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Biomedical subjects

R L Findling

Publications and source records attributed to R L Findling.

At least 37 records · Page 2Linked to original sources
PubMed1998

The antipsychotics. A pediatric perspective.

As can be discerned from this article, antipsychotics are commonly prescribed, and they are not used to treat only psychosis. Although some data support the use of typical antipsychotics in pediatric patients with a variety of psychiatric syndromes, concerns about the safety and tolerability of these agents often complicated their use and probably even interfered with case identification. A fundamentally new group of medications, the atypicals, have now become available and may not only have improved tolerability but also may have greater ability to reduce some target symptoms. Because of their superior side-effect profile in adults, some of these atypical treatments probably will be commonly prescribed despite a relative paucity of data about their use in the young. Moreover, although frequently prescribed in this age group, the overall prescription rate for antipsychotics will probably increase because of the putative improved safety profile of the newer agents. However, it is possible that serious side effects, such as tardive dyskinesia or neuroleptic malignant syndrome, may occur with these atypical agents. For this reason, the enthusiasm for prescribing these newer treatments should be tempered with the understanding that these agents, although they may in some ways be superior to their predecessors, still possess the potential for significant adverse events. Four atypical antipsychotics are currently marketed in the United States (see Table 2). One additional agent, ziprasodone, is undergoing clinical investigation. Ziprasodone has been shown to be superior to placebo in adults suffering from schizophrenia. Ziprasodone will probably be marketed in the United States in the near future. Whether all of these atypical drugs will have a place in the clinical armamentarium of the pediatric psychopharmacologist remains to be determined. Because the receptor binding profile of the atypical agents differ, it is not possible to assume that what is true for one of these agents is true for the others. Although results from most preliminary studies with atypical antipsychotics indicate that these are promising agents for pediatric patients, further research is needed to define just how these medications may be most judiciously used.

Adolescent↗
PubMed1998

Child and adolescent schizophrenia.

Until only very recently, the occurrence of schizophrenia in childhood and early adolescence had been largely neglected. Improved diagnostic formulations have resulted in clarification of the boundaries between childhood schizophrenia, other psychotic disorders, and pervasive developmental disorder. The study of schizophrenia in childhood or adolescence provides a unique opportunity to examine illness characteristics in the absence of the confounds of substance abuse illness, chronicity, and medication effects. Additionally, current etiopathologic models of schizophrenia can be tested in this patient subgroup.

Adolescent↗
PubMed1998

Treatment and outcomes in adolescents with schizophrenia.

The pharmacologic treatment and assessment of outcomes in adolescents with schizophrenia have been inadequately addressed. Structural brain imaging and brain function studies both point to a continuity between adolescent and adult stages of schizophrenia. Because the teenage population seems to be less tolerant of physical side effects, the advent of atypical antipsychotic medications may offer increased safety and efficacy. Studies support the notion that adolescent illness is associated with a more severe form of schizophrenia and that length of illness before treatment is correlated with long-term outcome. As a consequence, the authors recommend assertive pharmacologic intervention in adolescents with schizophrenia and future research focused on the issues of treatment and outcome in teenagers suffering a psychotic disorder.

Adolescent↗
PubMed1998

Psychopharmacology of ADHD: children and adolescents.

Medications can provide significant salutary effects for children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Due to their well-established safety and efficacy, psychostimulants are generally considered first-line pharmacotherapy for most young patients with ADHD. Since psychostimulant treatment often requires frequent dosing and may be associated with unacceptable side effects and risks, other classes of medication have been studied as possible treatment alternatives. The most extensively researched nonstimulant medications are the tricyclic antidepressants. In addition, alpha2 agonists have also been shown to reduce symptoms of ADHD. However, concerns regarding potential cardiotoxicity have tempered the enthusiasm for both of these classes of medication. Newer antidepressants such as bupropion and venlafaxine may hold promise as treatments for ADHD.

Adolescent↗
PubMed1997

High-dose pyridoxine and magnesium administration in children with autistic disorder: an absence of salutary effects in a double-blind, placebo-controlled study.

Several reports have described salutary effects such as decreased physical aggression and improved social responsiveness being associated with the administration of high doses of pyridoxine and magnesium (HDPM) in open-labeled and controlled studies of patients with autism. Despite this fact, this intervention remains controversial. A 10-week double-blind, placebo-controlled trial was undertaken to examine both the efficacy and safety of HDPM in autism. Twelve patients were enrolled, and 10 patients (mean age 6 years 3 months) were able to complete the study. HDPM at an average dose of 638.9 mg of pyridoxine and 216.3 mg of magnesium oxide was ineffective in ameliorating autistic behaviors as assessed by the Children's Psychiatric Rating Scale (CPRS), the Clinical Global Impression Scale, and the NIMH Global Obsessive Compulsive Scale. Furthermore, no clinically significant side effects were noted during HDPM administration. A trend for a transient change on the CPRS was found that was possibly due to a placebo response. This study raises doubts about the clinical effectiveness of HDPM in autistic disorder.

