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P Decina

Publications and source records attributed to P Decina.

At least 19 recordsLinked to original sources
PubMed1994

Adjunctive trazodone in the treatment of negative symptoms of schizophrenia.

OBJECTIVE: The study examined whether adjunctive treatment with trazodone would reduce negative symptomatology in patients with chronic, residual schizophrenia. METHODS: Patients selected for the study had an established clinical diagnosis of chronic schizophrenia with stable symptomatology, an absence of florid psychotic symptons, a stable regimen of neuroleptic medication, and an absence of depressive disorder. Active psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS) score on the thinking disturbance factor. Negative symptoms were assessed using the BPRS withdrawal retardation factor as well as the affective flattening and alogia subscales from the Scale for Assessment of Negative Symptoms. Forty-nine patients were randomly assigned to either trazodone or placebo in a six-week double-blind trial. RESULTS: Forty-seven patients, 23 men and 24 women with an average age of 60 years, completed the six-week trial. Twenty-six of the patients received trazodone. Adjunctive treatment with trazodone significantly reduced the severity ratings on two of three measures of negative symptoms and did not significantly increase the severity of positive symptoms; however, the magnitude of the therapeutic effect was modest. The scores for negative symptoms were reduced by approximately 10 to 15 percent, and only three of the 26 actively treated patients showed moderate clinical improvement. CONCLUSIONS: Trazodone, used in conjunction with neuroleptics, mildly reduces the severity of negative symptoms in residual schizophrenia and does not exacerbate florid psychosis. The potential benefits of adjunctive trazodone therapy may outweigh the risk of worsening psychosis.

Analysis of Variance↗
PubMed1993

Birth weight and CT scan findings in chronic schizophrenic patients.

The relations of birth weight to CT scan measures of lateral ventricular size, third ventricular size, frontal cortical sulcal prominence, and parieto-occipital cortical sulcal prominence were examined in 24 chronic schizophrenic patients. In contrast to the inverse correlation between birth weight and ventricular size found among offspring of schizophrenic parents in the Danish High-Risk Study, and the predictions of the subsequent hypothesis, no significant relations between birth weight and CT scan measures were observed in this study.

Adult↗
PubMed1992

Painful sensory symptoms in neuroleptic-induced extrapyramidal syndromes.

OBJECTIVE: The authors tested the hypothesis that neuroleptic-induced extrapyramidal syndromes are associated with painful sensations objectively conforming to the characteristics of primary sensory symptoms as reported in idiopathic and postencephalitic parkinsonism. METHOD: The frequency of subjective painful sensory symptoms and their relation to neuroleptic-induced extrapyramidal syndromes were examined in a consecutive series of 107 psychiatric patients newly admitted to acute care units at a teaching hospital. Patients without illnesses or conditions likely to be associated with pain were included in the study if they had a diagnosis other than organic mental syndromes and were receiving psychotropic medications as prescribed by their treating physicians. Structured interviews with a modified version of the McGill Pain Questionnaire to assess sensory complaints and neurological examinations for neuroleptic-induced extrapyramidal syndromes (parkinsonism and akathisia) were conducted independently by two raters blind to each other's findings and patients' medication status. RESULTS: Fourteen (23%) of 60 patients receiving neuroleptics reported experiences of spontaneous pain subjectively attributed to pharmacological treatment, compared with only one (2%) of 47 patients receiving psychotropic medications other than neuroleptics. There was no difference between these two groups in subjective complaints of paresthesia (8% versus 9%). Twelve (55%) of the 22 patients with neuroleptic-induced extrapyramidal syndromes reported pain, compared with only two (5%) of the 38 patients who received neuroleptics but did not experience extrapyramidal syndromes. CONCLUSIONS: Although consonant with the study hypothesis, these results should be regarded as preliminary and interpreted conservatively in the light of the methodological limitations of the study.

Adult↗
PubMed1991

Patterns of illness in parent-child pairs both hospitalized for either schizophrenia or a major mood disorder.

Results are reported of a blind rediagnosis of a consecutive series of parent-child pairs hospitalized with a diagnosis of schizophrenia or mood disorder. Patterns of illness in pairs meeting DSM-III-R criteria for either disorder were examined by contrasting the two generations on their respective distributions of diagnoses, and means of age at onset and severity of illness. While no case of mood disorder was found in the children of schizophrenic parents, 50% of the children of parents with psychotic mood disorders presented with schizophrenia. The offspring also had an earlier age at onset of illness than did their parents.

Adult↗
PubMed1990

Cigarette smoking and neuroleptic-induced parkinsonism.

