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Biomedical subjects

M Hummer

Publications and source records attributed to M Hummer.

At least 37 records · Page 2Linked to original sources
PubMed1995

Extrapyramidal side effects of clozapine and haloperidol.

Neuroleptic-induced extrapyramidal side effects (EPS) were evaluated in 92 patients treated with clozapine for the first time and 59 patients treated with haloperidol followed in a drug monitoring program. Side effects were measured by the Columbia University Rating Scale, the Simpson Dyskinesia Scale and the Hillside Akathisia Scale. The cumulative incidence rate for tremor was found to be 24.4% in the clozapine group and 39.3% in the haloperidol group. This did not amount to a statistically significant group difference. Bradykinesia was observed in 21.8% of the patients treated with clozapine and in 47.7% of the patients of haloperidol (P = 0.011). In the clozapine group the akathisia incidence rate was 5.6%, whereas haloperidol patients showed a higher rate of 31.7% (P = 0.005). Our results show higher incidence rates of tremor and bradykinesia during clozapine treatment than previous studies. We conclude that clozapine is not entirely free of EPS, but they are usually less severe and of a different quality than side effects induced by typical antipsychotics.

Adult↗
PubMed1995

Weight gain induced by clozapine.

Patients were investigated to gain more insight into the incidence and time course of clozapine induced weight gain (n = 81) and to compare weight gain in patients treated with clozapine (n = 31) with that of patients treated with standard antipsychotics (haloperidol, n = 11). 35.7% of the patients treated with clozapine gained weight according to our definition. If patients gained weight on clozapine this side effect was apparent within the first 12 weeks of treatment. Deviation from normal body weight at the beginning of treatment showed a significant influence on weight gain. Sex, severity of illness, comedication, mean clozapine dose and degree of improvement did not show an influence on this side effect. Weight increase was significantly higher in patients treated with clozapine than in patients treated with haloperidol.

Adult↗
PubMed1995

A comparison of European and American dosing regimens of schizophrenic patients on clozapine: efficacy and side effects.

We present a comparison of the results from two studies of patients on clozapine. The American study (n = 84; Hillside Hospital, Glen Oaks, NY) and the European study (n = 63; Innsbruck University Clinics, Innsbruck, Austria) both examine efficacy and side effects in schizophrenic patients on this atypical neuroleptic. There is a very substantial difference in the dosing regimen used on both continents and this is reflected in the studies reported. A question with major clinical implications is whether the higher doses commonly used in the United States lead to a better outcome or a different profile of side effects. Outcome as a function of serum concentration will be examined. Results confirm a lower dose, lower clozapine blood level, and a lesser degree of side effects in the Austrian cohort when compared to the American sample. Surprisingly, the clinical efficacy of the lower dosing regimen was superior to the higher dose. Reasons for this anomaly are explored.

Adult↗
PubMed1994

EEG alterations in patients treated with clozapine in relation to plasma levels.

It is well known that psychotropic drugs can induce EEG alterations. Dose dependence seems established; however, there are no data concerning the impact of plasma levels. The authors investigated the influence of clozapine plasma levels on the frequency of EEG alterations. Data from 29 inpatients (18 male, 11 female, 31.7 +/- 10.2 years) receiving clozapine in a dose range between 25 and 600 mg were collected prospectively. There was no psychotropic or anticholinergic comedication. All patients had normal EEGs before taking clozapine. Fifteen patients showed pathological changes (group 2) and 14 no changes (group 1). Discriminant analysis showed that EEG changes are dependent on plasma levels (P = 0.0009, plasma levels in group 1 mean 81.6 ng/ml, +/- SD 64.6, in group 2 235.7 ng/ml, +/- 169.8). A total of 72.4% of the patients were correctly classified as having either pathological EEG changes or none by this analysis. Variables such as dose, age, sex, weight and duration of treatment were not statistically relevant. It can therefore be suggested that clozapine plasma levels are a valid indicator for the appearance of electrophysiological reactions.

Adult↗
PubMed1994

Assessment of the alcohol withdrawal syndrome--validity and reliability of the translated and modified Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-A).

The alcohol withdrawal syndrome is a common phenomenon in psychiatric hospital care. Not only treatment strategies, but also the evaluation of the syndrome, are discussed controversially. The most widely used instrument is the Clinical Institute Withdrawal Assessment-Alcohol (CIWA-A) and the succeeding CIWA-Ar. We modified the CIWA-A and translated it into German. Validity and reliability of the modified and translated scale were analysed by several psychological tests as well as different somatic measures in 31 patients. The German version appears to be a valid and reliable instrument for the assessment of alcohol withdrawal syndrome useful for clinical routine as well as treatment trials.