Adolescent↗
PubMed1997

Cognitive impairment in adolescents with schizophrenia.

OBJECTIVE: The purpose of this study was to determine whether adolescent schizophrenia is characterized by neuropsychological deficits. METHOD: The performance on a battery of neuropsychological tests of 17 adolescents with schizophrenia (mean age = 15.71 years) was compared with that of 17 normal adolescents (mean age = 15.12 years). RESULTS: Compared with the normal subjects, the patients were impaired on 10 of the 13 measures; larger effect sizes were shown for measures involving working memory and attention than for those involving secondary memory, generative naming, and executive functions. CONCLUSIONS: Adolescents with schizophrenia have generalized cognitive dysfunction, which is most apparent on tests of attention and working memory.

Adolescent↗
PubMed1997

Age at onset and gender of schizophrenic patients in relation to neuroleptic resistance.

OBJECTIVE: The age at onset of schizophrenia for males has usually but not always been reported to be less than that for females. Early onset has also been associated with poor response to neuroleptic treatment and worse long-term outcome. The authors compared age at onset in neuroleptic-resistant and -responsive schizophrenic patients to determine whether the gender difference in age at onset is related to response to neuroleptic treatment. METHOD: The subjects were 322 patients with schizophrenia or schizoaffective disorder who were consecutively admitted to a university hospital-based research program. RESULTS: Analysis of variance showed significant relationship between age at onset and both gender and longterm responsivity to neuroleptic drugs. The mean ages at onset in the neuroleptic-responsive men (mean = 21.2 years, SD = 6.1, N = 75), neuroleptic-resistant men (mean = 19.4 years, SD = 4.7, N = 119), and neuroleptic-resistant women (mean = 20.1 years, SD = 6.3, N = 77) were fairly similar, whereas that of the neuroleptic-responsive women (mean = 24.2 years, SD = 8.7, N = 51) was significantly greater than for all other groups. A simple effects model indicated that male and female neuroleptic-resistant patients did not differ significantly in mean age at onset, whereas male and female neuroleptic-responsive patients did. The effect of gender and neuroleptic responsivity on age at onset was related to schizophrenic subtype. CONCLUSIONS: These results confirm previous data indicating neuroleptic resistance is associated with early onset. The finding that the difference in age at onset between males and females is smaller in neuroleptic-resistant patients than in neuroleptic-responsive patients suggests that neuroleptic-resistant patients differ premorbidly as well as after onset of illness.

Adolescent↗
PubMed1997

Functional MR to localize sustained visual attention activation in patients with attention deficit hyperactivity disorder: a pilot study.

PURPOSE: To evaluate brain control activation in patients with attention deficit hyperactivity disorder (ADHD) and to provide an initial comparison between activated regions in ADHD subjects and those previously localized in an unaffected population. METHODS: Ten patients with ADHD underwent imaging with a functional blood oxygen level-dependent MR technique during sustained visual vigilance. Pixel activation was inspected visually and statistical group analysis was performed. RESULTS: Activation was seen over the bilateral middle frontal gyri, the superior parietal lobules, and the inferior parietal lobules. The predominant activity occurred in the right middle frontal gyrus. Application of an additional statistical constraint revealed significant activity in the right inferior and left superior parietal lobules. CONCLUSION: ADHD patients effectively tolerated the necessary MR imaging constraints despite their difficulty with confinement and immobility. Single-section functional MR imaging revealed activation in brain regions known to be involved in the maintenance of the attention in healthy subjects responding to auditory, tactile, or visual stimulation; additional areas of activity that were identified may represent true abnormal regions in the affected population or artifacts.

Adolescent↗
PubMed1997

An open clinical trial of risperidone monotherapy in young children with autistic disorder.

Autistic disorder (AD) may be associated with dysfunctional behaviors which significantly interfere with a child's functioning. Risperidone has been described as having salutary effects as an adjunctive pharmacotherapy in adult and pediatric patients with AD. The purpose of this 8-week, open-label study was to examine the effectiveness and tolerability of risperidone monotherapy in young patients with AD. Doses of risperidone were to be started at 0.25 mg qhs and were titrated to maximize clinical efficacy. Six patients (ages 5 to 9 years) were enrolled in this protocol, and all completed it. After 8 weeks of treatment, with a mean risperidone dose of 1.1 mg, improvement in symptomatology was demonstrated by reduced scores on both the Children's Psychiatric Rating Scale (p < .005) and the Clinical Global Impressions Scale (p < .001). The most common side effect were weight gain and sedation. This study provides preliminary evidence that risperidone monotherapy may be safe and effective in ameliorating dysfunctional behaviors in children with AD.

