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Neuroendocrine responsivity to clomipramine and haloperidol challenge tests in drug naive psychotic patients
s24
Poster B. Psychophannaca
socio-economic background, whether there was therapeutic compliance and the length of therapy. The results are analysed using the initial evaluation, as it was noted in the record of every patient, as a basis. The policy of psychotropic agents in our Centre is discussed and compared with the results of other research studies worldwide.
B 53 El
Risperidone patients
treatment
in
resistant
R. Andrei, Ana-Maria Grigorescu, Diana Ilies-Alexandru. Hospital Psychiatry “SOCOLA ” lagi, Romaniu
schizophrenic University
of
Risperidone is a new “atypical” antipsychotic agent with a biochemical profile different from that of the conventional neuroleptics, having 5 HT2 and D2 receptors affinity and an established antipsychotic activity. The aim of this study was to evaluate the clinical response to Risperidone in schizophrenic patients (DSM IV criteria) that have proved poor response or unacceptable side effects in other treatments. The group consisted of 34 patients with over of 6 months psychotic symptomatology (BPRS>lS, SANSXO, SAPS>75-80) and/or marked extrapyramidal symptoms (Simpson-Angus scores >lO-15). We administered Risperidone in monotherapy, the dose was increased from 1 mg to 3 mgs twice daily on day 3; anticholinergic medication was withdrawn gradually. The assessment scales were BPRS, SANS, SAPS, CGI and SimpsonAngus Scale for EPS and patients were evaluated on weeks 4, 8 and 16 respectively. The results proved a constant symptomatology improvement assessed by the reductions in total scores on CGI, BPRS, SANS, SAPS after 8 weeks of treatment: the extrapyramidal side effects decreased at end point versus baseline that contributed to a better compliance to the treatment.
B 54 L-l
Neuroendocrine responsivity to clomipramine and haloperidol challenge tests in drug naive psychotic patients
E. Angelopoulos, M. Markianos, E. Daskalopoulou, J. Tzemos. Athens University Medical School, Psychiatric Clinic, Eginition Hospital, Vas. Sophias 74, Athens 11528, Greece Both dopamine and serotonin neurotransmitter systems have been proposed to be involved in the pathogenesis of schizophrenic symptomatology. The “dopamine hypothesis” of schizophrenia is based primarily on a significant correlation between the antipsychotic potency of neuroleptic drugs and their propensity to block dopamine receptors. An increase in DA may be most relevant to the early (acute) stage of the disorder and some aspects of schizophrenia, particularly components of the negative symptoms deficit state type of psychopathology could be due to decreased dopaminergic activity (1,2). Evidences for the involvement of the serotonergic system were initially based on the hallucinatory effects of lysergic acid diethylamide and the antipsychotic effect of atypical neuroleptics like clozapine and risperidone (3). In the present study, neuroendocrine responses induced by the serotonin reuptake inhibitor clomipramine and the D2 receptor antagonist haloperidol were studied in 17 male psychotic patients who had never received antipsychotic treatment. Their diagnoses according to the DSMIV were: schizophrenia (13 patients), delusional disorder (3 patients) and schizoaffective disorder (1 patient). Haloperidol and clomipramine challenge tests were administered to the patients in the drug free state and blood samples were taken in order to measure the hormones. Prolactin responses were correlated with the score of the positive and negative clusters of schizophrenic symptoms, measured by the Brief Psychiatric Rating Scale (BPRS). Prolactin responses to clomipramine were positively correlated with the positive symptoms of schizophrenia (APRL vs BPRS positive symptoms: r=0.5593, p=O.O20, n= 17) suggesting that a serotonergic hyperfunction is related to positive symptoms of schizophrenia, while the prolactin responses to haloperidol were negatively correlated with the negative symptoms of schizophrenia (APRL vs BPRS negative symptoms r = -0.6372, p=.OO6, n= 17) suggesting that negative symptoms are related to a dopaminergic hypofunction.
References Lindstrom, L.H. (1985) Low HVA and normal SHIAA CSF levels in drug-free schizophrenic patients compared to healthy volunteers:
Correlations to symptomatology and family history. Psychiatry Res. 14: 265-273. Meltzer H.Y. (1985) Dopamine and negative symptoms in schizophrenia: Critique of type I-type II hypothesis. In: M. Alpert (ed), Controversies in schizophrenia: Changes and constancies. New York, Guilford press, pp 110-136. Brunello N. et al. (1996) New insights into the biology of schizophrenia through the mechanism of action of clozapine. Neuropsychopharmacology. 177-213.
