[Drug prescriptions in general practice IV. Alterations in prescriptions of psychopharmaceuticals in general practice following easy access to psychiatric specialists].
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Biomedical subjects
Publications and source records attributed to L Kirk.
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The serum concentrations of cis(Z)-flupentixol after injection of 2% and 10% cis(Z)-flupentixol decanoate in Viscoleo (Depixol injection, Fluanxol Depot) have been investigated in a crossover study with eight schizophrenic patients. No statistically significant difference was found between the two preparations when the data from individual days or areas under the serum concentration curves were considered. For the individual patients a difference was found between the two treatments in six cases; one preparation gave the higher serum concentration in four cases and the other preparation in two cases. Thus, the difference found within individual patients reflects the intraindividual variation rather than a difference between preparations. The maximum serum concentration was seen at 4 or 7 days after injection. The maximum/minimum fluctuation ratio indicates that dosage intervals longer than 2 weeks seem reasonable for most of the patients. The similarity in the serum concentrations, no matter which concentration of flupentixol decanoate solution was given, indicates that a dispersal and possibly a metabolic breakdown of the oil depot takes place in the muscle.
The free and total plasma tryptophan concentrations were measured in 41 female depressive. Fifteen patients were subsequently treated with L-tryptophan. The free and total tryptophan were normal in the drug-free depressives and in the depressives on lithium. No significant in free and total plasma tryptophan were found between unipolar and bipolar depressed subjects, or between patients who recovered from depression following L-tryptophan therapy and patients who were resistant. The results suggest that the basal free tryptophan concentration in the plasma of depressed subjects is normal. They furthermore indicate that neither free nor total plasma tryptophan concentrations are valid predictors for the course of a treatment of depressed subjects with L-tryptophan.
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The effect of allopurinol on the kynurenine formation in three manic depressive patients, two in remission and on in depression, has been studied during long-term treatment with L-tryptophan. The patients were loaded with 100 mg L-tryptophan per Kg body weight prior to and after one week on allopurinol, 300 to 500 mg per day. The area under curve (AUC) of plasma total and free tryptophan increased slightly in the patients in remission but not in the depressive. The former showed no change in the AUC of plasma kynurenine whereas an increase was seen in the depressive. The results suggest that allopurinol does not inhibit the human tryptophan pyrrolase definitely during loadings with L-tryptophan.
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Two biochemical distinct groups of manic depressive patients seem to be present. One group showed a normal pattern of plasma amino acids and was resistant to oral tryptophan medication. Another group, characterized by a relative deficiency of tryptophan in plasma as measured by the ratio of total plasma tryptophan to competing amino acids, responded readily to tryptophan treatment. No significant differences could be demonstrated in the free tryptophan, total tryptophan, percentage of free tryptophan or kynurenine in the plasma between patients and controls. The findings are discussed in view of changes in the transport conditions of tryptophan from plasma into the brain.
Thirty patients on long-term treatment with chlorpromazine in moderate doses showed deposits in the lens, and the majority of the patients also showed deposits in the cornea. These deposits did not increase in the 13 patients who continued on chlorpromazine during an observation period of 31/2 years. Thus, when chlorpromazine is used in moderate doses, the deposits in the eyes seem to increase only up to a certain extent. Twelve patients who were switched over to thioridazine showed no change in the deposition in the lens and cornea after the observation period, indicating that the deposits are irreversible. After the observation period visual acuity had deteriorated somewhat in the material as a whole, presumably because of advancing age, not because of the deposits. The risk of using chlorpromazine in moderate dosage is slight.
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