Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gepirone, an azapirone, is a potent 5-hydroxytryptamine 1A (5-HT1A) agonist. We report an uncontrolled 6-week study in 21 patients (4 men, 17 women: mean age, 36.71 years) with a concurrent DSM-III-R diagnosis of generalized anxiety disorder and panic disorder with agoraphobia. After a 2-week medication-free period, patients were started on 2 mg of gepirone per day increasing over 3 weeks to 12 mg/day. Three patients dropped out in the first week, and one patient violated the protocol. They were therefore excluded from analysis. Two patients who dropped out at weeks 4 and 5 because they found the treatment ineffective were included. Twelve of the 17 patients (70.6%) had at least a 50% reduction in their panic attacks by week 6, and 9 of them had at least a 50% reduction by week 3. Ten patients had "0" panic attacks by week 6 (59%). On the Hamilton Anxiety Scale, 65% had a 50% or greater reduction in total score, mostly beginning in week 1. On Global Assessment, by week 6, 11 were much improved or better (65%). Adverse effects were rare and consisted of stomach upset, dizziness, or headaches. This preliminary study suggests the possible efficacy of gepirone in panic disorder.
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PMID:Gepirone and the treatment of panic disorder: an open study. 809 26

There is evidence that the psychiatric importance of hypochondriacal or cenestopathic symptoms in schizophrenia is prone to be neglected, in so far as these symptoms are expressed through the discourse of somatic medicine. Psychopathological studies of these symptoms are few as compared to studies of other schizophrenic symptoms such as delusion or verbal acoustic hallucination. However, it could be said that such study is indispensable in developing both an understanding of schizophrenics and therapeutic strategies for the treatment of them, in so far as hypochondriaco-cenestopathic symptoms directly indicate a pathology of body-consciousness in schizophrenia. Motivated by these practical as well as theoretical demands, the author presents first of all statistical characteristics of hypochondriaco-cenestopathic symptoms based on a longitudinal study of 183 schizophrenic patients, who were observed for at least 5 years. All the patients satisfied the DSM-III-R criteria for schizophrenia. Taking into consideration these statistical characteristics, as well as certain detailed representative cases, the author proposes a new psychopathological perspective of the hypochondriaco-cenestopathic symptoms in schizophrenia. The essential result of this statistical investigation is summarized as follows. 81 schizophrenic patients exhibited the hypochondriaco-cenestopathic symptoms, accounting for 44.3% of the sample. If we exclude the cases which presented physical experience of being influenced (physikalische Beeinflussungserlebnis), appearance frequency of hypochondriaco-cenestopathic symptoms accounted for 27.9% of the sample. Among the manifestations of these symptoms, uncharacteristic somatic complaint was the most frequent. Here, the most common was pain of body (especially headaches). The second most common was complaint of easy fatigability. Concerning the appearance pattern of the symptom, we found no significant difference between the acute and chronic types, nor between the early and tardive types, while the complex type was significantly more frequent in comparison with the simple type. Among the other symptoms that co-occurred with the hypochondriaco-cenestopathic symptom, the most common was acoustic hallucination, whose frequency was highly statistically significant when compared to the non hypochondriaco-cenestopathic group. Regarding the relationship of the hypochondriaco-cenestopathic symptom with the subtypes of schizophrenia, the proportion of the paranoid type was significantly high in the non hypochondriaco-cenestopathic group.
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PMID:[Psychopathological study of hypochondriaco-cenestopathic symptoms in schizophrenia]. 819 Aug 14

Tricyclic antidepressants, especially amitriptyline, are the medication of first choice in the treatment of chronic tension headache. Few previous studies meet modern standards of study design and statistical analysis. Tolerability and efficacy of 60-90 mg amitriptyline oxide (AO) as a single dose in the evening were compared with 50-75 mg amitriptyline (AM) and placebo (PL) in a double-blind, parallel-group trial consisting of a 4-week baseline phase and 12 weeks of treatment. The 3-armed study was conducted in 7 centers. The inclusion criterion was tension-type headache on at least 15 days monthly with a duration of at least 6 months. Exclusion criteria were a migraine history, previous participation in another clinical trial within the last 3 months, drug abuse, medication with other antidepressants or tranquilizers, current use of other acknowledged prophylactic headache medication, lack of compliance, major psychiatric disorder according to DSM-III and medical contra-indications against tricyclic antidepressants. The primary study endpoint was a reduction at least 50% of the product of headache duration and frequency and a reduction at least 50% in headache intensity. Statistics used were Fisher's Exact Test and an analysis of variance. A total of 211 patients were included in this trial. One hundred ninety-seven cases, 87 males and 110 females, with a mean age of 38 +/- 13 (18-68) years, could be analysed completely (66 AO, 67 AM, 64 PL). With regard to the strictly defined primary study endpoint, no significant difference emerged between AO, AM and PL: treatment responders were 30.3% with AO, 22.4% with AM and 21.9% with PL (PAO-PL = 0.3210, PAM-PL = 1.000, PAO-AM = 0.3299 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effectiveness and tolerance of amitriptyline oxide in chronic tension headache--a multicenter double-blind study versus amitriptyline versus placebo]. 845 Aug 93

