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R W Licht

Publications and source records attributed to R W Licht.

32 records · Page 2Linked to original sources
PubMed1998

Serum concentrations and side effects in psychiatric patients during risperidone therapy.

Steady state serum concentrations of risperidone and 9-hydroxyrisperidone (9-OH-risperidone), the active moiety, were measured in 42 patients. The concentration-to-dose ratios (C/D) varied by a factor of 20, from 1.8 to 36.8 (nmol/l)/(mg/24 hours), and 90% of the active moiety was constituted of 9-OH-risperidone. No correlation between the serum concentration of the active moiety and the side effects evaluated by the UKU Side Effect Scale was found. The absence of CYP2D6 (poor metabolizers) or the coadministration of drugs other than benzodiazepines increased the ratio between parent compound and metabolite but did not significantly influence the C/D of the total active moiety. A therapeutic range for serum risperidone has not been established, but 6 mg/day is considered the optimum dose for most patients. The authors found that in 90% of 22 patients administered 6 mg/day risperidone, the serum levels were within 50 to 150 nmol/l.

Adult↗
PubMed1998

Drug treatment of mania: a critical review.

While lithium is generally considered to be a first-line treatment for mania, the position of the anticonvulsants and the antipsychotics in the treatment of this disorder is currently under debate. For that reason, this paper reviews the original literature, in particular addressing the randomized controlled trials (RCTs) on lithium, anticonvulsants and antipsychotics, and the methodological limitations therein. As the treatment of mania needs to anticipate the future course of the illness, the data on prophylaxis will also be reviewed, albeit briefly. It is concluded that antipsychotics are powerful antimanics, which are particularly beneficial for some clinical presentations of severe mania. However, in general their use should not be prolonged into the maintenance phase. Lithium is still to be considered the mood-stabilizing drug par excellence, although it may be insufficient in mixed states and severe mania. The evidence for antimanic efficacy of valproate, in particular for mixed states, seems more convincing than that for carbamazepine, while the evidence for a prophylactic action of carbamazepine still exceeds that for valproate. Adjunctive treatment with benzodiazepines is often useful. Small sample sizes, highly selected study populations and high drop-out rates seem to be the most important limitations of the RCTs on mania. Quasi-experimental, naturalistic studies on unselected populations are needed to investigate how the various treatments work in clinical practice. Based on the available evidence, summary guidelines for treatment are proposed.

Anti-Anxiety Agents↗
PubMed1998

Outcome of lithium prophylaxis: a prospective follow-up of affective disorder patients assigned to high and low serum lithium levels.

The purpose of the study was to examine the outcome of long-term lithium treatment in consecutively admitted affective disorder patients assigned to high and low serum lithium levels. A total of 91 patients were diagnosed according to DSM-III criteria and randomly allocated to two open treatment groups in which prophylactic lithium was administered in high (serum lithium 0.8-1.0 mmol L-1) and low (serum lithium 0.5-0.8 mmol L-1) doses, respectively. The patients were followed for 2 years or until discontinuation of lithium treatment or readmission to hospital for recurrence of affective illness. The main outcome of the treatment groups was compared with Kaplan-Meier survival curves and by Cox regression analysis. A total of 31 patients (34%) completed 24 months of prophylactic lithium treatment without recurrence and readmission to hospital. In total, 18 patients (20%) suffered a recurrence on lithium, and 42 patients (46%) discontinued lithium or were lost to follow-up. No effect of treatment group was seen, either for the total patient group or for the large subgroup of bipolar patients when analysed separately. A number of patients did not maintain their original assignment to the high serum lithium levels group. The results were analysed both according to assignment and according to actual serum lithium levels. Abuse of alcohol or medication was associated with a poor outcome. Only one third of the patients completed 2 years of lithium prophylaxis successfully. No difference in the protection against recurrences was observed between patients maintained on high and low serum lithium levels.