Several studies have reported an apparent protective effect of cigarette smoking for the risk of idiopathic Parkinson's disease (IPD). These observations are supported by neurochemical studies demonstrating enhancement of central dopaminergic neurotransmission by nicotine. We studied the prevalence and severity of neuroleptic-induced parkinsonism (NIP) in relation to cigarette smoking in a homogeneous sample of 130 psychiatric inpatients receiving long-term neuroleptic treatment. Despite the fact that smokers had significantly higher dosage of neuroleptics during the month prior to evaluation and longer exposure to medication, they presented with significantly less prevalence and severity of NIP than nonsmokers. These findings suggest that the inverse association between smoking and IPD may apply to NIP.

Antipsychotic Agents↗
PubMed1990

The rabbit syndrome.

Explore the source record for details and available documents.

Antipsychotic Agents↗
PubMed1990

The impact of medication resistance and continuation pharmacotherapy on relapse following response to electroconvulsive therapy in major depression.

After clinical response to electroconvulsive therapy (ECT), 58 patients with major depressive disorder were followed for 1 year or until relapse. The rate of relapse was substantially higher in patients who had failed adequate antidepressant medication trials prior to ECT than in patients not determined to be medication resistant. Adequacy of post-ECT pharmacotherapy was only marginally related to likelihood of relapse. The subgroup of patients who appeared to benefit from adequate post-ECT pharmacotherapy were those who did not receive an adequate medication trial prior to ECT. The findings call into question the common practice of administering as continuation pharmacotherapy following ECT the same class of medications that patients had failed with during the acute episode prior to ECT. The findings also indicate that resistance to antidepressant medication is a strong predictor of relapse following response to ECT.

Aged↗
PubMed1990

Subjective awareness of abnormal involuntary movements in chronic schizophrenic patients.

The authors examined the effects of verbal and visual feedback on subjective awareness of involuntary movements in 20 chronic schizophrenic patients. At initial evaluation only 25% of the patients were fully aware of their movement disorder. Both verbal and visual feedback resulted in significant immediate enhancement of awareness. However, assessment of awareness 2 weeks later showed a return to prefeedback baseline levels. Lack of awareness of involuntary movements was associated with a lack of awareness of psychiatric disorder, and both were associated with a longer duration of illness.

Adult↗
PubMed1988

The development of mania and organic euphoria during ECT.

Mania that develops in depressed patients who are undergoing ECT is relatively uncommon and may occur more frequently in bipolar patients. The authors' review of three cases illustrates the importance of the clinician distinguishing mania from organic euphoric states that can also develop during ECT. Severity of cognitive impairment and the presence of silly or inappropriate laughter are useful in making this distinction. Capacity to clinically evaluate the persistence of depressive symptoms should determine whether ECT can continue when an organic euphoric state develops.

Adult↗
PubMed1988

Lithium in the treatment of bipolar disorders associated with epilepsy: an open study.

Eight DSM-III bipolar patients with seizure disorders were treated in an open study evaluating the effects of maintenance lithium treatment on affective relapses and clinical seizure activity. Lithium was effective in preventing the recurrence of affective episodes without worsening seizure frequency in patients with active seizures and did not induce seizures in those whose seizures were in remission. One patient showed remission of both affective and seizure symptoms on lithium alone. Lithium appears to be safe and effective in bipolar disorders associated with epilepsy and may have an anticonvulsant effect in some patients.

Adult↗
PubMed1987

Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement, and number of treatments.

In a random-assignment trial to unilateral right and bilateral electrode placements, electroconvulsive therapy (ECT) stimulus intensity was titrated to just above seizure threshold for each of 52 depressed patients. Seizure threshold was quantified in units of charge. There was a 12-fold range in the minimum electrical intensity necessary to produce seizure. Sex, age, electrode placement, and the cumulative number of treatments were each associated with seizure threshold. Bilateral ECT had both a higher initial seizure threshold and a greater cumulative increase in seizure threshold compared with unilateral ECT. Clinical and research implications are discussed with respect to dosing strategies in ECT.

Adult↗
PubMed1987

Studies of dosage, seizure threshold, and seizure duration in ECT.

