Divalproex sodium increases plasma GABA levels in healthy volunteers

The purpose of this study was to ascertain the effects of divalproex sodium (DVP), an anticonvulsant and mood stabilizer, on plasma gamma-aminobutyric acid (GABA) levels in healthy humans. Twenty healthy volunteers with no lifetime history of psychiatric illness or family history in first-degree relatives were recruited. Each subject received DVP 1000 mg per day for 1 week. Blood samples for assay of plasma levels of GABA were taken from each subject before and after the administration of DVP. GABA concentrations were analysed using high pressure liquid chromatography with fluorescence detection after derivatization with o-phthaldialdehyde. It was found that DVP administration for 1 week resulted in a small, but significant, increase in plasma levels of GABA. Our results suggest that DVP enhances GABA activity in humans. Further treatment studies of DVP on GABA function in patients with psychiatric disorders are needed to explore the significance of the enhancing effect of DVP on GABA activity.     

Increased platelet aggregation responses to 5-hydroxytryptamine in patients taking chlorpromazine.

1 The aggregation response of platelets induced by 5-HT was greatly increased in psychiatric patients receiving chlorpromazine therapy when compared with normal volunteers and psychiatric patients not receiving chlorpromazine. 2 Platelet aggregation responses to ADP were normal during chlorpromazine therapy, but 5-HT induced aggregation was increased in rate and the typical transient reversible response was converted to an irreversible response in all subjects. This was usually indistinguishable from the ADP response. 3 When chlorpromazine therapy was stopped, plasma concentrations of chlorpromazine, monodesmethylchlorpromazine and chlorpromazine sulphoxide fell rapidly within one week, whereas 5-HT induced platelet aggregation responses became normal after three weeks. The enhanced responses returned when chlorpromazine therapy was re-instituted. 4 It is possible that platelet aggregation responses to 5-HT in vitro could prove to be a useful index of the pharmacological effect of chlorpromazine in vivo.     

Prediction of attrition from day hospital treatment in lower socioeconomic cocaine-dependent men

This study attempted to identify predictors of completion of a 27 h/week 4-week day hospital program for cocaine dependence. The research subjects were 95 lower socioeconomic, primarily African American male veterans. Of a wide range of predictor variables available at baseline, including sociodemographic and historical information, Addiction Severity Index data, psychiatric diagnoses, SCL-90 measures, and measures of craving and familial alcoholism, only the cocaine urine toxicology result and self report of days of cocaine use in the past 30 days (log transformed) were significant predictors. The urine toxicology result was the more powerful predictor with 73% with a negative urine completing treatment, as contrasted with 36% with a positive urine. Three additional measures obtained at the end of treatment week 1 further increased ability to predict treatment completion/attrition. Two of these measures were based on counsellor ratings and one was based on the patient's report of psychiatric treatment services received during the first treatment week. Thus, patients at high risk for dropout can be identified fairly early. Whether treatments can be adapted to retain such patients is an important question for the field.     

Prevalence of substance abuse in a psychiatric evaluation unit.

The prevalence of substance abuse and psychiatric illness was studied in a Psychiatric Evaluations Unit. Twenty-six percent of the subjects received a psychiatric diagnosis only with no concomitant substance use disorder. Thirty-four percent were diagnosed with a substance use disorder but with no other psychiatric disorders. Thirty-nine percent of the subjects had a history of both psychiatric and substance use disorder; 62% of these substance abusers with a psychiatric illness reported using drugs (including alcohol) the week before the interview; 56% used illicit drugs while 44% used alcohol only. Differences among substance abusers with a psychiatric illness, those with a substance abuse diagnosis alone, and those with a psychiatric diagnosis alone are presented.     

奎硫平改善帕金森病患者精神障碍的临床运用探讨

目的探讨奎硫平对帕金森病患者精神障碍的临床疗效和安全性。方法对45例伴有精神障碍的帕金森病患者使用奎硫平25-75mg治疗4周,用阳性和阴性症状量表（PANSS）评定疗效,用副反应量表（TESS）评价安全性。结果PANSS总分在治疗前后有明显差异性,临床总有效率为88％,无严重不良反应。结论奎硫平能够有效缓解帕金森病患者的精神症状。     

Amoxapine in depressive illness

A double-blind trial was carried out in 29 patients recently admitted to hospital with depressive illness to compare the effectiveness and side-effect liability of treatment with amoxapine and imipramine. Both drugs were given in a dosage of 25 mg 3-times daily over a period of 4 weeks, and patients' progress was assessed using psychiatric and psychological rating scales for depression. Although amoxapine and imipramine proved equally effective, response to amoxapine was quicker and appeared to have the same effect after 1 week as did imipramine after 2 weeks. In addition, dryness of the mouth was complained of most frequently by patients taking imipramine.     

