Biomedical subjects
Publications and source records attributed to T A Ban.
1. Primary prevention of psychiatric disorders from the point of view of WHO was discussed. 2. It was emphasized that in contrast to developed countries malnutrition and infection-induced secondary mental deficiencies are still prevalent in the developing world. 3. Some of the relevant WHO projects were briefly reviewed.
1. Subsequent to the introduction of therapeutically effective psychotropic drugs, there has been a decrease in the resident population in mental hospitals. 2. Since maintenance therapy with neuroleptics and lithium may alleviate and/or prevent relapse in a considerable percentage of schizophrenic and manic depressive patients, there is a gradual increase of these patients in the community. 3. In this paper some of the adverse effects of long-term pharmacotherapy with psychotropic drugs will be presented, and possible negative effects of the increase in fertile marriages among community-based patients will be discussed.
1 In an uncontrolled clinical trial, carried out in 11 psychiatric patients with the clinical diagnoses of anxiety neurosis and depressive neurosis, clobazam, a new benzodiazepine preparation, in the dosage range 10-60 mg daily produced statistically significant improvement in the total and both factor scores of the Hamilton Anxiety Scale (HAM-A). The lowest mean total HAM-A scores occurred with a mean clobazam dosage of 48 mg daily. 2 Results of the uncontrolled clinical trial were further substantiated in a standard-controlled clinical study in which no statistically significant difference between the therapeutic effectiveness of clobazam and diazepam could be revealed. The lowest mean total HAM-A scores occurred with a mean clobazam dosage of 49 mg daily. There was a lower incidence of adverse effects reported in patients receiving clobazam than in those taking the control drug (diazepam).
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The hypothesis that endogenously formed, N-methylated metabolites of indoleamines may play a role in the pathogenesis of schizophrenia was reviewed. Although N-methylated indoleamines can be produced in vivo and have significant psychotomimetic effects, there is little evidence for a specific increase in the methylation of indoleamines in schizophrenic patients. It was noted that even if the relationship between schizophrenia and N-methylated indoleamines had existed, nicotinic acid would not be an appropriate therapeutic agent.
Since maintenance therapy with neuroleptics, lithium and tricyclic antidepressants may have to continue over extended periods of time, drug interactions between these psychotherapeutic agents and non-psychotropic treatments have become of practical clinical significance. In this paper some of the more common or important drug interactions between psychotherapeutic and non-psychotherapeutic agents are discussed.
A 16-week, standard-controlled, double-blind study was conducted to compare the efficacy of butaclamol with that of fluphenazine in the treatment of 24 newly admitted schizophrenic patients. Statistically significant improvement occurred in the entire population in the total scores of the BPRS and PAS; in the activation, anergia, thought disturbance and hostile/suspiciousness factor scores of the BPRS; and in the scores of 9 of the 12 factors of the PAS. There were no statistically significant differences between the scores of the two treatment groups on the total or factor scores of either scale during the course of the clinical trial. The most frequently occurring adverse effects in the butaclamol group were rigidity, akathisia and excitement/agitation. The most frequently occurring adverse effects in the fluphenazine group were insomnia, decreased motor activity and tremor. It is concluded that butaclamol exerts potent neuroleptic effects on schizophrenic patients.
Adverse effects in maintenance therapy with neuroleptic drugs and lithium salts were reviewed with special emphasis on tardive dyskinesia. The possible teratogenicity of neuroleptics and lithium salts was discussed and the chromosomal abnormalities seen in patients treated with lithium salts described.
Biological changes more frequently associated with late onset depressions, such as cerebral arteriosclerosis, increased urinary MHPG concentrations, decreased gonadal functions, and increased MAO activity were reviewed and the therapeutic implications of these biological changes considered. The rationale for the use of Hydergine, amitriptyline, Gerovitol H3, fluoxymesterone, doxepin, and trazodone in geropsychiatric patients was discussed.
Hemodialysis resulted in remission of psychopathological symptoms in eight of ten chronic schizophrenics and successful hemodialysis was associated with a decrease of leucine endorphin levels in the blood. Three endorphins (endogenous peptides) have been isolated from the brain, and among them beta-endorphin was found to be the most potent in inducing behavioral changes in the rat. Nevertheless, neither a positive, nor an inverse relationship between the severity of schizophrenic psychopathology and CSF endorphin concentrations could be borne out by clinical experiments. Most recently, on the basis of an entirely different line of research, the possibility that schizophrenia is a prostaglandin deficiency disease has been raised.
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