B 55 L2.i
unusual side effects of selective serotonin reuptake inhlbltors
The
Rilstem Askin, Hasan Herken. Medicul Faculty Department of Psychiatry, Kenya, Turkey
of Selguk
University,
Objective: The use of selective serotonin reuptake inhibitors has resulted in increased tolerability and safety of antidepressant therapy. Extrapyramidal side effects can at times compromise compliance of the patients. We report three cases of SSRIs related side effects. Ms. A, a 38-year-old woman, came to our outpatient psychiatric clinic for treatment of a 4-month history of severe depression. She was started on a regime of paroxetine, 20 mg once a day. After 7 days on this dose she exhibited torticollis on the right side. Mr. T, a 29-year-old married man with no previous psychiatric history, presented with signs and symptoms of GCD. He was started sertraline, 50 mg/day. About 20 hours later he had a urinary retention. The retention stopped when the drug was removed. Ten days after the retention, he was restarted on a regimen sertraline, 50 mg/day. He began reexperiencing urinary retention. Sertraline was discontinued. His urinary retention subsided in the following day. Mr. F, a 51-year-old man with 22-year history of major depression. He was started on a regimen of sertraline, 100 mg/day, after a 4-week drug free period. One week later, he developed akathisia. Sertraline treatment was discontinued, and Mr. F was given 40-mg tablets of propranolol. He needed to take the propranolol for the next day, after which the motor restlessness resolved. Concbuiont These cases we describe indicate that clinicians must be alert to the possibility of akathisia and other side effects during SSRl treatment. It appears that SSRIs related EPS should be carefully evaluated with all patients.
References Bouchard, R.H., Pourcher, E., Vincent, P., Fluoxetine and extrapyramidal side effects (letter). Am J Psychiatry. 1989; 146: 1353-1353. Baldessarini, R.J., Marsh, E.R., Kula, N.S. Interactions of fluoxetine with metabolism of dopamine and serotonin in rat brain regions. Brain Res. 1992; 579: 152-156. Shihabuddin, L., Rapport, D. Sertraline and extrapyramidal side effects (letter). Am J Psychiatry. 1994; 151:288.
B-56 El
Treatment of patients with depression on the organic base by mianserin along with agents stimulating brain metabolism
L. Bidzan, J. Turczynski. Gdarisk, Poland
II Department
of Psychiatry,
Medical Academy,
Affective diseases, mostly depression, appear to be the most popular disturbances among elderly people. At the same time, dementia, observed at 10% of people, is another chronic disease of the old age. Mutual relations between dementia and depression are not clear, regarding etiology, pathogenesis as well as prognosis. Numerous authors pay attention to the fact that depression syndrome, besides its typical symptoms, may also cause significant cognitive functions disturbances. Eliminating the depression syndrome exerts a positive impact on psychic condition of the demented patients, also on his cognitive functions. In the thesis, which is preliminary to longer-lasting research, efficiency of cyclic antidepressive agent mianserin has been compared. It has been connected with nicergoline, vinpocetine and piracetam. Examination covered a group of 31 people under 55 at whom depressive syndrome appeared within the course of previously recognized dementia process (of preliminary degenerative, vasogenic or mixed origin). Depression and dementia have been recognized on the basis of
Poster B. Psychophannaca
socio-economic background, whether there was therapeutic compliance and the length of therapy. The results are analysed using the initial evaluation, as it was noted in the record of every patient, as a basis. The policy of psychotropic agents in our Centre is discussed and compared with the results of other research studies worldwide.
B 53 El
Risperidone patients
treatment
in
resistant
R. Andrei, Ana-Maria Grigorescu, Diana Ilies-Alexandru. Hospital Psychiatry “SOCOLA ” lagi, Romaniu
schizophrenic University
of
Risperidone is a new “atypical” antipsychotic agent with a biochemical profile different from that of the conventional neuroleptics, having 5 HT2 and D2 receptors affinity and an established antipsychotic activity. The aim of this study was to evaluate the clinical response to Risperidone in schizophrenic patients (DSM IV criteria) that have proved poor response or unacceptable side effects in other treatments. The group consisted of 34 patients with over of 6 months psychotic symptomatology (BPRS>lS, SANSXO, SAPS>75-80) and/or marked extrapyramidal symptoms (Simpson-Angus scores >lO-15). We administered Risperidone in monotherapy, the dose was increased from 1 mg to 3 mgs twice daily on day 3; anticholinergic medication was withdrawn gradually. The assessment scales were BPRS, SANS, SAPS, CGI and SimpsonAngus Scale for EPS and patients were evaluated on weeks 4, 8 and 16 respectively. The results proved a constant symptomatology improvement assessed by the reductions in total scores on CGI, BPRS, SANS, SAPS after 8 weeks of treatment: the extrapyramidal side effects decreased at end point versus baseline that contributed to a better compliance to the treatment.