Reinforcing integrated psychiatric service attendance in an opioid-agonist program: A randomized and controlled trial

Background

The benefits of integrating substance abuse and psychiatric care may be limited by poor service utilization. This randomized clinical trial evaluated the efficacy of using contingency management to improve utilization of psychiatric services co-located and integrated within a community-based methadone maintenance treatment program.

Methods

Opioid-dependent outpatients (n = 125) with any current psychiatric disorder were randomly assigned to: (1) reinforced on-site integrated care (ROIC), with vouchers (worth $25.00) contingent on full adherence to each week of scheduled psychiatric services; or (2) standard on-site integrated care (SOIC). All participants received access to the same schedule of psychiatrist and mental health counseling sessions for 12-weeks.

Results

ROIC participants attended more overall psychiatric sessions at month 1 (M = 7.53 vs. 3.97, p < .001), month 2 (M = 6.31 vs. 2.81, p < .001), and month 3 (M = 5.71 vs. 2.44, p < .001). Both conditions evidenced reductions in psychiatric distress (p < .001) and similar rates of drug-positive urine samples. No differences in study retention were observed.

Conclusions

These findings suggest that contingency management can improve utilization of psychiatric services scheduled within an on-site and integrated treatment model. Delivering evidenced-based mental health counseling, or modifying the contingency plan to include illicit drug use, may be required to facilitate greater changes in psychiatric and substance abuse outcomes.     

Comparative study of short-term anxiolytic potency of alprazolam and tandospirone in psychiatric outpatients with anxiety disorders

Anxiolytic potency of 1 week of treatment with alprazolam or tandospirone in psychiatric outpatients with anxiety disorders was evaluated by changes in the scores on the Hamilton Anxiety Scale and the State and Trait Anxiety Inventory and in the saliva level of free-3-methoxy-4-hydroxyphenylglycol (free-MHPG). Saliva level of free-MHPG was significantly reduced by 1 week of treatment with alprazolam but not with tandospirone. Reductions in the HAS score after 1 week of drug treatment were greater in patients treated with alprazolam than in those treated with tandospirone. These results indicate that the short-term anxiolytic potency of alprazolam is greater than that of tandospirone and that the saliva level of MHPG would be a useful marker for the evaluation of the therapeutic potency of anxiolytic agents. Copyright 2001 John Wiley & Sons, Ltd.     

团体心理教育方法培训沟通技巧对精神科护士职业压力的影响

目的研究团队心理教育方法培训沟通技巧对精神科护士职业压力的影响。方法本研究纳入52名护士,所有纳入护士均工作于精神科病房。参与者采用随机数字表被随机分为实验组和对照组,每组各26名。由研究者设计护士职业压力调查问卷,分别在沟通技巧培训前、培训完成时及培训完成后1个月进行问卷调查。实验组的沟通技巧培训采用团体心理教育方法分8次进行,每周进行2次,每次持续时间1h。结果调查结果显示,干预前两组成员均有高水平职业压力,在培训完成时实验组成员职业压力水平显著下降,并且在培训后1个月仍持续有显著改善。结论使用团体心理教育方法培训沟通技巧可减少精神科护士的职业压力。     

A clinical evaluation of risperidone in the treatment of schizophrenia: a 10-week, open-label, multicenter trial

The efficacy and safety of risperidone have previously been demonstrated in controlled clinical trials in hospitalized chronic schizophrenia patients who met strict research criteria. The present study was designed to evaluate the efficacy and safety of risperidone in a heterogeneous patient population. Patients were enrolled in the study if they had a diagnosis of schizophrenia (DSM-III-R) with or without acute exacerbation. Of the 945 patients from 158 psychiatric centers who entered this phase IV study, 558 completed the 10-week trial. During week 1, the dose of risperidone was titrated to 6 mg/day, maintained there for 1 week, and then adjusted over a 4-week period as clinically necessary; the dose was then fixed for the final 4-week period. The mean dose of risperidone at endpoint was 5.9 mg/day. Patients were evaluated at baseline and at weeks 2, 6, and 10, using Clinical Global Impression scale, Psychotic Symptoms Assessment scale, and Global Assessment of Functioning scale. Significant improvement in mean scores was found on each of these measures at endpoint. Comparable results were obtained at week 10 in treatment-resistant and non-treatment-resistant patients. Risperidone was generally well tolerated and the severity of extrapyramidal symptoms was significantly reduced at endpoint. Received: 17 April 1996/Final version: 31 December 1996     

Changes in carbamazepine plasma concentrations in psychiatric patients during treatment.

