Combining ECT and Antipsychotic Agents: Benefits and Risks

A comprehensive review describes the benefits and risks of the combination of electroconvulsive therapy (ECT) and antipsychotic agents for patients with psychotic disorders. For some patients, combined treatment may lead to greater rates of response or more rapid improvement than with either therapy alone. Except for reserpine, combining neuroleptics with ECT is safe, but some precautions are suggested. The mechanism of interaction, effect on seizure threshold, the use of ECT for neuroleptic associated motor effects, and additional anesthesia considerations are discussed.     

The effect of electric fields on osteoporosis of disuse

Summary An experiment originally done by McElhaney et al. was repeated to obtain additional information about the effects of electrical fields on osteoporosis of disuse. The right femurs of 35 male rats were immobilized in plaster casts. Sixteen rats were treated with transcutaneous electrical fields of 30 Hz and 100 V/cm for periods of 2 or 8 h a day. While the right femurs of the untreated rats were found to be atrophic with respect to the opposite limb, in the treated rats the immobilized femur was made larger than the opposite bone. Longer daily treatments exaggerated this effect. The tumors found in the previous study were not seen in our experiments. Other similarities and differences in the 2 studies are discussed.     

Effects of 8-methoxypsoralen plus 365 nm UVA light on Candida albicans cells

Summary Candida (C.) albicans cells were exposed to 8-Methoxypsoralen (8-MOP) concentrations of 1.0 g/ml and 10.0 g/ml medium and irradiated with 365 nm light. The amount of energy emitted was 4.8 J/cm². Two divergent types of cell damage occured concerning yeast cell cytoplasm and cell wall. Two hours after exposure cytoplasmic changes involving mitochondria, which showed irregularities in shape, blurred appearance or loss of mitochondrial cristae and outer membrane were seen. The number of vacuoles was increased. The cytoplasm showed large electron transparent areas, the cytoplasmic membrane disappeared in some areas completely. Nucleus and nuclear envelope usually remained intact in early stages. 24h after exposure conspicuous cell wall alterations were observed in addition to cytoplasmic changes. Newly produced cell wall material formed ball-like protrusions or was adherent sickle-shaped to the cell wall. The investigations strongly suggest that the results found after 8-MOP-UVA treatment of C. albicans cells can not be interpreted in the sense of a general cytotoxic effect. Apparently it takes the form of a combination of events involving regressive and progressive alterations.     

Effect of captan on DNA synthesis in the liver and testes of rats

Rats were fed a diet containing 0.3% (w/w) captan for 2, 4 and12 weeks and compared with controls, and with rats fed 0.02%(w/w) N-2-acetylamino-fluorene (AAF). Cell loss was evaluatedfrom the drop of previously [¹⁴C] labeled DNA and DNA synthesiswas expressed as fractional incorporation of [³H] dThd intohepatic and testicular DNA. The feeding of AAF for 12 weeksproduced in the liver a cell loss and a stimulation of DNA synthesis( + 348%); in the testes, a cell loss but an inhibition of DNAsynthesis ( – 84%) occurred. The continuous feeding ofcaptan produced no cytotoxic effect on the liver but increasedhepatic DNA synthesis between 2 and 4 weeks of diet ( + 100%).Then, the synthesis induction seemed to reach a plateau until12 weeks. The captan diet did not provoke any cytotoxic effecton testes until 4 weeks of feeding. At 12 weeks, some loss oftesticular DNA and of [¹⁴C] labeling indicated a toxic effectof captan. The testicular DNA synthesis was clearly inhibitedby captan diet at 4 weeks ( – 22%), and the inhibitionincreased at 12 weeks ( – 27%). Experiments done at ahigher level of captan (1.5% in the diet) showed that the effecton DNA synthesis in liver and testes was dose-related.     

