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Biomedical subjects

Gerald A Maguire

Publications and source records attributed to Gerald A Maguire.

12 recordsLinked to original sources
PubMed2006

Improvement in hyperprolactinemia and reproductive comorbidities in patients with schizophrenia switched from conventional antipsychotics or risperidone to olanzapine.

This open-label, prospective, 4-month study in hyperprolactinemic patients with schizophrenia explored whether prolactin levels decrease after switching antipsychotic therapy to olanzapine. A secondary objective was to determine if reproductive morbidities and sexual dysfunction occurring with hyperprolactinemia improved with prolactin normalization. Clinically stable patients with schizophrenia, who had hyperprolactinemia defined as >18.8 ng/ml for males and >24.2 ng/ml for females, were randomized to: remain on current therapy (n=27) or switch to olanzapine, 5-20 mg/day, (n=27). Baseline prolactin levels in female patients randomized to receive olanzapine (n=14) were 66.3+/-38.7 ng/ml and were 82.0+/-37.6 (p=.32) in those remaining on their pre-study antipsychotic medication (n=14). In male patients, baseline prolactin levels were 33.7+/-12.1 and 33.5+/-13.8 ng/ml (p=.97), respectively, for those randomized to olanzapine (n=13) or remaining on pre-study treatment (n=13). At study end, patients switched to olanzapine experienced significant reductions in mean serum prolactin levels of 19.8+/-18.1 ng/ml in males (p=.02), and 32.3+/-47.5 ng/ml in females (p=.01), but prolactin continued to be elevated in patients who remained on pre-study antipsychotic treatment. After switching to olanzapine treatment, male patients experienced significantly (p=.03) increased free testosterone levels but there were no significant improvements in total testosterone levels; some female patients experienced improved menstrual cycling, as well as resolution of galactorrhea and gynecomastia, and sexual functioning was significantly improved in both genders. Patients switched to olanzapine, as well as those remaining on their pre-study medication, maintained clinical stability, their symptoms continued to improve, although there were no significant between-treatment differences in improvement. Treatment-emergent adverse events did occur in both treatment groups; however, they were not significantly different between groups. Olanzapine-treated patients experienced significantly lower eosinophil counts and higher elevations in low-density lipoproteins and standing blood pressure than non-switched patients. Olanzapine treatment may offer sustained reduction in serum prolactin and improvement in sexual and reproductive comorbid symptoms in patients with schizophrenia who have treatment-emergent hyperprolactinemia.

Antipsychotic Agents↗
PubMed2004

Alleviating stuttering with pharmacological interventions.

Stuttering is a speech disorder characterised by frequent prolongations, repetitions or blocks of spoken sounds and/or syllables. Stuttering is very common and is classified by the Diagnostic and Statistical Manual of Mental Disorders -- Fourth Edition (DSM-IV) as an Axis I disorder. In spite of this, stuttering treatment is sporadically addressed by a practicing physician, especially in the US. Much has recently been learned of the neurophysiological basis of this disorder, which has provided insight into novel treatment strategies, thus helping to guide the practising clinician. Stuttering is likely to be associated, at least in part, to dopamine hyperactivity in the brain. Novel dopamine antagonists such as risperidone and olanzapine, have recently been shown to improve the symptoms of stuttering providing a strong foundation for physicians to more effectively treat this disorder.

Benzodiazepines↗
PubMed2003

Effectiveness of rapid initial dose escalation of up to forty milligrams per day of oral olanzapine in acute agitation.

BACKGROUND: Patients experiencing an acute decompensation of schizophrenia or bipolar disorder often present in an agitated state. Agitation presents a barrier to therapy, interrupting the typical physician-patient alliance and creating a disruptive, even hazardous, environment. Rapid assessment and effective treatment are necessary to manage agitation and, potentially, to shorten the time to recovery. METHODS: One hundred forty-eight acutely agitated patients received either: rapid initial dose escalation (RIDE) in which up to 40 mg of oral olanzapine was allowed on days 1 and 2, up to 30 mg on days 3 and 4, and 5 to 20 mg thereafter; or usual clinical practice (UCP) in which patients received 10 mg/d olanzapine plus up to 4 mg lorazepam on days 1 and 2, up to 2 mg on days 3 and 4, and olanzapine 5 to 20 mg/d thereafter. The Positive and Negative Syndrome Scale-Excited Component (PANSS-EC: poor impulse control, tension, hostility, uncooperativeness, and excitement) measured at 24 hours was the primary measure. Secondary assessments of agitation and safety were also performed. RESULTS: Agitation improved significantly from baseline for both treatment groups; however, improvement with the RIDE strategy was superior to UCP. The RIDE group improvement was superior on the primary efficacy measure (PANSS-Excited) at 24 hours; it was superior on all agitation measures at the end of double-blind treatment. Both treatments were well tolerated, with no clinically significant differences in safety measures. Treatment was not limited by oversedation and attention improved from baseline in both groups. CONCLUSIONS: This study demonstrates the value of olanzapine in the treatment of acutely agitated patients. A new approach to olanzapine dosing that expands the initial dose range up to 40 mg/d may offer superior efficacy in rapidly and effectively controlling the symptoms of agitation.

Adolescent↗
PubMed2002

Comprehensive understanding of schizophrenia and its treatment.