Plasma concentrations of carbamazepine (CBZ) were studied in 24 psychiatric patients who were given 400 mg of CBZ every 12 h. The assays were performed on the 1st, 3rd, 8th, 15th, 22th and 29th day of the therapy. The highest minimum 12h plasma CBZ concentrations occurred on the 3rd day of therapy, then decreased up to the 15th day and remained stable thereafter. The CBZ half-time values also diminished up to the 15th day of therapy and then stabilized. This may suggest that the enzymatic autoinduction of CBZ is completed within the first 1-2 weeks of therapy. CBZ plasma levels were slightly but insignificantly higher in patients taking CBZ alone than in patients in which CBZ was added to other psychotropic drugs. A significant correlation was found between the minimum CBZ plasma concentration after the first dose and that at steady state. A dosing schedule for CBZ administration has been proposed with administration of 75% of the maintenance dose during the first week and the full CBZ maintenance dose from the beginning of the second week of CBZ therapy.     

Effect of fluvoxamine on platelet 5-HT2A receptors as studied by [3H]lysergic acid diethylamide ([3H]LSD) binding in healthy volunteers

Alterations in platelet 5-HT_2A receptor characteristics have been reported in major depression as well as in other psychiatric diseases, and some effort has been made to utilize platelet 5-HT_2A receptor status as a biological correlate to antidepressant drug response. In order to investigate whether treatment with a selective serotonin reuptake inhibitor affects platelet 5-HT_2A receptors, we have studied platelet [³H]lysergic acid diethylamide ([³H]LSD) binding in healthy subjects treated with fluvoxamine in increasing dosage once weekly for 4 weeks. After 1 week of fluvoxamine treatment (25 mg/day), both B_max and K_d were significantly lower than before the start of the treatment (19.9 versus 25.5 fmol/mg protein, P = 0.005 for B_max; 0.45 versus 0.93 nM, P = 0.006 for K_d). B_max returned to baseline during week 2, whereas K_d was lower than the baseline value throughout the treatment period. After discontinuation of fluvoxamine treatment, there was a significant increase in K_d (0.50 nM before discontinuation vs. 1.14 nM after discontinuation; P = 0.001), but not in B_max. The study demonstrates that fluvoxamine affects platelet 5-HT_2A receptor status irrespective of underlying psychiatric disease, and that this effect is evident already after 1 week at a subtherapeutic fluvoxamine dose. Received: 11 October 1996/Final version: 12 March 1997     

Predicting proximal factors in cocaine relapse and near miss episodes: clinical and theoretical implications.

This study examined the degree of correspondence between relapse vulnerability factors assessed at intake to aftercare in 100 cocaine dependent patients and proximal factors in their first cocaine relapse and near miss episodes during a 1-year follow-up. Proximal factors in relapse and near miss episodes were also compared. Correspondence between experiences associated with prior use and experiences in the week prior to relapse and near miss episodes was generally poor. Psychiatric and family/social problem severity and coping factors at intake to aftercare predicted experiences in the week prior to near misses, and to a lesser degree, experiences in the week prior to relapse episodes. However, relapse vulnerability factors were also associated with psychiatric and family/social problem severity and mood during abstinent periods. Therefore, there was little evidence of specificity in relationships between relapse vulnerability factors and experiences prior to relapse. Proximal measures of coping, sensation seeking, positive experiences, and unpleasant affect differentiated relapses from near misses in a within-subjects analysis.     

The effects of neuroleptic drugs on 5-hydroxytryptamine induced platelet aggregation in schizophrenic patients.

1 The effects of treatment with a range of neuroleptic drugs on 5-hydroxytryptamine (5-HT) induced platelet aggregation in vivo were examined in a group of recently admitted psychiatric patients and in a larger group of chronic schizophrenic patients. 2 Five of seven recently admitted patients treated with chlorpromazine showed enhanced aggregation. Four of seven patients treated with fluphenazine, flupenthixol, trifluoperazine and haloperidol showed enhancement. 3 Enhanced aggregation responses were observed in only 20% of chronic schizophrenic patients being treated with a neuroleptic drug. 4 The relationship between changes in platelet aggregation and clinical changes in recently admitted patients was variable and platelet aggregation responses were not predictive of response to treatment. 5 Chronic schizophrenic patients with enhanced aggregation showed significant week to week variation in platelet aggregation response. Variability of responses was not related to the drug used or to the dose administered. There was some evidence that higher plasma concentrations of neuroleptic drugs were associated with enhanced platelet aggregation responses. 6 Treatment with neuroleptic drugs leads to enhancement of platelet aggregation responses induced by 5-HT. The frequency and reliability with which such responses can be elicited is unpredictable and the value of platelet aggregation responses as an empirical guide to treatment with neuroleptic drugs is therefore open to question.     

