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Biomedical subjects

E Leinonen

Publications and source records attributed to E Leinonen.

At least 55 records · Page 3Linked to original sources
PubMed1994

Appropriacy judgements and pragmatic performance.

This paper examines judgements of inappropriacy made by groups of independent raters from different professional backgrounds when presented with data from two boys with semantic, pragmatic and syntactic difficulties, who are interacting with adults, and when presented with data in a transcript or video format. The purpose is to explore the nature of such judgements with the view to highlighting the centrality and the complex nature of inappropriacy judgements in the clinical management of pragmatic impairment. The current study suggests that consensus of view as to what is or is not appropriate in interactions involving child clients may not exist in the general population. It further suggests that professional experience with children may direct one's attention primarily to the child client. Video presentation of information also appeared to direct attention to the child interactant. Given that audiovisual presentation of data is able to reproduce the non-linguistic 'oddness' of a child (e.g. averted gaze, slumped posture, monotonous voice), a situation seems to be created in which the linguistic content is perceived as equally 'odd' or inappropriate. This study has implications for assessment, diagnosis and treatment of pragmatic difficulties in children.

Adult↗
PubMed1993

The use of clozapine in treatment-refractory schizophrenia.

The effects of clozapine on positive and negative symptoms were studied in 103 patients with treatment-refractory schizophrenia. The evaluation of symptom profile was made before and after clozapine treatment. Overt psychopathology did not vary significantly before clozapine treatment. Significant decreases in positive and negative symptoms were noted by the third month on clozapine. No further significant progress could be observed after 6 months of treatment. No fatal cases were observed, although two patients developed agranulocytosis during clozapine treatment.

Adult↗
PubMed1993

A long-term study of remoxipride in chronic schizophrenic patients.

The purpose of this study was to assess the tolerability and efficacy of 150-600 mg remoxipride (predominantly a DA2 receptor antagonist) in an open long-term (1 year) multicentre trial in chronic schizophrenic patients. The mean duration of illness before entering the study was 21 years and the pre-study neuroleptic dosage in chlorpromazine equivalents was 930 mg/day. The clinical efficacy was measured with the Brief Psychiatric Rating Scale and the Clinical Global Impression scale. The adverse events were recorded by a 26-item Adverse Symptom Checklist and by the Abnormal Involuntary Movements Scale. Forty-five patients were included in the study. The mean daily dose of remoxipride during the last week of treatment was 378 mg. Eighty percent (36 patients) withdrew prematurely (< 1 year). The main reasons for withdrawal were: ineffectiveness (n = 15), treatment refusal (n = 12) and adverse events (n = 8). The most frequently reported adverse events were insomnia (n = 20) and tiredness (n = 7), whereas only a few (n = 6) extrapyramidal symptoms were reported. There was no relationship between remoxipride plasma concentration and clinical efficacy nor was any relationship found between the ratio of pretrial chlorpromazine equivalent to last remoxipride dose and the therapeutic effect. Remoxipride alone seemed to have an insufficient neuroleptic efficacy in these chronic and treatment-resistant schizophrenic patients but was well tolerated.

Adult↗
PubMed1993

Delirium during fluoxetine treatment. A case report.

The correlation between high serum tricyclic antidepressant concentrations and central nervous system side effects has been well established. Only a few reports exist, however, on the relationship between the serum concentrations of selective serotonin reuptake inhibitors (SSRIs) and their toxic effects. In some cases, a high serum concentration of citalopram (> 600 nmol/L) in elderly patients has been associated with increased somnolence and movement difficulties. Widespread cognitive disorders, such as delirium, have not been previously linked with high blood levels of SSRIs. In this report, we describe a patient with acute hyperkinetic delirium connected with a high serum total fluoxetine (fluoxetine plus desmethylfluoxetine) concentration.

Aged↗
PubMed1992

Serum levels of mianserin and clinical outcome in elderly depressive inpatients.

Fifty-two elderly inpatients with moderate or severe depression underwent routine mianserin treatment with simultaneous measurements of 76 steady- state serum mianserin concentrations. These concentrations were correlated to the changes in the illness of the patients, who were divided into three classes according to the ratings by the Global Clinical Impression scale in steady-state and at two, four, and six weeks' intervals. Despite no significant differences in mean dosages, the serum mianserin concentrations of the patients with good clinical improvement were significantly higher than those of the patients with minimal clinical improvement, in six weeks of ratings. We conclude that some individual old patients have a correlation between good antidepressive effects and relatively high serum mianserin concentration.

Aged↗
PubMed1992

Debrisoquine hydroxylation phenotypes of patients with high versus low to normal serum antidepressant concentrations.

