Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Moclobemide (Ro 11-1163), a benzamide derivative, is a MAO-inhibitor which selectively and reversibly inhibits monoamine oxidase type A. Thirty-eight patients with episodic, chronic and atypical depressive disorder (DSM-III) were equally randomized to 6 weeks' treatment with either three daily doses of 100 mg moclobemide or 50 mg clomipramine. Both treatment groups improved with time as assessed weekly by the Hamilton Depression Scale and the Clinician's Overall Assessment of Depression State, and there was no interaction between treatment and time. Anticholinergic complaints, tremor and dizziness occurred more frequently on clomipramine, and they were longer lasting and more severe. Because of its low toxicity, good tolerance, its selectivity and reversibility moclobemide may be a better alternative than the older monoamine oxidase inhibitors.
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PMID:Moclobemide and clomipramine in the treatment of depression. A randomized clinical trial. 638 47

In an open study, 42 depressive patients (according to DSM-III-R) were administered paroxetine at mean minimal and maximum doses of 21 and 48 mg once daily in the morning. Treatment resulted in complete remission as defined by Serejsky in 57%, and 55% of patients were rated, according to CGI, as improved. Global HAMD and FKD scores significantly dropped compared to baseline values and responders and non-responders differed significantly as early as seven days of treatment, although the onset of the antidepressive effect was not clinically apparent before 2 weeks of treatment. Significant reductions were seen in all items except paranoidity and weight loss and hypochondria using the FKD scale. A substantial reduction in suicidal ideation and tendencies was also noted in the group of non-responders, a finding supporting a non-specific anti-suicidal effect of paroxetine, which was therapeutically significantly more successful in women than in men. Side effects occurring in 10% and more percent of treated subjects included fatiguability, sweating, tremor, dry mouth, obstipation and nausea.
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PMID:[Paroxetine in the treatment of depressive disorders (pilot study)]. 755 46

Extrapyramidal side effects of neuroleptics are important in clinical practice. Study of extra-pyramidal side effects is also of importance for researchers who test new antipsychotic agents or study tardive dyskinesia. A french translation of the Simpson-Angus Rating Scale of extra-pyramidal side effects thus appeared useful. This scale contains 10 items: Gait, Arm dropping, Shoulder shaking. Elbow rigidity, Wrist rigidity, Leg pendulousness, Head dropping, Glabella Tap, Tremor, Salivation. Each item is rated between 0 and 4. A total score is obtained by adding the items and dividing by 10. Scores of up to 0.3 are considered within the normal range. The scale original has been validated in a population of fourteen psychotic inpatients taking, in a double-blind procedure, placebo, haloperidol 6 mg/day or haloperidol 30 mg/day. Patients receiving haloperidol 30 mg/day presented more extrapyramidal symptoms than patients under placebo. The Simpson Angus rating scale has also been shown to have clinical validity and high inter-rater reliability. It can be routinely used in clinical drug evaluation. The french version was used in a population of 30 psychotic inpatients fulfilling the DSM III-R criteria of schizophrenic disorder. Patients were treated for at least two weeks, orally, either with a phenothiazine (chlorpromazine 350 mg) or a butyrophenone (haloperidol 15 mg). 10 of the 30 patients received, in addition, anticholinergic agents (trihexiphenidyl, 5 mg). The french version of The Simpson Angus Rating Scale appeared to be easy to use and not time-consuming. Interraters correlation was high. Patients receiving butyrophenones or phenothiazines had no significantly different ages and sociodemographic characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Translation and application of the Simpson and Angus Scale of Extrapyramidal Symptoms]. 827 89

The serotonin syndrome, induced by serotoninergic agents, includes confusion, agitation, myoclonus, diaphoresis, tremor and diarrhea. The authors prospectively evaluated all these symptoms in 38 depressed inpatients fullfilling DSM-III-R criteria for major depression. Sixteen (42%) of 38 patients presented at least one symptom of serotonin syndrome. In 14 cases tremor and myoclonus occurred simultaneously, and 10 patients presented at the same time tremor plus myoclonus, diaphoresis and shivering. Except for 2 patients, symptoms were transient, lasted less than 1 week and disappeared with the pursuit of treatment.
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PMID:Prospective evaluation of the serotonin syndrome in depressed inpatients treated with clomipramine. 829 81

