Some effects of chlordiazepoxide and meprobamate with psychiatric outpatients

Summary 85 psychiatric outpatients were treated under double-blind, flexible dosage conditions for 8 weeks with either chlordiazepoxide, meprobamate, or placebo. Patients were tested—on measures of tension, anxiety, and related criteria—prior to treatment and at weekly or biweekly intervals after receiving medication. Each drug group was compared with a different matching placebo group. Despite the small number of cases and relatively low anxiety levels of many patients, there was evidence that chlordiazepoxide was probably somewhat more effective than placebo with the kinds of outpatients normally treated principally or solely with tranquilizers. Most of the evidence suggested that the maximum benefits of chlordiazepoxide appeared between 4 and 6 weeks for this sample. There was no evidence to suggest that meprobamate was more effective than placebo. Meprobamate clearly did not produce the expected effects; with some patients it appeared to act contrary to expectations. The meprobamate findings were presented in some detail because other investigators might want to check their data for similar patterns.A Veterans Administration Cooperative Study of Chemotherapy in Psychiatry.We gratefully acknowledge the contributions of the thirteen Mental Hygiene Clinic staffs and, especially, the investigators who directed the study at each clinic: Albany (Ronald Tiffany, Ph.D.), Atlanta (Louis A. Cibelli, M.D.), Chicago (Irvin Roth, Ph.D.), Coral Gables (Jack Sandler, Ph.D.), Denver (Harl H. Young, jr., Ph.D.), Des Moines (Leo Subotnick, Ph.D.), Jackson (Veronica Pen-Nington, M.D.), New York (Melvin Weiderlight, M.D.), Philadelphia (Werner K. R. Welz, M.D.), San Diego (Loren E. Conner, M.D.), San Francisco (Donald A. Shaskan, M.D.), and Spokane (Alfred J. Hewitt, M.D.). We are also grateful to George J. Weinstein, M.D., Chief of Veterans Administration Outpatient Psychiatry, who was extremely helpful in making the study possible.     

西宁地区门诊以头晕为主症300例病因分析

目的:分析西宁地区神经内科门诊头晕患者病因构成特点。方法:回顾性分析2012年—2013年院神经内科门诊头晕为主症的300例患者临床资料,分析临床特点、辅助检查、治疗转归,总结病因构成。结果:300例患者中女性多见,男女比例为1∶1.5,45~60岁年龄段最多见,共142例(47.33%),常见病因依次为精神心理性头晕115例(38.33%),良性发作性位置性眩晕(BPPV)102例(34.00%),偏头痛性眩晕31例(10.33%)。结论:西宁地区门诊头晕患者以精神心理性头晕和BPPV为主,偏头痛性眩晕不少见。70%头晕患者通过病史询问即可诊断,加强学习头晕患者病史询问方法很重要,焦虑、抑郁评分及Dix-Hallpike试验不容忽视。     

The prevalence of presumed tardive dyskinesia in psychiatric inpatients and outpatients

Randomly selected psychiatric patients (271 total) were examined by raters blind to diagnosis and treatment history for the presence of abnormal movements. The prevalence of presumed tardive dyskinesia among neuroleptic-exposed patients was 4.6%. If minimal rating scale criteria were applied, 9% of those patients with no history of neuroleptic exposure might have been given presumptive diagnoses of dyskinesia. Problems in establishing diagnostic criteria are discussed and a longitudinal approach toward validating diagnoses is recommended.     

Depression and stages of change for smoking in psychiatric outpatients.

This article reports on the relations between depression and stages of change for smoking cessation. A convenience sample of 205 psychiatric outpatients (68% female, mean age 41) completed measures of depression Primary Care Evaluation of Mental Disorders [PRIME-MD] and Beck Depression Inventory-II [BDI-II]), all transtheoretical model constructs related to smoking (stages and processes of change, pros and cons of smoking, and situational temptations), and thoughts about abstinence. As hypothesized, patients who had never smoked showed substantially lower rates of currently diagnosed major depressive disorder (MDD) than those who had ever smoked. Patients in early stages of change did not show more MDD or depressive symptoms but, as hypothesized, showed more negative thoughts about abstinence. Findings are consistent with the documented association between smoking and depression and suggest the appropriateness of building smoking cessation interventions based on the transtheoretical model of change for use with psychiatric populations.     

Risperidone-associated hyperprolactinemia: evaluation in twenty psychiatric outpatients.

