Pharmakopsychiatrie, Neuro-Psychopharmakologie最新文献

Six patients suffered from a hyperventilation syndrome for 3.4 +/- 1.2 years. They had a lowered PAco2 at rest and an abnormal CO2 response curve. During the entire period they had received unsuccessful treatment with anxiolytics, and had also undergone behaviour therapy for the last 1 -- 2 years without success. Both treatments were discontinued and the patients were placed on clomipramine, 25 mg t.i.d. for 9 months. Their anxiety and hyperventilation attacks diminished after one month of clomipramine, and their fear of attacks an their phobias subsided after two months. Eighteen months after clomipramine therapy had been initiated, they were feeling well without medication. The possible mode of action of clomipramine on the hyperventilation syndrome via central serotonergic mechanism is discussed.

1. At the psychiatric hospital of the University of Munich physicians' practices in prescribing psychotropic drugs have been analyzed retrospectively for 1974. Case report of 2,100 patients from a total of 2,118 newly admitted inpatients in 1974 have been evaluated and various methods of analyzing data are compared. 2. 414 (19.7%) patients out of a total of 2100 have not been medicated by any drugs. On the average 2.7 psychotropic drugs/patient have been precribed in the remaining 1,186 patients (80.3%). 3. 37.4% of 4627 applications made have been allotted to neuroleptics. Clozapine has been found to be the drug most extensively used (37.4%). It was prescribed to 595 patients, followed by chloralhydrate (425 patients) and amitriptyline (374 patients). 4. Out of a total of 5373 prescriptions, 2,004 were allotted to a single substance and 3,369 to a combination of different drugs. With regard to combined medications, in 1,856 prescriptions two drugs were combined, in 1,015 three, in 404 four, in 70 five, in 18 six and finally in 6 prescriptions seven medications were applied to one patient. 5. Antidepressants and neuroleptics have been combined on the same patient in 768 prescriptions. As to neuroleptics most frequently clozapine and haloperidol have been prescribed together. 6. The mean time during which a defined combination of drugs was given continuously, never exceeded a quarter of the total time the individual had been admitted to the hospital. 7. It is evident that in clinical practice the combinations of psychotropic drugs are widely used. This pattern of psychopharmacological drug treatment is in conflict with the present accepted rules of psychotropic pharmacotherapy. Furthermore it is a remarkable result of the present studies that in therapeutical practice the single components of drug combinations are changed very often. Compounds with sedative effects are preferred within all classes of psychotropic drugs.

This report reviews 26 clinical drug trials which investigated the effectiveness of Hydergine, a dihydrogenated ergot alkaloid, used frequently in geriatric psychopharmacology. The methodological characteristics and significant results for each study are presented in outline form. In total, 32 symptoms were assessed in six or more studies. Therapeutic benefits following Hydergine treatment occurred in the areas of cognitive dysfunctions, mood depression, and the composite scores as measured by subjective clinical behavioral rating scales. It is suggested that the improvement reported in cognitive functions and mood depression is a reflection of the global change observed by clinicians in patients' overall behavior duirng the interview. This conclusion that Hydergine does produce some global improvement indicates that further research with Hydergine is warranted, provided more objective instruments are employed such as those described in the report.

In 105 patients with endogenous depression treated with antidepressants or ECT the course of the depressive state was evaluated by means of a self-rating mood scale (Befindlichkeits-Skala by von Zerssen). The scale was filled out every second day. The course of the depressive mood was computed by various algorithms for each patient. Two different courses of depressive mood could be identified: some patients showed a relatively continuous decline in the depressive mood, whereas others showed strong fluctuations. Although there were some correlations between type of treatment and extent of mood swings, other factors also seemed to be relevant. Thus, there appears to be an interaction between treatment effects and spontaneous rhythms.

Endocrine changes induced by dopaminergic inhibition may play a part in the development of sexual dysfunction (reduced libido/potency) in schizophrenic patients on long-term neuroleptic treatment. Prolactin, testosterone, LH and FSH serum level determinations by radioimmunoassays were performed in 24 schizophrenic males on long-acting fluphenazine decanoate treatment. Of these patients, sexual dysfunction was present in 17 cases, in 10 patients sexual activity remained unchanged. As compared to the 15 healthy controls (7.33 +/- 0.91 ng/ml), a significant increase of prolactin concentrations was found, i.e. 28.2 +/- 5.15 in the impotent groups, and 16.7 +/- 2.12 in the non-impotent group. The difference between the latter two mean values was, however, not significant. In the patients with normal sexual activity the increase of LH concentration was highly significant. It might be assumed that normal sexual behaviour despite neuroleptic treatment and hyperprolactinaemia is related to the high concentration of LH, though the mechanism of increased LH secretion has not been cleared as yet. The testosterone and FSH concentrations showed no differences in various groups.

Beta-Leu5-endorphin, a relative of "normal" beta-endorphin in which leucine is substituted for methionine at position 5 of the latter, has previously been found in high concentrations in the dialysate of schizophrenics. Its removal from plasma by means of hemodialysis has been claimed to relive the symptoms of schizophrenia. Using a highly sensitive radioimmunoassay of equal sensitivity to beta-endorphin and beta-leu5-endorphin, we have compared the plasma immunoreactivity of three schizophrenic patients befofe and after performance of their first session of membrane hemoperfusion. As compared to normal subjects, plasma beta-endorphin-like immunoreactivity was not greatly elevated in the schizophrenic patients before hemoperfusion.However, instead of the expected decrease, a consistent increase in the plasma levels of immunoreactive beta-endorphin was detected after hemoperfusion. In vitro experiments in which two different membranes and hemodialysis as well as hemoperfusion were used, revealed that synthetic beta-leu5-endorphin (and beta-endorphin) from human plasma was not cleared with any of these methods. This finding is inconsistent with the hypothesis that the claimed therapeutic effects of hemodialysis in schizophrenics are due to the removal of a beta-endorphin-like material from the plasma. Consequently, it seems to be unprobable that high concentrations of beta-leu5-endorphin occur in the dialysate or ultrafiltrate of schizophrenics.

Five groups of two volunteers lived during four weeks under arctic summer conditions (Spitsbergen) isolated in huts, without time information. They received lithium carbonate or placebo. All showed free-run of their circadian temperature and activity/rest rhythms with periods longer than 24 hours. Under lithium carbonate, a period-lengthening effect can be shown. This could help to understand theprophylactic effect of lithium salts in manic-depressive episodes.

After ip. injection of 14C-labelled sulpiride in rats, about one third is metabolized while the other two thirds are excreted unchanged in feces and urine. The highest level of its metabolites was found in the liver (about 65% of total radioactivity). In the brain, 90% of the radioactivity consisted of unchanged sulpiride, which seems to be responsible for the central effects of the drug. The highest concentrations within the brain were found in the median eminence, circumventricular organs, plexus, and pineal body.