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Biomedical subjects

R Grohmann

Publications and source records attributed to R Grohmann.

At least 37 records · Page 2Linked to original sources
PubMed2001

Disinhibition of libido: an adverse effect of SSRI?

BACKGROUND: The article focuses on adverse drug reactions (ADR) to selective serotonin reuptake inhibitors (SSRI) concerning libido and sexual behaviour: cases of disinhibition of libido observed at the Psychiatric Hospital of Kilchberg near Zurich are described. METHOD: Within the scope of a drug safety program, the physicians of the hospital are regularly asked about severe and unexpected events under drug treatment. RESULTS: During remission of depression, five outpatients noticed an increase of libido experienced as strange to them, i.e. preoccupation with sexual thoughts, first appearance of promiscuity, of unsafe sexual intercourse, and of excessive pursuit of pornography, respectively, during administration, change in dose or discontinuation of SSRI. DISCUSSION: The case studies suggest that SSRI treatment might be associated with increase and disinhibition of libido. The phenomena are discussed as a "selective switch" into partly manic symptomatology or an induction of mixed states with prevailing sexual symptoms.

Adult↗
PubMed2001

Asymptomatic bradycardia associated with amisulpride.

Well-known adverse effects of amisulpride include nausea, insomnia or tiredness, gastrointestinal, extrapyramidal and endocrine symptoms. Cardiac disorders, however, appear to be an extremely rare complication of the drug. Only a few case reports on this complication have been published so far, which deal with QT prolongation, hypotension, hypertension and palpitations. Bradycardia has not yet been mentioned. Here, we will report on a case of asymptomatic bradycardia that developed subsequent to therapeutic doses of amisulpride in a 25-year-old male patient with chronic paranoid-hallucinatory schizophrenia. The patient had been rehospitalized for an acute exacerbation of the psychosis. When the patient failed to respond at the beginning of hospitalization, the treatment was changed from clozapine to amisulpride. After a complete switchover to amisulpride, the patient's ECG showed sinus bradycardia and QT prolongation. When the daily dose of amisulpride was reduced from 800 mg/d to 600 mg/d, the patient's ECG quickly normalized (including blood pressure and pulse rate) within a few days. The patient did not report any cardiovascular-related complaints. Since the cardiovascular-specific diagnostics did not yield any indicative results, bradycardia may be a rare complication of amisulpride treatment.

Adult↗
PubMed2000

[New antidepressant drugs. What side effects and interactions are to be expected?].

The new antidepressants, selective serotonin reuptake inhibitors (SSRI), selective serotonin noradrenalin reuptake inhibitors (SSNRI) and selective noradrenalin reuptake inhibitors (SNRI) have few clinically relevant side effects. Overall, the new antidepressants are better tolerated and cause fewer side effects than the classical tricyclic antidepressants (TCA). They have virtually no anticholinergic effects, a low level of toxicity, and produce no psychomotoric or cognitive impairment. Both the frequency and severity of gastrointestinal and CNS side effects, as well as tremor, are low. The results of the drug safety program (AMSP) confirm the good tolerability and low clinical side effects of these new substances.

Antidepressive Agents↗
PubMed2000

[Schizophrenic psychoses and suicide in the clinic. Risk factors, psychopharmacologic treatment].

For all 5,352 patients treated for schizophrenia at the Psychiatric Hospital of the University of Munich in 1981 and 1992, detailed routine and data processing-assisted documentations were made of the psychopharmacological therapies. Nineteen of the patients committed suicide while undergoing inpatient treatment; the control group consisted of all other patients (n = 5,333). More than 77 sociodemographic and anamnestic variables as well as 195 items from the admission summaries were taken into account while comparing the groups. Furthermore, the pharmacological data were classified according to drug groups and comparison was based on the mean frequency of prescription of each group. We analyzed the mean number of prescriptions for neuroleptics, tranquilizers, and antidepressants, which were further differentiated into sedating and nonsedating types. For frequently administered drugs, mean daily doses were also compared. Bivariate analysis of the data suggests that the suicide cases presented depressive signs, symptoms, and tendencies already present on admission more frequently than with controls; the same applies to previously attempted suicides. Discriminating analysis showed that the variables "feeling of loss of feelings," thought insertion," "visible depression," "free-floating anxiety," "suicidal tendencies," and "previously attempted suicide" have the greatest predictive value with respect to suicide, in descending order. No differences in psychopharmacological treatment between suicides and controls were found, apart from a significantly higher percentage of antidepressive treatments and a higher mean number of antidepressant prescriptions for the suicides.

Adult↗
PubMed2000

Pisa syndrome (pleurothotonus): report of a multicenter drug safety surveillance project.