Despite the lack of extrapyramidal side effects, some atypical antipsychotics can induce an increase in prolactinemia, as the conventional neuroleptics do. We decided to evaluate the effects of risperidone on serum prolactin levels and prolactin-related adverse effects in 20 outpatients of an Italian community psychiatric service. Patients enrolled in this study were on risperidone (2-8 mg per day; mean dose=4.15+/-0.4 mg per day) treatment in the period May-November 2002. The 20 patients, 13 women and 7 men (mean age=36.38+/-3.2 years for women and 29.7+/-2.2 for men) who accomplished inclusion criteria, participated in the study after giving informed written consent. Raised prolactin levels were observed in 13 (9 women and 4 men) out of 20 patients, but only 8 patients presented prolactin-related adverse effects, libido reduction being the most frequent. In this observational study, risperidone enhanced serum prolactin in 65% of patients. A good correlation was found between age and prolactin levels in pre-menopausal women, although no clear correlation among duration of treatment, dose used, prolactin levels and prolactin-related adverse effects could be established.     

Long-term therapeutic drug monitoring of clozapine and metabolites in psychiatric in- and outpatients

RATIONALE: Clozapine is a unique antipsychotic drug, outstanding for its lack of extrapyramidal side-effects and its superior efficacy in refractory schizophrenia. However, an unambiguous concentration-response relationship has not yet been established. OBJECTIVE: We investigated serum concentrations of clozapine, norclozapine and clozapine-N-oxide in psychiatric in- and outpatients to identify particular metabolic patterns in clozapine responders and non-responders and putative threshold levels for clozapine response. METHODS: Psychiatric assessments, CYP2D6 genotype, and weekly serum concentrations of clozapine, norclozapine and clozapine-N-oxide were obtained in 34 adult schizophrenic in-and outpatients (18 men, 16 women) during 10 weeks of clozapine treatment with a naturalistic dose design. RESULTS: Responders (n=21) displayed significantly lower serum concentrations of clozapine corrected for dose compared to non-responders (n=13; P<0.05), while none of the other parameters (absolute clozapine concentration, metabolite ratios, gender) were different. Smokers had significantly lower dose-corrected clozapine concentrations. A positive correlation was observed between age and average steady state clozapine concentrations. CONCLUSIONS: These findings indicate a possible link between CYP activity and response to clozapine that is not mediated through differences in serum concentrations. No clinically meaningful pattern in serum parameters could be identified that differentiates responders from non-responders. Thus, clozapine TDM seems ineffective for predicting clinical response. Smoking behavior is a major determinant of clozapine clearance while CYP2D6 genotype does not impact clozapine disposition.     

Screening for psychiatric disorders in outpatients with DSM-IV substance use disorders

Psychiatric disorders are frequent in patients with substance use disorders, and have been associated with increased morbidity and poorer treatment outcome. Because of the clinical importance of comorbid mental disorders, concerns have been raised about the detection of psychiatric disorders in patients with substance use disorders. The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong, self-report scale designed to screen for the most common DSM-IV Axis I disorders encountered in outpatient mental health settings. Previously we described the diagnostic performance of the PDSQ in a large sample of psychiatric outpatients. For the present report, we examined the performance of the PDSQ in psychiatric outpatients with drug and alcohol abuse and dependence, and determined whether its performance in patients with substance use disorders is as good as it is in patients without substance use disorders. For the patients with a substance use disorder, 92% of the comorbid mental disorders were detected by the PDSQ subscales (i.e., mean sensitivity across subscales equals 92%) and 97% of the patients who screened negative did not have a disorder (i.e., mean negative predictive value equals 97%). For patients without a substance use disorder, the mean sensitivity and negative predictive values were 88% and 95%, respectively. Receiver Operating Characteristic curves were plotted for each PDSQ subscale for both patient groups, and all areas under the curve were significant and similar in the two groups.     

Psychological correlates of comorbid gambling in psychiatric outpatients: a pilot study

This study compared psychiatric outpatients with and without lifetime gambling problems on clinical disorder and personality disorder scales, and the relationship of these scales with involvement in gambling. One hundred and sixty-two adults (females = 112) in an urban, outpatient psychiatric setting completed the South Oaks Gambling Screen (SOGS; Lesieur, H. R., Blume, S. B. (1987). The south oaks gambling screen (SOGS): a new instrument for the identification of pathological gamblers. Am. J. Psychiatry 144(9):1184-1188) and the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, T. (1987). Manual for the MCMI-II: 2nd Edition. Minneapolis, MN: National Computer Systems, Inc.) after their initial psychiatric evaluation in 1999. Avoidant and compulsive personality features were significantly related to gambling problem status. The Self-Defeating and Dysthymic Disorder scales were positively associated with gambling involvement. The Alcohol Dependence scale was predictive of gambling involvement for males only. Findings are somewhat consistent with the literature examining comorbidity in pathological gamblers seeking treatment, although no association was found with antisocial personality disorder.     