B 54 L-l
Neuroendocrine responsivity to clomipramine and haloperidol challenge tests in drug naive psychotic patients
E. Angelopoulos, M. Markianos, E. Daskalopoulou, J. Tzemos. Athens University Medical School, Psychiatric Clinic, Eginition Hospital, Vas. Sophias 74, Athens 11528, Greece Both dopamine and serotonin neurotransmitter systems have been proposed to be involved in the pathogenesis of schizophrenic symptomatology. The “dopamine hypothesis” of schizophrenia is based primarily on a significant correlation between the antipsychotic potency of neuroleptic drugs and their propensity to block dopamine receptors. An increase in DA may be most relevant to the early (acute) stage of the disorder and some aspects of schizophrenia, particularly components of the negative symptoms deficit state type of psychopathology could be due to decreased dopaminergic activity (1,2). Evidences for the involvement of the serotonergic system were initially based on the hallucinatory effects of lysergic acid diethylamide and the antipsychotic effect of atypical neuroleptics like clozapine and risperidone (3). In the present study, neuroendocrine responses induced by the serotonin reuptake inhibitor clomipramine and the D2 receptor antagonist haloperidol were studied in 17 male psychotic patients who had never received antipsychotic treatment. Their diagnoses according to the DSMIV were: schizophrenia (13 patients), delusional disorder (3 patients) and schizoaffective disorder (1 patient). Haloperidol and clomipramine challenge tests were administered to the patients in the drug free state and blood samples were taken in order to measure the hormones. Prolactin responses were correlated with the score of the positive and negative clusters of schizophrenic symptoms, measured by the Brief Psychiatric Rating Scale (BPRS). Prolactin responses to clomipramine were positively correlated with the positive symptoms of schizophrenia (APRL vs BPRS positive symptoms: r=0.5593, p=O.O20, n= 17) suggesting that a serotonergic hyperfunction is related to positive symptoms of schizophrenia, while the prolactin responses to haloperidol were negatively correlated with the negative symptoms of schizophrenia (APRL vs BPRS negative symptoms r = -0.6372, p=.OO6, n= 17) suggesting that negative symptoms are related to a dopaminergic hypofunction.
References Lindstrom, L.H. (1985) Low HVA and normal SHIAA CSF levels in drug-free schizophrenic patients compared to healthy volunteers:
Correlations to symptomatology and family history. Psychiatry Res. 14: 265-273. Meltzer H.Y. (1985) Dopamine and negative symptoms in schizophrenia: Critique of type I-type II hypothesis. In: M. Alpert (ed), Controversies in schizophrenia: Changes and constancies. New York, Guilford press, pp 110-136. Brunello N. et al. (1996) New insights into the biology of schizophrenia through the mechanism of action of clozapine. Neuropsychopharmacology. 177-213.
B 55 L2.i
unusual side effects of selective serotonin reuptake inhlbltors
The
Rilstem Askin, Hasan Herken. Medicul Faculty Department of Psychiatry, Kenya, Turkey
of Selguk
University,
Objective: The use of selective serotonin reuptake inhibitors has resulted in increased tolerability and safety of antidepressant therapy. Extrapyramidal side effects can at times compromise compliance of the patients. We report three cases of SSRIs related side effects. Ms. A, a 38-year-old woman, came to our outpatient psychiatric clinic for treatment of a 4-month history of severe depression. She was started on a regime of paroxetine, 20 mg once a day. After 7 days on this dose she exhibited torticollis on the right side. Mr. T, a 29-year-old married man with no previous psychiatric history, presented with signs and symptoms of GCD. He was started sertraline, 50 mg/day. About 20 hours later he had a urinary retention. The retention stopped when the drug was removed. Ten days after the retention, he was restarted on a regimen sertraline, 50 mg/day. He began reexperiencing urinary retention. Sertraline was discontinued. His urinary retention subsided in the following day. Mr. F, a 51-year-old man with 22-year history of major depression. He was started on a regimen of sertraline, 100 mg/day, after a 4-week drug free period. One week later, he developed akathisia. Sertraline treatment was discontinued, and Mr. F was given 40-mg tablets of propranolol. He needed to take the propranolol for the next day, after which the motor restlessness resolved. Concbuiont These cases we describe indicate that clinicians must be alert to the possibility of akathisia and other side effects during SSRl treatment. It appears that SSRIs related EPS should be carefully evaluated with all patients.
References Bouchard, R.H., Pourcher, E., Vincent, P., Fluoxetine and extrapyramidal side effects (letter). Am J Psychiatry. 1989; 146: 1353-1353. Baldessarini, R.J., Marsh, E.R., Kula, N.S. Interactions of fluoxetine with metabolism of dopamine and serotonin in rat brain regions. Brain Res. 1992; 579: 152-156. Shihabuddin, L., Rapport, D. Sertraline and extrapyramidal side effects (letter). Am J Psychiatry. 1994; 151:288.
B-56 El
Treatment of patients with depression on the organic base by mianserin along with agents stimulating brain metabolism
L. Bidzan, J. Turczynski. Gdarisk, Poland
II Department
of Psychiatry,
Medical Academy,
Affective diseases, mostly depression, appear to be the most popular disturbances among elderly people. At the same time, dementia, observed at 10% of people, is another chronic disease of the old age. Mutual relations between dementia and depression are not clear, regarding etiology, pathogenesis as well as prognosis. Numerous authors pay attention to the fact that depression syndrome, besides its typical symptoms, may also cause significant cognitive functions disturbances. Eliminating the depression syndrome exerts a positive impact on psychic condition of the demented patients, also on his cognitive functions. In the thesis, which is preliminary to longer-lasting research, efficiency of cyclic antidepressive agent mianserin has been compared. It has been connected with nicergoline, vinpocetine and piracetam. Examination covered a group of 31 people under 55 at whom depressive syndrome appeared within the course of previously recognized dementia process (of preliminary degenerative, vasogenic or mixed origin). Depression and dementia have been recognized on the basis of