An overview of schizophrenia is presented, including diagnostic criteria, etiology, neurologic findings, pharmacotherapy options, quality-of-life issues, and the financial impact of the disease. Schizophrenia is a chronic disease characterized by positive symptoms, negative symptoms, mood symptoms, and cognitive deficits. Often comorbid substance abuse is present. Schizophrenia accounts for 20% of all hospital bed-days and over 50% of all psychiatric beds in the United States. There is a strong genetic component to schizophrenia, and other possible contributing factors are explored. The diagnostic workup should include a detailed longitudinal history, mental status exam, physical and neurologic exams, and laboratory tests. A magnetic resonance imaging scan can rule out structural causes of psychosis and should be considered at the time of diagnosis. Treatment is based on a biopsychosocial model including pharmacotherapy in combination with individual, group, and family therapies. Rather than classifying antipsychotics as typical or atypical, a new classification scheme has been proposed based on risk of causing extrapyramidal symptoms and tardive dyskinesia (TD), effect on prolactin level, and efficacy profile: first-generation or traditional agents (e.g., chlorpromazine and haloperidol); second-generation agents (e.g., risperidone and ziprasidone); and third-generation agents (e.g., clozapine, olanzapine, and quetiapine). The binding affinities of antipsychotics in the brain help explain the mechanisms by which different antipsychotics alleviate specific symptoms of schizophrenia, as well as cause specific adverse effects. Improved cognition, fewer depressive and mood symptoms, and decreased risk of TD associated with third-generation antipsychotics have improved the quality of life for patients with schizophrenia.

Adult↗
PubMed2002

Computer detection of cognitive impairment and associated neuropsychiatric dimensions from the content analysis of verbal samples.

This is a report of a study testing the capacity of a computerized measure of the content analysis of five minute verbal samples to detect and measure cognitive impairment and comorbid neuropsychiatric dimensions in 117 drug-abusing inpatients. The cognitive impairment scores obtained from the computerized procedure correlated significantly with independent scores from the Trails B and Stroop Color and Word test as well as with ANAM (Automated Neuropsychiatric Assessment Metric) neuropsychological tests, including the Matching to Sample Efficiency and Accuracy, the Code Substitution Efficiency, the Continuous Performance Task Efficiency and Accuracy, the Code Substitution Delayed Recall Accuracy, and the Simple Reaction Time Efficiency. When the computerized verbal-content-analysis-derived cognitive impairment scores were combined with scores of selected other ANAM measures, more and higher intercorrelations occurred with Trails A, Trails B, the Stroop Color and Word test, and the Wisconsin Card Sort test. In addition, validated measures of a broad range of associated neuropsychiatric dimensions can be obtained simultaneously from the same five minute verbal samples providing the cognitive impairment scores. No significant effects were found on the cognitive impairment scores of age, education, gender, race, and duration of drug-abuse abstinence.

Adult↗
PubMed2002

Prolactin elevation with antipsychotic medications: mechanisms of action and clinical consequences.

Antipsychotic agents differ in efficacy and side effects such as movement disorders and prolactin elevation because of varying mechanisms of action. A revised nomenclature for antipsychotic agents, which categorizes the drugs according to efficacy, risk of movement disorders, and risk of prolactin elevation, is described. Prolactin elevation, a potential side effect of some antipsychotic medications, is underdiagnosed but can have serious short-term and long-term consequences. Short-term problems include menstrual irregularities, sexual dysfunction, and depression. Long-term problems related to prolactin elevation include decreased bone density and osteoporosis, relapse of psychosis because of poor compliance due to sexual dysfunction or depression, and perhaps cancer, although more research in this area is needed. Despite the serious nature of these effects, prolactin elevation is seldom detected because clinicians often fail to inquire about sexual function or other symptoms that signal that a patient's prolactin may be elevated. These are problems that patients may not bring up with clinicians unless they are asked. Therefore, when patients are taking antipsychotic medications, clinicians should regularly inquire about sexual dysfunction, depression, menstrual disturbances, galactorrhea, and gynecomastia.

Antipsychotic Agents↗
PubMedDate not supplied

Olanzapine in the treatment of developmental stuttering: a double-blind, placebo-controlled trial.

Stuttering is a speech disorder that affects one-percent of all adults and much has been learned recently of its neurologic correlates. Stuttering has been associated with excessive cerebral activity of the neurotransmitter, dopamine. Pharmacologic research has suggested that older generation dopamine antagonist (i.e. "typical antipsychotic") medications improve stuttering symptoms, but are associated with poorly tolerated adverse effects. The purpose of this study was to compare the efficacy and tolerability of olanzapine, a novel dopamine antagonist (or "atypical antipsychotic"), versus placebo in the treatment of adult developmental stuttering. Twenty-four adults who stutter participated in a twelve-week, randomized, double-blind, placebo-controlled trial conducted at two separate sites. Subjects received either olanzapine (2.5 mg titrated to 5 mg) or matching placebo. Subjects were rated on an objective measure of stuttering severity (SSI-3), a clinician based global impression (CGI), and a subject-rated self-assessment of stuttering (SSS). Subjects were also monitored for potential side-effects. Twenty-three of the twenty-four subjects enrolled in the trial successfully completed the full course of the study. Olanzapine was statistically superior to placebo on the three ratings of stuttering severity, the SSI-3, the CGI and SSS (p < .05). Olanzapine is a promising medication for the treatment of stuttering and further research is warranted.

Administration, Oral↗