Pharmakopsychiatrie, Neuro-Psychopharmakologie最新文献

The purpose of the present study was to investigate the effect of bromocriptine in single doses of 20 and 30 mg on the unwanted effects most frequently caused by neuroleptics: elevated prolactin levels and extrapyramidal disturbances. 111 chronic schizophrenics were included in the investigations, 58 of them being treated with haloperidol and 53 with chlorpromazine. It was found that a single dose of 30 mg bromocriptine brought about a statistically significant decrease in the prolactin levels of patients treated with haloperidol but produced no more than a downward tendency in patients receiving chlorpromazine (the initial prolactin levels of both groups of patients were equal.) The effect of bromocriptine on EPS disturbances was more marked in the chlorpromazine group, but side effects such as nausea and agitation also occurred more frequently in this group. These results show that there is no correlation between the reduction in prolactin levels produced by bromocriptine and an improvement in unwanted EPS effects. This supports the hypothesis that the effect of neuroleptics on the prolactin secreting cells of the anterior pituitary and their effect on the EPS are mediated by different sets of receptors.

Oral administration of the serotonin precursor, L-tryptophan, to normal male volunteers (n = 7) in a dose (3 g) sufficient to increase free plasma tryptophan concentrations more than 12-fold had no significant effect on basal growth hormone secretion or on apomorphine HCL-induced (0.75 mg sc) peak growth hormone concentrations. These data suggest that, in man, tryptophan administration has little effect on central dopaminergic function, at least in the hypothalamic-pituitary axis and that serotonergic mechanisms have no major modulatory effect on dopamine-mediated growth hormone secretion.

Basal and stimulated (0.2 mg TRH, 0.025 mg LHRH) levels of prolactin, TSH and LH were measured in serum of 12 male and 10 female chronic schizophrenic patients, hospitalized and treated with neuroleptics from 6-21 years. The mean values of the 3 pituitary hormones were within the normal range in both sexes. Tolerance to the prolactin increasing effect of neuroleptics appears to develop after long-term neuroleptic treatment. TSH and LH secretion are not markedly impaired by chronic neuroleptic treatment.

A wide range of literature on the use of psychoactive drugs in pregnancy and breastfeeding is reviewed critically and systemically. The question of 'guidelines' for an adequate treatment of pregnant psychiatric patients cannot be answered in an unequivocal or reassuring way. First of all, it is our inconclusive knowledge of this subject which demands caution prior to prescribing. Only in second line, isolated evidence of possible but mostly unproven damage to unborn children by the use of individual psychotropic drugs should be taken into account.

A double-blind placebo-controlled cross-over investigation of the possible antipsychotic action of [des-Tyr1]-gamma-endorphin (DT gamma E) was undertaken in schizophrenic patients. This non-opiod derivative of gamma-endorphin has recently been shown to exert both neuroleptic-like effects in animals and an antipsychotic action in schizophrenic patients failing to respond to conventional neuroleptic therapy. 13 patients undergoing continuous neuroleptic therapy, and suffering from either chronic or acute, frequently-relapsing schizophrenia and displaying persistent productive symptoms (hallucinations, acute delusions) were selected for the trial. After one day of single-blind injection of placebo, two successive double-blind treatment periods of 4 days each followed, viz 4 days with i.m. injections of 2 mg DT gamma E preceding 4 days of placebo injections or vice versa. Psychopathological evaluation was performed twice daily by use of the IMPS and an eight-point-scale appropriate for the estimation of special target symptoms (VBS). The mean data obtained from the whole sample of 13 patients show that placebo and DT gamma E produce a reduction in symptomatology of an appoximately equal magnitude. The results provide no support for the hypothesis of an antipsychotic efficacy of DT gamma E in the treatment of chronic schizophrenic patients. In the subgroup of acute cases, however, a therapeutic action of DT gamma E appears possible

Beta-blocking agents have been used for many years in psychiatry. But many are suspicious about their mechanisms and therapeutic effects. In this review, the most part of clinical trials is reported and criticized. With the exception of anxiolytic effects, the other therapeutic effects are still questionable for many reasons, such as the methodology of clinical trials. In this paper, others agents which interact with the noradrenergic system are envisaged. It is taking into account all these factors (alpha and beta receptors, alpha and beta agents) that we can looking for award for a real progress in the field of biochemical psychiatry.

The symptom of anxiety, perhaps the most common in all clinical medicine, presents in a variety of forms--psychologic, somatic, behavioral--and often masquerades or is misdiagnosed. Anxiety is a manifestation encountered in a heterogeneous group of syndromes or disorders embracing all of psychiatry. It is necessary to develop the best treatment or combination of treatments appropriate for each case or group of cases. In the treatment of anxiety controlled comparative studies indicate that patients receiving psychotherapy do better than controlled groups. According to present knowledge no one method of psychotherapy is superior to others. The effectiveness of pharmacotherapy alone in the treatment of anxiety is unequivocally established. However, combined therapy of pharmacologic agents and psychotherapy would appear to be superior to either therapy alone. Critical research using existing modalities and combinations of modalities is of vital importance in the treatment of anxiety. Rapid developments in the past twenty-five years in the discovery and differential use of pharmacotherapeutic agents have stimulated renewed interest in the anxiety states and related disorders, as has the emerging body of knowledge regarding possible specific receptor sites in the brain related to anxiety. These developments have heightened interest in research on anxiety with resulting innovations in treatment.