506 patients with schizophrenia, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria, were included in a long term treatment programme with remoxipride, a selective dopamine (D2)-receptor antagonist. This overview includes pooled data from all patients who have been treated long term with remoxipride in clinical trials, focusing on patients treated for more than 6 months (n = 283). Remoxipride was administered in daily doses of 75 to 600mg. The assessment tools were Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Simpson and Angus scale, Abnormal Involuntary Movements Scale (AIMS) for abnormal involuntary movements, adverse events/symptoms using a 26-item checklist, clinical chemistry, and haematology and cardiovascular investigations. The majority of patients had a long duration of illness (median 11 years). 67% of patients (340/506) withdrew from treatment before 12 months and 44% (223/506) stopped treatment before 6 months. The median BPRS total score decreased during the first 3 months from 23 to 12, and this level of improvement was maintained throughout the 12-month period. Treatment-emergent adverse events reported by more than 5% of the patients were insomnia, tiredness, drowsiness and tremor in the group treated for 6 to 12 months. No symptoms, including checklist extrapyramidal symptoms (EPS), were reported by more than 5% of patients treated for 12 months. Low frequencies of EPS according to the Simpson and Angus scale were seen in patients treated for more than 6 months (n = 147). A small but statistically significant reduction of the mean total AIMS score from baseline to last rating was observed. There were infrequent changes in heart rate, resting diastolic blood pressure and electrocardiogram (ECG). Clinical chemistry and haematology data showed no evidence of clinically significant changes over time during the 12 months of treatment. Among 506 patients, 7 suicides and 7 suicide attempts occurred during the study period. Other serious adverse events were abnormal liver function test (2 cases), gastrointestinal, urinary retention, status epilepticus (psychotic polydipsia), granulocytopenia (1 each) and myocardial infarction (5 cases). Remoxipride is of potential value as a drug which is both effective and well tolerated in the long term management of patients with schizophrenia.
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PMID:Tolerability of remoxipride in the long term treatment of schizophrenia. An overview. 832 49

In animals the occurrence of a behavioural syndrome consisting of hyperactivity, stereotyped movements and increase of temperature has been induced by MAOIs, 5-HT precursors (L-tryptophan) and 5-HT reuptake inhibitors. Most of these manifestations were specifically blocked by a pretreatment with an inhibitor of serotonin synthesis. In humans, the association of myoclonus, diarrhea, confusion, hypomania, agitation, hyperreflexia, shivering, incoordination, fever and diaphoresis, when patients are treated with serotoninergic agents, could constitute a "serotonin syndrome". Such cases of serotonin syndrome were reported after treatments with L-tryptophan, MAOIs, serotonin reuptake inhibitors and tricyclics alone or in association. The authors prospectively evaluated all the "serotonin-related" symptoms in 38 depressed inpatients fulfilling DSM III-R criteria of major depression. 16 (42%) out of 38 patients presented at least one symptom of serotonin syndrome. In 14 cases tremor and myoclonus occurred simultaneously and 10 patients presented at the same time tremor, myoclonus, diaphoresis and shivering. Except for two patients, symptoms were transient, lasted less than one week and disappeared with the pursuit of the treatment. Most often, serotonin syndrome thus corresponds to a reaction induced by a combination of serotoninergic agents at high dosages. In very rare cases, a toxic and potentially fatal interaction can occur between MAOIs, tricyclics and selective serotonin reuptake inhibitors at therapeutic dosages. Serotonin syndrome also provides an heuristic model of the putative mode of action of antidepressants. Serotonin-related symptoms are the physical and objective expression of the antidepressant-induced increase in serotonin. The specificity of serotonin-related syndrome also needs to be discussed since most of the symptoms, such as tremor and diaphoresis, are not in all cases related to an increase in serotonin.
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PMID:[The serotonin syndrome: review of the literature and description of an original study]. 852 62

Laboratory studies of cocaine-exposed rodents, and positron emission tomographic studies of human cocaine abusers have suggested that chronic cocaine abuse downregulates dopaminergic function in the basal ganglia. The present study sought to provide behavioral evidence for this phenomenon by demonstrating enhanced levels of resting hand tremor among patients with previous histories of cocaine dependence. to determine the specificity of the phenomenon, patients with previous histories of alcohol dependence, cocaine/alcohol codependence, and cocaine/opiate codependence were also evaluated. Patients were assigned to one of four groups according to DSM-IIIR diagnostic criteria: (1) cocaine dependent (n = 19); (2) cocaine and alcohol dependent (n = 12); (3) cocaine and opiate dependent (n = 7); (4) alcohol dependent (n = 9). All were abstinent from their primary drug of abuse for a period of 1 to 5 months. The three patient groups with histories of cocaine dependence exhibited significantly more resting hand tremor than the alcohol-dependent and normal control groups. Furthermore, hand tremor in the former three groups was positively related to the number of self-reported uses of cocaine and negatively related to the number of months of cocaine abstinence.
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PMID:Resting hand tremor in abstinent cocaine-dependent, alcohol-dependent, and polydrug-dependent patients. 890 70

