Amenorrhea and galactorrhea associated with fluvoxamine in a loxapine-treated patient.
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Biomedical subjects
Publications and source records attributed to G Remington.
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Loxapine, its N-demethylated metabolite amoxapine, and their 7- and 8-hydroxy metabolites were determined simultaneously in plasma by a simple two-step extraction procedure followed by reversed-phase liquid chromatography. Baseline separation was achieved by a 5-microns Spherisorb C6 column. The mobile phase consisted of 5 mM phosphate buffer (with 14 mM orthophosphoric acid)-acetonitrile (with 105 microM nonylamine) (77:23, v/v). Assays of the steady-state plasma samples obtained from seventeen patients on loxapine showed substantial amounts of 8-hydroxy metabolites, lesser amounts of loxapine, amoxapine and 7-hydroxyloxapine and trace amounts of 7-hydroxyamoxapine. As 8-hydroxy metabolites possess only weak dopamine-D2 blocking activity, the final neuroleptic property of loxapine may be affected significantly by metabolic polymorphism.
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The rabbit syndrome is an extrapyramidal side effect associated with chronic neuroleptic therapy. Its occurrence in a patient being treated with imipramine is described, representing the first reported case of this syndrome in conjunction with antidepressants. Repeated cerebral perfusion SPECT scans revealed decreased basal ganglia perfusion while the movement disorder was present, and a return to normal perfusion when the rabbit syndrome resolved.
After a 7-day washout period, 16 subjects suffering from unipolar depression were randomly assigned to either desipramine (DMI) or DMI plus propranolol treatment for 21 days. Both groups showed a significant improvement in their scores on the Hamilton Rating Scale for Depression (HRSD) after 21 days of drug treatment. However, there was no significant difference in the improvement in HRSD scores between the two groups. The results of this pilot study support the need to reevaluate the popular belief that propranolol induces or worsens depression.
There exists in the literature a group of nonorganic psychoses which appear to have no obvious relationship to either schizophrenia or affective illness. Diagnostic terminology to classify these atypical psychoses has been varied, although features in common can be identified. For example, they often are associated with antecedent personality problems, acute onset, florid and mixed symptomatology, brief duration, and full remission with a return to premorbid level of functioning. Case material reflecting these types of psychoses is presented here, and is discussed with reference to the nosologic status of these atypical psychoses.
Ethnocultural differences between supervisor and resident can play a significant role during the course of psychotherapy supervision. Failure to deal with these issues can adversely affect the supervisory relationship, the supervised therapy, and the overall education of the resident. Four cases of black supervisor and white supervises illustrate the problems.
Numerous advances in our understanding of schizophrenia and its pharmacotherapy have occurred over the last forty years, reflected in basic research endeavours exploring the pathophysiology of schizophrenia, as well as efforts to establish new medications with a more selective psychotropic action and fewer side effects. Ongoing clinical research has, at the same time, provided valuable information regarding the applicability of the various agents, appropriate dosing, symptom response patterns and side effect profiles. This growth in knowledge also has served to underscore the limitations and drawbacks of currently available drugs, leading to a more cautious approach in their use. Newer technologies, such as positron emission tomography, hold considerable promise in our efforts to further clarify the precise mechanisms mediating schizophrenia, and to establish treatment alternatives.
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The question of lithium-haloperidol incompatibility has been debated for a number of years now. The difficulty remains in distinguishing a combined toxicity syndrome, rather than toxicity to either agent alone. The authors reviewed a further case of adverse drug response following the concomitant use of lithium and haloperidol. It is their conclusion that a combined toxicity syndrome does exist, although it remains for future investigations to determine whether this effect is additive or synergistic. Finally, the possibility of underlying organic susceptibility is raised with reference to the case presented here.
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The effects of inescapable shock on subsequent escape performance and shock-elicited activity were examined in six lines of mice selectively bred for differences in general locomotor activity. The line differences in locomotor activity were found to be unrelated to the differences observed on shock-elicited activity. However, escape performance following exposure to inescapable shock was predictable from the levels of shock-elicited activity. Those lines that displayed the greatest decline in motor activity during shock likewise displayed the most pronounced escape deficits. The line differences in escape performance induced by inescapable shock could be mimicked by treatment with a tyrosine hydroxylase inhibitor, alpha-methyl-p-tyrosine. As predicted, the lines that displayed the least interference after tyrosine hydroxylase inhibition exhibited the smallest reduction in levels of catecholamines. The effects on escape performance following inescapable shock are interpreted in terms of the role of response maintenance deficits produced by catecholamine depletion.
Highly inbred mice of 3 strains (A/J, DBA/2J, and C57BL/6J) were tested in an open field at 14, 21, or 28 days of age. Ten minutes prior to testing, mice received treatment of saline, scopolamine (.5 or 1.0 mg/kg of body weight), or d-amphetamine (.5, 1.0, or 5.0 mg/kg). The d-amphetamine (5.0 mg/kg) increased activity in all strains at 14 days and 28 days of age, and at 21 days significantly increased activity in all except the C5BL/6. In contrast, increased activity with the scopolamine treatment was seen in DBA/2 at 21 days, but not in A and C57BL/6 until 28 days postnatally. The data support a caudal-rostral gradient of brain development with the inhibitory cholinergic system developing more slowly than the excitatory catecholamine system. In addition, strain-specific differences in activity levels are discussed in relation to the differential rates of chloinergic maturation.
A simple and accurate device to evaluate frequency and intensity of involuntary tremor is described. Discrete and quantifiable measures of tremor could be obtained in terms of vertical (i.e., absolute effects at a given time) and horizontal (i.e. temporal) changes. The technique was evaluated employing dosages of physostigmine 0.1-0.7 mg/kg. Applications to other behavioral indices, such as locomotor activity and wet-dog shakes, are discussed.
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For many decades clinicians have recognized the importance of some nonorganic psychoses that have no obvious relationship to either schizophrenia or affective illness. These atypical psychoses are characterized by sudden onset, florid and fluid symptoms, brief duration, remitting outcome, and a pattern of recurrences. They are presumed to be caused by major stress or characterologic defects or both. Systematic investigations into these conditions have been comparatively sparse. This report reviews the literature concerning these remitting atypical psychoses, proposes descriptive criteria for their recognition, and makes suggestions for further research.