Antipsychotic Agents↗
PubMed1997

Effects of the postpartum period on nortriptyline pharmacokinetics.

The objective of this research was to investigate sequential serum levels and level/dose ratios of the tricyclic antidepressant nortriptyline (NTP) through the first 17 postpartum weeks. The initial NTP dose was given immediately postpartum to 16 mothers and increased gradually to 70 mg over the first week. A dose of 75 mg was prescribed until adjustment according to serum levels. Serum levels of NTP and its metabolites Z- and E-OH-NTP were determined. At postpartum Week 2, the women developed a mean level/dose (L/D) ratio for NTP of 1.11 (range 0.37 to 3.23), and subsequently experienced an increase in the L/D ratios which continued through Week 6. At Week 8, the NTP L/D ratios declined, and became relatively stable at Week 11 and beyond. For postpartum women treated with NTP, side effect profiles should be carefully followed during the first 6 weeks after delivery as a clinical marker for elevation of serum levels. Since our highest L/D ratios for NTP occurred at Week 6, a serum level is recommended at this time. If the dose needs to be lowered to maintain a nontoxic level, a repeat serum level should be obtained at Week 11, at which time an increase in dose may be required.

Adult↗
PubMed1997

Nortriptyline and its hydroxymetabolites in breastfeeding mothers and newborns.

We previously reported the serum nortriptyline levels of a series of breastfeeding mother-infant pairs. Nortriptyline was below the level of detectability in the infants' sera; however, two young infants aged 10 weeks or less had low concentrations of 10-hydroxy-nortriptyline. Because very young breastfeeding infants are likely to be at increased risk for toxicity, we have focused our study on breastfeeding newborns. We present additional data from six mothers and their infants (4 weeks of age), as well as data from one prematurely born baby. We were able to quantify nortriptyline in one infant and another had higher levels of hydroxymetabolites than previously reported, although still very low. No adverse clinical effects were observed in the infants.

Breast Feeding↗
PubMed1996

Pre-morbid asociality in neuroleptic-resistant and neuroleptic-responsive schizophrenia.

The purpose of this study was to evaluate whether childhood and adolescent pre-morbid asociality differed in neuroleptic-responsive and neuroleptic-resistant schizophrenia. Pre-morbid asociality was assessed with the Pre-morbid Asociality Adjustment Scale in 411 patients meeting DSM-III-R criteria for chronic schizophrenia or schizoaffective disorder categorized as being either neuroleptic-responsive or neuroleptic-resistant. Patterns of childhood and adolescent asociality were found to be different in neuroleptic-resistant and neuroleptic-responsive patients. Pre-morbid asociality during the pre-adult years was not consistently worse in patients with poor response to neuroleptic treatment. Greater impairment in late adolescent psychosexual functioning was predictive of poor outcome with regard to neuroleptic treatment.

Adolescent↗
PubMed1996

Open-label treatment of comorbid depression and attentional disorders with co-administration of serotonin reuptake inhibitors and psychostimulants in children, adolescents, and adults: a case series.

Attention-deficit hyperactivity disorder (ADHD) and major depression are common ailments that can cause significant dysfunction throughout the life cycle. These two disorders may occur comorbidly. This case series describes 7 pediatric patients (aged 10-16 years) and 4 adults (aged 38-44 years) whose ADHD and comorbid major depression were treated in a naturalistic open clinical fashion. For all 11 patients, symptoms of major depression appeared to respond well to either fluoxetine or sertraline monotherapy. Using starting doses of fluoxetine 10 mg or sertraline 25 mg daily, we did not observe any adverse behavioral activation or clinical deterioration. However, no improvement in ADHD symptoms was observed in any patient during fluoxetine or sertraline monotherapy. Adjunctive treatment with a psychostimulant seemed necessary for chronic ADHD symptoms to be effectively addressed. The psychostimulants did not appear to provide observable antidepressant effects. With the exception of one adult who had a 20 mm Hg increase in diastolic pressure on methylphenidate monotherapy at 22.5 mg daily, the administration and coadministration of these agents were not associated with significant changes in blood pressure or heart rate. No patient developed suicidality, increased aggressiveness, mania, or other problematic side effects. This combination therapy was well tolerated and appeared to be effective in ameliorating both ADHD and depressive symptoms. These cases support previous suggestions that adjunctive treatment with psychostimulants might be a safe and effective intervention for children treated with fluoxetine or sertraline who have persistent ADHD symptoms and suggests that such combined treatment may be suitable for adults as well.

1-Naphthylamine↗
PubMed1996

Risperidone in the treatment of children and adolescents with schizophrenia: a retrospective study.