BACKGROUND: Pisa syndrome is usually regarded as a rare adverse event of neuroleptic medication. However, its frequency and predisposing factors have yet to be defined. Here, we investigated risk factors of Pisa syndrome occurring in a large population of psychiatric patients surveyed during a multicenter drug safety project. METHOD: Twenty episodes of Pisa syndrome were documented in 17 patients within a population of 45,000 psychiatric patients monitored by a multicenter drug safety surveillance project (Projekt zur Uberwachung der Arzneimittelsicherheit in der Psychiatrie) between 1990 and 1997. All results were related to the epidemiologic data provided for this population and systematically analyzed regarding history of medication, current medication, comedication, and clinical course. RESULTS: A constellation of putative risk factors was found in the majority of patients: previous treatment with classical neuroleptics, combined pharmacologic treatment, female gender, old age, and the presence of an organic brain disorder. Given these risk factors, Pisa syndrome was also documented with atypical neuroleptic drugs such as clozapine, olanzapine, and sertindole. CONCLUSION: We conclude that Pisa syndrome is a very rare adverse event occurring with neuroleptic treatment. In patients exhibiting the reported constellation of risk factors, neuroleptic drugs should be administered with particular caution.

Adult↗
PubMed1999

Assessment of adverse drug reactions in psychiatric inpatients with the AMSP drug safety program: methods and first results for tricyclic antidepressants and SSRI.

The AMSP (Arzneimittelsicherheit in der Psychiatrie) study is a new program for continuous assessment of adverse drug reactions (ADR) in psychiatric inpatients under naturalistic conditions of routine clinical treatment. It is based on the preceding drug surveillance study AMUP (Arzneimittelüberwachung in der Psychiatrie). Currently, 29 hospitals are participating in the study. This paper reports on the methods of the AMSP study and the first findings on the comparative risks of tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRI) . Data assessment is restricted to "severe" ADR as defined in the study protocol. Drug use is estimated from reference day data. From 1993 to 1997, 896 cases of severe ADR were observed in 48,564 patients (1.84%). SSRI and the new substances mirtazapine and venlafaxine were increasingly used as antidepressants (AD), but TCA were still the most common AD in 1997 (52.1% of all AD patients). Similar rates of ADR were observed for SSRI and TCA (1.7% and 1.5%, respectively, for all cases, 0.9% and 1.0%, respectively, only for cases rated as probable). However, different types of ADR occurred with the two AD subgroups; whereas toxic delirium and increased liver enzymes were the most frequent ADR related toTCA, nondelirious psychic and neurologic ADR predominated with SSRI. The duration of inpatient treatment was considerably longer in patients who experienced an ADR due to TCA or SSRI than in those who did not. The AMSP study promises to contribute greatly to drug safety by providing the relative frequencies of severe ADR from a large-scale database and by improving our knowledge of ADR.

Adult↗
PubMed1999

Two cases of olanzapine-induced reversible neutropenia.

Olanzapine is a tricyclic neuroleptic agent that due to structural similarities was expected to be a safe alternative to clozapine, which has a 0.5-2% risk of agranulocytosis. So far, only rare cases of leukocytopenia and thrombocytopenia have become known. In the association, "Drug Safety in Psychiatry", which is made up of 25 German psychiatric hospitals, two cases of olanzapine-induced neutropenia occurred in patients with chronic schizophrenia. The adverse drug reaction was noticed 17 days after the first intake of olanzapine in case 1 and more than 5 months after the first intake in case 2. In the second case, a reexposure to olanzapine caused the neutrophil cells to decrease again. There were no clinical signs of an infection, and the blood cell counts increased immediately to normal ranges after discontinuation of olanzapine. No special treatment was necessary.

Adult↗
PubMed1998

Risk factors for suicides of inpatients with depressive psychoses.

Research on identifying the relevant risk factors for suicides is faced with a multitude of methodological problems. The present study attempts to improve on some of these problems and to isolate those risk factors that are accessible in the early stages of the treatment of inpatients. A total of 3792 inpatients with monopolar or bipolar depression were treated during the period 1981-1992. Suicides (n=33) and controls (n=3759) were compared with respect to 77 sociodemographic and anamnestic variables and 195 standardised items of the admission summary. In addition to an analysis of contingency tables a discriminant analysis was performed. The suicide rate of patients with depressive psychosis was 2.7 times higher than the average rate of 0.324% for the entire clinic. Suicidal tendencies on admission proved to be the best predictor with a frequency of 91% in the suicide group and 40% in the control group, previous attempted suicide being the second best predictor. We conclude that the rate of inpatient suicide may have been underestimated for methodological reasons in the past decades. Many of the risk factors discussed in the literature may be of little predictive value at least in the initial stages of hospital treatment.

Adult↗
PubMed1993

Adverse psychic reactions to psychotropic drugs--a report from the AMUP study.

