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Biomedical subjects

R L Dufresne

Publications and source records attributed to R L Dufresne.

At least 19 recordsLinked to original sources
PubMed2000

Patient compliance and blood pressure control on a nuclear-powered aircraft carrier: impact of a pharmacy officer.

The impact of a pharmacy officer on patient compliance and blood pressure control on a deployed nuclear-powered aircraft carrier for a 2-week at-sea period was evaluated. Before any counseling by a pharmacy officer, 43 crewmembers on chronic medications anonymously completed a compliance questionnaire. The pharmacy officer then counseled these crewmembers. A follow-up compliance questionnaire was completed 2 weeks later. After counseling, compliance had increased 58% (p < 0.0001) from compliance measured before counseling. The pharmacy officer also initiated therapeutic interventions. Among 26 crewmembers diagnosed as hypertensive, preintervention blood pressure (BP) measurements were obtained. Ten to 14 days after the initial BP measurement, BP was remeasured. After intervention, 31% (p < 0.02) more crewmembers were at BP goal compared with before intervention. A pharmacy officer, working closely with a medical officer, improved patient compliance and blood pressure control. One problem identified was that these warships require computer software that can prospectively identify drug-drug interactions.

Blood Pressure↗
PubMed1999

Clozapine-associated elevation in serum triglycerides.

OBJECTIVE: This study was conducted to determine serum lipid level changes in patients who received clozapine or haloperidol. METHOD: Medical records of 222 inpatients treated with clozapine or haloperidol were reviewed. Age, weight, gender, daily antipsychotic dose, total cholesterol level, serum triglyceride level, and concurrent medications were recorded. RESULTS: Clozapine-treated men had significantly higher follow-up serum triglyceride concentrations over baseline than did haloperidol-treated men. Female patients experienced serum triglyceride level elevations regardless of antipsychotic treatment. Changes in total cholesterol levels were not significantly different between treatment groups. CONCLUSIONS: An increase in serum triglyceride levels occurred in clozapine-treated patients; screening for serum triglyceride elevations may be warranted before treatment with clozapine.

Adult↗
PubMed1999

Elevated serum triglycerides with clozapine resolved with risperidone in four patients.

Serum triglyceride levels of four patients with psychotic disorders were decreased after switching therapy from clozapine to risperidone. In two patients clozapine was reinstated after risperidone was discontinued; serum triglyceride levels increased. This increase when clozapine was switched to risperidone and vice versa is consistent with our previous report of elevated serum triglyceride levels in clozapine-treated patients. Other reports show increases with the atypical antipsychotics, olanzapine and quetiapine. We believe serum triglyceride levels should be monitored in patients who have other cardiac risk factors and are receiving clozapine.

Adult↗
PubMed1999

Olanzapine increases weight and serum triglyceride levels.

BACKGROUND: Previous studies have suggested that clozapine is associated with increases in both weight and serum triglyceride (but not cholesterol) levels. Because of the pharmacologic similarities between clozapine and olanzapine, we decided to evaluate if olanzapine use was associated with an increase in triglycerides. METHOD: Twenty-five inpatients (21 men, 4 women) were treated with olanzapine, and their outcomes were tracked prospectively in a medication utilization evaluation study. RESULTS: After 12 weeks on a mean +/- SD dose of 13.8+/-4.4 mg/day, weight increased a mean of 12 lb (5.4 kg; from 190+/-37 lb [85.5+/-16.7 kg] to 202+/-30 lb [90.9+/-13.5 kg]), while fasting triglycerides increased a mean of 60 mg/dL (from 162+/-121 mg/dL to 222+/-135 mg/dL). Both increases were significant at p < .05. Fasting total cholesterol did not increase. The triglyceride increase was even larger when we excluded 8 patients who received various interventions to lower lipid levels (e.g., pravastatin, low-fat diet) during the olanzapine trial. There was a strong association between weight change and triglyceride change (p < .02); after controlling for weight, analysis of covariance showed no independent increase in triglycerides. CONCLUSION: These results suggest olanzapine has significant effects on weight and serum triglyceride levels. Clinical implications are discussed.

Adult↗
PubMed1996

Issues in polypharmacotherapy: focus on major depression.

Combination therapy is often used to improve efficacy, speed response, or attenuate an adverse effect of the initial pharmacotherapy. This article examines key issues in the use of polypharmacotherapy in the treatment of major depressive disorders. The addition of lithium and to a lesser extent triiodothyronine T3 have been shown to be effective augmentation strategies in treatment-resistant depression. There is also evidence suggesting that lithium augmentation of tricyclic or serotonergic antidepressants and the combination of a serotonergic and noradrenergic antidepressant may hasten response. Some newer combination strategies in treating major depressive disorders are discussed.

Depressive Disorder↗
PubMed1995

Issues in polypharmacotherapy: focus on depression in schizophrenia.

The use of polypharmacotherapy in the treatment of psychiatric disorder is commonplace. However, few studies evaluate the safety and efficacy of combination treatments. In general, studies of combinations of drugs are difficult to perform and are not required for approval of medications, nor are they commonly used to justify the almost routine use of combination therapy in daily clinical practice. This article examines the complexities involved in performing research in combination drug therapy and discusses how homogeneity of the study population can influence response to treatment. Studies that evaluate the usefulness of adding antidepressant medication to antipsychotics in the treatment of depression secondary to schizophrenia are used as examples to help illustrate these topics.

