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Biomedical subjects

Steven Lippmann

Publications and source records attributed to Steven Lippmann.

18 recordsLinked to original sources
PubMed2006

Psychotropic medications and leukopenia.

Neutropenia and/or agranulocytosis are among the medicinal side-effects induced by many psychotropic drugs. Clozapine and carbamazepine cause the highest incidence of this side-effect and require long-term blood cell monitoring. Bone marrow suppression can have an allergic, hypersensitivity etiology (e.g., clozapine), which mandates the causative drug discontinuation. It can also be a direct, toxic effect (e.g., carbamazepine), which calls for dosage reduction or a medication change. Other treatment options may include filgrastim, sargramostim, or lithium. Blood cell count monitoring is encouraged on patients receiving clozapine as long as the drug is continued. Such evaluation is also advised on those medicated with other psychotropics, especially carbamazepine.

Agranulocytosis↗
PubMed2003

Problems with sleep: what should the doctor do?

Complaints of poor sleep are frequent. The physician's assessment should seek to diagnose the social, medical, and psychiatric etiologies of insomnia and to treat the identified causative conditions. Management must match the specific pathology and type of sleep problem.

Adult↗
PubMed2003

Generalized anxiety disorder.

Anxiety is a part of daily life. While mild levels of anxiety can be positive, moderate to severe levels can cause intense distress. When anxiety interferes with a person's ability to function, it warrants treatment. Generalized anxiety disorder (GAD) is a chronic disabling condition characterized by at least 6 months of frequent worries and three of the following symptoms: fatigue, restlessness, poor concentration, irritability, muscle tension, and unsatisfying sleep. The primary treatment for anxiety is pharmacotherapy. Medication prescribed for anxiety has shifted from exclusive benzodiazepine therapy to a combination of benzodiazepine and antidepressant drugs. The principal disadvantages of benzodiazepines are their long-term use with associated physical dependence, tolerance, and withdrawal symptoms. Several reports support the serotonin reuptake inhibitors and the serotonin norepinephrine reuptake inhibitors for the treatment of anxiety disorders.

Anxiety Disorders↗
PubMed2002

Attention deficit disorder in adults.

ADHD/ADD, once thought to occur only in children, is now recognized as continuing into adulthood in many people. In order to be labeled as such, signs and symptoms must start before age 7 and are primarily characterized by inattention, distractibility, and impulsiveness. Although the exact mechanism is unknown, a number of associated neurochemical and structural abnormalities have been observed. This disorder can negatively affect the educational, social, and occupational lives of those who suffer from its symptoms. It interferes with the ability to establish and maintain close relationships. Pharmacotherapy remains the primary mode of treatment. Stimulants such as dextroamphetamine and methylphenidate are the main drugs utilized; they are available in immediate and longer duration versions. Bupropion is another important medicinal option, and there are a variety of other miscellaneous medications to consider, including modafinil, venlafaxine, tricyclic antidepressants, and guanfacine. Psychotherapy is shown to help control impulsiveness, form more satisfactory relationships, rear children more effectively, and improve organizational and problem-solving skills.

Adult↗
PubMed2002

Body weight changes associated with psychopharmacology.

OBJECTIVE: The authors discuss changes in body weight associated with various psychopharmaceuticals. METHODS: A large number of articles and books about drug-induced changes in body weight, selected on the basis of various literature searches and the authors' clinical experiences with psychopharmaceuticals, were reviewed. RESULTS: Many psychotropic drugs with antipsychotic, mood stabilizing, and antidepressant properties are associated with weight gain. Others, such as fluoxetine, isocarboxazid, nefazadone, topiramate, and psychostimulants, may cause weight loss. The antipsychotic drugs chlorpromazine, clozapine, and olanzapine are often associated with weight gain. Among antidepressants, amitriptyline and mirtazapine are known to cause weight gain. However, reductions are sometimes observed, and each antidepressant has its own unique weight-effect profile. Mood stabilizers, especially valproate-related products, are also associated with weight gain. CONCLUSIONS: Careful monitoring and consideration of alternative therapies are essential.

Humans↗
PubMed2002

Divalproex as a calmative adjunct for aggressive schizophrenic patients.

BACKGROUND: Selection of appropriate pharmacotherapy for psychotic patients who exhibit dangerousness is an important issue. Divalproex is a fast-acting agent which appears to be safe and effective in such circumstances. The objective of the following inpatient study was to investigate divalproex as a pharmaceutical adjunct in treating agitated and/or violent, psychotic schizophrenic subjects. METHODS: For the purpose of comparison, 147 hospitalized patients were separated into violent (n = 60) and non-violent (n = 87) groups. In addition to antipsychotic drugs given to all subjects, divalproex was preferentially prescribed for the more dangerous patients (n = 40). The clinical status of demographics and parameters related to dangerousness in all participants was assessed to document differences during these admissions and for rehospitalization over one year. RESULTS: Divalproex was well tolerated; however, one individual developed a transient granulocytopenia. Its use in agitated and/or violent psychotic persons appears to have included a calmer, less dangerous hospital course, like that observed among their less disruptive counterparts. CONCLUSIONS: Divalproex seemed to have been helpful in this study at facilitating a more routine hospital course for agitated psychotic patients, similar to that of less overtly disturbed individuals. No significant adverse events were observed. The validity of this study is limited by its retrospective, uncontrolled nature.

Adult↗
PubMed2002

Attention-deficit/hyperactivity disorder: an update.

Attention-deficit/hyperactivity disorder, a syndrome involving inattention, impulsivity, and hyperactivity, was originally thought to occur only in children. It is now a recognized condition throughout life in some individuals. For a valid diagnosis, the onset of symptoms should occur before age 7. Dysfunction of catecholamine neurotransmission is implied by the clinical improvement induced by stimulants. Positron emission tomography studies reveal reduced glucose metabolism in the basal ganglia and sometimes in the frontal cortex. Excessive cortical slowing is documented on the electroencephalogram. Twin studies show a familial, genetic influence. Data from multiple sources are necessary for a diagnosis, and rating scales are particularly useful for the adult syndrome. Older individuals typically manifest disorganization and impulsivity more than hyperactivity. Stimulant drugs are the principal forms of treatment for all ages, but bupropion is favored for patients with substance abuse history.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

Cataract occurrence with antipsychotic drugs.

Chlorpromazine and several other phenothiazine neuroleptic drugs appear to induce cataract formation. However, the newer generation of antipsychotic agents has shown no evidence of an etiologic relationship with cataract occurrence. Research did reveal cataract occurrence in dogs who received quetiapine, which prompted concern despite there being no known causal link between quetiapine and lens opacities in humans. Nevertheless, quetiapine's manufacturer issued formal recommendations for ophthalmological follow-up examinations with the use of this drug. Infrequent occurrences of cataract development have been documented in people taking olanzapine but, again, without established causative association; a similar situation is seen with ziprasidone. Periodic ocular examinations of the lens are suggested for patients prescribed long-term treatment with phenothiazines or quetiapine.

Antipsychotic Agents↗