Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Potassium (K+) channels are the most heterogeneous and widely distributed class of ion channels. K(+) channels are dynamic pore-forming transmembrane proteins known to play important roles in all cell types underlying both normal and pathophysiological functions. Essential for such diverse physiological processes as nerve impulse propagation, muscle contraction, cellular activation and the secretion of biologically active molecules, various K(+) channels are recognized as potential therapeutic targets in the treatment of multiple sclerosis, Alzheimer's disease, Parkinson's disease, epilepsy, stroke, brain tumors, brain/spinal cord ischemia, pain and schizophrenia, migraine, as well as cardiac arrhythmias, pulmonary hypertension, diabetes, cervical cancer, urological diseases and sepsis. In addition to their importance as therapeutic targets, certain K(+) channels are gaining attention for their beneficial roles in anesthesia, neuroprotection and cardioprotection. The K(+) channel gene families (subdividing into multiple subfamilies) include voltage-gated (K(v): K(v)1-K(v)12 or KCNA-KCND, KCNF-KCNH, KCNQ, KCNS), calcium-activated (K(Ca): K(Ca)1-K(Ca)5 or KCNM-KCNN), inwardly rectifying (K(ir): K(ir)1-K(ir)7 or KCNJ) and background/leak or tandem 2-pore (K(2P): K(2P)1-K(2P)7, K(2P)9-K(2P)10, K(2P)12-K(2P)13, K(2P)15-K(2P)18 or KCNK) K(+) channels. Worldwide, the pharmaceutical industry is actively developing better strategies for targeting ion channels, in general, and K(+) channels, in particular, already generating over $6 billion in sales per annum from drugs designed to block or modulate ion channel function. This review provides an overview of recent patents on emerging K(+) channel blockers and activators (openers) with potential for development as new and improved nervous system therapeutic agents.
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PMID:Potassium channel blockers and openers as CNS neurologic therapeutic agents. 1822 Dec 32

Intramuscular injection of haloperidol or epinephrine in a minimum effective dose produces the maximum antipsychotic effect in rat model of schizophrenia, i.e. completely removes stereotypy, hyperlocomotion, and ataxia induced by MK-801. Haloperidol in the specified dose induces catalepsy, while epinephrine exhibits no cataleptogenic effect. Combined intramuscular injection of haloperidol and epinephrine in the threshold doses, ineffective in monotherapy, causes the maximum antipsychotic effect, but not catalepsy. Preliminary anesthesia of the gastric mucosa with 1% lidocaine and blockade of intramural ganglia in the gastric mucosa with hexamethonium completely abolished the potentiated antipsychotic effects produced by combined treatment with haloperidol and epinephrine. Hence, potentiation of the antipsychotic effect of haloperidol with epinephrine is related to stimulation of afferents in the gastric mucosa.
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PMID:Epinephrine potentiates antipsychotic, but not cataleptogenic effect of haloperidol in rats. 1823 84

In spite of recent developments in the pharmacotherapy of depressive disorders, the delay until clinical improvement can be achieved, and the considerable rate of nonresponse and nonremission, are major problems which remain unresolved. Electroconvulsive therapy (ECT) is a nonpharmacologic biological treatment which has been proven to be a highly effective treatment option, predominantly for depression, but also for schizophrenia and other indications. Though there is a lack of controlled investigations on long-term treatments, ECT can also be used for relapse prevention during maintenance therapies. The safety and tolerability of electroconvulsive treatment have been enhanced by the use of modified stimulation techniques and by progress in modern anesthesia. Thus, today a safe treatment can also be offered to patients with higher somatic risks. ECT still represents an important option, especially in the therapy of treatment-resistant psychiatric disorders after medication treatment failures. Earlier consideration of ECT may reduce the rate of chronic and difficult-to-treat psychiatric disorders.
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PMID:Electroconvulsive therapy and its different indications. 1847 88

Pharmacological magnetic resonance imaging (phMRI) provides a powerful means to map the effects of drugs on brain activity, with important applications in pharmacological research. However, phMRI studies in preclinical species are often conducted under general anaesthesia as a means to avoid head motion and to minimise the stress induced by the procedure. Under these conditions, the phMRI response to the drug of interest may be affected by interactions with the anaesthetic agent, with consequences for the interpretation of the data. Here, we have investigated the phMRI response to phencyclidine (PCP), an NMDA receptor blocker, in the halothane-anaesthetised rat for varying levels of anaesthesia and different PCP challenge doses. PCP induces psychotic-like symptoms in humans and laboratory animals and is widely applied as a pharmacological model of schizophrenia. However, PCP possesses anaesthetic properties per se, and its interactions with halothane might result in significant effects on the phMRI activation patterns. We observed two qualitatively different patterns of phMRI response. At 0.5 mg/kg iv PCP and 0.8% halothane maintenance anaesthesia, the lowest doses explored, an activation of discrete cortico-limbo-thalamic structures was observed, consistent with neuroimaging studies in humans and 2-deoxyglucose functional mapping in conscious animal models. However, higher anaesthetic concentrations or higher PCP challenge doses resulted in complete abolition of the positive response and in a widespread cortical deactivation (negative response). In the intermediate regime, we observed a dichotomic behaviour, with individual subjects showing one pattern or the other. These findings indicate a dose-dependent drug-anaesthetic interaction, with a complete reversal of the effects of PCP at higher challenge doses or HT concentrations.
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PMID:Drug-anaesthetic interaction in phMRI: the case of the psychotomimetic agent phencyclidine. 1848 87

