Diseases of the nervous system最新文献

Serum luteinizing hormone and testosterone were determined weekly during the course of a comparison of the effects of lithium versus placebo on impulsive aggressive behavior in 16-24 year-old male prisoners. The duration of drug treatment for each individual was up to 3 months. A significant reduction of serious agressive behavioral incidents occurred in the third month on lithium and was accompanied by a significant rise in serum luteinizing hormone, with no change in serum testosterone.

Fifty-seven neurotically depressed outpatients with sleep disturbance were randomly assigned to treatment with either imipramine pamoate or amitriptyline given in a single dose at bedtime in a double-blind study for four weeks. The results indicate that both imipramine pamoate and amitriptyline are equally effective in treating neurotic depression. The clinical lore that imipramine is more effective for retarded depression and amitriptyline for anxious, agitated depression was not supported by this study. Of special interest is the fact that the imipramine pamoate group had significantly earlier rising times, and a trend toward better quality of sleep. The side effect profiles of the two drugs were also remarkably similar in this population though more patients complained of side effects on amitriptyline than on imipramine.

Two chronic schizophrenic out-patients with tardive dyskinesia were treated with chlorpromazine in 2 regimens -- once-daily and four times-daily -- using a cross-over design. Two "blind" raters evaluated the severity of symptoms of tardive dyskinesia, pseudoparkinsonism and schizophrenia on rating scales every week during the 14-week-trial period. Results showed that the intensity of dyskinesia was significantly lower, and that of pseudoparkinsonism higher (but not significantly) with Q.I.D. than with O.D. medication. Symptoms of schizophrenia did not vary in severity appreciably with the two frequencies of drug intake. It is suggested that multiple-dose administration of a phenothiazine maintains a steady level of dopamine blockade throughout the day and thus masks the manifestations of tardive dyskinesia.

Both psychiatrists and neurologists must be able to recognize illnesses that have atypical presentations so as to insure prompt and accurate diagnosis and treatment. The disease described in this case report graphically illustrates this point.

A patient is presented with "normal" pressure hydrocephalus including dementia, incontinence, and apraxic gait. He had a normal lumbar CSF pressure, hydrocephalus with lack of air over the convexities on pneumoencephalography, and ventricular filling with prolonged retention on cisternography. He did not receive a shunt and, nevertheless, showed spontaneous improvement in his mental function over the next few years. This cases emphasizes the necessity for a controlled study of shunting for "normal" pressure hydrocephalus.

The use of stimulant drugs for control of hyperactivity in children led one mental health center to centralize the procedure in a medication clinic. A number of benefits were derived from monitoring the children through routine folow up visits. One of the retrospective findings over a three-year period was the low incidence and prevalence rates of medicated hyperactive youngsters in a high volume children's service.

Fifteen depressed patients were treated with amitriptyline in a dosage ranging from 75 mg to 200 mg/day for a minimum of three weeks, two of which were at a fixed dosage. Plasma samples were drawn 12 to 16 hours after the bedtime dose of medication for determination of amitriptyline and its metabolite nortriptyline. Electrocardiograms were taken prior to treatment and after three weeks of drug treatment. The only abnormality noted prior to treatment was bradycardia in one patient. After treatment, two patients exhibited nonspecific T-wave abnormalities. Otherwise, the electrocardiograms were unremarkable. A significant increase in heart rate (p less than 0.001) was noted. The mean increase in rate was sixteen beats per minute. Those patients having a rate change greater than sixteen beats per minute had significantly higher amitriptyline levels (p less than 0.05), and total tricyclic antidepressant levels (p less than 0.05), than those patients having a mean rate increase less than sixteen. While tricyclic antidepressants can produce multiple cardiac effects, the risk of cardiac morbidity and mortality is relatively low in patients undergoing tricyclic antidepressant treatment with moderate dosages.