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Biomedical subjects

G A Keepers

Publications and source records attributed to G A Keepers.

15 recordsLinked to original sources
PubMed1991

Use of neuroleptic-induced extrapyramidal symptoms to predict future vulnerability to side effects.

OBJECTIVE: Susceptibility to neuroleptic-induced extrapyramidal syndromes varies widely, even within age and sex subgroups. Individual vulnerability to extrapyramidal syndromes has been assumed to explain this, but the utility of past history for predicting future occurrence of extrapyramidal syndromes has not been studied extensively. This investigation was undertaken to determine whether patients' previous histories of extrapyramidal syndromes predict future episodes of extrapyramidal syndromes and to compare the importance of this predictive factor with patient age, sex, neuroleptic dose, and anticholinergic dose as predictors of extrapyramidal syndromes. METHODS: The charts of 62 schizophrenic patients with multiple neuroleptic treatment episodes were reviewed. Extrapyramidal syndromes, neuroleptic drug doses, and anticholinergic drug doses during the first 21 days of each treatment episode were recorded. RESULTS: Previous extrapyramidal syndromes correctly predicted extrapyramidal syndromes in subsequent treatments for 84% of the patients. Variations in neuroleptic potency, neuroleptic dose, and anticholinergic dose partially explained incorrect predictions. CONCLUSIONS: These results support the hypothesis that patients with a history of extrapyramidal syndromes are at greater risk for future extrapyramidal syndromes. If confirmed, these results strongly support individual susceptibility as a major predictor of extrapyramidal syndromes and indicate that prophylaxis of extrapyramidal syndromes should be considered for patients who have previously suffered extrapyramidal syndromes from similarly prescribed neuroleptic therapy.

Adult↗
PubMed1990

Pathological preoccupation with video games.

Controversy continues concerning the harmfulness of video game use by children. The author encountered clearly pathological preoccupation with video games in a preadolescent. The child had stolen, forged checks, and skipped school to continue using video games. He and his mother were physically abused by his father. Placement of the child in a residential treatment center with martial and family therapy resulted in resolution of the patient's pathological use of video games.

Child↗
PubMed1988

Neuroleptic side effects: acute extrapyramidal syndromes and tardive dyskinesia.

The neuroleptic-induced motor system side effects of acute extrapyramidal syndromes (EPS) and tardive dyskinesia (TD) are the major limitations of these drugs. Effective strategies for managing these problems are based on the clinical presentations, pathophysiological processes, and a complex interaction of patient and treatment variables. New concepts about the causes and long-term outcome of acute EPS and TD are emerging to challenge some of the commonly held views about these syndromes. The primary method of preventing undue side effects is to use the lowest effective dose of both neuroleptic and anti-EPS drugs. The pressing need is for novel compounds which treat schizophrenia and are free of the undesirable motor system effects (a nonneuroleptic neuroleptic).

Antipsychotic Agents↗
PubMed1988

Efficacy of anticholinergic prophylaxis for neuroleptic-induced acute dystonia.

The authors analyzed data from nine studies comparing the incidence of acute dystonia induced by neuroleptic agents with and without concomitant use of anticholinergic agents. Anticholinergic agents reduced the rate of dystonia by 1.9-fold in all patients treated with different neuroleptics and by 5- to 8-fold in patients treated with high-potency neuroleptics. In addition, the incidence of dystonia and the efficacy of anticholinergic prophylaxis were related inversely to age. These results support the efficacy of anticholinergic agents in preventing neuroleptic-induced dystonia, particularly in young male patients treated with high-potency neuroleptics.

Acute Disease↗
PubMed1987

The prevalence and significance of medical illness among chronically mentally ill outpatients.

The prevalence and significance of medical illnesses were examined in a sample of chronically mentally ill patients from an urban community mental health program. Eighty-eight percent had at least one significant medical illness, 51% had at least one previously undiagnosed illness and 53% were judged to be in need of some form of medical attention. The bulk of these illnesses were typical of primary care problems. In terms of causal significance, nearly as many medical illnesses appeared to be the result of the psychiatric disorder (18%) as vice versa (22%). Community mental health programs should make provisions for the medical needs of patients in comprehensive management programs.