Modafinil is a wake-promoting agent that is pharmacologically different from other stimulants. It has been investigated in healthy volunteers, and in individuals with clinical disorders associated with excessive sleepiness, fatigue, impaired cognition and other symptoms. This review examines the use of modafinil in clinical practice based on the results of randomized, double-blind, placebo-controlled clinical trials available in the English language in the MEDLINE database. In sleep-deprived individuals, modafinil improves mood, fatigue, sleepiness and cognition to a similar extent as caffeine but has a longer duration of action. Evidence for improved cognition in non-sleep-deprived healthy volunteers is controversial.Modafinil improves excessive sleepiness and illness severity in all three disorders for which it has been approved by the US FDA, i.e. narcolepsy, shift-work sleep disorder and obstructive sleep apnoea with residual excessive sleepiness despite optimal use of continuous positive airway pressure (CPAP). However, its effects on safety on the job and on morbidities associated with these disorders have not been ascertained. Continued use of CPAP in obstructive sleep apnoea is essential. Modafinil does not benefit cataplexy.In very small, short-term trials, modafinil improved excessive sleepiness in patients with myotonic dystrophy. It was efficacious in fairly large studies of attention deficit hyperactivity disorder (ADHD) in children and adolescents, and was as efficacious as methylphenidate in a small trial, but has not been approved by the FDA, in part because of its serious dermatological toxicity. In a trial of 21 non-concurrent subjects, with 2-week treatment periods, modafinil was as effective as dexamfetamine in adult ADHD. Modafinil was helpful for depressive symptoms in bipolar disorder in a trial that excluded patients with stimulant-induced mania. A single dose of modafinil may hasten recovery from general anaesthesia after day surgery. A single dose of modafinil improved the ability of emergency room physicians to attend didactic lectures after a night shift, but did not improve their ability to drive home and caused sleep disturbances subsequently.Modafinil had a substantial placebo effect on outcomes such as fatigue, excessive sleepiness and depression in patients with traumatic brain injury, major depressive disorder, schizophrenia, post-polio fatigue and multiple sclerosis; however, it did not provide any benefit greater than placebo.Trials of modafinil for excessive sleepiness in Parkinson's disease, cocaine addiction and cognition in chronic fatigue syndrome provided inconsistent results; all studies had extremely small sample sizes. Modafinil cannot be recommended for these conditions until definitive data become available.Modafinil induces and inhibits several cytochrome P450 isoenzymes and has the potential for interacting with drugs from all classes. The modafinil dose should be reduced in the elderly and in patients with hepatic disease. Caution is needed in patients with severe renal insufficiency because of substantial increases in levels of modafinil acid. Common adverse events with modafinil include insomnia, headache, nausea, nervousness and hypertension. Decreased appetite, weight loss and serious dermatological have been reported with greater frequency in children and adolescents, probably due to the higher doses (based on bodyweight) used. Modafinil may have some abuse/addictive potential although no cases have been reported to date.
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PMID:Approved and investigational uses of modafinil : an evidence-based review. 1872 34

The mechanisms by which the nucleus accumbens integrates afferent input from limbic and cortical structures have been influential in the development of models of psychiatric disorders such as schizophrenia. Previous studies of the response of nucleus accumbens (Nacb) cells to the stimulation of afferent inputs from hippocampus (HC) and prefrontal cortex (PFC) have demonstrated that PFC throughput can be modulated by preceding HC input. Examination of the post-synaptic potential size has suggested, however, that summation of these inputs is sublinear. All studies to date examining Nacb integration of inputs via stimulation of afferents have been performed in the anaesthetized rat. The present experiments compare the response of Nacb cells to different combinations of PFC and HC stimulation in awake and isoflurane-anaesthetized rats that were chronically implanted with both stimulating and recording electrodes. The results of these experiments suggest that summation of afferent input in the Nacb of the awake rat is predominantly sublinear, with only a minority of neurons demonstrating modulation of PFC inputs by the HC in the awake or the anaesthetized animal. The response profile of many cells changed during anaesthesia when compared to the awake condition, and on average showed suppression to PFC input 50 and 150 ms following HC stimulation while under deep isoflurane anaesthesia. These results suggest that sublinear integration of afferent input from the PFC and HC is the dominant mode of integration of Nacb cells in the awake animal, which has implications for corticostriatal models of psychiatric dysfunction.
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PMID:Sublinear summation of afferent inputs to the nucleus accumbens in the awake rat. 1922 Nov 23