Placebo response,placebo effect,and two attributes

Two putative predictors of placebo response were studied in three samples of psychiatric outpatients. Two groups, 73 university medical center patients and 56 college health service patients, underwent 1 week of placebo treatment. A quasi-control group of 112 patients receiving no medication waited about 1 week before beginning psychotherapy. One attribute, acquiescence or traditionalism, predicted placebo response, thereby replicating prior findings. Acquiescence was unrelated to change in controls indicating that it may represent a correlate of true placebo effect under some conditions. Additonal findings suggested qualifications as to the generality of the relationship. The second attribute, autonomic awareness, was associated with change in all three samples. It appeared to predict nonspecific improvement unrelated to placebo probably due to its relationship to intensity of somatization.     

Methylphenidate vs. resperidone in treatment of methamphetamine dependence: A clinical trial

Background and aims

Currently, there is no widely accepted evidence-based pharmacotherapy regime for the treatment of psychostimulant dependence. Yet, different pharmacological approaches have been tried in the treatment of MA addiction. The present study was conducted to compare efficiency of methylphenidate which is relatively easily accessible in our country, with resperidone for this purpose.

Methods

Eighty-six patients with MA dependence according to criteria defined by DSM IV-TR were divided into two groups. Patients in group R were given oral resperidone 1 mg daily for 1 week; then 2 mg daily in a divided dose for 3 weeks. Patients in group M were given oral methylphenidate 10 mg daily for 2 weeks, 7.5 mg daily for 1 week, then 5 mg daily for 1 week. They were evaluated for drug craving, psychological, neurologic and somatic symptoms at the start and end of the study.

Findings

Both drugs were useful for lowering drug craving in patients; however resperidone was more effective (6.31 ± 8.31 vs.19.6 ± 12.45 cravings per week, respectively). The effects of resperidone were more notable in lowering frequency and intensity of psychiatric, neurologic, cardiac and somatic symptoms of the patients after discontinuation of MA abuse; however methylphenidate was effective too; though with a lower potency.

Conclusion

The present study confirmed that both methylphenidate and resperidone can successfully be used for treatment of MA dependence, in order to reduce drug craving and psychological, neurologic, and somatic problems in patients. However, the efficacy of methylphenidate was estimated to be less than that of resperidone for this purpose.     

Behavioral side effects of triazolam in psychiatric inpatients: report of five cases

Triazolam was administered to five psychiatric inpatients for a two-week period. This period was preceded by a one-week placebo baseline and followed by another week of placebo administration. All conditions were double blind. By the second week of active drug administration, psychopathology greatly intensified across all of the patients with the emergence of anxiety, memory impairment, confusion, paranoid ideation, and hallucinations. The drug-induced behavioral changes persisted during the initial withdrawal period, but then gradually subsided. Also following drug withdrawal, four patients showed a marked worsening of their sleeplessness for several nights.     

Reduction of flurazepam's antiseizure efficacy persists after stress.

Twenty-four hours after mice were forced to swim for up to 10 min in cold (6 degrees C) water, the ability of flurazepam to antagonize the electrical precipitation of seizures was reduced. This stress-induced reduction in flurazepam's antiseizure efficacy persisted for at least 72 h; but was absent 1 week after the single session of swim stress. The data may be relevant to stress-related psychiatric disorders and suggest that the therapeutic efficacy of benzodiazepines may be altered after a severe stress.     

National survey of state psychiatric hospital pharmacies.

The results of a winter 1990 nationwide mail survey of pharmaceutical services provided in state psychiatric hospitals are reported and discussed. The survey universe consisted of all 207 state psychiatric hospitals registered by the American Hospital Association. Private and federal and other government-operated psychiatric hospitals were not included. Questionnaires were mailed to the director of pharmacy at each institution. Two questionnaires were not deliverable. There were 117 usable replies, for a net response rate of 57.1%. Compared with community hospitals, state psychiatric hospitals had pharmacy departments that were open fewer hours per week, occupied more floor space, were less likely to have a complete unit dose distribution system and i.v. admixture program, had lower inventory turnover rates, and had fewer full-time positions. About 28% of the respondents employed pharmacists who spent at least two thirds of their time providing clinical services. Differences in the provision of pharmaceutical services between state psychiatric hospitals and community hospitals may be due in part to the fact that most of the former are long-term-care institutions rendering a specific class of therapies.