Alcohol Withdrawal Delirium↗
PubMed1994

[Hemosurveillance: the physician's point of view].

Physicians are overloaded with the new Health Department rules about follow-up of transfused patients. Indications of fresh frozen plasma must be restricted and its use must be decreased; patients must be informed before and after transfusion and all informations about transfusion must be collected in a special file. This file will permit to answer the question: "Who received what?" Incidents occurring during transfusion need to be collected and transmitted to the "Centre National d'Hémovigilance". Such a policy will be effective only with an actual help (i.e. financial help) of the administration.

Blood Transfusion↗
PubMed1994

Clozapine-induced transient white blood count disorders.

BACKGROUND: The aim of the study was to shed more light on the incidence and course of clozapine-induced transient white blood count (WBC) disorders. METHOD: In an analysis of our clozapine drug monitoring program, we evaluated the data of 68 patients receiving clozapine for the first time. Incidence rates were calculated by actuarial life table analysis. The potential influence of sex, age, dose, and plasma level was evaluated using discriminant analysis. RESULTS: Two patients developed progressive neutropenia, leading to agranulocytosis in one case. We also found the following transient hematologic dysfunctions: neutropenia (22.0%), eosinophilia (61.7%), and leukocytosis (40.9%). One patient showed chronic leukocytosis. Additionally, minor changes in the number of lymphocytes, monocytes, and basophilic granulocytes were detected in the study population. CONCLUSION: Hematologic side effects are frequently induced by the atypical antipsychotic clozapine. Next to agranulocytosis, a progressive and potentially lethal hematologic adverse effect, most of the WBC disorders are transient and appear to be harmless.

Actuarial Analysis↗
PubMed1994

Clozapine dose in the United States and Europe: implications for therapeutic and adverse effects.

The report (1) provides an overview of clozapine doses used in trials conducted in Europe and the United States, (2) compares data on efficacy, and (3) compares side effects of clozapine from recent European and U.S. investigations. The reviewed European trials used a mean dose of 283.7 mg/day, while the mean dose in the U.S. studies was 444 mg/day. Even though the mean doses used in the United States are considerably higher than those used in Europe, the response rates for the two continents are strikingly similar. The main differences in a comparison of two samples evaluated in New York and Innsbruck were found in the prevalence of seizures (Innsbruck, 0%; United States, 7.1%) and confusion (Innsbruck, 0%; United States, 14%). Excitement was less prevalent in the U.S. study. The data presented appear to suggest that a lower dose of clozapine may be as effective as a higher dose in the management of treatment-resistant schizophrenic patients and may cause fewer side effects.

Akathisia, Drug-Induced↗
PubMed1993

Intravenous flunitrazepam in the treatment of alcohol withdrawal delirium.

Alcohol withdrawal delirium (AWD) requires treatment with an adequate sedative, anticonvulsant, and antipsychotic agent next to general intensive care measures. Optimal medication should have a rapid onset of action and the possibility of parenteral application. A specific antagonist should be available. Flunitrazepam is a benzodiazepine that fulfills all these criteria. Twenty five patients suffering from AWD (mean age 45 years) took part in an open trial and underwent treatment with infusions of flunitrazepam (concentration: 8 mg/250 ml NaCl; speed, 250 ml/hr). Psychopathological, vegetative, and vital parameters were assessed every hour. All patients survived. They were treated with a mean total dose (SD) of 83.9 (45.4) mg of flunitrazepam (1.3 mg/kg body weight), which induced sedation 13.2 (5.3) min after the initiation of intravenous treatment. The mean duration of AWD (85.1 +/- 39.4 hr) corresponded to other studies, whereas the frequency of preexisting and concomitant diseases was higher (92%) in our patients. A patient who suffered from bronchitis and had a nasopharyngeal tamponade showed severe respiratory depression after having received 4 mg of flunitrazepam. This complication remitted immediately when 0.5 mg of flumazenil was given intravenously. No epileptic manifestation was observed during the treatment or after discontinuation of flunitrazepam. Vegetative and psychopathological symptoms (tremor, sweating, hallucinations, confusion, and restlessness) remitted rapidly. Our data suggest that intravenous flunitrazepam can be an efficacious and safe alternative to traditional treatment strategies of AWD.

Adult↗
PubMed1992

[Value of transcranial Doppler ultrasonography in patients with suspected brain death].

