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 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Alzheimer's disease is a slowly progressive disorder involving deterioration of both intellect and personality. The neuropathological features of Alzheimer's disease include abundant neurocortical senile plaques and neurofibrillary tangles. Drug therapies of Alzheimer's disease have been based on empirical observations of the signs and symptoms of the disease and have included the use of hypnotics to reverse insomnia or inverse sleep rhythms; anxiolytics to relieve anxiety, tension and restlessness antipsychotics to "tranquilize" or control psychotic symptoms, such as delusions and hallucinations; stimulants to overcome withdrawn behavior or lethargy; and lastly, antidepressants to control depression. Our growing knowledge of neuropathological and neurochemical changes associated with normal aging and Alzheimer's disease has made it possible to explore and develop pharmacologically-based therapies in Alzheimer's disease. Recent research has revealed behavioral symptoms associated with underlying biochemical changes in either the cholinergic, dopaminergic/ GABAergic (gama-aminobutyric acid) noradrenergic, serotoninergic, neurochemical and/or neuropeptidergic systems. Pharmacological strategies involving manipulation of these systems as a means of relieving Alzheimer's disease symptoms will be reviewed from several perspectives, e.g., those involving transmitter substitution, enzyme inhibition and direct specific receptor stimulation.
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PMID:Pharmacotherapy in Alzheimer's disease: basis and rationale. 354 Oct 49

Thirty-two patients in remission were followed by regular ratings during a prospective neuroleptic withdrawal study. They were outpatients who fulfilled the DSM-III criteria of schizophrenia and who were motivated for drug withdrawal. The relapse rate was 81%. The results from the rating scales confirm the hypothesis that a symptom increase occurs before psychotic relapse. In the order statistical differences occurred, the factors predicting relapse were those concerned with positive psychopathology, motor dysfunction, impaired affects and sleep disturbances. The corresponding symptoms and signs were mainly concerned with thought disorders, paranoid ideation, overactivity, depression and insomnia middle, all of nonpsychotic degree of severity. If prodromes appear, the patient should resume his neuroleptic treatment, or other preventive measures should be taken. By such therapeutic interactions, psychotic relapse may be prevented, or can be dealt with in an outpatient setting.
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PMID:Schizophrenic relapse after drug withdrawal is predictable. 370 94

Electroencephalographic (EEG) sleep patterns were examined in 27 psychotic and 79 nonpsychotic subjects with major depression to evaluate the validity of the psychotic-nonpsychotic subtype dichotomy. Sleep in psychotic depression was characterized by increased wakefulness, decreased rapid eye movement (REM) sleep percentage, and decreased REM activity even after controlling for clinical differences in age, severity, and agitation. Psychotic depressive subjects also were more likely to have extremely short sleep-onset REM latencies. In psychotic depression EEG sleep varied as a function of total illness duration. Patients with recent-onset syndromes had profiles characterized by marked initial insomnia, increased stage 1 sleep percentage, and long REM latency; patients with illnesses of longer duration had extremely short REM latencies. Demonstration of selected EEG sleep variables discriminating between psychotic and nonpsychotic depression further supports psychotic depression as a distinct subtype of major affective disorder.
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PMID:Electroencephalographic sleep in psychotic depression. A valid subtype? 375 66

Alprazolam treatment was tapered in 17 panic patients at a rate of 10% of the starting dose every 3 days. Only four subjects completed withdrawal on schedule (4-5 weeks); four additional subjects discontinued treatment in 7-13 weeks. During withdrawal 15 patients had recurrent or increased panic attacks and nine had significant new withdrawal symptoms. Most common among the latter were malaise, weakness, insomnia, tachycardia, lightheadedness, and dizziness. None had seizures, psychosis, or significant neurological or EEG abnormalities. Results indicate that relapse and withdrawal are important considerations in the choice of alprazolam treatment for panic attacks.
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PMID:Discontinuation of alprazolam treatment in panic patients. 382 28

