Pharmakopsychiatrie, Neuro-Psychopharmakologie最新文献

The clinical profile and side-effects of perphenazin-enanthate and fluspirilene were compared in 45 female chronic schizophrenic patients. 100 mg perphenazin-enanthate fortnightly or 8 mg fluspirilene weekly were administered. During the four months' period the psychopathological and somatic symptoms were evaluated by means of the AMP-system and the self-evaluation scale PD-S (v. Zerssen). A covariance analysis was carried out covering 12 AMP syndromes and 6 PD-S factors. The antipsychotic effect of both drugs was similar concerning the paranoid, the hallucinatory-desintegrative and the catatonic syndromes. A significant difference with regard to perphenazin-enanthate was found in the AMP-syndromes of hostility, hypochondria, and autonomic symptoms. Neither drug induced any depression. In the self-rating scale, the factors anxiousness and depressivity were also significantly lower in the perphenazin-enanthate regime. The patients under perphenazin-enanthate required a smaller amount of antiparkinsonian drugs. The more pronounced sedative effect of perphenazin-enanthate can be recommended in hostile and restless schizophrenic patients, whereas fluspirilene should be given to inactive autistic patients.

40 acute schizophrenic in-patients were examined using a rating scale (AMP-system) and a self-report questionnaire (APZ) immediately after their admission and on average 7 weeks later. The aim of the study was to clarify the usefulness of self-report questionnaires in schizophrenic patients. There were four groups of subjects: 1. Patients, who filled in the questionnaire immediately after admission, 2. patients, who did not at this phase of their illness, 3. patients, who filled in the form 7 weeks later during remission and 4. patients, who did not. The main questions were: --Are their any differences in the psychopathology between testable and untestable patients immediately after admission resp. during remission 7 weeks later? --How do the psychiatrist's ratings and the self-ratings correlate in different phases of the illness? If was found that the degree of psychopathology correlated negatively in the acute state with the capacity to perform a self-rating. Seven weeks later during remission this correlation could not be found anymore. Motivational variables of staff and patients in influencing the testability are mentioned. It is also shown that there are selfreports and rating-scales. The correlations are different during the two phases of the illness.

Patients suffering from acute schizophrenia are subjected to treatment according to different therapy standards, depending on the individual hospital. Hence, the present study aimed at a comparative investigation of the effects and side effects of fluphenazine dihydrochloride administered to 51 acutely diseased schizophrenics via the intravenous, intramuscular and oral routes. It was also interesting to record the assessment of efficacy, painfulness and, as the case may be, repeated selection of the form of application concerned, by the patients themselves. Finally, we also investigated the relations between the age of the patients, duration of previous hospitalisation, and the effects achieved with the three application forms. Documentation was effected via the following examination instruments described and recommended by the National Institute of Mental Health (NIMH), USA; CGI, BPRS, Dotes, APDI and PTR.

This study attempted to clarify sources of artefact in biochemical studies with affective disorders in which 3-methoxy-4-hydroxy phenylglycol (MHPG) is used as a measurement of change in central nervous system norepinephrine (NE) turnover. Substantial increases in urinary MHPG excretion occurred in ten of the 11 patients when they increased their level of physical activity (0.5 +/- .14 mg/12 hrs versus 1.54 +/- .49 mg/12 hrs). Increases were also observed in NE (19.2 +/- 5.1 microgram/12 hrs versus 25.2 +/- 3.7 microgram/12 hrs). In four patients in whom cerebrospinal fluid MHPG levels were obtained a consistent increase of MHPG levels was observed during the activity period. Elevation of these metabolites were not correlated with changes in depression as reflected by psychiatric observation and rating scales. These data reveal a considerable amount of lability in urinary and CSF MHPG levels in the face of an unchanging affective state. They ask for careful controls for activity and stress in psychiatric patients when urinary MHPG is used as an index of central NE turnover.

It can be expected that investigations on the effect of lithium on the "normal" human mind may elucidate the influence of lithium on experience and behaviour during the "free interval" of manic-depressive patients. In a placebo-controlled double-blind trial 24 normal healthy volunteers were given lithium sulphate (24--36 mval/die) or placebo over a period of two weeks. The subjects were tested after one and two weeks drug intake using the following tests: quantitative pharmaco-EEG, psychological performance, and mood scales. In comparison to placebo lithium shows decreased flicker fusion threshold, and mood change towards depression (Bf-S). In the resting EEG a decrease of relative slow alpha (7.5--9.0 cps)--and an increase of relative fast beta (20.0--30.0, and 30.0--48.0 cps)--power was observed. The results suggest that lithium leads to decreased vigilance and reduced spontaneous activity.

The study reports about the intravenous application of Biperiden at patients with acute hypokinetic reaction suffering from schizophrenia of the paranoid-hallucinatory type. In all of the six cases examined a fast abolition of the stupor could be observed. The pathophysiological mechanisms deriving from our clinical experiences are discussed. Furthermore, a therapeutic procedure is suggested to treat acute schizophrenic stupor merely with drugs.

15 patients with formerly endogenous recurrent depression or manic-depressive illness free of psychotic symptoms, who are under lithium prophylaxis about 3,9 years, and 16 healthy controls with approximately the same age and sex were tested with 0,1 U Insulin/kg, 200 micrograms TRH and 50 micrograms LHRH for their hGH-, TSH-, hPRL-, FSH-, LH-and Cortisol levels about 2 hours. hPRL, FSH and LH did not show any change under lithium salts. All patients under lithium showed elevated TSH-levels under basal conditions and after stimulation compared with the control groups. For the young women before menopause the difference was highly significant. Men and praemenopausal women had significantly higher hGH-levels after stimulation under lithium than the normal controls. However postmenopausal women did not show this lithium effect on their hGH levels.

The antimanic action of high doses of the beta-receptor blocking agent propranolol was investigated by the use of a double-blind placebo controlled ABA design. For comparison, the d-stereoisomer (which is practically devoid of beta-blocking activity) was used. 6 trials were performed with d-propranolol, 6 trials with the racemic mixture. From dose-effect relations one can conclude that the d-stereoisomer is about half as effective against manic syndromes as the racemic mixture. From this finding it can be concluded that the antimanic action of propranolol is at least partially due to a mechanism independent of its beta-blocking action.

The improvement of depression after partial sleep deprivation in the second half of the night (sd) is tested for its predictory power for the therapeutical efficacy of pharmacotherapy with lofepramine. In a group of 15 patients with depression, we found that in contradiction to the findings of Wirz-Justice and collaborators (1976), the velocity of the antidepressive effect of sd has no predictive value. On the other hand, the amount of depression improvement after sd is of predictive value. This is independent of the time of occurrence of the improvement peak after sd. An improvement of more than 35% measured in the Bf-S or in the H.DRS on the first or the second day after sd is highly predictive for a good response to three weeks of 210 mg lofepramine per day (p = .05).

In connection with clinical drug trials we compared the ECG-recordings during application of two different antidepressants. Tandamine (AY 23946) is a tricyclic drug with main effects on the norepinephrine reuptake, Fluvoxamine (DU 23 000) a nontricyclic antidepressant with a selective effect on the serotonin reuptake. No differences were observed regarding both frequency and patterns of the repolarisation disturbances. Thus, it appears that the chemical structure of the drug is not responsible for the "typical" form of the repolarisation disturbances. We further hypothesize that toxic effects and regulatory mechanisms of the cardiovascular system, caused by changes in norepinephrine and 5-hydroxytryptamine levels may be responsible for the areforementioned ECG aberrations.