We report three patients with a history of neuroleptic malignant syndrome for whom modified electroconvulsive therapy (m-ECT) was scheduled. Two patients suffered from schizophrenia, and one suffered from depression. Their symptoms, such as hyperthermia, consciousness disturbance, myotonus, tremor, sweating, and tachycardia, improved gradually with administration of dantrolene and fluid infusion. However, their psychotic state was exacerbated. Therefore, m-ECT was scheduled. When patients were restless at the hospital ward, they were sedated with propofol and transferred to the operating room. General anesthesia was induced with thiopental 2.5-5 mg x kg(-1). After loss of consciousness, vecuronium bromide 0.01 mg x kg(-1) followed by a dose of 0.1 mg x kg(-1) was administered and ventilation was assisted using a face mask and 100% oxygen. After the ECT stimulus, the patients were sedated with propofol until full recovery from muscle relaxation. Although anesthesia time (mean 38 min) was slightly longer (19 min) than in those anesthetized with thiopental and suxamethonium chloride, m-ECT was performed safely and effectively.
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PMID:[Anesthetic management for electroconvulsive therapy in the patients with a history of neuroleptic malignant syndrome]. 1946 6

Postanesthesia bradycardia or asystole before electroconvulsive therapy (ECT) occurs very infrequently but is a potentially fatal complication of pre-ECT anesthesia. The optimal strategy for the prevention of its recurrence is unclear because the use of premedication with atropine may not always be successful. In this article, we present the case of a 21-year-old man with schizophrenia who developed bradycardia directly after receiving succinylcholine during the first 3 ECT sessions. Replacing succinylcholine with mivacurium seemed to be a successful strategy in preventing bradycardia during the final 9 ECT sessions.
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PMID:Severe bradycardia after anesthesia before electroconvulsive therapy. 1971 Jun 20

The gamma-aminobutyric acid (GABA) type A receptor system, the main fast-acting inhibitory neurotransmitter system in the brain, is the pharmacological target for many drugs used clinically to treat, for example, anxiety disorders and epilepsy, and to induce and maintain sedation, sleep, and anesthesia. These drugs facilitate the function of pentameric GABA(A) receptors that exhibit widespread expression in all brain regions and large structural and pharmacological heterogeneity as a result of composition from a repertoire of 19 subunit variants. One of the main problems in clinical use of GABA(A) receptor agonists is the development of tolerance. Most drugs, in long-term use and during withdrawal, have been associated with important modulations of the receptor subunit expression in brain-region-specific manner, participating in the mechanisms of tolerance and dependence. In most cases, the molecular mechanisms of regulation of subunit expression are poorly known, partly as a result of neurobiological adaptation to altered neuronal function. More knowledge has been obtained on the mechanisms of GABA(A) receptor trafficking and cell surface expression and the processes that may contribute to tolerance, although their possible pharmacological regulation is not known. Drug development for neuropsychiatric disorders, including epilepsy, alcoholism, schizophrenia, and anxiety, has been ongoing for several years. One key step to extend drug development related to GABA(A) receptors is likely to require deeper understanding of the adaptational mechanisms of neurons, receptors themselves with interacting proteins, and finally receptor subunits during drug action and in neuropsychiatric disease processes.
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PMID:Regulation of GABA(A) receptor subunit expression by pharmacological agents. 2012 53

We report a case of a schizophrenic patient who rejected an emergent operation for ovarian torsion. A 48-year-old woman with ovarian torsion strictly turned down emergent surgery against the recommendation of her gynecologist, who could not communicate with her. In response to his request, a psychiatrist examined and diagnosed her as schizophrenia. Therefore, she was transferred to our hospital for management in closed wards. She was so paranoiac and self-defensive that we, the psychiatrist, the gynecologist, and the anesthesiologist, could not obtain informed consent for the operation from her. Because this was an emergent and life-threatening case, we attempted anesthesia and surgery with the consent of her mother and uncle. First, we took her not directly to the operating room but to ICU to relieve her anxiety and fear. Then, we intubated her under sedation and analgesia. Finally, we took her to the operating room and started the operation. Anesthesia was maintained with 1.5-2.0% sevoflurane and fentanyl (total 9 microg x kg(-1)). The operation was uneventful and she was retransferred to ICU with the tracheal tube in place. Next day she was extubated and left ICU. She was informed by her psychiatrist of the fact that the operation had been performed. Fortunately, her mental status and postoperative course was generally stable.
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PMID:[Case of a schizophrenic patient refusing emergent operation for ovarian torsion]. 2016 65


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