Debrisoquine hydroxylation phenotype was determined in 22 psychiatric patients who had previously developed exceptionally high serum antidepressant (AD) concentrations, and in 22 sex-, age-, and dose-matched counterparts who had low to normal serum AD levels. The patients were recruited from 641 subjects in whom serum AD levels were monitored. In each AD level group, 16 patients had been treated with tricyclic antidepressants (amitriptyline, doxepin, trimipramine, imipramine, clomipramine) and 6 with mianserin. Eight poor metabolizer (PM) phenotypes (debrisoquine/hydroxydebrisoquine ratio in 6-hour urine greater than or equal to 41.5) were identified in the high AD level group, but only two in the group with low to normal AD level (p = 0.03, Fisher's test). Comedications in the two study groups did not differ markedly from ach other and could not, therefore, explain the greater frequency of PMs among the patients with high serum AD levels. Three of 6 mianserin patients, who had developed high serum AD levels, were PMs. This high proportion of PMs raises the question of a possible involvement of the same metabolic pathway (cytochrome P-450IID6 isoenzyme) also in mianserin hydroxylation. The results suggest further that during AD therapy with standard dosage, PM phenotypes are at special risk for high serum AD concentrations and, consequently, for clinical symptoms of toxicity.

Antidepressive Agents↗
PubMed1991

Serum mianserin concentrations in psychiatric inpatients of different ages.

One hundred and sixty-nine depressive psychiatric inpatients were treated with routine therapeutic doses of mianserin. Altogether 256 serum mianserin samples were measured gas-chromatographically in 3 age groups: 17 samples in patients under 35 years, 116 samples in patients between 35 and 65 years, and 123 samples in patients over 65 years. No differences in dose-corrected (calculated as mg/kg dose basis) mean serum mianserin concentrations were found between the age classes. Neither the interindividual variation nor the number of high serum mianserin concentrations was larger among elderly subjects than in the other age groups. Concurrent neuroleptic treatment significantly increased serum mianserin levels in the oldest patient group but not in the 2 others. The results suggest that mianserin dose should not be generally reduced with advancing age.

Adult↗
PubMed1991

Effects of carbamazepine on serum antidepressant concentrations in psychiatric patients.

The combination of carbamazepine and an antidepressant (doxepin, amitriptyline, mianserin) was given to 22 psychiatric inpatients with 29 measurements of their serum antidepressant concentrations. For comparison, sex-, age-, and dose-matched inpatients, treated with the antidepressant but not with carbamazepine, were selected as controls (N = 29). All the patients were treated with their routine daily dose for at least 7 days before the gas-chromatographic measurement of serum predose concentrations of the antidepressants. In patients with carbamazepine, serum doxepin and doxepin + nordoxepin concentrations (N = 17) were decreased significantly (p less than 0.05), on average to 46% and 45%, respectively, as compared to that in subjects without carbamazepine. Also in carbamazepine + amitriptyline patients, serum nortriptyline and amitriptyline + nortriptyline concentrations (N = 8) were significantly lower than in those not receiving carbamazepine (p less than 0.05). The mean serum antidepressant levels were decreased to 42% and 40%, respectively. The serum mianserin concentration of carbamazepine patients (N = 4) was reduced to 30% of that in patients not treated with carbamazepine (p less than 0.01). The percentage fractions of demethylated metabolites (nordoxepin, nortriptyline) from the total antidepressant levels were not influenced by carbamazepine. In patients treated with carbamazepine, serum total antidepressant concentrations remained more often below the suggested therapeutic ranges than in those patients without carbamazepine. The results suggest that serum antidepressant concentrations are reduced by concurrent carbamazepine therapy, and that the concentrations should be carefully monitored when carbamazepine is added to the antidepressant regimen.

Adult↗
PubMedDate not supplied

Early developmental differences between DSM-III-R schizophrenics treated with clozapine and typical neuroleptics.

Developmental deviance is known to be associated with schizophrenia. We tested the hypothesis that the most severe schizophrenia requiring treatment with clozapine would particularly show these effects. Therefore, associative factors from pregnancy, delivery, neonatal and socio-demographic characteristics were compared between the clozapine-treated schizophrenic cases (n = 17) and the remaining cases of schizophrenia treated with typical neuroleptics (n = 59) from an unselected, general population North Finland 1966 Birth Cohort, (n = 11,017). By the end of 1994, seventeen (22%) of a total 76 DSM-III-R schizophrenia patients, had received clozapine treatment. The mean length at birth was 52 cm in the clozapine group (in the non-clozapine group 50 cm) and correspondingly the mean one year weight 10.4 kg (9.8 kg), with the differences between the groups being statistically significant (P < 0.05). Other pregnancy, delivery, and socio-demographic characteristics were, however, similar in the clozapine-treated and the remaining cases with schizophrenia. There was no evidence that severe schizophrenia requiring treatment with clozapine was associated with impaired intrauterine or post-natal development. Indeed, during the first years of life the former group was larger in terms of weight and length than those treated with typical neuroleptics. These early developmental characteristics did not predict clinical severity of schizophrenia in adulthood.

Adult↗