Risperidone is a newly available atypical antipsychotic agent that has been reported to be associated with fewer extrapyramidal side effects (EPS) than conventional neuroleptics in adults with schizophrenia. This study assessed the safety and efficacy of risperidone in 16 children and adolescents (aged 9-20 years, mean 14.9 years) who were clinically diagnosed with psychotic disorders: 13 patients met DSM-III-R criteria for schizophrenia, 2 met criteria for schizoaffective disorder, and 1 had schizophreniform disorder. Eleven of the 16 patients had previous unsuccessful neuroleptic trials. Patient charts were reviewed by the patients' child and adolescent psychiatrist for diagnoses, clinical changes, and adverse events. Clinical response was assessed retrospectively using the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression (CGI) scale. With the risperidone dose titrated gradually, an optimal clinical response was found at a mean daily risperidone dose of 5.93 mg (range 2-10 mg). All but one of the 16 patients had an adequate clinical response to risperidone therapy. Statistically significant improvements were found in the CGI (p < 0.0001), the BPRS Total Score (p < 0.0001), and the BPRS Negative Symptom Score (p < 0.001). In general, only mild drug-induced side effects were experienced, with 5 patients developing mild sedation and 3 developing EPS. Risperidone appeared to be safe and effective in ameliorating symptoms of schizophrenia in this age group. It is speculated that the gradual titration of risperidone was crucial in achieving a relatively low rate of EPS.

Adolescent↗
PubMed1996

Antidepressant treatment during breast-feeding.

OBJECTIVE: The primary purpose of this article is to review critically the literature about use of antidepressants during lactation. Strategies for the clinical management of depressed breast-feeding mothers are also suggested. METHOD: The authors conducted a computerized search of MEDLINE for articles. The review includes studies in which serum levels of drugs were obtained from nursing infants. RESULTS: Fifteen published reports were located that provided information for the following nine antidepressants: amitriptyline, nortriptyline, desipramine, clomipramine, doxepin, dothiepin, fluoxetine, sertraline, and bupropion. CONCLUSIONS: Amitriptyline, nortriptyline, desipramine, clomipramine, dothiepin, and sertraline were not found in quantifiable amounts in nurslings, and no adverse effects were reported. Therefore, these are the drugs of choice for breast-feeding women. Adverse effects were described in some young infants whose mothers had been treated with doxepin or fluoxetine during breast-feeding. The collective serum level data suggest that infants older than 10 weeks are at low risk for adverse effects of tricyclics, and there is no evidence of accumulation. Research needs include an expanded database of mother-baby serum levels, behavioral assessments of infants during nursing, and longitudinal developmental evaluation of nurslings. Prescription of an antidepressant for a breast-feeding woman is a case-specific risk-benefit decision.

Age Factors↗
PubMed1996

Venlafaxine in adults with attention-deficit/hyperactivity disorder: an open clinical trial.

BACKGROUND: It is becoming commonly recognized that adults suffer from attention-deficit/hyperactivity disorder (ADHD). Since medications used in the past of treat adults with ADHD may be ineffective or poorly tolerated by some patients, it is important to determine if newly available medications can safely ameliorate symptoms of ADHD in adults. METHOD: An open clinical trial was undertaken to examine whether venlafaxine was safe and effective in the treatment of adults with ADHD. Ten subjects who met DSM-IV criteria for ADHD were enrolled in this 8-week trial. Individuals were started on 37.5 mg of venlafaxine b.i.d. If moderate ADHD symptoms persisted at the end of Week 4, the dose of venlafaxine was increased to 75 mg b.i.d. Assessments of ADHD symptomatology included the ADHD Rating Scale, Self-Report Version (ARS) and the Clinical Global Impressions (CGI) scale. RESULTS: Nine patients completed the study. At the end of the study, 7 patients were receiving 37.5 mg b.i.d. of venlafaxine. Repeated measures ANOVA demonstrated that treatment with venlafaxine was associated with significant reductions in ADHD symptomatology (p < .02 for the ARS; p < .005 for the CGI). Of the 9 subjects who completed the trial, 7 were considered responders. Venlafaxine was well tolerated, and most patients experienced only mild side effects. CONCLUSION: Venlafaxine may be a promising agent for the treatment of ADHD in adults. Controlled clinical trials are needed to further examine this issue.

Adolescent↗
PubMed1996

Antipsychotic medications in children and adolescents.

Antipsychotic medications are commonly prescribed to children and adolescents. These medications, however, are not only prescribed for young patients with psychosis, but are often prescribed for youths with a variety of psychiatric disorders. Despite the fact that psychiatric illness in the pre-adult era is not rare, few controlled clinical trials have examined the short-term safety and efficacy of these agents in youths with psychosis. There are even fewer data regarding the long-term safety and efficacy of these agents in psychotic children and adolescents. As new antipsychotics become available, the study of these agents in youngsters with a variety of psychiatric illnesses may become an exciting new avenue for research.

Adolescent↗