Hospital Management of Acute Iron Ingestion

Abstract

This overview summarizes the major and minor side effects and drug interactions of fluoxetine. The adverse reactions include the “serotonin syndrome”, cardiovascular complications, extrapyramidal side effects such as akathisia, dyskinesias, and parkinsonian-like syndromes and an apparently increased risk of suicidality. Fluoxetine-induced mania and hypomania, seizures and sexual disorders are evaluated along with minor symptoms of allergic reactions, stuttering, hematological changes, psoriasis, and inappropriate secretion of the antidiuretic hormone. The major fluoxetine-drug interactions involve the amino acids L-dopa and L-tryptophan, anorexiants, anticonvulsants, antidepressants, anxiolytics, calcium channel blockers, cyproheptadine, lithium salts, and drugs of abuse. The underlying mechanism and the paradoxical effects of fluoxetine are addressed.     

液质联用法测定犬血浆中阿普唑仑及其代谢物α-羟基阿普唑仑的浓度

目的建立测定Beagle犬血浆中阿普唑仑及其代谢物α-羟基阿普唑仑浓度的液相色谱-质谱联用(LC-MS)法。方法血浆样品采用1 mol·L~(-1)硼酸盐缓冲液(pH 9.0)碱化、乙酸乙酯-正庚烷(85:15,V:V)萃取后LC-MS测定。色谱柱:Zorbax SB-C_(18)柱(150 mm×3 mm,3.5μm);流动相:乙腈-0.01 mol·L~(-1)乙酸胺缓冲液(含1%甲酸)(45:55,V:V);流速:0.3 mL·min~(-1);柱温:40℃。采用电喷雾正离子模式离子化,用于定量分析的离子分别为m/z 309.2(阿普唑仑)、m/z 325.2(α-羟基阿普唑仑)和m/z 343.2(三唑仑,内标)。结果阿普唑仑和α-羟基阿普唑仑的线性范围分别为0.5～50μg·L~(-1)和0.5～32μg·L~(-1),两者定量下限均为0.5μg·L~(-1),提取回收率均>80%,方法回收率为97.3%～102.5%,批内RSD≤10.4%,批间RSD≤12.2%。结论本方法灵敏、准确、重现性好,适用于阿普唑仑犬体内药动学研究。     

Effects of buspirone and alprazolam treatment on the startle-potentiated startle response

The startle potentiated startle (SPS) paradigm has been reported to be an effective procedure for studying the conditioned enhancement of acoustic startle in the absence of electric shocks or extinction. This study examines the effects of two anxiolytic treatments, buspirone and alprazolam, on this SPS effect. Subjects were tested in the SPS paradigm 2 days a week (Monday and Thursday) for 10 weeks. Each startle test session consisted of 10 Noise Alone trials (115 dB acoustic noise burst presented for 40 ms) and 10 Light+Noise trials (115 dB acoustic stimuli presented during the latter 40 ms of a 3,540 ms period in which a 15-watt light was illuminated). Although there was no difference in startle amplitude on Noise Alone trials when compared to Light+Noise trials initially, by the end of the first test session and continuing throughout the duration of the experiment, startle amplitude on Light+Noise trials was significantly (approximately 50-75%) greater than on Noise Alone trials. After five control (i.e., no injection) SPS test sessions, once-weekly drug challenges were conducted over the course of 7 weeks. In these weekly drug challenges, subjects received acute treatment with various doses of the benzodiazepine anxiolytic alprazolam (0.25, 0.5, 1.0 mg/kg) or the novel anxiolytic buspirone (1.0, 2.0, 4.0 mg/kg); subjects also received vehicle treatment (0.5% methylcellulose) on one treatment day. All treatments were administered intraperitoneally (i.p.), 15 min before the start of startle testing. Consistent with previous reports, buspirone increased and alprazolam decreased startle amplitude on the Noise Alone trials; these effects were dose-related. Both agents reduced the magnitude of the SPS effect when it was expressed as the Light+Noise startle amplitude minus the Noise Alone startle amplitude. These findings are similar to the effects of these treatments in the traditional shock-based fear-potentiated startle paradigm.     

The acute effects of L-theanine in comparison with alprazolam on anticipatory anxiety in humans

L-Theanine (delta-glutamylethylamide) is one of the predominant amino acids ordinarily found in green tea, and historically has been used as a relaxing agent. The current study examined the acute effects of L-theanine in comparison with a standard benzodiazepine anxiolytic, alprazolam and placebo on behavioural measures of anxiety in healthy human subjects using the model of anticipatory anxiety (AA). Sixteen healthy volunteers received alprazolam (1 mg), L-theanine (200 mg) or placebo in a double-blind placebo-controlled repeated measures design. The acute effects of alprazolam and L-theanine were assessed under a relaxed and experimentally induced anxiety condition. Subjective self-reports of anxiety including BAI, VAMS, STAI state anxiety, were obtained during both task conditions at pre- and post-drug administrations. The results showed some evidence for relaxing effects of L-theanine during the baseline condition on the tranquil-troubled subscale of the VAMS. Alprazolam did not exert any anxiolytic effects in comparison with the placebo on any of the measures during the relaxed state. Neither L-theanine nor alprazalam had any significant anxiolytic effects during the experimentally induced anxiety state. The findings suggest that while L-theanine may have some relaxing effects under resting conditions, neither L-theanine not alprazolam demonstrate any acute anxiolytic effects under conditions of increased anxiety in the AA model.     

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.     