Neuroendocrinology and brain peptides

To date about thirty peptides--low-molecular-weight, single-chain amino acid compounds--are known to be distributed widely in the central nervous system within selective neuron pathways. These findings, combined with a large body of neuropharmacological, behavioral, and electrophysiological data, open new horizons in neurobiology, force a reexamination of old and accepted hypotheses, and hold important implications for the clinician. There is evidence that substance P and the opioid peptides play a major role in the pain pathway, particularly at the level of the spinal cord. Available evidence also implicates vasoactive intestinal polypeptide in the control of cerebral circulation, cholecystokinin in the regulation of appetite, and vasopressin and adrenocorticotropic hormone in memory. Many questions, however, remain. For most peptides there is little information on mechanisms of biosynthesis, release, interaction with receptors, and termination of biological effect. Another important question is the interaction of peptides with other neurotransmitters. The evidence that both "classic" neurotransmitters and peptides can be found in the same neuronal necessitates reformulation of Dale's "one neuron, one neurotransmitter" hypothesis. It may be that a single cell, while containing different classes of neurotransmitter, will contain only one member of any particular class. It is not too early to speculate on the role of the numerous and diverse peptides in neuronal tissue and on the implications of peptide abnormalities in a variety of neurological diseases. The answers to these and other questions pose a fascinating challenge to neurobiologist and clinician alike.     

Fetal Krabbe leukodystrophy

Summary Two new cases of Krabbe disease were diagnosed prenatally in a family with two previous affected children. The activity of galactosylceramide--galactosidase was virtually absent in cultured amniotic cells.The prenatal diagnosis was confirmed enzymatically in cultured fibroblasts, brain, and visceral organs.Light and electron microscopy studies in both fetuses, 20 and 23 weeks of gestational age respectively, revealed the presence of typical globoid cells in the white matter of the spinal cord. Specific inclusions were also found in the brain stem and in peripheral nerves of the second fetus.A comparison with other Krabbe disease fetuses described in the literature contributes to the consensus that abnormal morphological findings can be expected in particular in the most actively myelinating areas of the nervous system.Although most of the cells containing the specific melusions are probably non-glial in nature, some of them could represent myelination glia.This work was supported by the FGWO (grants nos. 3.0033.77 and 3.0012.77), by the FRSM (grant no. 3.4542.79), and by the Baron Charles Bracht Foundation     

Clinical pharmacy services: Part II--the issues

The development of clinical pharmacy programs over the past decade has been both dramatic and satisfying as well as divisive and frustrating. In our experience the broad spectrum of possible clinical activities is responsible for both situations as it concerns the individual pharmacist. At Sunnybrook, liaison pharmacists have accepted departmentally prioritized clinical activities as their primary focus while removed from the distribution system. Documentation for each individual staff member, satellite and departmental achievements for patient counselling, adverse reaction and drug information programs was undertaken to provide visible endpoints for both staff and administration. Hospital Pharmacy visibility to the lay public, a need expressed by several prominent practitioners, has been addressed by the production of a Pharmacy Services Brochure which helps to educate in-patients about our many programs. Lastly the attempt by several colleagues to evaluate the profession's clinical impact by means of a quality assurance program illustrates the difficult task ahead of us if we are to indeed demonstrate an improved patient care program through our efforts.     

Spinal cord dysfunction in Paget's disease of bone. Has medical treatment a vascular basis?

The medical treatment of eight patients with paraparesis associated with Paget's disease of the vertebrae is described. Treatment, for 3 to 87 months, with calcitonin or with diphosphonates produced marked clinical improvement in seven of these patients. From this series and a review of 19 additional case reports it is concluded that favourable clinical response is seen in about 90 per cent of patients, and that this may occur very rapidly. Results are as good or better than those obtained by surgical decompression. It seems possible that paraparesis in some cases may be due to diversion of blood supply from the spinal cord to the highly vascular Pagetic bone giving rise to a vascular "steal" syndrome. It is suggested that medical treatment should be used more widely to avoid or delay the need for operation and reduce the risks of recurrence. These patients, however treated, require lifelong follow-up because relapses are common.     

Health services research in alcoholism

Alcoholism has become an important health care problem for the United States and the VA medical care system. The percentage of inpatients in Veterans Administration hospitals with a diagnosis of alcoholism rose from 13.0% in 1970 to a high of 15.6% in 1977. Health services research work in alcoholism has generally fallen into four major areas: community diagnosis; utilization of services by alcoholics; the effectiveness, efficiency, and quality of services; and the organization of information systems and their applicability to alcoholism. Obstacles to research include a poor understanding of the prevalence of the disease among the veteran's population, but the system offers many more opportunities than obstacles. A new information system. SATAR (Substance Abuse Treatment Automated Records), offers a chance for large-scale investigation of the problem of alcoholism among VA patients when combined with other information systems and allows for special comparisons through its large, integrated network of hospitals and clinics.