The symptoms include, by ascending order of severity: nightmares and insomnia, nausea and vomiting, muscular weakness or tremor, postural hypotension, hyperthermia, muscle twitching, convulsions, confusional state or psychosis. Prominent features are the late onset of these symptoms, several days after treatment has been discontinued, and the sometimes difficult diagnosis, since patients are usually unaware of their dependence on these drugs. Reinstituting benzodiazepine treatment, then withdrawing it progressively are the best curative measures. Prevention is easy if treatment is gradually rather than abruptly withdrawn in all patients who receive the compound in high dosage for more than one month.
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PMID:[Benzodiazepine physical dependence. 6 cases (author's transl)]. 610 22

The benzodiazepines are the most effective, safest, and most widely used antianxiety drugs. As a class of drugs, there are few major differences between the various benzodiazepine derivatives. The main distinguishing features are different plasma half-lives and the presence or absence of pharmacologically active metabolites. Plasma half-lives vary considerably, from 2 to 3 hours to more than 100 hours. All benzodiazepines are equally effective in the short term management of anxiety and insomnia, and their classification into 'anxiolytics' and 'hypnotics' is not justified. There are numerous other indications for benzodiazepine use, such as muscle spasm in osteoarthritic conditions, and acute alcohol withdrawal, but the benzodiazepines have no antidepressive or analgesic effects. While there is no good evidence for their long term efficacy in the treatment of anxiety and insomnia, the benzodiazepines are more effective and safer than their main predecessors, the barbiturates. Some of the benzodiazepines, particularly those with long plasma half-lives which are commonly used as hypnotics, have a prolonged duration of action and cause marked 'hang-over' effects. Alcohol enhances the effects of these drugs, and thus can also increase their side effects. Adversely effects such as oversedation, tremor, ataxia and confusion are much more common in elderly patients. Ever since the benzodiazepines were first marketed 20 years ago their use has increased rapidly, and it is now estimated that between 12 and 16% of the adult population in developed countries use tranquillisers at some time each year. However, their overall use has probably diminished somewhat in the last few years. Although their indications are very common, it is possible that some of this extensive usage may be the result of dependence. Until recently, published reports of such dependence were comparatively few. However, withdrawal symptoms have now been demonstrated in a substantial proportion of patients on long term, normal dose benzodiazepine treatment. The abstinence syndrome usually lasts for 8 to 10 days, and is characterised by insomnia, anxiety, loss of appetite and bodyweight, tremor, perspiration, and a host of perceptual disturbances. More serious developments such as epileptic fits and psychosis are probably infrequent during withdrawal from therapeutic doses. The overall incidence of benzodiazepine dependence remains unknown.
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PMID:Rational use of anxiolytic/sedative drugs. 613 9

In both general practice and psychiatry, the indication for benzodiazepines recognized by the French Technical Commissions--"all forms of anxiety"--remains very broad, and absolute contraindications are limited to severe respiratory insufficiency and, for certain drugs, myasthenia. Responsibility for deciding at what moment it becomes necessary to prescribe benzodiazepines therapy lies with the individual doctor--he is sole judge in his relationship with the patient: reactional anxiety, anxiety or distress accompanying somatic disease, insomnia. Benzodiazepines should not be prescribed to children, unless there are exceptional reasons for doing so. In psychiatry, higher doses are authorized for neurotic or psychotic anxiety, which are considered to be more serious forms. It is more or less accepted practice to prescribe benzodiazepines in combination therapy of various kinds with other psychotropic drugs. There are certain indications for which benzodiazepines in monotherapy are wrongly used, such as depressive states, and others where their use is contested, schizophrenic states, for example. Pharmacokinetic data are now beginning to provide a guide to dosage scheduling and to the choice of drug for the different indications. Maximum duration of benzodiazepine therapy should not exceed 4 months in certain cases. Risk of withdrawal syndrome appears to be slight for usual therapeutic doses. Finally, benzodiazepines are not the first choice of the drug addicts.
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PMID:[Consumption of benzodiazepines: good and bad uses]. 614 36

