Pharmakopsychiatrie, Neuro-Psychopharmakologie最新文献

The prolactin (hPRL) level in the serum of 17 patients (10 females, 7 males) with primary depression (manic-depressive disease) was determined before and after prophylactic treatment with lithium salts. All patients were free of acute psychotic-depressive symptomes. However, 9 of 17 patients received moderate doses of additional antidepressive medication continuously for 4 weeks. No significant changes of the serum hPRL were observed in the group as a whole, the lithium serum levels being within the normal therapeutic range. The mean hPRL level in patients with concomitant antidepressive medication was significantly higher as compared to the "only lithium" group, but never exceeded the normal range in both groups. Considering similar results of other authors, it is suggested that lithium does not influence the hPRL serum level, at least if no special methods of hPRL stimulation are used. However, with regard to recent communications suggesting that besides dopaminergic influences also serotonergic mechanisms play an important part in hPRL regulation, it is held that the prolactin response in lithium-treated patients warrants further investigations using serotonergic stimulation methods.

A 31-year-old white woman developed bilateral papilloedema whilst on lithium carbonate therapy for five years because of manic depressive illness. Oedema of the optic disc disappeared after lithium administration had been discontinued. To our knowledge this is the second case of this kind which has been reported in literature.

The paper reports on an open study of flupirilene administration in ten previously untreated female outpatients with paranoid symptomatology who were of advanced age. In eight of the ten patients who had been included in the 12-week study the authors observed a remission particularly of delusion dynamics, delusional intuitions, delusional perceptions, and restlessness as well as excitment. The therapy failed in two patients. Preexisting cerebro-organic impairments deteriorated partly, whereas vegetative and extrapyramidal side effects were of only moderate intensity. Hence, fluspirilene proved to be a depot neuroleptic with good antipsychotic effect in outpatient treatment of paranoid psychoses of patients of advanced age. However, especially in patients of advanced age. However, especially patients with preorganic brain syndrome, the obviously sedating and retarding effects of this drug must be taken into account, since they may contribute to further disturbance of the impaired cerebral function.

The antidepressant effect of amitriptyline was studied in 28 endogenous depressive patients. They received 150 mg amitriptyline once nightly in a sustained release form for 4 weeks. Blood samples were drawn 12 hrs. after medication. Amitriptyline concentrations were between 35--300 ng/ml Nortriptyline concentrations were between 20--330 ng/ml. No correlations were found between plasma concentrations of amitriptyline, nortriptyline, or their sum, and the clinical outcome of treatment. Plasma levels of amitriptyline depended on neither the age nor the sex of the patients. A significant correlation was found between the ratio of nortriptyline to amitriptyline concentrations in serum (demethylation ratio) and clinical improvement. The demethylation ratio appeared to be relatively constant after a few days of treatment. The results suggest that monitoring the demethylation ratio of endogenous depressive patients treated with amitriptyline may predict therapeutic effects of the treatment. They also suggest that a balance between noradrenergic and serotonergic mechanisms is necessary to improve antidepressant treatment with amitriptyline.

The relationship between the plasma levels of amitriptyline and its metabolite nortriptyline, as well as their side-effects and clinical response, were studied in 102 depressed female in-patients, treated with different dosages of amitriptyline. For 50 and 100 mg dosages, significant positive correlations were found between amitriptyline concentration and the Hamilton amelioration scores, as well as between Hamilton final values and side effects. For depressive neurosis and involutional melancholia best therapeutic responses were yielded at a dosage of 50 mg, while in the treatment of manic-depressive illness, comparable results occurred at a 150 mg dosage. In the depressive neurosis and in the involutional melancholia the upper plasma concentration limits for the therapeutic effect of nortriptyline were identified. The lower plasma concentration limits of amitriptyline and nortriptyline in the treatment of manic-depressive illness were also pointed out.

The treatment of schizophrenic patients with high-dosed neuroleptics is discussed. The drug-response difference between a low dose and a high dose of Fluphenazine-Decanoate was investigated in 40 chronic schizophrenic patients. All patients were resistant to standard doses of neuroleptics and were therefore treated with higher doses. All patients entering the study were treated for at least three months with high doses of Fluphenazine-Decanoate, i.e. 100 mg or more within three weeks. From this pool of 40 patients two groups were created at random for the doubleblind study: In one group the high dose was continued (average dose 225 mg/in 14 days), in the other group Fluphenazine-Decanoate was reduced to a standard-dose of 25 mg in 14 days. During the 24 weeks of investigation the somatic and psychopathological state of the patient was evaluated by means of the AMP-System. Furthermore the self-rating scale EWL-K was used. After 24 weeks the patients of the high-dosed group were more often rated as unchanged, while the patients in the standard-dosed group were evaluated significantly more often as better or worse. Average condition-differences between the both groups could not be found in a covariance-analysis. A factorial covariance-analysis showed that differences in the initial hostility-syndrome and catatonic-syndrome scores are predictors for a syndrom-relevant differential dosage per group. Patients with low hostility- and low catatonic-syndrome-scores improved after reduction of the doses in the apathic, the halluzinatoric-desintegrative and the neurological syndrome, whereas patients with high initial hostility- and catatonic-syndrome-scores became psychopathologically worse after dosage reduction. Finally the possibilities of generalizing from the results obtained to the relevance of high and standard neuropletic therapy are discussed.