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Biomedical subjects

B G Wells

Publications and source records attributed to B G Wells.

At least 19 recordsLinked to original sources
PubMed1995

Interactions between antipsychotic and antihypertensive drugs.

OBJECTIVE: To provide a comprehensive review of the pharmacokinetic and pharmacodynamic interactions between antipsychotics and antihypertensive and to provide recommendations for the selection of antihypertensive in patients receiving antipsychotic therapy. DATA SOURCES: A MEDLINE search of the English-language literature was used to identify pertinent human and animal studies, reviews, and case reports. STUDY SELECTION: All available sources were reviewed. DATA EXTRACTION: Background information was obtained from comprehensive reviews. Individual case reports were assimilated, and pertinent data were extracted. DATA SYNTHESIS: Because hypertension is common in patients with psychiatric illness and antihypertensive agents are used for a multiplicity of indications, significant numbers of patients receive concurrent therapy with antihypertensives and antipsychotics. Many antipsychotics may block the antihypertensive efficacy of guanethidine and related drugs. The interaction between clonidine and antipsychotics is defined less clearly. Limited data suggest possible additive hypotensive effects when chlorpromazine and methyldopa are given in combination. Increased plasma concentrations of thioridazine with a resultant increase in adverse effects have been reported when propranolol or pindolol are added to the regimen. A similar increase in chlorpromazine concentrations has been reported when propranolol was added. Although there are no reports documenting an interaction between a calcium-channel antagonist and an antipsychotic, the possible inhibition of oxidative metabolism of antipsychotics, additive calcium-blocking activity, and additive pharmacodynamic effects are theorized. Hypotension and postural syncope were reported in a patient given therapeutic dosages of chlorpromazine and captopril, and in 2 patients when clozapine was added to enalapril therapy. CONCLUSIONS: No antipsychotic-antihypertensive combination is absolutely contraindicated, but no combination should be considered to be completely without risk. Antihypertensives with no centrally acting activity, such as diuretics, may be the least likely to result in adverse reactions. The combination of the beta-antagonists propranolol or pindolol with thioridazine or chlorpromazine should be avoided if possible. Scrupulous patient monitoring for attenuated or enhanced activity of either agent is essential whenever antipsychotics and antihypertensives are given concurrently.

Adrenergic alpha-Agonists↗
PubMed1993

Are calcium-channel blockers effective in the treatment of tardive dyskinesia?

OBJECTIVE: To review the data describing the use of calcium-channel blockers in the treatment of tardive dyskinesia (TD). DATA SOURCES: A MEDLINE search of the English-language literature and a bibliographic review of pertinent articles examining the use of calcium-channel blockers in the treatment of TD were performed. Medical Subject Headings (MESH) terms used were calcium-channel blockers, tardive dyskinesia, nifedipine, verapamil, and diltiazem. STUDY SELECTION AND DATA EXTRACTION: Relevant case reports, open trials, and controlled studies reporting on the efficacy of calcium-channel blockers for treating TD are reviewed. Appropriate conclusions are drawn from the data and guidelines are suggested for the practitioner. DATA SYNTHESIS: Studies addressing the efficacy of calcium-channel blockers in the palliative treatment of TD have yielded mixed results. Positive findings have been reported for nifedipine, verapamil, and diltiazem; nifedipine may be the most efficacious treatment and diltiazem the least. It appears that patients with TD who can tolerate higher doses of calcium-channel blockers may respond more favorably to treatment. Patient characteristics that may help determine a better response to treatment with calcium-channel blockers include advanced age and more-severe TD. CONCLUSIONS: To determine the efficacy of calcium-channel blockers in the treatment of TD, additional data are needed from double-blind, placebo-controlled studies with larger sample sizes and longer durations of treatment. Until these data are available, calcium-channel blockers should be considered potentially useful therapy for the heretofore unresponsive TD.

Aged↗
PubMed1991

Bromocriptine in augmentation of antipsychotic response in chronic schizophrenia: a negative pilot report.

To further assess the usefulness of bromocriptine in treatment of schizophrenia seven inpatient chronic schizophrenics with acute exacerbation who had failed to respond to four weeks of antipsychotic therapy were treated with bromocriptine 2.5 mg daily for a treatment duration varying from one dose to four weeks while their antipsychotic dose was continued unchanged. Mean age of patients was 38.9 +/- 11.6 years and mean number of prior psychiatric hospitalizations was 12.0 +/- 7.2. Patients were rated with the Brief Psychiatric Rating Scale prior to the first bromocriptine dose, at 24 hours after dosage initiation, and at weekly intervals. One patient showed clinically significant improvement in both positive and negative schizophrenic symptoms. One patient showed slight improvement in unusual thought content, and four patients were clinically unchanged. One patient significantly worsened after the first dose. Factors possibly contributing to response and non-response are discussed. This is a report of an open study in 7 patients. It is the only report of bromocriptine treatment in patients previously shown unresponsive to antipsychotics and whose antipsychotics dose was held constant throughout the study. Addition of bromocriptine to the antipsychotic regimen remains an unproven treatment approach which may be considered only in patients refractory to or inadequately controlled with antipsychotics.

Adult↗
PubMed1991

A placebo-controlled trial of nadolol in the treatment of neuroleptic-induced akathisia.