Antidepressive Agents↗
PubMed1993

Thioridazine improves affective symptoms in schizophrenic patients.

Consenting schizophrenic patients ranging in age from 18 to 63 years were withdrawn from antipsychotics for at least 1 week and randomly assigned to receive identical capsules of thioridazine (n = 13), molindone (n = 10), or haloperidol (n = 12) for a minimum of 6 weeks. Compared with the molindone- and haloperidol-treated patients, the thioridazine-treated patients were significantly improved over time as measured by Brief Psychiatric Rating Scale (BPRS) and Hamilton Rating Scale for Depression (HAM-D) total scores. Improvement in BPRS scores was due largely to improvement in symptoms of anxiety and depression. Subjects did not differ significantly on other measures, with the important exception of weight. On average, molindone patients lost 5 pounds over the 6 weeks of treatment, whereas thioridazine patients gained 6 pounds. Haloperidol-treated patients had no significant weight changes.

Adolescent↗
PubMed1991

Chronic DMI reduces thresholds for brain stimulation reward in the rat.

The authors sought a demonstration of the validity of brain stimulation reward (BSR) models of depression. It was predicted that chronic, but not acute antidepressant treatment would enhance BSR responding. Rats with medial forebrain bundle electrodes were separated into 4 groups that received either saline or desmethylimipramine at 5, 10, or 20 mg/kg daily. A rate-free, threshold measure that has not previously been employed in studies of BSR and antidepressants was used. BSR thresholds were monitored every 3rd day over a 9-day baseline period and an 18-day drug treatment period, and after 12 days of drug withdrawal. Groups did not differ from one another till the 15th and 18th day of drug treatment. The greatest effects were seen in the 10 and 20 mg groups. The 20 mg group returned to baseline after drug withdrawal, but the 10 mg group did not. The absolute size of the effect was considered to be small, leading the authors to speculate that antidepressants act on homeostatic mechanisms that stabilize BSR substrates, only indirectly enhancing transmission of the reward signal.

Animals↗
PubMed1991

Attention tasks and EEG power spectra.

The authors attempted to observe differences in alpha and beta hemispheric asymmetry during a task in which attention was directed toward input from the environment (intake task) as opposed to tasks that required that environmental events be excluded from the focus of attention (rejection tasks). In comparison to resting, both attention tasks caused a shift in alpha asymmetry ratios toward increased power on the right, with the greatest effect at temporal leads. The only significant difference between attention tasks was a finding of higher alpha power during intake than during rejection. Some characteristics of the EEG during attention indicate potential clinical utility.

Adult↗
PubMed1990

Effects of a single inescapable swim on long-term brain stimulation reward thresholds.

Rats were subjected to a 15-min inescapable swim in a procedure which induces "behavioral despair" (immobility) 24 hr later. Their thresholds for brain stimulation reward were measured six times over the subsequent two weeks. Under one condition thresholds were first determined 3 hr postswim and, under a second condition, 24 hr postswim. Rats tested in the 3-hr condition showed elevated thresholds compared to preswim baselines. Elevations remained significant for six days. Thresholds for rats in the 24-hr condition did not change. Results are discussed in terms of a) the lack of correspondence between behavioral despair and brain stimulation reward models of depression, b) possible mechanisms for the 3-hr condition effect, and c) the significance of long-term changes in brain reward substrates.

Animals↗
PubMed1988

Antipsychotic-withdrawal akathisia versus antipsychotic-induced akathisia: further evidence for the existence of tardive akathisia.

The authors present a study in which 33 chronic schizophrenic patients who, when withdrawn from antipsychotic drug treatment for more than 2 weeks, presented with concurrent signs of akathisia and tardive dyskinesia; however, signs of akinesia, facial masking, rigidity, or dystonia were not concurrent with the patients' akathetic presentation. In a subsequent study phase, these patients were treated with antipsychotics for up to 6 weeks. The dyskinetic signs that had been dramatically more severe in those patients exhibiting akathisia following withdrawal from antipsychotic medication continued for up to 6 weeks following the renewal of antipsychotic drug therapy. These findings help to confirm a relationship between tardive dyskinesia and a persistent akathisia of later onset known as tardive akathisia.

Adult↗
PubMed1984

Bupropion hydrochloride.

Bupropion is a trimethylated monocyclic phenylaminoketone that is an effective antidepressant in humans. It neither is sedating, anticholinergic, nor cardiotoxic. Its mechanism of action may be related to dopamine, but remains uncertain at this time. Clinical trials comparing bupropion 300-750 mg/d with placebo show it to be superior to placebo in efficacy and as well tolerated. Bupropion, in controlled clinical trials, is as effective as amitriptyline or imipramine, with fewer side effects. The only clinically significant adverse reaction to bupropion in more than 1000 patients studied has been seizure induction at a frequency comparable with that of imipramine. Bupropion appears to be safe and effective in both adult and geriatric depressed patients. Although it appears to be safer and equally efficacious when compared with currently used antidepressants, it has not been tested by routine clinical use.

Animals↗
PubMed1982

Perceptual changes with bupropion, a novel antidepressant.

The authors assessed perceptual changes in 12 depressed patients treated wih bupropion, 12 patients given other antidepressants, and 12 drug-free controls. Bupropion was associated with vivid dreaming and changes in attention, memory, and perception. which may have contributed to its therapeutic effectiveness.

Antidepressive Agents↗