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Biomedical subjects

C A Johns

Publications and source records attributed to C A Johns.

At least 37 records · Page 2Linked to original sources
PubMed1989

Clozapine: guidelines for clinical management.

The advent of antipsychotic drugs represented a milestone in psychotherapeutics. Despite their proven efficacy, antipsychotic drugs are limited by side effects and treatment resistance in some patients. Since the introduction of chlorpromazine and the subsequent development of numerous neuroleptic compounds, there have been no significant qualitative advances in the clinical efficacy of antipsychotic drugs. Clozapine is an experimental neuroleptic with atypical properties. In clinical testing, this agent has shown superior antipsychotic efficacy in treatment-refractory schizophrenics and a more favorable extrapyramidal side effect profile in comparison with standard neuroleptics. Because clozapine represents a potential contribution to our therapeutic armamentarium, this article provides an overview of its pharmacology, efficacy, and methods of clinical utilization.

Clinical Trials as Topic↗
PubMed1988

Platelet alpha 2-adrenergic receptor function in psychiatric disorders.

The inhibitory effects of norepinephrine (NE) on the cyclic adenosine-3',5'-monophosphate (cAMP) response to prostaglandin E1 (PGE1), a measure of alpha 2-adrenergic receptor function, have been compared in platelets from drug-free schizophrenic patients, depressive patients, and normal controls. The absolute value of the inhibition by NE of the cAMP response to PGE1 was smaller in platelets from schizophrenic and depressive patients than in controls. However, this result was secondary to the smaller baseline platelet cAMP response to PGE1 in patients with these disorders. Effects of NE on cAMP production did not discriminate between actively ill and remitted patients with either schizophrenia or depression. Platelet alpha 2-receptor sensitivity, as measured by the effects of NE on cAMP production, does not appear to be altered in these psychiatric disorders.

Adult↗
PubMed1988

Cl(-)-dependent ATP-driven H+ transport in rabbit renal cortical endosomes.

An endosomal fraction isolated from rabbit renal cortex by a novel, fast, and simple procedure was enriched in ATP-dependent H+ pumping that was oligomycin insensitive but was inhibited by dicyclohexylcarbodiimide (DCCD), N-ethylmaleimide (NEM), Zn2+, Hg2+, diethylstilbestrol, mersalyl, and 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole. No substantial Na+-H+ exchange was detected. Electrogenicity of the pump was demonstrated using [14C]-SCN-. In addition, these membranes featured ATP-dependent Cl- flux. The ATP-driven H+ pumping had an absolute requirement for Cl-: an inside-negative membrane potential was not a substitute for Cl-. The protonophore carbonyl cyanide p-trifluoromethoxyphenylhydrazone inhibited ATP-driven Cl- uptake but no inhibition was observed with nigericin. Finally, both ATP-driven H+ pumping and ATP-dependent Cl- flux were inhibited by Cl(-)-channel inhibitors. Part, or all, of the absolute dependence on Cl- may derive from a Cl- channel, the function of which is intimately related to H+ pumping by the ATPase. Flux through this Cl- channel may be regulated by one or more factors, including ATP, membrane potential, and pH.

Adenosine Triphosphate↗
PubMed1988

Clozapine-induced agranulocytosis: non-cross-reactivity with other psychotropic drugs.

Clozapine, an atypical neuroleptic with unique clinical and preclinical properties, represents a potentially valuable addition to the psychopharmacopeia. Its development and use have been limited by its higher frequency, compared with other pharmacologic treatments, of the potentially fatal side effect of agranulocytosis. This article describes the natural history of five cases of agranulocytosis that occurred in the course of clozapine treatment. The cases were generally uniform as to onset, recovery, and hematologic features. No patient had hematologic reactions to treatment with psychotropic agents before or after clozapine treatment. These findings, along with other work in progress, suggest that clozapine's granulocytoxic effects are produced by a highly specific immune-mediated mechanism.

Adult↗
PubMed1987

Platelet [3H]imipramine binding in psychiatric disorders.

The Bmax and Kd values for [3H]imipramine binding were measured in platelets from drug-free normal controls and schizophrenic and depressive patients. No differences among groups were found. Exacerbated and remitted patients with either schizophrenia or depression did not differ in platelet [3H]imipramine binding parameters. No correlations were observed between platelet [3H]imipramine binding parameters and measures of symptom severity among actively ill patients with either schizophrenia or depression.