Adult↗
PubMed1997

The effect of chronic lithium treatment on the calibre of axons and nerve fibres in the rat sural nerve.

Cases of peripheral neuropathy have been reported in humans receiving lithium therapy. However, no previous studies have addressed the question of whether chronic lithium treatment causes morphological changes in the peripheral nervous system in experimental animals. The present study used stereological methods to determine whether long-term administration of lithium affected the calibre of the axons or of the nerve fibres in the rat sural nerve. Twenty-two rats were divided into 2 groups and given either no treatment or lithium, with serum levels averaging from 0.5 to 0.7 mmol/l. After 30 weeks of treatment, the animals were killed and the sural nerve was isolated at the level of the knee and was removed. The cross-sectional area of axons and of nerve fibres was estimated by point counting. Compared with the controls, a strong tendency towards a reduced nerve fibre area in the lithium-treated animals was found, with a between-group difference of 1.79 microns 2 (P = 0.06). For the axon area, the difference was 0.73 micron 2 (P = 0.20).

Animals↗
PubMed1997

Validation of the Bech-Rafaelsen Mania Scale using latent structure analysis.

The essential criteria of internal validity have not been sufficiently evaluated for any mania rating scale, although the fulfillment of such criteria is a prerequisite for summing the item scores to give a total score reflecting the severity of mania, and for comparing total scores across patient groups that differ with regard to variables such as age and sex. This study investigated the internal validity of the Bech-Rafaelsen Mania Scale (MAS), based on the ratings of 100 consecutively admitted drug-free DSM-III-R manic patients. Application of logistic latent structure models did not statistically confirm the additivity of the MAS. However, a modified MAS (the MAS-M) arising from the analyses fulfilled the measurement model. Transferability of the MAS-M across age and sex was also confirmed. The MAS-M showed an acceptable concurrent validity and an adequate sensitivity in discriminating between responders and non-responders among patients participating in a drug trial. The MAS-M presented here is the first mania rating scale that has been shown to fulfil statistical criteria for internal validity.

Adult↗
PubMed1997

Generalisability of results from randomised drug trials. A trial on antimanic treatment.

BACKGROUND: Exemplified by a randomised trial on antimanic treatment, this paper addresses the question of whether selection of patients for drug trials may limit the applicability of study results from the randomised patients to a wider population. METHOD: During two-year period, all consecutively admitted patients from a defined catchment area were screened for inclusion criteria concerning age, diagnosis and severity of illness. The subsequently excluded subgroups of patients were compared with the randomised patients by multivariate data analysis. RESULTS: One hundred and sixty-four patients met the inclusion criteria. However, after exclusion for various reasons, only 27 (17%) patients remained for randomisation. The randomised patients and the excluded patients differed substantially. CONCLUSIONS: The generalisability of trial results is limited. Reports of randomised drug trials should carefully describe the screening procedure for inclusion and, when possible, present relevant comparisons-between the randomised patients and the various subgroups of excluded patients.

Adolescent↗
PubMed1996

Treatment of manic episodes: zuclopenthixol and clonazepam versus lithium and clonazepam.

For the treatment of acute mania, no single drug is sufficiently effective in daily clinical routine for all patients. Drug combinations are often prescribed but poorly investigated. The present study examined whether a treatment with a neuroleptic drug (zuclopenthixol) combined with a benzodiazepine (clonazepam) was superior to a treatment with lithium and the same benzodiazepine (lithium citrate and clonazepam). Twenty-eight hospitalized patients with a DSM-III-R manic episode were included, randomized to fixed drug doses and observed up to 28 days. Degree of mania, side effects and patients satisfaction with the treatment were registered. Approximately two thirds of the patients improved fully or partially on both drug combinations. Furthermore no statistically significant differences were found regarding acceptance and tolerance of the two drug combinations. The present drug combination are only two among several which deserve a thorough examination in order to prevent a random polypharmacy for treatment of mania.

Administration, Oral↗
PubMed1994

[Mortality among long-term psychiatric patients in Denmark 1972-1988].