A study was carried out in a rural area of Senegal to ascertain the pattern of mental disorders among patients presenting at primary health facilities. Among 545 children aged 5-15 years, attending health centres and posts, 17% were found to be suffering from some form of emotional problem, behaviour disturbance or neuro-psychiatric disorders. Using a 10-item screening questionnaire, it was shown that the symptoms "never plays with others' and "speech disturbance' were the strongest predictors of mental disorder among children. Among 933 adults, it was found that 16% reported more than seven symptoms commonly associated with psychiatric illness on a 24-item self-reporting questionnaire. The order in adults does not allow a precise estimate of morbidity to be made. Health workers diagnosed 9% of the patients as suffering from a mental health problem, usually in association with a physical problem. It was found that psychotic and suicidal symptoms (e.g. hallucinations, delusions) were more likely to be recognized by health workers as diagnostic of mental disorder, whereas psychophysiological symptoms (e.g. anorexia, insomnia, headache) and psychological symptoms (e.g. anxiety, depression) were less frequently recognized. The study supports the view that psychological symptoms and mental disorders occur relatively frequently among adults and children attending primary health facilities. Data allowing insight into the diagnostic sensitivity of primary health workers can provide a rational basis for planning training programmes in mental health.
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PMID:Diagnosis and symptoms of mental disorder in a rural area of Senegal. 630 31

The main clinical value of the EEG in psychiatry is as a non-invasive tool for the investigation of organic mental syndromes and epilepsy. Predictions that CT scanning would make the EEG redundant have not been fulfilled. Indeed, the 2 instruments complement each other, the EEG being a measure of function and the CT scan a reflection of brain structure. Both are proving useful in the investigation of dementia, providing different but complementary information about the extent and progress of the disease. Quantitative methods of EEG analysis using laboratory computers are now readily available. Significant changes in both the EEG background activity and event related potentials have been clearly demonstrated in the functional psychoses. These are not specific for any diagnostic condition. This implies that they reflect changes caused by the impact of the psychotic mental state on the individual's cognitive processes and level of arousal. The challenge for the future is to develop models of the relationship between the electrical events and underlying cognitive processes. Some progress has been made concerning the ERP changes in selective attention and in phobic disorder. The computerized EEG has a clearly established place in the investigation of drug action, by-passing the blood brain barrier and providing direct access to brain activity. Clearly this work may prove useful in the study of the effects of drug induced change on neurotransmitter systems. The EEG study of all night sleep in patients with functional psychiatric disorders has not lived up to the early expectations of workers in the field. Nevertheless the studies of insomnia and hypnotic drug effects have had valuable practical implications.
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PMID:The electroencephalogram in psychiatry: clinical and research applications. 637 4

During a four-week open study, amoxapine (AX), a new antidepressant agent, was administered to seven patients with pseudoneurotic schizophrenia, seven with neurosis and another seven with schizophrenia, all having similar symptoms. The improvement ratio was 71.4% in the pseudoneurotic schizophrenia group, 57.1% in the neurosis group and 42.8% in the schizophrenia group. Through the application of rating instruments, improvements were observed in the pseudoneurotic schizophrenia group in such items as psychotic and psychoneurotic symptoms in the assessment through the Springfield Outpatient Symptom and Adjustment Index, somatic concern and blunted affect through the Brief Psychiatric Rating Scale, and depression and depersonalization through the Clinical Rating Scale. On the other hand, overall improvements were less seen in the items of the neurosis group and the schizophrenia group. Effective doses of AX were 30 to 75 mg/day in the three groups. Side effects were observed in four cases which included insomnia, tachycardia, palpitation and hypomanic state. There were no cases in which AX was discontinued because of the side effects as these symptoms were slight. AX is remarkable and characteristically efficacious in the pseudoneurotic schizophrenia, and this effectiveness is presumed due to its antidepressant and antipsychotic actions.
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PMID:Effects of amoxapine, a new antidepressant, on pseudoneurotic schizophrenia. 702 96


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