Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Medication management of obsessive-compulsive disorder (OCD) has consisted of monotherapy with either clomipramine (CMI) or selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine, paroxetine, or sertraline. Frequently, OCD patients receiving monotherapy experience low treatment response rates and problematic side effects that may result in discontinuation or noncompliance. This open-label case series presents 7 patients (6 male, 1 female) ages 9 to 23 years with OCD who were effectively treated with combination of CMI plus an SSRI. Treatment effects persisted through 5 to 22 months of follow-up from onset of combination therapy. The drug combination was effective in the 2 patients with OCD and no mood/anxiety comorbidity. Side effects appeared in 5 of 7 patients; cardiovascular side effects were the most common adverse effects. Two patients had prolongation of QTc intervals and 2 developed tachycardia while taking CMI and SSRI combinations. Other risks might include serotonin syndrome, manic switch, insomnia, and possibly headaches, EPS, and sexual dysfunction. Recommendations are made to monitor electrocardiograms, CMI blood concentrations, and vital signs in all cases because SSRIs can increase the blood levels of CMI and/or its active metabolite, desmethylclomipramine (DCMI). CMI could also potentially increase SSRI absorption and/or protein binding. The use of CMI and SSRI combination therapy was found to be more effective compared with their monotherapy in all 7 cases.
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PMID:Combination treatment with clomipramine and selective serotonin reuptake inhibitors for obsessive-compulsive disorder in children and adolescents. 963 80

This short-term, single-blind, pilot trial was initiated to investigate the usefulness of quetiapine therapy in the treatment of schizophrenic patients refractory to first-generation antipsychotics. Following a neuroleptic-free period prior to study entry (at least 1 week for oral formulations and 6 weeks for depot formulations), quetiapine was started at 50 mg/day and titrated up to 500 mg/day by Day 6. This 500 mg daily dose was then maintained or increased up to a maximum of 750 mg/day, at the discretion of the treating physician, who was aware of the antipsychotic prescribed. Efficacy measures were represented by changes in total and component PANSS score from baseline to different intervals. Safety and tolerability were evaluated by monitoring the spontaneously referred moderate-to-severe adverse events, changes from baseline in SAS, BARS, and AIMS scores, supplementary use of flurazepam, lorazepam, and benztropine, clinically relevant physical changes, abnormalities in vital signs, blood chemistry, and hematology, and modifications in QTc interval and body weight. Rating scale assessments, categorization of adverse events, determination of physical examination, vital signs, and body weight were performed by a qualified physician blind to the particular antipsychotic under investigation and the aims of the study. All 12 patients completed the 4-week quetiapine treatment course. Mean total PANSS scores were significantly reduced between baseline and study endpoint (p=0.006). Five out of six PANSS subcomponent scores also showed significant decreases (p < 0.05). Six patients showed a reduction of > or = 20% in PANSS total score by the final day of quetiapine treatment, so were classified as responders. There were responders in all schizophrenia diagnostic subgroups (undifferentiated, paranoid, and disorganized). Two patients reported moderate adverse events. One patient received 3 days of benztropine therapy for EPS and five received flurazepam for insomnia. Weight change was minimal and mean SAS, BARS, and AIMS scores all showed nonsignificant decreases between baseline and endpoint. The 50% quetiapine response rate reported here in refractory patients is comparable with those previously reported for other atypical antipsychotics in populations of both refractory and intolerant patients.
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PMID:Quetiapine in hospitalized patients with schizophrenia refractory to treatment with first-generation antipsychotics: a 4-week, flexible-dose, single-blind, exploratory, pilot trial. 1546 4

