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Biomedical subjects

L Citrome

Publications and source records attributed to L Citrome.

12 recordsLinked to original sources
PubMed1997

New antipsychotic medications: what advantages do they offer?

New, so-called atypical antipsychotic medications will no doubt supplant the traditional, or "typical," antipsychotic medications, just as the new generation of antidepressant agents has replaced the older tricyclic drugs. At issue with most of the new drugs is not acute efficacy, but long-term tolerability. Side effects must be minimized to enhance compliance and prevent relapse. It appears that many of the new antipsychotic drugs have fewer or less troublesome side effects than the older agents. In addition, the "atypical" antipsychotic agents hold promise for treating refractory schizophrenia. At present, only clozapine, with its risks for agranulocytosis and seizures, is clearly established as a treatment for refractory illness. Risperidone may be an alternative for treatment-resistant schizophrenia, but this has not yet been clearly proved. Olanzapine has recently been introduced. Sertindole should be available soon, and quetiapine and ziprasidone should quickly follow. Safety, efficacy, and cost will guide their use. None of these newer agents have been compared head-to-head with clozapine. More research is needed to place these new drugs into clinical perspective.

Antipsychotic Agents↗
PubMed1996

Adjunctive nadolol in the treatment of acutely aggressive schizophrenic patients.

BACKGROUND: This study assessed the safety and efficacy of nadolol 120 mg/day compared with placebo, when administered adjunctively to neuroleptic in a group of acutely aggressive schizophrenic patients. METHOD: Thirty-four male patients enrolled in this double-blind, placebo-controlled trial. The subjects were evaluated with the Brief Psychiatric Rating Scale (BPRS) and the Simpson Angus Neurologic Rating Scale for extrapyramidal effects. The total BPRS score as well as three factors, thought disturbance, hostility, and activation, was analyzed. RESULTS: Compared with those who received placebo, the patients taking nadolol showed significant improvement on total BPRS score, particularly on the thought disturbance and activation factors, after the first treatment week (p = .05). By the end of the second treatment week, the patients taking placebo also began to show improvement, and the group differences were no longer significant. The patients treated with nadolol showed significantly more improvement on Simpson-Angus scores than those who received placebo (p = .03). However, there was no significant correlation between BPRS and Simpson-Angus changes. In the nadolol group, patients with and without akathisia showed no significant difference in their BPRS scores. CONCLUSION: These findings suggest that adjunctive nadolol may be useful in the treatment of acutely aggressive schizophrenic patients by inducing a more rapid and consistent decrease of overall psychiatric symptoms and by reducing the extrapyramidal effects. Our results raise the possibility that the mechanism of action of nadolol on psychiatric symptoms in schizophrenic patients may be different from the mechanism of improvement of neuroleptic-induced extrapyramidal symptoms and akathisia. Nadolol may be a helpful adjunctive treatment for schizophrenic patients in general and not just for those with a high hostility level.

Acute Disease↗
PubMed1996

Utilization of depot neuroleptic medication in psychiatric inpatients.

This report describes the extent and pattern of use of depot neuroleptics within the 21 adult civil psychiatric hospitals operated by the New York State Office of Mental Health (OMH). All inpatients receiving depot or oral neuroleptics in calendar year 1994 were identified. In addition to descriptive data on admission and drug orders, a logistic regression was fit using gender, age, race, and facility for the probability of receiving depot. Depot utilization ranged from 12 percent to 39 percent of all patients receiving neuroleptics (N = 18,543). Differences among facilities were statistically significant (p < .05). Gender was not found to be a statistically significant factor, but blacks and Hispanic/others were found to be more likely than whites to receive depot (p < .05), and those 65 years or older were found to be less likely to receive depot (p < .05). For patients admitted in 1994, depot neuroleptics were typically started within a month or two of admission and continued for 2 to 3 months, with 86 percent of these patients discharged by December 31, 1995. Except for milligram dose and frequency of injection, haloperidol decanoate and fluphenazine decanoate did not differ in terms of extent and pattern of use.

Adult↗
PubMed1995

Clinical and administrative consequences of a reduced census on a psychiatric intensive care unit.

The Psychiatric Intensive Care Unit at the FDR VA Hospital is a specialized ward designed to assess and treat suicidal and assaultive patients. Since its creation in 1983, over 1600 admissions have taken place. The authors have previously reported that patients referred for aggressive behavior had a statistically significant higher recidivism rate, as well as a statistically significant longer length of stay. The unit went through several changes in response to externally perceived needs and available resources. When the census cap was decreased, the referral pattern changed and the patients were even more likely to be aggressive. Length of stay decreased dramatically leading to a unit with a significantly higher turnover rate. Clinical and administrative concerns are also discussed.

Aggression↗
PubMed1994

Management of depression. Current options for this highly treatable disorder.

Depression is a common disorder that leads to substantial functional impairment and even death if untreated. Suicide rates in persons with untreated major depression can be as high as 30%. However, the disorder is treatable; pharmacotherapy in combination with psychotherapy is effective in up to 90% of patients. Established diagnostic criteria enable physicians to differentiate major depression from other psychiatric disorders and from somatic conditions that may mimic depression. Current treatment options include traditional antidepressant medications as well as the newer serotonin-reuptake inhibitors. Successful treatment depends on administration of an appropriate dose for an adequate duration.

Antidepressive Agents↗
PubMed1990

The dangerous agitated patient. What to do right now.

Short-term management of the agitated patient involves the use of psychological, behavioral, diagnostic, and pharmacologic options. Knowledge of verbal interventions may help physicians prevent personal injury and destruction of property. Accurate diagnosis allows safe and effective pharmacologic intervention. Involuntary treatment in emergency situations is legal; however, clearly documenting all clinical events is essential.

Adult↗
PubMed1990

A double-blind, placebo-controlled study of adjunctive nadolol in the management of violent psychiatric patients.

We report a controlled 3-week study (n = 30) of adjunctive use of nadolol, 80 to 120 mg per day, vs. placebo for the management of violent psychiatric patients. There were no remarkable adverse cardiac effects at this dose. The active treatment group showed lower total Brief Psychiatric Rating Scale (BPRS) scores after the first week of treatment (analysis of covariance [ANCOVA], p less than .08) and similar trends for the activation factor and the hostility scale. There were parallel findings for measures of extrapyramidal symptoms (EPS) (Simpson-Angus Neurological Rating Scale), which were reliable after the second week (ANCOVA, p less than .02). A significant association between changes in EPS and BPRS scores was found by regression analysis, after the effects of baseline measures were removed. Given that nadolol does not penetrate the central nervous system well, the antiaggressive effects may be associated with sympathetic nervous system feedback mechanisms.

Adult↗
PubMed1989

Differential diagnosis of psychosis. A brief guide for the primary care physician.

By keeping in mind that not a psychosis is schizophrenia, the primary care physician can often avoid misdiagnosis in behaviorally disturbed patients. Abnormal behavior may result from mood disorders, drug-induced psychosis and other organic disorders, personality disorders, delusional disorders, autism, or mental retardation. A long-term history is essential for correct diagnosis and treatment.

Affective Disorders, Psychotic↗