The authors present the actual state of knowledge about genetically determined metabolism of psychotropic drugs and its influence on the efficacy and safety of pharmacotherapy.
Enzymatic activity of inositol monophosphatase in erythrocytes was estimated in 12 patients with schizophrenia, in 18 patients with depression in the course of affective illness and in 20 healthy control subjects. Inositol monophosphatase activity in drug-free patients with schizophrenia during exacerbation of illness was significantly higher compared to control subjects. The results obtained may suggest an importance of inositol metabolism, phosphatidyl inositol (PI) cycle or receptors acting via PI (e.g. 5HT2) in the pathogenesis of schizophrenia.
The author described the immunopathological conception or Alzheimer's disease and resulted therapy possibilities. (ed.)
In 27 patients in GAD with concominant depressive symptoms the authors evaluated (using HAMD, MADRES and HARS) the effect or 4 weeks therapy with alprazolam (Xanax). Anxiolitical effect or alprazolam manifested during l week therapy by a small dose and was parallel to antidepressive influence.
Alprazolam as the benzodiazepin preparation, possessing in its chemical structure a triazol ring, by its typical antianxiety (anxiolitic) influences, characterises in antidepressive effect. The purpose of the study led simultaneously in some Polish centers was to estimate clinical efficacy and safety of therapy. Researches in Wrocław were led in 24 patients with a diagnosis of generalized anxiety disorder (GAD), with concomitant depressive symptoms during six weeks lasting treatment with precise range of the dosage. Anxiolitical activity of Xanax significantly manifested after 1 week therapy by a daily dose of about 2 mg and was parallel to an antidepressive effect. Therapeutical effect appeared for a whole period of serving the medicine and wasn't accompanied with serious side symptoms.
Thirty schizophrenics with aggressive behavior were treated using three different sedative strategies in every 10-subjects subgroup: intramuscular injections of: zuclopentixol acetate, haloperidol, and chloropromazine. The sedative strategy with zuclopentixol acetate (clopixol acuphase – Lundbeck TM) was the most effective, i.e. the most sedative treatment, the most antipsychotic treatment, and the less side-effective one.
During l year in 348 schizophrenic patients the therapy with 6 depot neuroleptics (haloperidol, flupenthixol, fluphenazine, perphenazine, pipothiazine, zuklopenthixol) were provided. Psychopathological state (BPRS, CGI, AMDP), adverse events (ARI, SOZP) and social functioning (SAI) were evaluated. Full remission was observed in 49% of the patients. In group of 209 patients the effect of therapy with different neuroleptics was compared during l year medication. These results suggest that the therapy with neuroleptics with high affinity to the serotoninergic receptor companied few severe extrapyramidal symptoms (fluphenazine, flupenthixol). The neuroleptics with D1, alfa-l-adrenergic blocking and antihistaminic activity caused marked sedation in patients (zuklopenthixol, fluphenazine).
A comparative trial in a group of residual schizophrenics was undertaken to evaluate the clinical efficacy and relative tolerability of zuclopenthixol decanoate (Z) and fluphenazine decanoate (F), respectively. Patients were randomly allocated to receive zuclopenthixol or fluphenazine at 3- or 4-week intervals for 3 months. Forty in-patients of either sex entered the study. Positive symptoms decreased progressively in Z-group compared with partial effect in F-group. Also patients treated with zuclopenthixol showed a greater improvement as assessed on the SANS than patients treated with fluphenazine. The number of extrapyramidal side-effects observed in the patients allocated to zuclopenthixol treatment slight1y decreased over the 3-month study period contrasting with increased noted in the patients treated with fluphenazine.
We have studied concentration of C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP) and alpha-1-antychymotripsin (ACT) and their major microheterogeneity (AGP-RC, ACT-RC) in 46 patients during lithium prophylaxis: 21 – up to 2 years, 25 – over 10 years and in 20 healthy controls. Concentrations of CRP were in the range of healthy controls in both groups. AGP and ACT levels were in both groups higher than in controls. The values of microheterogeneity of ACT and AG P were elevated in the patients treated for 2 years and the patients treated for more than 10 years were in the range of controls. The results obtained may suggest that during prophylaxis lithium exerts the immunomodulatory effect on glycosylation of acute phase proteins.
The levels of TSH, T3 and T4 were estimated in 40 cases in which lithium was used for treatment. 5 mlU/L was considered as a limit for TSH concentration – above this limit subclinical hypothyroidism was diagnosed. The subclinical hypothyroidism was found in 4 cases (10% of patients). The neuropsychological test after substitutional treatment by L-thyroxine showed the improvement of memory functions of those patients.
The aim of this work was to estimate the effect of long term lithium treatment on electrocardiographic recording (ECG) in 30 patients with bipolar affective illness. In each patient, the ECG was analysed prior to and after 4 months and after 10 years of lithium treatment. The results obtained may suggest the decrease of unfavourable influence of lithium, on ECG in long term treatment. One of the factors which may contribute to the remission of previous changes in ECG is the maintaining of lower serum lithium concentration.
The effect of long-term lithium administration on the recurrences of affective episodes and the recurrences of labial herpes was estimated in 32 patients with bipolar affective illness (l1 male, 21 female) who have had recurrent labial herpes prior to starting prophylactic lithium. The assessments made in 1987 and after further 7 years of observation (1994) showed similar effect of lithium on the recurrences of affective episodes in these two study periods. The effect of lithium on the recurrences of labial herpes was significantly better with longer administration of the drug. In individual patients, the quality of prophylactic lithium effect on affective recurrences paralleled the lithium effect on the recurrences of labial herpes.
The authors present the preliminary results of studies on prophylactic effect of combined therapy with lithium and carbamazepine in patients with rapid cycling bipolar affective disorder. In 11 patients with earlier inefficacious prophylaxis with lithium, the addition of carbamazepine resulted in the significant improvement of therapeutic effect in 8 patients (73%). The better effect was observed in the patients with shorter duration of illness and shorter duration of lithium treatment. The number of side effects during combined treatment was reduced comparing with that observed during lithium.
The purpose of this study was to evaluate fluoxetine's efficacy in the treatment of major depressive illness met the criteria of DSM III R. The subjects were 20 patients receiving fluoxetine of 20 mg daily by 8 weeks. The psychic state was evaluated on the Hamilton Depression Rating Scale at the beginning and after 3, 6 and 8 weeks of the treatment. The course of the depression illness so far as its seriousness and the main symptoms were considered. Fluoxetine was the effective treatment for 13 of 20 patients. 3 patients were dropped out, l because of worsening and 2 because of severe insomnia. One patient did not respond and in 3 cases the respond was not sufficient. Prozac is recommended for the treatment of the depression syndrome of low intensity.