BACKGROUND: Although propranolol has been documented to be useful in treatment of neuroleptic-induced akathisia, preliminary anecdotal reports on the efficacy of nadolol in treatment of this condition are contradictory. METHOD: To evaluate the efficacy of nadolol in treatment of this condition, a double-blind, placebo-controlled trial was conducted in 20 psychiatric inpatients. Patients with akathisia of at least moderate severity were randomly assigned to receive nadolol 40 to 80 mg/day or placebo. Patients were rated daily for 4 days, then every other day for 15 days by means of the Extrapyramidal Symptom Rating Scale. RESULTS: No significant differences were found between or within groups in subjective restlessness scores. In objective akathisia scores, there were no significant differences between groups; however, beginning at Day 9, both groups showed significant improvement compared with Day 1. There was no difference between groups in number of responders. CONCLUSIONS: The authors' data do not support the efficacy of nadolol in the treatment of neuroleptic-induced akathisia and do not provide support for a peripheral site of action for beta-blockers in treatment of this condition.

Adolescent↗
PubMed1991

Buspirone in the treatment of posttraumatic stress disorder.

Three patients with a DSM-III-R diagnosis of posttraumatic stress disorder were successfully treated with buspirone in final maximum dosages ranging from 35-60 mg daily. The onset of clinical efficacy ranged from 5-29 days. Symptoms that improved included anxiety, insomnia, flashbacks, and depressed mood. Patients experienced no side effects. Serotonin partial agonist effects are a possible mechanism underlying buspirone's efficacy.

Aged↗
PubMed1990

EEG alpha asymmetries in stutterers and non-stutterers: effects of linguistic variables on hemispheric processing and fluency.

The EEG hemispheric alpha asymmetry technique was used to gather data from anterior and posterior language areas during a resting condition and in a sentence repetition task. Subjects were nine adult stuttering males and nine adult fluent male controls. Sentences were controlled for imagery, syntactic complexity, and rate. Significant within- and between-groups differences were found for both resting and testing conditions. Posteriorly, stutterers showed no differences between resting and testing conditions, while controls showed increased left hemisphere activation. Of the linguistic variables investigated, only imagery was involved in a significant interaction. Fluent males showed greater posterior left hemispheric activation for high and low visual imagery sentences, compared to greater posterior right hemispheric activation in stuttering males. Significantly greater alpha power was found for low vs high imagery sentences in the anterior and posterior left hemisphere sites for both subject groups, and in the right hemisphere sites for the stuttering group only. Fluency data is presented. Differences between groups in alpha power changes from resting to testing conditions are discussed.

Adolescent↗
PubMed1990

Seizure activity associated with antipsychotic therapy.

Approximately one percent of patients receiving antipsychotic medications develop seizure activity. In addition, approximately seven percent of epileptic patients develop chronic psychosis requiring antipsychotic treatment. A history of antipsychotic-induced seizures in patients exhibiting florid psychosis should not preclude the use of antipsychotic medications. Different antipsychotics affect the seizure threshold in varying degrees, and the least epileptogenic agents should be selected for this population. Predisposing factors and other risk factors associated with antipsychotic-induced seizures are identified. Guidelines for the use of antipsychotic medications in psychotic patients with a history of seizures are presented.

Antipsychotic Agents↗
PubMed1990

Injection site reactions after intramuscular administration of haloperidol decanoate 100 mg/mL.

The authors report four cases of injection site reaction after intramuscular administration of haloperidol decanoate 100 mg/mL. In each case, the injection site became edematous, red, pruritic, and tender, and a palpable mass remained for up to 3 months. No systemic symptoms were reported. All four patients had previously received the 50 mg/mL haloperidol decanoate injection without incident. Two of these events followed the initial injection of haloperidol decanoate 100 mg/mL. Rechallenge with the 100 mg/mL product in one case and the 50 mg/mL product in two resulted in similar reactions. The incidence of this reaction at the authors' facility is estimated to be 7.7%. The authors speculate that the reaction is most likely to be related to the concentration of haloperidol decanoate in the injection.

Adult↗
PubMed1990

Possible influence of carbamazepine on plasma imipramine concentrations in children with attention deficit hyperactivity disorder.

The effect of carbamazepine on the plasma concentration of imipramine and its metabolite desipramine was examined retrospectively in 36 sex- and age-matched children with attention deficit hyperactivity disorder. One-half of the children received imipramine and the other half received combined carbamazepine and imipramine for 1-6 months. The imipramine dosage was significantly higher in the combined treatment group than in the imipramine-only group. Despite receiving larger doses, the combined treatment group had significantly lower mean levels of imipramine, desipramine, and total tricyclic antidepressant compared with those children receiving imipramine alone. Lowered plasma concentrations of tricyclic antidepressants with carbamazepine coadministration have not been reported previously. Although more rigorous studies are needed to confirm these findings, our data suggest that increased imipramine doses may be necessary for adequate response in children on combined therapy. Moreover, toxicity could result upon withdrawal without imipramine dosage adjustment.

Adolescent↗
PubMed1990

Psychiatric applications of bromocriptine therapy.

Bromocriptine, an ergot alkaloid derivative that possesses both dopamine agonist and antagonist activity, has been studied in a broad spectrum of psychiatric illnesses. The literature consists primarily of case reports and small trials limited by methodological shortcomings. The authors critically review these reports, focusing on efficacy, mechanistic issues, dosing, side effects, predictors of response, monitoring parameters, and practical guidelines. Preliminary data suggest bromocriptine may have promise in the treatment of neuroleptic malignant syndrome, cocaine withdrawal, and depression. At present, the agent appears less efficacious in the treatment of tardive dyskinesia, mania, and schizophrenia; however, doses in these trials may have been excessive, producing primarily postsynaptic agonist effects. More extensive clinical trials are required to clearly define the role of bromocriptine in psychiatry.

Bromocriptine↗