Seizure threshold, defined as the minimal electrical dosage necessary to elicit adequate generalized seizure, was determined throughout the course of electroconvulsive therapy (ECT) in depressed patients randomly assigned to bilateral and right unilateral treatment, with brief pulse, constant current stimulation. In Study 1, it was found that seizure threshold may be more accurately measured using the unit of charge compared to the traditional unit of watt-second. In Study 2, it was found that seizure threshold was associated with seizure duration. Patients with high thresholds had shorter seizure durations. This indicated that the seizure threshold measure assesses in part functional neural activity. In Study 3, it was found that failure for seizure threshold to increase substantially over the course of ECT was associated with poor clinical outcome. In Study 4, it was found that electrical dosage at threshold was not related to magnitude of acute cognitive impairments. This suggested that the degree to which dosage exceeds threshold may be more strongly tied to adverse effects than the absolute dosage administered to patients. Implications of the data are discussed, particularly in relation to a hypothesized link between the anticonvulsant properties of ECT and its mechanism of therapeutic action.

Cognition Disorders↗
PubMed1987

Serial dexamethasone suppression tests in initial suppressors and nonsuppressors treated with electroconvulsive therapy.

Four different methods of quantifying the 1-mg Dexamethasone Suppression Test (DST) were contrasted with serial testing in endogenous depressives receiving electroconvulsive therapy (ECT). Of three continuous measures in 38 patients with pretreatment DSTs, only the log-transformed value for plasma cortisol was normally distributed, indicating that it possessed superior psychometric properties. Pretreatment Hamilton Depression Rating Scores (HAM-D) correlated positively with pretreatment DST status, with a similar association noted between posttreatment DST status and HAM-D scores. There was no uniform effect of ECT on the DST. Although pretreatment nonsuppressors showed a trend toward decreased postdexamethasone cortisol values, initial suppressors (cutoff: 5 micrograms/dl) evidenced a significant increase in these values, and 35.3% of initial suppressors were nonsuppressors at final DST assessment. These trends were noted in the DST assessment done following the third ECT treatment, suggesting an effect of regression to the mean. The findings highlight the importance of following initial DST suppressors in studies of this type.

Depressive Disorder↗
PubMed1987

Effects of ECT on the TRH stimulation test.

The prognostic value of the TRH stimulation test was evaluated in 23 inpatients with major depressive disorder before and after a trial of ECT. In contrast to previous reports, the peak TSH response to TRH was significantly decreased after treatment compared with before treatment. This effect was consistent across individuals and subgroups (responders/nonresponders; unilateral/bilateral ECT). The particular ECT technique used in the study may account for the discrepancies between these findings and those previously reported by other authors.

Aged↗
PubMed1987

Acute effects of ECT on cardiovascular functioning: relations to patient and treatment variables.

In 34 patients with primary, major depressive disorder, randomly assigned to bilateral or right unilateral ECT, heart rate (HR) and blood pressure (BP) were assessed prior and following seizure induction at every treatment. In contrast to prior reports, no cumulative pattern was observed in HR or BP changes as a function of treatment number. Generally, treatment variables, including ECT modality (bilateral vs. unilateral), anesthetic agent (methohexital vs. pentothal), and prior subconvulsive stimulation in a session, had no effects on the magnitude of peak postictal increases in HR or BP. The peak changes were also unrelated to the history of cardiac illness, remission of depressive symptomatology, patient seizure threshold and patient seizure duration. Pre-treatment HR was strongly predictive of peak postictal change in both HR and BP, while pretreatment BP was not. Patients with high pre-ECT HR had smaller peak postictal HR and BP increases. The findings suggested that low dosage, titrated ECT has HR and BP effects similar to traditional high dosage techniques, and that pre-treatment HR is the best predictor of these effects.

Blood Pressure↗
PubMed1987

Continuation ECT in the management of relapses of major affective episodes.

Three cases are reported describing the use of continuation ECT. Continuation ECT consisted of six to twelve treatments for about 3 to 6 months after recovery from the index affective episode. Continuation ECT may be indicated in patients with a severe episode of illness, optimal acute response to ECT, and negative response to continuation drug therapy. In such patients, the mostly theoretical risks associated with the procedure may be outweighed by the dangers associated with early relapse.

Adult↗
PubMed1987

Effects of electrode placement on the efficacy of titrated, low-dose ECT.

This double-blind, random-assignment study contrasted the relative efficacy of bilateral and unilateral right ECT with a low-dose titration procedure. In 52 patients with primary major depressive disorder, bilateral ECT was markedly superior in short-term symptom reduction to unilateral right ECT. The two conditions did not differ in the duration of generalized seizures or in the number of treatments administered to achieve clinical response. The findings challenge the claim that the elicitation of generalized seizure is, in and of itself, sufficient for the antidepressant properties of ECT. Rather, a dose in excess of seizure threshold may contribute to the efficacy of ECT, particularly with a unilateral right electrode placement.

Clinical Trials as Topic↗