Recently, the therapeutic benefit of lithium augmentation in old age has come into question. These data, in light of the documented high incidence of side effects after lithium use in elderly patients, resulted in the design of a prospective, placebo-controlled lithium augmentation withdrawal study in elderly patients with unipolar depression. Twelve eligible geriatric patients (10 women and 2 men; mean [+/-SD] age, 76.2 +/- 5.7 years) with DSM-III-R unipolar depression receiving adjunct lithium therapy were randomized to receive continued lithium augmentation or matching placebo (withdrawal rate 150 mg/day/wk). At each clinic visit, patients were assessed for depression (Montgomery-Asberg Depression Rating Scale and Geriatric Depression Rating Scale) and lithium-induced toxicities (a 21-item side-effect checklist, renal and thyroid biochemistry). Over the 2-year observation period, the placebo group reported a decrease in composite 21-item side-effect score and specific lithium toxicities (e.g., urinary urgency, hand tremor, and renal/thyroid abnormalities). Two patients in the lithium maintenance group had a recurrence of depression at 61 and 96 weeks, respectively, immediately after a stressful life event (cerebrovascular accident [CVA] or death of spouse), and two patients had a recurrence in the placebo group at 7 and 92 weeks, respectively, without any apparent changes in life stresses. No other prognostic risk factors for recurrence were identified. Depression that recurred in patients who were receiving placebo was relatively resistant to reinstitution of lithium augmentation therapy. In otherwise stable geriatric patients with unipolar depression, the documented benefits of reduced side effects should be weighed against the risk of recurrence and subsequent lithium resistance before withdrawal of lithium augmentation.
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PMID:Gradual discontinuation of lithium augmentation in elderly patients with unipolar depression. 900 53

A 6-week, randomised, double-blind, multicentre study in 256 patients with a DSM-III-R diagnosis of major depression was carried out to compare the selective noradrenaline reuptake inhibitor (NARI), reboxetine, with the reference standard tricyclic antidepressant, imipramine. The efficacy of reboxetine, as measured by the extent of improvement of Hamilton Depression Rating Scale. Montgomery and Asberg Depression Rating Scale and the Clinical Global Impression Scale, was similar to that of imipramine. The improvement was observed in the overall population and in severely depressed and melancholic patients. Reboxetine tolerability compared favourably with that of imipramine. Frequency of discontinuation due to adverse events was lower in the reboxetine-treated group (10.0%) than in the imipramine-treated group (14.3%), and the cumulative risk of development (Kaplan-Meier analysis) of dry mouth, hypotension and/or related symptoms and tremor was significantly higher on imipramine than on reboxetine.
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PMID:Efficacy and tolerability of reboxetine compared with imipramine in a double-blind study in patients suffering from major depressive offsodes. 916 9

A common observation in neurological practice is parkinsonism with concomitant cognitive decline, an association that usually arises from various underlying degenerative or vascular conditions, most of which are untreatable. An elderly woman with no history of psychiatric disease presented complaining of memory and cognitive impairment serious enough to interfere with daily life activities over the preceding year. She soon developed a predominantly left-sided tremor, rigidity and bradykinesia. She had had only 2 years of formal education. Neuropsychological assessment showed poor performance on Wechsler memory scale sub-items, as well as constructional apraxia, dyscalculia, reasoning difficulties and gross information deficits. A 3-month trial course of levodopa was followed by dramatic improvement in both parkinsonian symptoms and cognitive performance, including a 7-point gain in the Mini-Mental Status Examination score. At the same time, the Beck Depression Inventory score fell from 27 (baseline) to 18. Over the 10-year follow-up period the patient developed late levodopa syndrome and a persistent but mild dysthymic disorder, but never manifested dementia as defined by DSM-III-R criteria. This patient's case illustrates three important principles. First, although parkinsonism is known to be preceded by depressive episodes, particularly in a subgroup of younger patients, the symptoms of the elderly patient whose Parkinson's disease is foreshadowed by depression can mimic depressive pseudodementia, potentially leading to diagnostic confusion. Second, impaired motivation and disturbances in cognitive function are different from mood disorders, as the former involve the mesolimbic/mesocortical dopamine system, explaining the beneficial effect of levodopa on motivation and cognition in this patient even as mood was unaffected. Finally, depressive pseudodementia in Parkinson's disease does not necessarily herald the development of organic dementia in the long term.
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PMID:[Depressive pseudodementia in early Parkinson's disease: lessons from a case with long-term follow-up]. 919 54


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