Adult↗
PubMed1987

Prediction of neuroleptic-induced dystonia.

For patients receiving neuroleptics, age, sex, neuroleptic potency, and dose all influence the likelihood of a dystonic reaction. Little is known, however, of the relative importance of these factors or of the feasibility of predicting dystonia in individual patients. We reviewed 135 charts of psychotic inpatients to examine these factors and their usefulness in predicting dystonia. Age, sex, neuroleptic type, dose, and occurrence of dystonia were recorded for the first 4 days of drug treatment and were used to construct a linear discriminant function that classified the cases as to whether dystonia was expected. Internal cross-validation was performed, and the error rate of this classification procedure was calculated. Forty-nine (36%) of the patients had dystonia. A younger age was the most powerful predictor of dystonia. Male gender was second in predictive power with minor effects from neuroleptic dose and potency. The overall error rate (false-positive and false-negative errors combined) of the discriminant function was 30%. These results suggest the possibility of predicting dystonia in individual patients but should be regarded with caution since the predictive procedure has not been tested prospectively. If confirmed, these data may allow treatment strategies that protect patients from dystonia while sparing patients not at risk unnecessary treatment with antiparkinson agents.

Adolescent↗
PubMed1983

Initial anticholinergic prophylaxis for neuroleptic-induced extrapyramidal syndromes.

Initial prophylaxis with anticholinergics for neuroleptic-induced extrapyramidal syndromes (EPSs) is controversial. Recommendations, based on conflicting research findings, vary from routine prophylactic use of anticholinergics to withholding these agents until dystonia, akathisia, or parkinsonism develops. To determine whether anticholinergic prophylaxis influenced EPS rates during the first 21 days of neuroleptic treatment, 215 psychotic inpatients were reviewed. Initial prophylaxis with anticholinergic drugs significantly reduced the occurrence of EPSs. This treatment's efficacy depended on a complex interaction of variables, including the patient's sex and age, antipsychotic drug type and dose, and treatment phase.

Adolescent↗
PubMed1978

Major side effects of antipsychotic drugs.

Since the introduction of phenothiazines into clinical practice in 1952, over 250 million people have received these drugs for the treatment of psychotic states. In addition to the phenothiazines, five other classes of neuroleptic medications are now in use: butyrophenones, thioxanthenes, dihydroindolones, diphenylbutylpiperidines, and dibenzoxazepines. Besides their use in the treatment of psychosis, these drugs have been used in the treatment of anxiety, depression, nausea, alcoholic withdrawal, and pain, and are often administered in combination with other medications. Through the use of these drugs, many psychotic patients have been able to move back into the community, and the family physician is coming into contact with more patients on maintenance dosages of neuroleptics. He/she may wish to prescribe these drugs or may, in the treatment of a medical problem, need to prescribe other medication to an individual already receiving neuroleptics. It is important, therefore, for the family physician to be aware of the side effects of these drugs and of complications which can arise when neuroleptics are given in combination with other families of drugs.

Butyrophenones↗
PubMedDate not supplied

Acute extrapyramidal syndromes in neuroleptic-treated elders: a pilot study.

The incidence, morbidity, and risk factors for acute extrapyramidal syndromes (EPS) such as akathisia and drug-induced parkinsonism (DIP) in neuroleptic-treated elders have not been systematically explored. This study presents data on 17 elderly patients who were prospectively examined for up to 4 weeks for acute EPS, functional and cognitive status, and behavioral disturbances. Seventy-one percent of subjects developed DIP, and 18% developed akathisia. Predictors of DIP included pre-neuroleptic treatment parkinsonian signs and neuroleptic dose, despite use of low doses of neuroleptics. Development of acute EPS was associated with failure to improve behaviorally. New-onset urinary incontinence was the most common functional abnormality.

Aged↗