中药与佳乐定对失眠症疗效的对照研究

目的　探讨中药与佳乐定治疗失眠症的疗效与不良反应。方法　对 91例符合CCMD - 3失眠症诊断标准的患者按心理测验时的单双序号分为研究组 (中药 ) 4 6例和对照组 (佳乐定 ) 4 5例 ,其中 86例完成了 2w治疗。在治疗前后用睡眠障碍评定量表、汉密尔顿焦虑量表及临床总体印象量表评定疗效 ,用副作用量表评定不良反应。结果　经过 14d治疗 ,睡眠障碍评定量表评定结果显示 ,研究组有效率为 5 8.7% ,对照组为 6 4 .4 % ,两组与治疗前比较均有极显著性差异 (P <0 .0 1) ,两组间无显著性差异 (P >0 .0 5 )。两组汉密尔顿焦虑量表及临床总体印象量表评定与治疗前比较均有极显著性差异 (P <0 .0 1) ,两组间比较无显著差异 (P >0 .0 5 ) ,但研究组不良反应少 ,依从性好。结论　中药可以作为治疗失眠症的一种有效方法     

西酞普兰与阿普唑仑治疗广泛性焦虑症对照研究

目的探讨西酞普兰治疗广泛性焦虑症的临床疗效及安全性。方法将60例广泛性焦虑症患者随机分为两组，分别给予西酞普兰与阿普唑仑治疗，观察6w。于治疗前及治疗后第1w、2w、4w、6w末采用汉密顿焦虑量表、焦虑自评量表及副反应量表评定疗效及安全性。结果治疗6W末，西酞普兰组显效率73％，有效率90％；阿普唑仑组分别为63％，83％。两组疗效相当（X^2=0．69，P〉0.05）。汉密顿焦虑量表评分治疗1w末起两组总分及各因子分均较治疗前显著下降（P均〈0.01），并随治疗时间的延续呈持续性下降。两组间比较除精神性焦虑因子分治疗1w末有显著性差异（t=1．83，P〈0.05）外，其余均无显著性差异（P均〉0．05）。焦虑自评量表评分两组治疗6w末均较治疗前有显著下降（P〈0.01），组间比较无显著性差异（P〉0．01）。西酞普兰组不良反应较阿普唑仑组少且轻微，患者依从性好。结论西酞普兰抗焦虑疗效肯定，与阿普唑仑相当，安全性高，依从性好。     

度洛西汀治疗广泛性焦虑症对照研究

目的：评价度洛西汀治疗广泛性焦虑障碍患者的疗效和安全性。方法将60例广泛性焦虑障碍患者按随机数字表法分为两组,每组30例,研究组口服度洛西汀治疗,对照组口服阿普唑仑治疗,观察6周。于治疗前后采用汉密顿焦虑量表评定临床疗效,副反应量表评定不良反应。结果治疗1周末起两组汉密顿焦虑量表评分均较治疗前显著下降（P＜0．05）,并随着治疗时间的延续均呈持续性下降,同期两组间评分比较无显著性差异（P＞0．05）;治疗6周末研究组总有效率为86．7％,对照组为83．3％,两组比较差异无显著性（ P＞0．05）。两组不良反应较轻微,研究组发生率为23．3％,对照组为36．7％,两组比较差异无显著性（ P＞0．05）。结论度洛西汀治疗广泛性焦虑障碍疗效显著,不良反应较轻微,安全性高。     

菖欢胶囊治疗抑郁性神经症临床观察

目的　观察菖欢胶囊对抑郁性神经症的疗效。方法　对 5 4例符合抑郁性神经症诊断标准的患者进行了治疗 ,并用阿普唑仑做对照 ,治疗 8周后进行统计分析。结果　菖欢胶囊治疗组 5 4例 ,痊愈 6例 ( 11.1%) ,显效 14例 ( 2 5 .9%) ,进步 2 7例 ( 5 0 .0 %) ,无效 7例 ( 13.0 %) ,有效率为 87%。阿普唑仑对照组 30例 ,显效 8例 ( 2 6 .7%) ,进步 16例 ( 5 3 .3 %) ,无效 6例 ( 2 0 %) ,有效率为 80 %,2组差异无显著性 ,χ2 =0 .5 2 6 ,P >0 .0 5。 2组HAMD总分和各因子分均有明显下降 ,治疗组治疗前HAMD总分为 2 7.74± 3 .5 7,治疗 8周后降至 13 .5 9± 4.91(减分率为 5 1.0 1%) ,对照组分别为 2 6 .87± 4.45和16 .2 7± 4.35 (减分率为 39.45 %) ,2组HAMD总分治疗后有显著性差异 (P <0 .0 5 )。结论　菖欢胶囊对抑郁性神经症具有一定的治疗作用 ,其机理可能和改善中枢单胺能神经的功能状态有关。     

A double-blind study of alprazolam and oxazepam in the treatment of anxiety

In a randomized double-blind study with parallel group design involving 60 anxious psychoneurotic outpatients, the anxiolytic activity of alprazolam was compared with that of oxazepam. Following a 4 to 7-day placebo washout period, both groups showed a similar and significant response to treatment during the 4-week active treatment phase. An important intergroup difference emerged in the fear/anxiety component of the Lipman SRSS with the alprazolam groups showing a significantly greater mean reduction from the baseline score. During alprazolam treatment there was also a significant reduction in the depression factor score of the Lipman SRSS by the termination of the study and for all 4 weeks combined. Furthermore, the global impression of treatment was judged by patients as more favourable towards alprazolam than towards oxazepam. Only one person in each group reported a serious side effect. The results indicate that the anxiolytic activity of alprazolam is at least as good as that of oxazepam.