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 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

As part of a study of drug treatment of aggressive behavior to be reported separately, we have evaluated the double-blind procedure in a recently completed comparison of the efficacy of lithium carbonate versus placebo in modifying aggressive behavior in nonpsychotic incarcerated delinquents. We conclude that the side effects of lithium carbonate are sufficient to reveal the medication to most subjects receiving it. Thus, while the study staff could not identify lithium-receivers at better than chance levels, and while subjects who received placebo could not identify their medication at better than chance levels, subjects who received lithium could accurately identify it. On a weekly symptom check list there was no difference between lithium and placebo groups on average lithium target symptoms reported during 4-week pre- and postmedication control periods; however, lithium-receivers reported significantly more target symptoms every week medication was administered. Of 16 subjects who quit the study, 14 had received lithium and nearly all of those who gave reasons for quitting specified side effects, most often nausea. The methodological problems of using lithium in a double-blind design might be overcome by employing a "discontinuation" design, or, speculatively, a double-blind, cross-over design utilizing an "active placebo".
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PMID:An evaluation of the double-blind design in a study comparing lithium carbonate with placebo. 78 50

Limited toxicity information is available in the medical literature on the antidepressant fluoxetine (Prozac, Dista Products Co, Indianapolis, IN). The goal of this prospective multicenter study was to develop a toxicity profile of initial signs and symptoms observed in an acute fluoxetine overdose. A prospective study was made of patients reported to one of four American Association of Poison Control Centers' regional poison control centers after ingesting an acute overdose of fluoxetine. A standard data collection form was used on all patients ingesting fluoxetine. Information obtained included age, current medications, dose, coingested drugs, presenting symptoms, vital signs, electrocardiogram abnormalities, outcome, and fluoxetine levels. The authors collected 272 cases; 234 cases met the criteria of the study. Fluoxetine was ingested alone in 87 cases and with ethanol or other drugs in the remaining 147 cases. Of the 87 cases where fluoxetine was ingested alone, 67 patients were adults and 20 were children. Symptoms that were seen in the adult group included: tachycardia (15/67), drowsiness (14/67), tremor (five/67), vomiting (four/67), or nausea (four/67). Thirty patients did not develop symptoms. Twelve of the adult overdose patients had total fluoxetine levels ranging from 232 to 1390 ng/mL. The authors conclude that symptoms that develop after an acute overdose of fluoxetine appear minor and of short duration. Aggressive supportive care is the only intervention necessary.
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PMID:Acute fluoxetine overdose: a report of 234 cases. 158 2

Identification of 5-HT receptor subtypes--5-HT1A, 5-HT1B, 5-HT1C, 5-HT1D, 5-HT2 (possibly A and B), 5-HT3 subtypes, and possibly 5-HT4--has encouraged the manufacture of 5-HT receptor inhibitors with greater subtype specificity. However, it appears that the receptors interact, and drugs initially thought to be specific may have multiple actions. For some conditions such as anxiety/depression, almost all receptors are implicated. Clinical studies provide clear evidence that manipulation of the 5-HT system has a role in treating depression, anxiety, obsessional illness, migraine, and eating disorders. Interactions between the various receptor subtypes make it difficult to identify specific clinical functions. The 5-HT1A receptors may be involved in aggression, anorexia, and hypotension. The 5-HT1B receptors may be involved in aggression, while the 5-HT1C receptors may play a role in central aversion systems and anxiety/depression. The role of the 5-HT1D receptors remains speculative; 5-HT2 receptors appear to be involved in depression, anxiety, appetite, sleep, vasoconstriction, and hypertension. Many drugs that are effective in treating migraine are potent 5-HT2 antagonists. 5-HT3 antagonists at high doses are effective in treating nausea and at low doses in treating anxiety. Treatment of aggression, suicidal behaviour, addiction behaviour, memory impairment, dementia, and schizophrenia with 5-HT inhibitors requires further testing.
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PMID:Is there a relationship between serotonin receptor subtypes and selectivity of response in specific psychiatric illnesses? 269 41

The majority (85%) of patients receiving high dose Interleukin-2 (IL-2) experience gastrointestinal side effects, namely nausea, vomiting and diarrhea. In this article we describe four cancer patients that developed localized necrosis or perforation of the colon during IL-2 treatment. They represent 1.3% of patients (n = 315) or 0.9% of treatment courses (n = 452). All underwent surgical intervention and survived to leave the hospital. No common etiologic factor was apparent. Two patients were subsequently retreated with IL-2 without complication. Localized colonic necrosis or perforation is a rare complication associated with high dose IL-2 treatments. Aggressive surgical intervention is advocated and retreatment following recovery is safe.
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PMID:Colonic perforation. An unusual complication of therapy with high-dose interleukin-2. 326 82

We report the case of a 59-year-old diabetic woman with emphysematous pyelonephritis. The patient presented with nausea, vomiting, and right flank pain of three days duration. The diagnosis was established by a plain abdominal radiograph in the emergency department. Aggressive rehydration, control of diabetes, broad-spectrum antibiotic therapy, and early right nephrectomy resulted in rapid clinical improvement. Emphysematous pyelonephritis is rare and often fatal. Survival depends on early diagnosis and aggressive combined medical and surgical management.
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PMID:Emphysematous pyelonephritis: an emergency indication for the plain abdominal radiograph. 328 24

