should be considered in relation to response. Accordingly, the concept of 'therapeutic window' (as conceived in the '70s) for NDs (as for antidepressants) needs to be reexamined in relation to recent clinical, neurochemical and neuromorphological data. Finally, the indications for NDs monitoring (particularly for drugs like haloperidol and fluphenazine) are reported, suggesting that a multidimensional operational strategy could be particularly suitable to deal with drug resistance problems.

Antipsychotic Agents↗
PubMed1993

Quazepam versus triazolam in patients with sleep disorders: a double-blind study.

Quazepam, a recently introduced long-half-life benzodiazepine, seems to have a more specific hypnotic activity and a physiological mechanism of action. The present study evaluated clinical efficacy and eventually rebound symptoms after the treatment with quazepam and triazolam. Sixty-five patients, affected by sleep disorders, were entered into the study. Patients were treated with a placebo for four days and, if no amelioration of insomnia was observed, they were allocated randomly to receive 15 mg of quazepam (32 patients) or 0.5 mg triazolam (33 patients) for eight weeks and finally the placebo for another week. The sleep quality, the sleep efficacy, the unwanted effects and the rebound effects had been assessed by specific evaluation scales. Both of the drugs showed a hypnogenic efficacy but patients treated with quazepam had significantly less night awakenings; at the treatment's interruption, only the patients treated with triazolam had longer awakenings and rebound symptoms. In conclusion, quazepam seems to have a good hypnotic effect without inducing rebound effects. On the contrary, triazolam turned out to be just a hypnoinducent drug with higher risks of rebound effects after withdrawal.

Adolescent↗
PubMed1993

The use of antidepressants for long-term treatment of recurrent depression: rationale, current methodologies, and future directions.

Present strategies for long-term treatment of major depressive disorder stem from the following three observations: the high frequency of recurrent depression, the length of a depressive episode, and the ability of antidepressants to prevent recurrences. Two different phases of long-term antidepressant treatment are now considered: continuation and a "true" maintenance or prophylactic phase. Moreover, it seems important to discriminate between relapse (from a previous episode) and recurrence (a new episode). However, there are some unresolved questions, such as (1) the duration of antidepressant treatment, (2) the type and posology of antidepressants to be used, and (3) some methodological aspects, such as the choice of comparators, definition of response, and combination with other therapies. This paper deals with all of these aspects, finally suggesting different prophylactic strategies in relation to factors like severity of symptoms, frequency of episodes, compliance, and susceptibility to side effects.

Adult↗
PubMed1990

Prevalence and risk factors for tardive dyskinesia: a study in an Italian population of chronic schizophrenics.

The aim of this study was to evaluate tardive dyskinesia (TD) (prevalence and possible risk factors, pharmacological and clinical), in a population of schizophrenic patients after prolonged institutionalization. A total of 148 patients (80 male, 68 female) aged between 28 and 87 years (mean 55, SD 11) diagnosed according to DSM III were included in the study and assessed for the presence and severity of TD using the Abbreviated Rockland Simpson Scale for TD. Of the examined population, 32% were found to be affected by TD. Patients over 55 years had a relative risk of TD that was 2.3 times higher than in subjects under 55 (P less than 0.05). The most frequent movements were orofacial (60%) and in the extremities (56.4%). No significant relationship between duration of neuroleptic treatments, illness or hospitalization, anticholinergic drugs and TD prevalence was found. Severity was related to age, since there was a positive linear relationship between age and Simpson Scale scores (r = 0.45, P less than 0.01).

Adult↗
PubMed1990

Pharmacokinetics and adverse effects of single doses of dothiepin in young and elderly subjects.

1. The pharmacokinetics and side-effects of Dothiepin (DOT) were studied for four days after administration of a single oral dose of 75 mg to young adult and elderly subjects. 2. In the elderly DOT is absorbed, distributed and eliminated with half-lives about the same as in young adults but it is cleared less efficiently. 3. This difference of clearance in the elderly, after single-dose administration, is not reflected in increased incidence of side-effects.

Adult↗
PubMed1990

Nimodipine in human alcohol withdrawal syndrome--an open study.

The aim of this study was to evaluate the efficacy and tolerability of the DHP Ca2+ antagonist nimodipine in human AWS and post-AWS. Ten hospitalized alcoholics of both sexes with a diagnosis of AWS according to the DSM-III criteria were treated for 3 weeks in monotherapy with nimodipine p.o. at flexible daily dosages. Evaluation of AWS symptoms was performed at baseline and after 3, 5, 7, 10, 14 and 21 days. A statistically significant improvement of AWS was seen at evaluation on day 3, particularly in neurovegetative and psychopathological symptoms, and lasted up to the end of the study. The treatment was well tolerated and no side effects were observed or reported. In this pilot, open study nimodipine proved effective in the treatment of mild-to-moderate AWS. If these data are confirmed in a double-blind study nimodipine could be a rational alternative to benzodiazepines in the treatment of AWS.

Adult↗
PubMed1990

Drug-resistance phenomena in major psychoses: their discrimination and causal mechanisms.

Drug-resistance phenomena are commonly encountered in psychiatric practice and are of particular concern in the treatment of major psychoses. Of paramount importance is the need to discriminate between drug-resistance problems due to pharmacodynamic factors (i.e., receptor sensitivity) or pharmacokinetic factors (inadequate plasma concentration of the drugs at receptor sites). To exclude the former, plasma level measurements of antidepressant and neuroleptic compounds are desirable. Actually, lack of or poor compliance is a peculiarity (often underestimated) when treating psychotic patients, and the use of the drug plasma level/dose ratio (L/D) approach is useful, particularly with outpatients. Another source of drug resistance stems from the inter-individual metabolic variability, as with haloperidol or anticholinergic drugs, which are used to counteract neuroleptic-induced extrapyramidal side effects. In general, plasma-level measurement is advisable whenever no or poor response is obtained during standard treatments with neuroleptic, antidepressant, or anticholinergic drugs. Finally, this author suggests a four-level discrimination process to determine drug resistance in major psychoses, which includes clinical, pharmacological, pharmacokinetic, and pharmacodynamic factors.

