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Biomedical subjects

D L Garver

Publications and source records attributed to D L Garver.

At least 73 records · Page 4Linked to original sources
PubMed1984

Mood-incongruent versus mood-congruent psychosis: differential antipsychotic response to lithium therapy.

The authors previously reported that a subgroup of schizophrenic-like patients respond favorably to lithium (Li) therapy, as do patients with a classical manic illness. In the present study, the time course of psychotic and affective symptom remission after Li therapy was examined in these two groups of patients. Li responsive patients with a mood-incongruent psychosis (schizophrenic-like illness) demonstrated a rapid antipsychotic response to Li therapy, showing a 50% improvement during the first 7 days, while no improvement in affective symptoms was seen until week 2 or 3 of treatment. Alternatively, patients with a mood-congruent psychosis (where mania is the primary diagnosis) demonstrated no antipsychotic response to Li therapy during the first 2 weeks of treatment, while some improvement in manic symptoms occurred during treatment week 2. The present study demonstrates that Li therapy differentially affects psychotic symptoms in mood-incongruent as opposed to mood-congruent psychosis. Further, the growth hormone (GH) response to apomorphine administration differentiated these two groups of Li responsive patients. Patients with a Li responsive mood-incongruent psychosis demonstrated over a seven-fold greater GH response than mood-congruent psychotic patients. The present data suggest that mood-incongruent and mood-congruent psychoses may represent two biologically distinct psychotic processes separable by both medication response and central dopamine function.

Apomorphine↗
PubMed1984

Platelet monoamine oxidase activity in the psychoses: relationship to symptoms and lithium response.

The kinetics of platelet monoamine oxidase (MAO) were studied in 100 psychotic and manic patients and 36 controls. No relationship was found between MAO activity and response to lithium in the schizophrenic-like illnesses. However, the data do suggest there is an association between enzyme affinity (Km) and specific symptom clusters. Patients with the low Km variant of platelet MAO are enriched in depressive symptoms, while those with the high Km variant are enriched in manic symptoms.

Adult↗
PubMed1984

Lithium response and psychoses: a double-blind, placebo-controlled study.

Lithium-associated remission of psychosis has been described in schizophreniform disorders and in psychotic patients with variants of the red blood cell (RBC)/lithium ratio. To determine whether such remissions are the consequence of lithium treatment rather than spontaneous in nature, a double-blind, placebo-controlled study was undertaken in 16 psychotic patients preselected for the variant of RBC/lithium ration and/or DSM-III schizophreniform diagnosis. Essentially full and sustained remission of psychosis began during periods of lithium treatment in 4 of 15 of the study patients. Improvement was significantly greater during lithium treatment periods than in counterbalanced placebo treatment conditions in these four subjects (p less than 0.02). Fifteen of the same 16 study patients failed to initiate sustained improvement either spontaneously or while on placebo during the initial 14-day treatment period. In this preselected psychotic population, sustained response to lithium occurred at a rate at least four times greater than that which could be attributed to spontaneous remission.

Affective Disorders, Psychotic↗
PubMed1984

Impact of lithium therapy on core psychotic symptoms of schizophrenia.

The authors have previously reported that a sub-group of schizophrenic-like patients respond favorably to lithium therapy: furthermore, psychotic patients who respond to lithium demonstrate appreciable improvement during the first seven days of treatment. The present study investigated which symptoms of schizophrenia improved quickly during lithium treatment. We found that patients who do respond to lithium show significant improvement in the core symptoms of psychosis--hallucinations, delusions and formal thought disorder--during the first seven days of treatment, thus allowing early identification of 88 per cent of schizophrenic patients who ultimately respond to lithium and 91 per cent of those who do not.

Delusions↗
PubMed1984

Fluphenazine plasma levels and clinical response.

Plasma levels of fluphenazine and clinical response were examined in 19 inpatient schizophrenics (DSM-III diagnoses) using a constant dose, steady-state methodology. A significant curvilinear correlation was demonstrated between clinical response and steady-state plasma levels of fluphenazine (p less than .05). A therapeutic range of plasma fluphenazine is suggested in the range of .13-.70 ng/ml. The lowest plasma level detected (.13 ng/ml) appeared to be well within the therapeutic range. The 9 patients with plasma fluphenazine levels in this range demonstrated a mean clinical improvement of 59% compared to 34% for patients with plasma levels above .70 ng/ml (p less than .01).

Administration, Oral↗
PubMed1984

Haloperidol plasma and red blood cell levels and clinical antipsychotic response.

Two investigators have recently suggested therapeutic ranges for plasma haloperidol in the treatment of schizophrenia. An apparent optimal therapeutic range of red blood cell haloperidol as early as day 7 of the drug trial is described in this article. With continued treatment, an optimal plasma haloperidol range for response could be observed by day 14 of treatment. The previously described correlation between response at day 7 and plasma/red blood cell haloperidol ratio was confirmed but was found not to predict response at day 14 of drug treatment in this cohort of DSM-III schizophrenic patients.

Erythrocytes↗
PubMed1984

Clinical relevance of thiothixene plasma levels.

The authors examined plasma levels of thiothixene and clinical response in 19 DSM-III diagnosed inpatient schizophrenics, using an improved methodology. A significant curvilinear correlation was demonstrated between clinical response and plasma levels for thiothixene (p less than 0.02). Optimal clinical response to thiothixene appears to be associated with plasma levels from 2.0 to 15.0 ng/ml (p less than 0.05). These findings suggest that laboratory measurement of thiothixene levels may assist in determining the minimum effective dose for individual patients.