In assessing the needs of the elderly patient with cancer, we need first to determine the extent of cancer, its complications, and the type of comorbid physical and psychologic conditions. The next step is to determine the goals of our care and specifically the extent to which supportive care is needed to deal with problems. For supportive care to be truly effective, the specific underlying condition producing a complaint must be investigated. It is also important not to underestimate the significance of a symptom such as constipation. Furthermore, nutritional support requires as much planning as, for example, the control of pain. Some problems (eg, nausea, vomiting, pain, and constipation) are best managed with preventive measures; others (eg, anemia, granulocytopenia, and coagulopathies) have very specific indications for intervention. Considerable progress has been made toward understanding the mechanisms of clinical problems such as nausea and vomiting, and a more rational approach to supportive therapy is now possible. However, it is usually not possible to recommend any one intervention for a particular problem: no one intervention is uniformly effective or safe. Aggressive supportive care in elderly cancer patients can improve their ability to tolerate anti-cancer therapies and, more importantly, provide palliation of distressing symptoms.
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PMID:Supportive care of the patient with cancer. 330 47

The premenstrual syndrome (PMS) is a complex of symptoms that usually occurs seven to ten days before menses in large numbers of women. These symptoms typically cease during the 24 hours after the onset of menses. PMS affects many areas of the body, with each afflicted woman having her personal set of symptoms. Frequently encountered signs and symptoms include breast tenderness and swelling, weight gain, headache, abdominal cramping and bloating, food cravings, thirst, nausea, joint pain, acne, dizziness, hyperalgesia and one or more psychologic symptoms: irritability, lethargy and fatigue, depression, anxiety, hostility and aggression. Theories relating PMS to hormonal imbalance, vitamin deficiency or psychosomatic aberration have failed to explain this condition fully. Treatments using hormones, vitamins, oral contraceptives or diuretics have failed to relieve all the symptoms of PMS. The prostaglandin (PG) theory proposes that these nearly ubiquitous substances, produced in pathophysiologic amounts in brain, breast, gastrointestinal tract, kidney and reproductive tract, can trigger many of the PMS symptoms. If that is true, then a PG inhibitor could counteract excessive PG production and successfully control those PMS symptoms related to prostaglandin excess or imbalance. Therapy based upon this theory can proceed to the use of PG inhibitors in conservative steps. First, permanent deletion of xanthine-containing beverages (coffee, tea, cola and chocolate) from the diet can reduce nervousness, irritability and breast tenderness. Luteal phase salt restriction, with a mild diuretic used if necessary the last week before menses, adds to this effect. For the 20-25% of women who need more help, either a PG inhibitor or natural progesterone (to oppose the action of PGs), given when PMS begins, brings relief. In women with depressive PMS complaints, small daily doses of an antidepressant may prove helpful.
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PMID:The use of prostaglandin inhibitors for the premenstrual syndrome. 635 May 80

A recently proposed diagnostic class, psychotic trigger reaction, is deduced from careful clinical studies of eight white men, who upon a very specific trigger stimulus committed murder or attempted to (and in one case also rape). The new class is defined as a sudden ego-alien, motiveless (at least with respect to aggression), motor-wise well organized, violent complex action without emotional concomitants. The action is evoked (not provoked) by an individually unique stimulus within a specific context reviving repeated past traumatic experience. Typically there is no (significant) loss of consciousness and practically full recall. Observed are first-time hallucinations (visual, auditory, tactile, somesthetic, but not olfactory as in temporal lobe epilepsy) and signs of imbalance in the autonomic nervous system (loss of bladder control, ejaculation, profuse sweating, nausea). Only four of these men had previous psychiatric diagnoses (and then various ones) or abnormal EEGs at some time in their lives. Variety in prior diagnoses would be consistent with a seizure-like disorder, here specifically implicating an imbalance in functioning between limbic and frontal lobe systems. Clinical tests for the latter were prevailingly indicative of dysfunctioning. A detailed clinical analysis of the violent acts within their context suggests behaviors are analogous to certain limbic system mechanisms, especially the kindling phenomenon.
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PMID:Specific stimulus-evoked violent action in psychotic trigger reaction: a seizure-like imbalance between frontal lobe and limbic systems? 649 48

Dextromethorphan (DM), the dextrorotatory isomer of 3-hydroxy-N-methylmorphinan, is the main ingredient in a number of widely available, over-the-counter antitussives. Initial studies (Bornstein 1968) showed that it possessed no respiratory suppressant effects and no addiction liability. Subsequently, however, several articles reporting abuse of this drug have appeared in the literature. The drug is known to cause a variety of acute toxic effects, ranging from nausea, restlessness, insomnia, ataxia, slurred speech and nystagmus to mood changes, perceptual alterations, inattention, disorientation and aggressive behavior (Rammer et al 1988; Katona and Watson 1986; Isbell and Fraser 1953; Devlin et al 1985; McCarthy 1971; Dodds and Revai 1967; Degkwitz 1964; Hildebrand et al 1989). There have also been two reported fatalities from DM overdoses (Fleming 1986). However, there are no reports describing the effects of chronic abuse. This report describes a case of cognitive deterioration resulting from prolonged use of DM.
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PMID:Cognitive deterioration from long-term abuse of dextromethorphan: a case report. 780 71

Cachexia is a frequent and devastating complication of advanced cancer. Current understanding of the pathophysiology of this syndrome implicates tumour induced metabolic changes and immune responses. Clinical manifestation include anorexia, chronic nausea, asthenia and change in body image. Aggressive nutritional intervention has not been shown to be of benefit. Patients and families should be counselled about the goals of nutritional intake. In selected cases, enteral nutrition may be appropriate. Pharmacological management should first be directed at correcting nausea. Agents of potential usefulness in the treatment of anorexia include corticosteroids, megestrol acetate, cyproheptadine, hydrazine sulphate and dronabinol. Future research should further address pathophysiology, symptomatic and metabolic effects of interventions and interactions with other syndromes of terminal cancer.
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PMID:Anorexia and cachexia in advanced cancer patients. 856 2


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