Adult↗
PubMed1987

Clinical correlates of platelet prostaglandin receptor subsensitivity in schizophrenia.

A diminished cAMP response to prostaglandin E1 (PGE1) in platelets from schizophrenic patients has been demonstrated previously. The authors report that among 35 actively psychotic male schizophrenic patients, the platelet cAMP response to PGE1 was negatively correlated with global symptom severity and with several indexes of positive symptom severity but not with negative symptom severity. If this subsensitivity of platelet PGE receptors extends to brain PGE receptors, schizophrenic patients may have an impairment in the ability of endogenous PGEs to inhibit dopaminergic transmission. Such impairment could have a permissive effect on the production of psychotic symptoms during exacerbations in schizophrenic patients.

Adult↗
PubMed1986

Cortisol and Alzheimer's disease, I: Basal studies.

Patients with Alzheimer's disease and nondemented elderly control subjects participated in studies of cortisol secretion during sleep and at 9:00 a.m. and were given dexamethasone suppression tests (DSTs) and lumbar punctures. Nocturnal and 9:00 a.m. cortisol concentrations were significantly higher in the demented patients. CSF MHPG negatively correlated with mean nocturnal cortisol. The most severely demented patients had the highest 9:00 a.m. and mean nocturnal cortisol concentrations. DST results did not distinguish samples with substantially different nocturnal cortisol concentrations. These results suggest that measurements of basal plasma cortisol concentrations and dexamethasone suppression provide different information but support the notion of somewhat higher than normal cortisol concentrations in Alzheimer's disease patients.

Aged↗
PubMed1986

Cortisol and Alzheimer's disease, II: Dexamethasone suppression, dementia severity, and affective symptoms.

The course of Alzheimer's disease can be complicated by depressive illness, often presenting enigmatically. To determine whether the dexamethasone suppression test (DST) can help distinguish patients with coexisting dementia and depression from those with dementia alone, DSTs were conducted with 22 nondepressed Alzheimer's disease patients. Eleven patients were nonsuppressors. The nonsuppressors were older than the suppressors but did not differ in depression or dementia ratings. The 8:00 a.m. postdexamethasone cortisol level correlated with depressive symptoms. A relationship between severity of dementia and depressive symptoms was also demonstrated.

Aged↗
PubMed1986

Correlates of lateral ventricular size in chronic schizophrenia, I: Behavioral and treatment response measures.

The ventricle-brain ratio (VBR) of 28 drug-free male schizophrenic inpatients was significantly higher than that of 21 matched normal control subjects and was not related to severity of positive or negative symptoms. Response to haloperidol in an open 6-week trial using a fixed-dose schedule was not predicted by severity of positive or negative symptoms or by VBR. The nine severely deteriorated patients with chronic "Kraepelinian" schizophrenia had left lateral ventricles 28% larger than their right, whereas the control subjects and other schizophrenic patients did not show ventricular asymmetry.

Adult↗
PubMed1985

Plasma homovanillic acid concentration and the severity of schizophrenic illness.

Concentrations of plasma homovanillic acid before treatment were highly correlated with global severity of illness in schizophrenic patients, both before and after treatment. In contrast, a fixed dose of haloperidol did not affect those concentrations. Thus, in patients with a diagnosis of schizophrenia, plasma homovanillic acid may reflect the severity of illness, but not be influenced by short-term pharmacological perturbations by neuroleptics.

Adult↗
PubMed1985

Evaluating prolactin response to dopamine agonists in schizophrenia. Methodological problems.

Serum prolactin (PRL) level was assessed after challenges with apomorphine hydrochloride, saline, dopamine hydrochloride, or levodopa-carbidopa (Sinemet) in 19 control and 38 chronic schizophrenic subjects. Baseline PRL level varied inversely with age. High correlations existed between baseline PRL level and any subsequent absolute measure of PRL after administration of a dopamine agonist or placebo. Percent decrease was not a function of baseline concentrations and was therefore the only independent measure of drug response. Baseline PRL level was generally lower during exacerbation than remission in patients studied during two states of illness. Percent PRL level decrease after apomorphine administration was significantly greater in normal subjects than in schizophrenics. Correction of apomorphine responses for corresponding placebo (saline) values abolished differences between groups. Prolactin responses after dopamine or levodopa-carbidopa did not differ; however, placebo correction was not possible.