Humans↗
PubMed1983

Clinical response and plasma haloperidol levels in schizophrenia.

Plasma haloperidol levels were compared to clinical response during the first 14 days of drug treatment in 14 DSM III-diagnosed inpatient schizophrenic patients using an improved methodology, which utilized predetermined constant dosages and derived a therapeutic range of plasma haloperidol levels from a curvilinear regression analysis. An inverted U-shaped relationship was found which reflected a significant curvilinear correlation (r = 0.66, P less than 0.02) between plasma levels (as assayed by gas chromatography) and improvement on the Serial New Haven Schizophrenia Index. A therapeutic window was suggested by the present study, with optimum patient response associated with plasma haloperidol levels of 4.2-11.0 ng/ml for the first 2 weeks of treatment.

Haloperidol↗
PubMed1982

Schizophrenia and reduced cyclic AMP production: evidence for the role of receptor-linked events.

Reduced cyclic AMP (cAMP) production has been found in platelets of schizophrenic patients. cAMP is generated physiologically as a result of a series of steps beginning with receptor activation by a ligand, progressing through activation of the enzyme protein, adenylate cyclase. The deficit of cAMP found in the schizophrenic population may occur at any one, or at multiple steps in this cascade. The present study attempts to discriminate whether impaired adenylate cyclase itself was responsible for the cAMP deficit or whether abnormalities in receptor events or linkage are present in schizophrenics. The production of cAMP following direct stimulation of adenylate cyclase by NaF was contrasted with receptor mediated activation of adenylate cyclase by prostaglandin E1 (PGE1) in disrupted platelet preparations from schizophrenics and normal controls. cAMP formation stimulated by NaF was not different in platelets of schizophrenics as compared to controls, however, platelets of schizophrenics showed reduced response to PGE1 stimulation. The authors interpret these findings as evidence for a membrane associated abnormality of either receptor or receptor-adenylate cyclase linkage in the schizophrenias.

Adenylyl Cyclases↗
PubMed1982

Monoamine distribution in primate brain-IV. Indoleamine-containing perikarya in the brain stem of Macaca arctoides.

The histochemical fluorescence technique for the demonstration of monoamines in the central nervous system was employed to assess the distribution of serotonin-containing neurons within the brain stem of the immature and adult stump-tailed macaque (Macaca arctoides). Microspectrofluorometric analysis was performed in order to verify the existence of serotonin within perikarya which contained yellow histofluorescence. Serotonin-containing perikarya were found with raphe nuclei including nucleus raphe-pallidus, -obscurus, -points, -magnus, -dorsalis, and -centralis superioralis. Serotoninergic perikarya did not appear confined exclusively to the raphe, but were observed in the reticular formation and other brain stem nuclei including the locus coeruleus and nucleus subcoeruleus. Serotoninergic cells were not seen within the brain stem at superior collicular levels. The localization of serotoninergic perikarya in regions other than the raphe nuclei presents certain dissimilarities in relation reported in other mammalian species.

Animals↗
PubMed1982

Growth hormone levels and lithium ratios as predictors of success of lithium therapy in schizophrenia.

The authors previously found a high correlation between lithium response and clinical diagnostic criteria in a subgroup of schizophrenic-like patients who responded favorably to lithium therapy. In the present study the authors extend this research by using biological markers to predict and identify such patients. They examined growth hormone (GH) response to apomorphine administration and the in vitro lithium ratio in 31 patients before and after a 2-week lithium trial. Peak GH levels (greater than or equal to 20 ng/ml) and lithium ratios (greater than or equal to .39) were correlated with a positive response to lithium therapy. The authors discuss 1) the use of these two biological markers to predict the success of lithium therapy in schizophrenia and 2) biological abnormalities characteristic of lithium-responsive schizophrenic patients.

Apomorphine↗
PubMed1981

Physostigmine and lithium response in the schizophrenias.

Conflicting reports concerning cholinomimetic-induced reduction of schizophrenic symptoms prompted the authors to study such changes in schizophrenic symptoms following physostigmine infusions in subgroups of patients with schizophrenic-like illness. These subgroups were defined by the presence or absence of antipsychotic response during a 2-week trial of lithium alone after physostigmine infusion. Patients who showed significant but temporary improvement in their thinking disturbance on serial Brief Psychiatric Rating Scale scores following physostigmine infusion subsequently responded to lithium; patients who failed to improve following physostigmine also failed to respond to lithium. The authors suggest that some schizophrenic-like illnesses may be biologically similar to mania both with respect to physostigmine and lithium-induced changes in symptomatology.

Adult↗
PubMed1980

Phenothiazine levels in plasma and red blood cells. Their relationship to clinical improvement in schizophrenia.

A controlled study investigated the relationship between steady-state plasma and RBC concentrations of the phenothiazine derivative butaperazine maleate and the therapeutic response in 24 hospitalized schizophrenic patients who received constant maintenance doses of butaperazine during the first two weeks of treatment. Butaperazine concentrations in RBCs correlated significantly with clinical improvement in an inverted U-shaped pattern, whereas plasma levels of butaperazine were not significantly related to clinical response. Both plasma and RBC levels of butaperazine showed large interpatient variations. The level of RBC-bound drug might be a better peripheral correlate of drug levels in the brain than are drug levels in plasma. Thus, monitoring drug levels in RBCs might have an advantage over measured drug levels in plasma. These findings might not allow generalization to other antipsychotic agents.

Adolescent↗