Transcranial Doppler ultrasonography (TCD) is a non invasive technique which assesses blood flow velocitics in basal cerebral arteries. Specific patterns have been observed in brain death. In a continuous series of 72 patients, the TCD recordings from the intracranial internal carotid and middle cerebral arteries were compared with the results from the usual investigations for brain death, such as electroencephalogramme (EEG), and arteriography. All the patients were clinically brain dead: Glasgow score of 3, apnoea, bilateral mydriasis, loss of cortical function and cerebral reflexes. This clinical diagnosis was confirmed by and isoelectric EEG with or without angiographic circulatory arrest. Two characteristic patterns were identified: an oscillating to and fro signal, with a positive sharp systolic peak and a negative diastolic reflux; and a systolic peak without any diastolic component. The absence of signal on both sides did not allow any conclusion, except when this pattern occurred during follow-up. The oscillating pattern was seen on both sides in 60 patients (83%), and, in 3 other patients, only on one side, always combined with a contralateral systolic peak pattern, in 3 other patients. A bilateral systolic peak pattern was identified in 7 patients (10%). The TCD results were compared with angiography in 37 cases. TCD circulatory arrest preceded angiographic arrest by six hours in three cases. Hypotension was the main limitation to this technique. n the other hand, TCD may be used in patients treated with sedative drugs. The non invasive character of TCD, its low cost, the possibility of repeating it at the patient's bedside make TCD a very interesting diagnostic tool.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Transient neutropenia induced by clozapine.

Blood dyscrasias are frequently reported to be induced by the atypical antipsychotic clozapine. Next to agranulocytosis, a potentially lethal form of these side effects, hematologic disturbances include leucocytosis, eosinophilia, and neutropenia. Neutropenia is of considerable clinical relevance because it can be a sign of incipient agranulocytosis. In an analysis of our clozapine drug monitoring program, we have analyzed the data from 68 patients receiving clozapine for the first time. Neutrophil granulocytes dropped to 290 and 660/mm3 in 2 patients, both recovered after the discontinuation of clozapine. Another patient with a granulocyte count of 1800/mm3 was stopped because regular white blood cell monitoring was not possible. Eight additional patients demonstrated a transient decrease of granulocytes during ongoing clozapine administration. This amounts to a cumulative incidence of transient neutropenia of 22 percent (95% confidence interval 7.5%-36.5%).

Adult↗
PubMed1992

Granulocyte-macrophage colony-stimulating factor (GM-CSF) treatment of clozapine-induced agranulocytosis: a case report.

BACKGROUND: Granulocytopenia and agranulocytosis are severe side effects of clozapine therapy. Even if these side effects are detected early and if clozapine is discontinued, patients suffering from agranulocytosis are extremely endangered by infectious diseases for up to 3 to 4 weeks until hematologic recovery. Therefore, any treatment that reduces this critical time span would decrease the risks of clozapine treatment. METHOD: The case of a patient in whom severe agranulocytosis developed after 7 weeks of clozapine treatment is presented. RESULTS: After clozapine discontinuation, treatment with granulocyte-macrophage colony-stimulating factor (GM-CSF), a glycoprotein that has been shown to stimulate the proliferation of precursor cells in the bone marrow and their differentiation into granulocytes and macrophages, was initiated. Under GM-CSF treatment, total granulocyte count rose from 63/cu mm to a value greater than 1500/cu mm within 5 days without complications or major side effects. CONCLUSION: This case report suggests that treatment with GM-CSF may lower the risks associated with clozapine-induced agranulocytosis and therefore may indirectly improve the safety of clozapine therapy.

Adult↗
PubMed1987

[The value of prick tests in the detection of anaphylaxis caused by muscle relaxants].

Intradermal tests (IDR) are a sure diagnostic procedure for confirming the IgE origin of anaphylactoid accidents due to muscle relaxant drugs. Because carrying these out and interpreting them correctly is difficult, epidermal prick-tests (PT) could be used if they proved as sure as IDR. To ascertain this, IDR and PT were carried out in 38 patients who had a shock after being given a muscle relaxant 6 months to 5 years previously; for these tests, increasing concentrations of five muscle relaxants were used (suxamethonium, gallamine, alcuronium, pancuronium and vecuronium). The PT were also carried out with the five same pure and diluted muscle relaxants in a group of 147 volunteer controls. For the 38 patients, PT and IDR were always positive for the same drugs, but at different concentrations, the epiderm seeming less sensitive than the derm (with a ratio of 1 to 100). In the control group, all the tests were negative, even with the pure drug. PT with muscle relaxants were sensitive, specific of anaphylaxis, and permanent. Easy to carry out, easily interpreted, they could be useful as tests for predicting latent sensitisation in risk patients requiring muscle relaxants. But all muscle relaxants must be tested, and not just the one the anaesthetist is likely to use.

Adolescent↗