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Biomedical subjects

C L Ravaris

Publications and source records attributed to C L Ravaris.

At least 19 recordsLinked to original sources
PubMed1994

Headache and electroconvulsive therapy.

While headache is a documented side effect of electroconvulsive therapy (ECT), there is little information on this phenomenon. Studies of the mechanisms of ECT as a treatment for depression indicate that alterations in serotonergic neurotransmission appear to be related to its efficacy. While ECT and many of the antidepressant drugs have similar effects on serotonergic transmission, they are notably different in the changes they induce in type 2 receptors for 5-hydroxytryptamine (5-HT). ECT upregulates 5-HT2, and antidepressants down regulate the receptor's expression. 5-HT2 receptor sensitization has been associated previously with headache genesis, which may explain why ECT induces headache, and amitriptyline relieves headache. In our study we surveyed 98 patients retrospectively about their experiences with headache prior to and following ECT. Of the 54 patients who submitted properly completed questionnaires, five reported new onset of headaches following ECT, four reported exacerbation of a previous headache problem, and two reported their headaches improved. The patients experienced changes in the character or location of pain, with a tendency to progress from tension-type to migrainous headache. In all but two cases these developments persisted at least eight months after ECT. We discuss the possible reasons and significance of our findings.

Adult↗
PubMed1991

A controlled study of alprazolam and propranolol in panic-disordered and agoraphobic outpatients.

We studied the efficacy of propranolol (Inderal) compared to alprazolam (Xanax) in 29 patients with a diagnosis of agoraphobia with panic disorder or panic disorder with or without limited phobic avoidance in a 6-week double-blind controlled experiment. Alprazolam is effective in those syndromes, whereas to date only negative or ambiguous results had been reported for propranolol. Fourteen patients received a mean daily dose of 5.0 +/- 2.3 mg of alprazolam and 15 patients received 182.0 +/- 60.5 mg mean daily dose of propranolol. We found both drugs to be effective to suppress panic attacks and reduce avoidance behavior. The only significant between-drug difference was a more rapid onset of alprazolam's panicolytic effect. Propranolol merits further study. We suggest patients worthy of a clinical trial.

Adolescent↗
PubMed1989

Sleep in patients with spontaneous panic attacks.

Twenty-four drug-free patients with a DSM-III diagnosis of panic disorders (and their age- and sex-matched normal controls) slept in the laboratory for 3 consecutive nights. Panic patients showed a slightly longer sleep latency and a lower sleep efficiency than their normal controls. They also had more overall movement time and more body movements during stage 2 sleep. Eight panic attacks were recorded arising out of sleep. Six of them occurred in the transition phase between stage 2 and stage 3 sleep. The nocturnal panic attacks of these patients are unique, different from stage 4 sleep terrors, and different from dream anxiety attacks.

Adolescent↗
PubMed1988

Electrochemical detection for high-performance liquid chromatography of ketoconazole in plasma and saliva.

Ketoconazole, cis-1-acetyl-4-[4[[2-(2,4-dichlorophenyl)-2-(1H-imidazol- 1-ylmethyl)-1,3-dioxolan-4-yl]methoxy]phenyl]piperazine, a clinically used antifungal agent, is also an inhibitor of steroid hormone biosynthesis. A high-performance liquid chromatographic method is described which resolves ketoconazole with selectivity and high sensitivity provided by the use of electrochemical detection. Ketoconazole can be detected in high-performance liquid chromatography by electrochemical oxidation at a glassy carbon electrode at a potential of +1.0 V. Electrochemical detection offers improved sensitivity and selectivity over ultraviolet absorbance or fluorescence detection after derivatization. The method utilizes a volatile buffer system compatible with postcolumn analyses and an internal standard which is electrochemically active. This technique provides a simple method to assay ketoconazole. Ketoconazole can be detected in human plasma and saliva after a single oral therapeutic dose.

Chromatography, High Pressure Liquid↗
PubMed1981

Current drug therapy for agoraphobia.

The hallmark of agoraphobia is the spontaneous panic attack, a reaction of extreme fearfulness and impending doom with cardiorespiratory symptoms. The end result can be a patient who is housebound. The basic therapeutic principle is confrontation with the avoided object or activity. Controlled clinical experiments demonstrate that both imipramine and phenelzine, the drugs of choice for this prevalent and disabling disorder, have a specific antipanic effect.