Recent preclinical and clinical studies suggest that buprenorphine, an opioid mixed agonist-antagonist, may be useful for the treatment of dual dependence on cocaine and opiates. This report describes an inpatient clinical evaluation of the safety of buprenorphine alone and in combination with single doses of cocaine and morphine. Twenty subjects with a DSM-III-R diagnosis of concurrent cocaine and opioid dependence were randomly assigned to maintenance treatment with single daily doses of 4 or 8 mg of sublingual buprenorphine for 21 days. Side effects and vital signs were evaluated every day once every 8 hours and for 2 hours after daily buprenorphine administration. The physiologic effects of a single-blind challenge dose of cocaine (30 mg intravenously), morphine (10 mg intravenously), and intravenous saline placebo were measured before and during buprenorphine maintenance. Before buprenorphine maintenance, subjects underwent methadone detoxification followed by a 9-day drug-free period. Three baseline single-blind challenge dose studies were conducted on study days 7, 8, and 9 during the drug-free period. Cardiovascular responses to cocaine and to morphine were equivalent under drug-free and buprenorphine maintenance conditions. Respiration and temperature changes in response to cocaine were also equivalent before and during buprenorphine maintenance. Respiratory rates were slightly lower after morphine administration during maintenance on 8 mg of buprenorphine, but this was not statistically significant. Mild opioid agonist-like side effects were reported during buprenorphine induction and maintenance. These included headache, sedation, nasal discharge, abdominal discomfort, and anxiety. Most opioid agonist side effects decreased within 12 to 14 days. An electrocardiogram and blood chemistry measures were normal before and during buprenorphine maintenance. These data suggest that daily maintenance on buprenorphine is not associated with adverse side effects or toxic interactions with a single acute dose of intravenous cocaine or morphine.
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PMID:Acute interactions of buprenorphine with intravenous cocaine and morphine: an investigational new drug phase I safety evaluation. 846 53

The efficacy and tolerability of moclobemide and sertraline were compared in a 13 week trial on 55 depressive patients. Patients were diagnosed according to DSM-III-R criteria using SCID (Structured Clinical Interview for DSM-III-R). The study group was composed of 48 patients with major depression and 7 with minor depression. Patients were randomized in two drug groups and raters were blind to the drugs patients used. HDRS and CGI were used to assess the change in depressive symptoms. Twenty seven patients received moclobemide and 28 patients received sertraline. The dose of moclobemide used was 300-600 mg/day and that of sertraline was 50-200 mg/day. At the end of 13 weeks mean drop in HDRS for the overall group was 14.78 and the response rate calculated as percentage of patients showing a 50% drop in HDRS score was 77.8. The response rate was 76.5% for moclobemide and 78.5% for sertraline. The difference was not significant. The side effects were assessed by using UKU Side Effects Rating Scale. The most three observed side effects were dry mouth, headache and insomnia.
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PMID:Moclobemide and sertraline in the treatment of depressive disorders: a comparative study. 852 56

Bacillary dysentery, an acute infection caused by various strains of Shigella, is characterized by abdominal pain, tenesmus, and diarrhea with mucus, pus and blood. Neurologic manifestations including meningismus, delirium and convulsions may accompany the infection. We describe a thirteen-year-old girl who presented with headache, convulsion and loss of consciousness at the onset and developed diarrhea with blood and pus after hospitalization. The diagnosis of shigellosis was based on clinical data and isolation of the microorganism in the stool specimen. After improved physical functions, the patient developed mutism that continued for two days in the course of her illness, despite having no history of neurologic or psychological problems. She was diagnosed by a psychiatrist with organic mental syndrome NOS (Not Otherwise Specified) according to DSM-III-R criteria. None of the conditions that may cause mutism could be confirmed. This is the first reported case of mutism accompanying shigellosis.
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PMID:A case of childhood shigellosis with mutism. 856 Jun 15

The authors present the results of the treatment with methylphenidate in 24 children with attention deficit disorder based on DSM-III. The prescribed dose was 5 to 10 mg per day, once or twice a day. The results were good in 79.1% of the patients and poor in 16.6%. The drug was withdrawn in one patient because of side effects and the evaluation of efficacy was not possible. Side effects occurred in 2 children (headache and/or nausea). The therapeutic response and the side effects are compared with the literature. The authors claim attention to the efficacy and safety of the treatment with methylphenidate.
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PMID:[Attention deficit disorder: treatment with methylphenidate]. 873 40