Side effects of clozapine

In addition to the low risk of agranulocytosis, several more frequent side effects are associated with clozapine therapy. We tried to estimate the incidence of these side effects. We analysed 391 treatments in 315 inptients, who received clozapine alone or combined with other neuroleptic and antidepressant drugs. Two thirds were combined treatments, one third were treatments with clozapine alone (i.e., no other neuroleptic, antidepressant or anticonvulsive drugs were allowed). The numbers in brackets show the incidence based on the analysis of the treatments with clozapine alone. In 49% (61%) of the treatments a rise in the liver enzyme values was observed. However, counting only the cases in which a two-fold increase over the normal values was observed, the incidence was reduced to 20% (31%). Increase in temperature was observed in 4% (6%) and leukopenia (leukocyte count under 3500/l) was recorded in 2% (2%). Hypotensive dysregulation (systolic blood pressure under 90 mm Hg) was observed in 25% of all treatments and pharmacogenic delirium in 8%. No cases of agranulocytosis were observed. Mean treatment duration was 56 days, mean daily dosage 257 mg. The mean age of the patients was 34 years. In the overall evaluation 71% of the treatments were classified as successful; clozapine therapy was continued after discharge in 68% of the treatments. Adverse reactions (delirium, rise in temperature, hypotension, fatigue, rise in liver enzymes) necessitated a change of medication in 17% of the treatments. Change-over to another neuroleptic drug due to ineffectiveness of clozapine was necessary in 7% of the treatments. The quality of the data is somewhat adversely influenced by the fact that the study was conducted retrospectively on the basis of medical records.     

尼美舒利的药物不良反应

尼美舒利(Nimesulide)化学名为4-硝基-2-苯氧基甲磺酰苯胺，是磺酰苯胺的衍生物，对环氧化酶(COX)有选择性的抑制作用。是前列腺素(PG)生物合成的关键酶。本品高度选择性抑制COX2的活性，对COX1抑制作用不明显，在发挥有效抗炎作用的同时，减少了其它NSAIDs常见的消化性溃疡和出血的副作用。该药最早由德国-家公司研制，1985年在意大利上市。随后在美国、德国上市，     

氧氟沙星的不良反应

氧氟沙星为第三代喹诺酮类抗菌素，临床上主要用于革兰阴性菌所致的急、慢性感染，现将氧氟沙星近几年的不良反应报道综述如下：     

Side effects of ranitidine

Ranitidine was first marketed in 1981; since then many patients have been treated such that much experience has been accumulated on the safety of this histamine H2-receptor antagonist in the treatment of gastroduodenal disease. A wide array of ranitidine-associated side effects has been described, but infrequently. As so much information is now available, the aim of this review is to assess the weight of evidence for a causal link between ranitidine and the reported side effects. Overall, ranitidine is well tolerated. The incidence of general side effects at less than 2% is very similar to placebo. Headaches, tiredness, dizziness and mild gastrointestinal disturbance (e.g. diarrhoea, constipation and nausea) are among the most frequent complaints, but have very seldom resulted in stopping treatment. Cardiovascular side effects are extremely rare and unpredictable with the usual doses of oral ranitidine (at most 1 in 1 million patients). They mostly comprise sinusal bradycardia and atrioventricular blockade, especially after rapid intravenous administration, receding after cessation of the drug. Clinical studies, however, have not shown a significant pharmacological effect of ranitidine on the cardiovascular system via H2-receptors, even though individual sensitivities cannot be ruled out in a few isolated reports. Ranitidine is unlikely to be directly hepatotoxic: a transient change in liver function tests has been noted in only 1 in 100 to 1 in 1000 patients. Several cases of mixed hepatitis have been reported, but very few were fully documented. The incidence of ranitidine-associated acute hepatitis has been estimated to be less than 1 in 100,000 patients. Neuropsychiatric complications may be less common and clinically quite similar to those reported with cimetidine, i.e. confusion, disorientation, hallucinations, delirium. These side effects have occurred especially in critically ill and multiple-therapy patients, or patients with chronic renal or hepatic failure, so that the direct causal link with ranitidine treatment was often difficult to ascertain. Even though an H2-receptor-mediated effect is an attractive hypothesis (since similar complications were noted with other H2-receptor antagonists), other mechanisms have been suggested to play a role, e.g. cholinergic or histaminic effects. The overall incidence of neuropsychiatric complications is probably markedly less than 1%. White cell injury (i.e. agranulocytosis) appears to be the most frequent haematological complication, even though case reports are very few and poorly documented.(ABSTRACT TRUNCATED AT 400 WORDS)