The AMUP study (AMUP = Arzneimittelüberwachung in der Psychiatrie (Drug Monitoring in Psychiatry)) was conducted from 1979 to 1989 in order to provide for a systematic and standardized assessment of all adverse reactions to psychotropic drugs under the conditions of routine clinical treatment at two psychiatric hospitals. This paper presents data from the AMUP study on the type and frequency of adverse psychic reactions to psychotropic drug groups and relevant single drugs. Psychic ADR leading to drug discontinuation were observed in 4.5% of 15,264 inpatients monitored over an eight-year period. Only neurological ADR were more frequent (4.9%). Neuroleptics and antidepressants were involved with similar frequencies in ADR that were at least "probably" drug-related (3.3 and 3.5%). Lithium salts and benzodiazepines were only rarely involved in psychic ADR. Toxic delirium (1.0%), agitation (0.9%), and sedation (0.8%) were the most frequent single events, usually rated as "probably" drug-related. Depression and psychotic states were next in frequency, but judged as only "possibly" drug-related in a considerable proportion of cases. Haloperidol, the most common high-potency neuroleptic, was imputed mainly for depression, sedation, agitation, and (malignant) neuroleptic syndrome; with medium-potency perazine, toxic delirium and sedation prevailed; among the most common antidepressants, amitriptyline was above all connected with toxic delirium, while with clomipramine agitation predominated. The paper discusses the particular difficulties encountered in the field of psychic ADR in psychiatric patients regarding causality assessment, and emphasizes the need for continuous ADR assessment studies including state hospitals.

Adult↗
PubMed1990

Extrapyramidal symptoms in neuroleptic recipients.

Adverse drug reactions (ADRs) in psychiatric therapy were continuously assessed in the AMUP study (AMUP = Arzneimittelüberwachung in der Psychiatrie (drug surveillance in psychiatry] conducted at two psychiatric university departments in the F.R.G. The Intensive Drug Monitoring (IDM) method was used to monitor 1107 patients, 754 of whom received neuroleptics (NLs). As is the rule in clinical psychiatric practice, polypharmacy was frequent, with combinations of two neuroleptics and combinations of a neuroleptic and an antiparkinson drug ranking first and second, respectively. Extrapyramidal motor symptoms (EPMS) were observed in 35% of the NL patients. In most cases they required a change in medication, usually addition of an antiparkinson drug. In about one quarter of all EPMS cases, withdrawal of the imputed NL was necessary. Parkinsonism was the most frequent single symptom, followed by acute dystonia and akathisia. Differences in EPMS rates between the two most frequently used neuroleptics, haloperidol, a high-potency butyrophenone, and perazine, a medium-potency phenothiazine, were distinct. EPMS were observed with haloperidol in 56% and attributed to haloperidol alone in 92% of these cases. With perazine, an EMPS occurred at a rate of only 14%, and in 37% of the cases EMPS were attributable to perazine in combination with other NLs. Age, sex, diagnosis and dosage of administered NLs were closely interrelated. For instance, NL patients over 60 years of age were almost exclusively female, the majority of them being endogenous depressives, whereas in younger patients the diagnosis of schizophrenia prevailed. Therefore, analysis of potential risk factors for development of EPMS must simultaneously include diagnosis, sex and age as well as concomitant physical disease, duration and dosage of all drugs administered before development of EPMS. However, the small case numbers in some subgroups, as we found them in this study based on everyday clinical practice, will probably be a limiting factor in such multivariate analyses.

Acute Disease↗
PubMed1990

Pilot study on the therapeutic efficacy, clinical safety, and dosage finding of enciprazine in out-patients with anxious and anxious-depressive syndromes.

The new basic propanolamine derivative enciprazine (D 13 112) was tested in an open single-blind phase-II trial with regard to therapeutic efficacy, clinical safety, and dosage finding. The drug showed a good efficacy in mildly ill patients. Under the highest dosage frequently fatigue was reported. In 78% of the patients the enciprazine trial succeeded in shifting patients from benzodiazepines to non-benzodiazepines or in discontinuation of psychopharmacotherapy after completion of the trial.

Adult↗
PubMed1989

Efficacy and adverse effects of clozapine in the treatment of schizophrenia and tardive dyskinesia--a retrospective study of 387 patients.

Medical charts of 387 in-patients (schizophrenia n = 284, tardive dyskinesia, TD, n = 48), were analyzed to evaluate efficacy and adverse effects of clozapine. These patients were previously treated with between two and four other neuroleptics and were either therapy resistant or had severe side effects. Schizophrenic patients were treated with clozapine for 48 +/- 35 (TD 49 +/- 40) days, dosage was 189 +/- 119 (TD 220 +/- 176) mg. Four per cent showed worsening, 13% no change, 38% slight improvement, 42% marked improvement and 3% nearly total reduction of symptoms. In TD, 44% showed marked improvement, but only in 17% the drug was superior to previous neuroleptics. Adverse effects occurred in 56% of patients. Most frequent were sedation (17%), EEG alterations (16%), increase of liver enzymes (8%), hypotension (7%), hypersalivation (5%), fever (5%), ECG alterations (4%), tachycardia (3%), gastro-intestinal (3%) and delirious states (2%). A gradual increase in dosage seems to considerably reduce the incidence of some side effects. Clozapine treatment had to be discontinued because of severe side effects in 5.9%. In none of these patients did serious complications such as agranulocytosis occur. Only EEG alterations were significantly related to clozapine dosage (P less than 0.0005). At dismissal, most patients continued to receive clozapine; only in 22% (TD 20%) was it replaced by another neuroleptic. Thus, the ratio benefit/risk of clozapine treatment seems to be satisfactory in most of the negatively selected patients. Nevertheless, a gradual increase in dosage and careful control of hematological and other variables is highly recommended.

Adult↗