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Biomedical subjects

D G Spiker

Publications and source records attributed to D G Spiker.

62 records · Page 4Linked to original sources
PubMed1976

Tricyclic antidepressants. Prolonged plasma levels after overdose.

Twenty-four patients hospitalized for overdose of a tricyclic antidepressant were monitored clinically, and serial plasma-drug measurements were taken for up to 144 hours. Six of 24 patients had maximum antidepressant plasma levels greater than or equal to 1,000 ng/ml, and their plasma levels at 96 hours ranged from 170 to 1,280 ng/ml. Patients ingesting substantial tricyclic overdoses may remain medically unstable for days. When high tricyclic levels persist, accurate psychiatric assessment is often impossible.

Amitriptyline↗
PubMed1976

Combining tricyclic and monoamine oxidase inhibitor antidepressants.

The charts of 150 inpatients and 51 outpatients treated with a monoamine oxidase inhibitor (MAOI)-tricyclic antidepressant combination were reviewed. The incidence and severity of side effects among the patients on the combined regimen were essentially the same as those seen in the control groups. There were no deaths or strokes resulting from use of this regimen. The most frequent troublesome side effect was orthostatic hypotension. We conclude that the use of a MAOI-tricyclic combination in oral therapeutic doses is safe. However, the efficacy of this combination has not yet been proved, and it may be particularly toxic if taken in an overdose.

Amitriptyline↗
PubMed1976

Psychiatric diagnosis and tricyclic plasma levels in 36 hospitalized overdose patients.

Thirty-six hospitalized patients who were considered by emergency room physicians to have ingested medically serious tricyclic overdoses were studied. The purpose of the project was to determine if psychiatric diagnosis and associated psychiatric factors correlated with the severity of the overdose as defined by plasma drug levels. Medically serious overdoses were ingested by patients with alcoholism, primary affective disorder, undiagnosed psychiatric illness, and Briquet's syndrome. Prior psychiatric treatment, prior admissions, prior overdoses, or precipitating events did not correlate with the medical severity of the ingestion. Attempting to predict the individual medical severity of the overdose from psychiatric factors resulted in a dangerous underestimation of the risk of patients with Briquet's syndrome and an overprediction in the case of primary affective disorder.

Adjustment Disorders↗
PubMed1975

Tricyclic antidepressant overdose: clinical presentation and plasma levels.

Fifteen patients were studied at 8- to 12-hr intervals during the first 24 hr after overdosing with tricyclic antidepressants, and subsequently followed daily for up to 144 hr. The severity of the overdose was determined by measuring the plasma tricyclic antidepressant level using gas chromatography-mass fragmentography. No correlation was found between total, tertiary, or desmethyl tricyclic antidepressant plasma levels and maximum heart rate, lowest blood pressure, degree of unconsciousness, or EKG changes involving the P-R interval or ST-T wave changes. There was a weak correlation between drug plasma level and maximum pupil size (r = 0.46; p less than 0.05) and a strong correlation between the duration of the QRS complex and tricyclic antidepressant plasma levels (r = 0.75; p less than 0.01). All patients with a total tricyclic antidepressant plasma level greater than or equal to 1,000 ng/ml had a QRS interval greater than or equal to 100 msec. As the total plasma tricyclic level fell, the duration of the QRS interval returned to normal. Thus, the duration of the QRS complex on the electrocardiogram appears to be the most reliable clinical sign for evaluating the seriousness of tricyclic antidepressant overdosage.

Adolescent↗
PubMedDate not supplied

Placebo response rates in psychotic and nonpsychotic depression.

The authors reanalyzed data from two earlier studies that used double-blind placebo-controlled formats to study the efficacy of amitriptyline. Using a 14-day drug-free 'wash-out' period, they found that the placebo response rates were 0% for psychotic depressives and 13.3% for nonpsychotic depressives. Amitriptyline was significantly superior to placebo for both psychotic (P less than or equal to 0.05) and nonpsychotic (P less than or equal to 0.05) depressed patients.

Amitriptyline↗