Acute Disease↗
PubMed1985

Clinical studies of the cholinergic deficit in Alzheimer's disease. I. Neurochemical and neuroendocrine studies.

Autopsy studies indicating that cholinergic neurons are selectively lost in patients with Alzheimer's disease (AD) and senile dementia of the Alzheimer type (SDAT) suggest that peripheral markers for central cholinergic activity would be useful in diagnosis. The present studies found that cerebrospinal fluid (CSF) concentrations of acetylcholine (ACh) correlated with the degree of cognitive impairment (r = .70) in a sample of carefully diagnosed patients with AD/SDAT, but metabolites of other neurotransmitters were not related to cognitive state; this suggests that CSF ACh may be a valid measure of cholinergic degeneration. Cortisol and growth hormone were measured in plasma samples drawn from patients and controls every 30 minutes from 2100 to 1100 hours the next day. Mean plasma cortisol concentrations were higher in patients with AD/SDAT than in controls and correlated inversely with CSF methoxy-hydroxyphenylglycol (MHPG) (r = .61) and positively with degree of cognitive impairment (r = +.53); as anticholinergic drugs suppress cortisol this finding indicates that cortisol dysregulation may be a marker for abnormalities in other neurotransmitter systems, particularly the noradrenergic system. Growth hormone secretion was not different in patients and controls but was positively correlated with CSF MHPG (r = +.63).

Acetylcholinesterase↗
PubMed1985

Clinical studies of the cholinergic deficit in Alzheimer's disease. II. Psychopharmacologic studies.

Two studies investigated the ability of physostigmine, given both intravenously and orally, to reduce symptoms of Alzheimer's disease. Intravenous physostigmine significantly and reliably enhanced memory in 13 of 16 patients tested, but the dose producing the improvement varied among patients. Oral physostigmine decreased overall symptom severity in a reliable way in seven of 12 patients tested. The extent of improvement was correlated with the increase in mean cortisol secretion produced by physostigmine, suggesting that the drug improved behavior and cognition only to the extent that it had a specific central cholinomimetic effect. There was no significant association between response to physostigmine and results of a dexamethasone suppression test and physostigmine had no effect on growth hormone secretion.

Administration, Oral↗
PubMed1985

Oral physostigmine treatment of patients with Alzheimer's disease.

Twelve patients with Alzheimer's disease received 0.0, 0.5, 1.0, 1.5, and 2.0 mg of oral physostigmine every 2 hours for 3-5 days; symptoms after each dose were assessed with the Alzheimer's Disease Assessment Scale. Placebo and the dose associated with the least severe symptoms were then readministered for 3-5 days each. Of the 10 patients who completed the study, three showed clinically significant improvement on the highest physostigmine dose in both phases, four more were marginally improved in both phases, and three had inconsistent responses to physostigmine. Cortisol measures obtained during a sleep study suggest that patients whose symptoms improved on physostigmine were those in whom oral physostigmine enhanced central cholinergic activity.

Administration, Oral↗
PubMed1984

Positive and negative symptoms in schizophrenia.

Negative and positive symptoms were determined for 46 drug-free patients who met Research Diagnostic Criteria (RDC) and/or Feighner criteria for schizophrenia. A modified version of the Scale for the Assessment of Negative Symptoms (SANS) was completed for each patient based on items from the Schedule for Affective Disorders and Schizophrenia (SADS) and other scales. Positive symptoms were scored from the SADS as well as from the following four diagnostic systems: RDC, Schneider's first-rank symptoms, the 12-point Flexible system, and Langfeldt's criteria for poor prognosis schizophrenia. For all patients, there was no correlation of negative symptoms and positive symptoms defined by any diagnostic system. Within the paranoid and undifferentiated subtypes, there was a positive correlation of positive and negative symptoms. Patients moving from stable to exacerbated states had an increase in both positive and negative symptoms, and patients with a poor history of treatment response had both more positive and more negative symptoms than responsive patients in a stable state. These results do not support the view that subgroups of patients have predominantly either negative or positive symptoms.

Adult↗