The results of an open tolerability and exploratory efficacy study of bretazenil, a partial benzodiazepine-receptor agonist in hospitalized schizophrenic patients with an acute psychotic episode (DSM-III-R criteria), are presented. The duration of the study was 6 weeks, with a mandatory titration (ascending doses of 3-18 mg/day) period of 14 days. The assessment criteria for tolerability were the frequency of adverse events (including EPS), vital signs and laboratory tests. The efficacy criteria, which were only descriptively analysed, were: (a) Clinical Global Impression (CGI, percentage of "very much" and "much" improvement); and (b) change in BPRS total score (e.g. percentage of patients showing > or = 40% decrease of BPRS score at the end of the treatment). Sixty-six patients (aged 21-62 years) with acute episodes of schizophrenia of moderate to marked severity (mean BPRS score = 46.3, range 26-76) were included in the study. Of these 66 patients (68%) were reportedly non-responders (n = 10) or partial responders (n = 35) to previous neuroleptic therapy. Twenty patients (30%) terminated the trial prematurely due to therapeutic failure (no improvement or worsening after 2 weeks of treatment), 17% of patients dropped out due to other reasons (transfer to other hospitals, withdrawal of consent, intercurrent diseases) and 4.5% of patients stopped the treatment due to adverse reactions. Four patients (6%) showed early complete remission and refused to be further treated. The analysis of efficacy (intention-to-treat) revealed a sustained decrease of BPRS scores with 49% of patients showing > or = 40% BPRS score change by the end of the treatment. Forty-four per cent of patients improved "very much" or "much". Eleven patients (17%) were full responders (BPRS score decrease 75-100%) and 21 patients (32%) showed at least 40% reduction of BPRS score. The reduction of BPRS scores in completers only was 60%. All BPRS factor scores decreased in parallel and, particularly, no preferential decrease of anxiety/depression subscores was found. The analysis of tolerability showed that 59% of patients presented no complaints at all. The most frequent treatment-related adverse reactions in the remaining patients were: sedation (n = 14), dizziness (n = 4) and headache (n = 3). The results of this study suggest moderate antipsychotic efficacy of bretazenil in schizophrenic patients. They encourage further investigations of partial benzodiazepine-receptor agonists in this indication, particularly because of the excellent tolerability and lack of extrapyramidal side-effects.
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PMID:Antipsychotic effects of bretazenil, a partial benzodiazepine agonist in acute schizophrenia--a study group report. 890 33

Patients meeting the social phobia criteria of the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) on the DSM-III-R Structured Clinical Interview (n = 101) entered a long-term moclobemide treatment study. These patients were treated for 2 years with moclobemide (phase I) followed by drug withdrawal, in most cases abruptly (phase II). Those who relapsed entered phase III for a further period of 2 years of treatment. During phase I 40 patients (39.6%) withdrew due to inefficacy or relapse. Two patients were removed from the study because of other diagnoses (borderline or schizophreniform). At the end of phase I the remaining patients (58.4%) were rated as not ill (45.5%) or minimally ill (11.9%). Effort was taken to achieve the maximum dose of moclobemide (750 mg/day) and the mean (+/-SD) dose was 723.3 +/- 67.7 mg/day (month 21). A marked decrease in symptoms in the patients who responded was recorded on the Liebowitz Scale for Social Phobia, Clinical Global Impressions. Hamilton Anxiety Scale and Hamilton Depression Scale. Non-response was mainly associated with co-morbidity, especially alcohol abuse, axis II disorders, and a history of major depression or secondary dysthymia. The drug was well tolerated; the more frequent side effects were mild and occurred mainly in the first 2 months of phase I, including nausea, headaches or insomnia. In phase II there was a relapse rate of 88% and 51 patients entered phase III; these patients are still being treated.
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PMID:The long-term treatment of social phobia with moclobemide. 892 15

Following the conduct of a 28-day inpatient bioequivalence study of clozapine in schizophrenia patients, withdrawal effects after abrupt discontinuation from clozapine were assessed. Thirty patients who met DSM-III-R criteria for schizophrenia, residual type, or schizophrenia in remission were enrolled in the study. Patients were evaluated for symptoms of withdrawal effects for 7 days after clozapine 200 mg/day was abruptly withdrawn. Of 28 patients who completed the study, 11 had no withdrawal symptoms; 12 had mild withdrawal adverse events of agitation, headache, or nausea; four patients experienced moderate withdrawal adverse events of nausea, vomiting, or diarrhea; and one patient experienced a rapid-onset psychotic episode requiring hospitalization. Cholinergic rebound is a likely explanation for the mild to moderate withdrawal symptoms and is easily treated with an anticholinergic agent. Mesolimbic supersensitivity, as well as specific properties of clozapine, are discussed as likely causes for rapidonset psychosis. Our findings are consistent with previous reports of withdrawal reactions associated with clozapine, further reminding clinicians to monitor patients closely following abrupt discontinuation of clozapine.
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PMID:Cholinergic rebound and rapid onset psychosis following abrupt clozapine withdrawal. 893 13


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