Antidepressive Agents↗
PubMed1990

Alternative prophylactic treatments to lithium in bipolar disorders.

The research literature on alternative drug treatments to lithium therapy for the prevention of recurrences in bipolar disorders is discussed. In particular, the data on anticonvulsants (carbamazepine and valproic acid), antidepressants (alprazolam), and calcium channel blockers (verapamil) are reviewed and original data on clonazepam (CLN) are reported. In a preliminary study on six patients with bipolar disorders (DSM-III-R) without a history of psychotic features in which lithium prophylaxis was ineffective, contraindicated, or badly tolerated, CLN was administered in combination with low-dose neuroleptics or antidepressants in all but one case. All subjects were followed for 13 to 34 months. There were no relapses during the observation period with CLN dose regimens ranging from 1.5-8 mg/day p.o. Side effects were minimal and mostly consisted of transient sedation.

Alprazolam↗
PubMed1990

Conventional vs controlled-release carbamazepine: a multicentre, double-blind, cross-over study.

The tolerability and pharmacokinetics of a new controlled-release (CR) formulation of carbamazepine (CBZ), were assessed in a multicentre, double-blind, cross-over trial, carried out in 48 epileptic patients (21 men, 27 women; mean age 34.2 years) on conventional CBZ monotherapy, but without complete seizure control (n = 22) or with intermittent side effects (n = 4), or with both (n = 22). Eligible patients were randomized to conventional CBZ or CR CBZ, each given in sequence at individualized daily doses, subdivided into the lowest number of administrations. Each period of the cross-over consisted of a first phase of optimal dose finding (lasting up to two months) and a second one of maintenance (lasting one month) used for evaluation. At the end of each period, a 10-h plasma CBZ and CBZ-epoxide concentration profile, as well as the tolerability and the efficacy of the drugs, were evaluated. The mean CBZ daily dose increased by 16% during the administration of the CR formulation. Fluctuations of total CBZ and 10, 11-epoxide plasma level daily profiles at steady-state were significantly (p less than 0.001) lower during CR CBZ treatment, leading to a significant (p less than 0.001) decrease in intermittent side effects (6 patients on CR CBZ vs 26 on conventional CBZ). Finally, 38 patients on CR CBZ (vs 15 patients on conventional CBZ) were treated with a b.i.d. regimen.

Adolescent↗
PubMed1990

Clinical and toxicological profile of fluphenazine decanoate in elderly chronic schizophrenia.

Twenty elderly chronic schizophrenic inpatients of both sexes, age ranging from 60 to 73 years (mean age 63 +/- 0.81 years), diagnosed according to DSM III-R, were treated with fluphenazine decanoate, 12.5 mg intramuscularly, administered every 21 days for six months. Psychopathological features were assessed by means of the Brief Psychiatric Rating Scale at time 0 and then weekly. At 0, 6, 12, 24, 36, 48, 72h and 7, 14 and 21 days after each administration, extrapyramidal side-effects were evaluated using the Extrapyramidal Side-Effects Scale. Fluphenazine was significantly effective in treating symptoms such as emotional withdrawal, blunted affect, suspiciousness, thought disturbances, but not hallucinations. The most severe extrapyramidal side-effects occurred within the first two days of administration of fluphenazine, with a peak after 36 h, following the first four administrations of the drug, possibly related to early peak plasma concentrations. The severity of these effects was reduced after the fifth injection indicating the occurrence of tolerance mechanisms during long-term fluphenazine administration.

Aged↗
PubMed1990

Alcoholism and depression: a placebo controlled study with viloxazine.

Depressive disorders are frequently associated with alcohol abuse. Though many studies have been carried out to clarify the role of antidepressant drugs in the management of alcoholic patients, the data are controversial. The present placebo-controlled study was planned to assess the antidepressant and attenuating drinking-behaviour efficacy of viloxazine (400 mg per os daily) versus a placebo in 30 dysthymic patients affected by alcohol dependence. The results significantly favour viloxazine treatment in alleviating depression and in reducing alcohol abuse. All patients showed baseline haematochemical evidence of liver dysfunction that did not change significantly during the treatment.

Adult↗
PubMed1989

Residual neuroleptic-induced parkinsonian symptoms in schizophrenia. A naturalistic study with orphenadrine.

A naturalistic study was performed on 44 schizophrenic outpatients diagnosed according to DSM III-R and presenting neuroleptic-induced extrapyramidal side-effects. All patients had been treated continuously for the previous 10-12 weeks with haloperidol (HL) combined with orphenadrine (ORD). The dosages of HL and ORD remained unchanged for at least four weeks before the evaluations. All patients were assessed for depressive features (HRS-D), extrapyramidal (EPSE) and anticholinergic (ACS check list) side-effects. The plasma levels of ORD and its metabolite tofenacine (TOF) were determined by gas chromatography. There was a positive relationship between HRS-D and EPSE total scores, while there was a negative relationship between age and EPSE total scores. No relationship between the administered dose and plasma levels of ORD was found. The HL daily dose (mg/kg), ORD plasma levels and the TOF/ORD plasma level ratio seem to influence significantly the severity of residual extrapyramidal side-effects.

Adult↗