Biomedical subjects
Publications and source records attributed to D H Mielke.
Lithium therapy for bipolar illness is well accepted, despite some difficulties with its use. The administration of anticonvulsants has increased over the past 20 years. This paper outlines advantages and problems associated with anticonvulsant therapy for mood disorders.
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Forty-four patients with severe endogenous depression, all of whom had been administered multiple-monitored electroconvulsive therapy (MMECT), were studied by retrospective chart review. The subjects were divided into two groups, the elderly and the nonelderly, and compared for number of anesthesia inductions (treatment sessions), total number of seizures, total seizure time, and therapeutic outcome. One myocardial infarction occurred in an elderly man, and a confusional state developed whenever MMECT was administered simultaneously with lithium. The conclusions from this project are that MMECT is as safe and efficacious for the elderly as for the nonelderly and that the elderly tolerate many seizures as well as do the nonelderly. While other variables were similar between groups, the overall number of anesthesia inductions in both groups was less than is expected with conventional electroconvulsive therapy.
Guidelines are given for the differential diagnosis of dementia and depression, with an emphasis on Alzheimer's dementia. Treatment for both the family and the patient is discussed.
Sulpiride is a new and chemically different neuroleptic. In a study of 16 severely ill schizophrenic patients, this compound displayed definite evidence of antipsychotic activity while producing few adverse reactions. The relative absence of extrapyramidal side effects may indicate that sulpride has a low potential for producing tardive dyskinesia. Two patients who did not develop significant increases in prolactin levels did show a definite therapeutic response to sulpiride. Thus it appears that central dopaminergic blockade in the hypothalamic area is not a prerequisite for antipsychotic activity.
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Sulpiride is a new antipsychotic agent chemically different from recognized psychotropic compounds. The animal profile and the rapid urinary excretion without metabolism also distinguishes this drug from other neuroleptics. Previous studies have indicated therapeutic efficacy and few side effects. Sulpiride was evaluated in 10 hospitalized, chronic schizophrenic patients over a 10 week period. The overall findings support those studies reporting neuroleptic activity. Although no side effects were encountered, a mild leukocytosis was observed in one patient and broadening and flattening of T-waves was observed in another when each received high doses. Toxic levels appear to be well beyond the therapeutic range.
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