By use of the computerized, nationwide psychiatric case register in Denmark, three cohorts of psychiatric patients hospitalized for at least one year during either 1972, 1977 or 1982, were identified and followed until April 1, 1988, regarding time of death. A decline in overall excess mortality compared with the general population was seen from the 1972-cohort to the 1982-cohort irrespective of sex, age group and diagnosis. This may be due to real improved survival, but could also reflect different mechanisms of selection. To analyse cause of death, 298 long-stay patients at Psychiatric hospital in Arhus were followed for 5.5 years. Lung disease caused the highest excess mortality. The authors emphasize that risk of death in long-stay patients below 50 years of age is still fourfold compared to the general population and point to the necessity of improving medical care.

Cohort Studies↗
PubMed1994

Effect of chronic lithium treatment with or without haloperidol on number and sizes of neurons in rat neocortex.

The present study used stereological methods to determine whether long-term administration of lithium, with or without haloperidol, affects the number and average volume of neocortical neurons. Twenty-five rats were divided into three groups and given no treatment, lithium, or lithium combined with haloperidol. Serum lithium levels ranged from 0.5 to 0.8 mmol/l. Haloperidol was injected intraperitoneally at a daily dose of 1 mg/kg. After 30 weeks of treatment, the animals were killed and the brains were prepared. Neocortical volume, density of neurons, total number of neurons and mean volume of neurons were estimated. As no differences were found between the groups, the present study provides no evidence for quantitative morphological changes in the cerebral cortex due to long-term 'therapeutic' levels of lithium, with or without haloperidol.

Animals↗
PubMed1994

Treatment of manic episodes in Scandinavia: the use of neuroleptic drugs in a clinical routine setting.

To provide longitudinal data on the treatment of acute mania with neuroleptics in a routine setting, 125 consecutively admitted manic patients were examined. Out of the 125 patients, 111 (89%) were primarily treated with neuroleptics during the index episode, and a substantial use of drug combinations was observed. Of the 111 patients, 27% were still hospitalized and in a manic state after 10 weeks. Our results indicate that treatment under routine conditions is an outcome variable which is determined by the severity and persistence of the manic symptoms. If typical neuroleptics are used as first choice antimanic agents, dosages can be minimized by the concomitant use of a benzodiazepine. In non-responders, a mere shift from one neuroleptic to another does not seem rational, so to improve outcome, a mood stabilizer should be added.

Adult↗
PubMed1993

Mortality in Danish psychiatric long-stay patients, 1972-1982.

By use of the computerized, nationwide psychiatric case register in Denmark, 3 cohorts of psychiatric patients hospitalized for at least one year in 1972, 1977 and 1982, respectively, were identified and followed until April 1, 1988, regarding cause of death. A decline in overall excess mortality compared with the general population was seen from the 1972 cohort to the 1982 cohort irrespective of sex, age group and diagnosis. To analyse cause of death, 298 long-stay patients at Aarhus Psychiatric Hospital were followed for 5.5 years. Lung diseases caused the highest excess mortality. The authors emphasize that risk of death in long-stay patients below 50 years of age is still fourfold compared with the general population and point to the necessity of improving medical care.

Adult↗
PubMed1991

Trends in long-stay hospitalization in Denmark: a descriptive register study, 1972-1987.

By means of 4 cross-sections at 5-year intervals from 1972 to 1987, information on long-stay inpatients and daypatients was extracted from the computerized, cumulative psychiatric case register in Denmark. Long-stay refers to continuous hospitalization of more than 1 year. The prevalence of long-stay patients declined from 101 per 100,000 general population in 1972 to 38 per 100 000 in 1987. As the prevalence of all diagnoses declined, regardless of age and sex, it is suggested that the major cause of the observed trends is altered political and administrative strategies, influenced by and influencing altered capabilities and methods of treatment. The trends are described in detail and their implications discussed.

Adolescent↗