Subjects were patients with schizophrenia or schizoaffective disorder enrolled in extension studies (Study A and Study B) after participating in 12-week studies of long-acting injectable risperidone [Kane, J.M., Eerdekens, M., Lindenmayer, J.-P., Keith, S.J., Lesem, M., Karcher, K., 2003. Long-acting injectable risperidone: efficacy and safety of the first long-acting atypical antipsychotic. Am. J. Psychiatry 160, 1125-1132; Lindenmayer, J.-P., Eerdekens, L., Berry, S., Eerdekens, M., 2004. Safety and efficacy of long-acting risperidone in schizophrenia: a 12-week, multicenter, open-label study in stable patients switched from typical and atypical oral antipsychotics. J. Clin. Psychiatry 65, 1084-1089]. Twelve months of treatment were completed by 55% of Study A patients and 52% of Study B patients. The median modal dose of long-acting injectable risperidone was 50 mg/14 days in both studies. Most frequent adverse events were psychosis, headache, insomnia, agitation, and rhinitis. EPS-related adverse events were reported in 33% of patients in Study A and 22% in Study B. Patients with Clinical Global Impressions ratings of "not ill" and "mild" increased from 14% at baseline to 54% at endpoint in Study A and from 42% to 65% in Study B. It is concluded that treatment with long-acting injectable risperidone for 1 year or longer appeared to be safe and well tolerated in patients with schizophrenia or schizoaffective disorder.
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PMID:Long-term safety and tolerability of long-acting injectable risperidone in patients with schizophrenia or schizoaffective disorder. 1704 18

Forty hospitalized treatment-resistant schizophrenics were randomly assigned to high (40 mg.) or low (10 mg.) daily oral doses of thiothixene. Differential effects were predicted on measures of CNS arousal, performance tests, clinical ratings, and perceptual-cognitive training. The high dose showed effects consistent with antipsychotic activity. The low dose showed some changes indicating activating properties. Side effects on high dose included several instances of EPS: akathisia and tremor, and transient CNS stimulation. Low dose produced persistent CNS stimulation: excitement and insomnia. The differentiation of "turbulence" from "activation" is of clinical importance. Methodological problems of sample size, lost performance and EEG data, fixed dose level, and refractory patients probably account for the paucity of statistically significant dose differences.
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PMID:High and low dose thiothixene treatment in chronic schizophrenia. 1789 41

Aripiprazole is a new anti psychotic with a unique receptor binding profile that combines partial agonistic activity at D2 receptor and 5-HT 1A receptor and potent antagonism at 5-HT 2A receptor. This receptor profile makes it possible for it to act as a dopamine system stabilizer. Based on various short term and long term studies, aripiprazole has been found to be effective in schizophrenia and has no significant adverse effect on QTc prolongation, prolactin, serum lipids, and has a low potential for weight gain. Present study aims to evaluate the efficacy and tolerability of aripiprazole (10-15mg/day) in the treatment of Indian patients of schizophrenia and to see its effect on QTc interval, prolactin levels, serum lipids, plasma sugar and weight gain in these patients. Outpatients with an ongoing/newly diagnosed ICD-10 Schizophrenia (n=136) were randomly assigned to 10 or 15 mg dose of Aripiprazole for a period of six weeks. Clinical response was evaluated by the Positive And Negative Symptoms Scale (PANSS), Clinical Global Impression (CGI) scale and safety was evaluated by observing spontaneously reported adverse events and changes in various laboratory parameters. Switching schizophrenic patients to aripiprazole (10/15 mg) from both conventional and atypical anti-psychotics was safe and well tolerated. Six weeks after switching to aripiprazole, patients showed improvements in PANSS scores (P< 0.001), EPS, prolactin levels and weight over the baseline levels. No difference was seen in the 10 or 15mg dose groups. One hospitalization was reported (due to hepatitis E). Common side effects reported were insomnia, somnolence, nausea, vomiting and diarrhea. Aripiprazole is a safe and effective anti psychotic in Indian patients - both in newly diagnosed, as well as, in patients not responding to or intolerant to other available typical and atypical antipsychotics.
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PMID:Open labeled, randomized, switch-over study of two fixed doses (10/15mg) of aripiprazole : to evaluate its safety and efficacy in the treatment of Indian patients of schizophrenia. 2120 77