Adult↗
PubMed1980

Phenelzine and amitriptyline in the treatment of depression. A comparison of present and past studies.

We present the results of a direct comparison of pheneizine sulfate and amitriptyline hydrochloride therapy in 105 depressed patients. We believe this is the first definitive double-blind controlled clinical trial of a monoamine oxidase inhibitor and a tricyclic antidepressant in the outpatient setting. The results show both antidepressants to be effective, with the similarities between the two exceeding the differences. Both drugs had marked antidepressant and antianziety effects. Phenelzine tended to exert a stronger antianxiety action; amitriptyline was more effective in reversing weight loss and improving sleep. The incidence of two side effects, sedation and orthostatic hypotension, was almost identical. Dry mouth was more prevalent with amitriptyline. We discuss the indications for the differential clinical use of both drugs in depressed outpatients.

Adult↗
PubMed1979

Plasma tricyclic drug levels in amitriptyline-treated depressed patients.

In a double-blind phenelzine controlled clinical trial, 49 depressed outpatients were treated with a fixed dose of amitriptyline (AMI) 150 mg/day for 6 weeks. No significant relationships were found between steady-state plasma levels of AMI and its metabolite, nortriptyline, at 4 weeks and therapeutic response at 6 weeks or side effects. In the patient subgroup with more severe endogenous symptoms, there was a general trend for a weak positive association between AMI plasma levels and clinical improvement. Plasma tricyclic determinations appear to have little if any predictive value for antidepressant effect in outpatients treated with AMI.

Adult↗
PubMed1978

Clinical pharmacology of phenelzine.

There is renewed interest in the clinical pharmacology of phenelzine sulfate and other monoamine oxidase (MAO) inhibitors. Newer clinical and analytic techniques recently have been applied to investigations of this class of drugs in man. The results show that drugs such as phenelzine are effective in nonendogenous depression and phobic disorders. Clinical response to phenelzine is related to platelet MAO inhibition and dosage per unit body weight. High percent MAO inhibition in platelets at two weeks is associated with greater improvement after a six-week course of treatment. Our data show that a safe, effective phenelzine dose in 1 mg/kg body weight per day. These results have delineated the pharmacologic and therapeutic effects of phenelzine and support a continuing role for MAO inhibitors in psychopharmacology.

Acetylation↗
PubMed1978

Use of MAOI antidepressants.

The monoamine oxidase inhibitors (MAOIs) exert significant antidepressant, antianxiety and antiphobic effects. They are safe, provided the patients are carefully selected for treatment and are given instructions on incompatible foods and drugs that must be avoided. The MAOIs represent effective alternatives to the tricyclic antidepressants. Phenelzine is an excellent agent for treating ambulatory patients with neurotic depression and those with agoraphobia and social phobias.

Adjustment Disorders↗
PubMed1977

Relationship between age and tricyclic antidepressant plasma levels.

Older depressed patients treated with imipramine or amitriptyline developed higher steady-state plasma levels of imipramine, desipramine, and amitriptyline. In imipramine-treated patients this finding was associated with a decreased rate of drug elimination from plasma. These findings provide at least a partial explanation for the increased susceptibility of the older patient to tricyclic antidepressant side effects and also provide a pharmacological rationale for use of lower dosages in this age group.

Administration, Oral↗
PubMed1976

A multiple-dose, controlled study of phenelzine in depression-anxiety states.

In a double-blind, controlled experiment, 62 outpatients with symptoms of depression with anxiety were selected for treatment with phenelzine sulfate, 60 mg daily, phenelzine sulfate, 30 mg daily, or placebo for six weeks. Forty-nine patients (79%) completed the experiment. Phenelzine sulfate, 60 mg daily, was significantly more effective than placebo in relieving symptoms of both depression and anxiety. Phenelzine sulfate, 30 mg daily, did not differ from the placebo. Only phenelzine sulfate, 60 mg daily, resulted in a median inhibition of platelet monoamine oxidase that exceded 80%. The results confirm a previous study that found phenelzine to be effective in the treatment of outpatients with depressive-anxiety states. Drug dosage is an important variable influencing clinical outcome in this patient group.

Adult↗