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Biomedical subjects

G Chouinard

Publications and source records attributed to G Chouinard.

At least 73 records · Page 4Linked to original sources
PubMed1990

Zopiclone and triazolam in insomnia associated with generalized anxiety disorder: a placebo-controlled evaluation of efficacy and daytime anxiety.

In a double-blind placebo-controlled study, following a 1 week washout, 75 outpatients suffering from generalized anxiety disorder with severe insomnia as the target symptom were randomly assigned to 4 weeks of treatment with zopiclone 7.5 mg, triazolam 0.5 mg or placebo at bedtime. Zopiclone was significantly better than placebo on most sleep parameters. Triazolam tended to be superior to placebo, but its superiority was significant only on the sleep induction factor. Triazolam-treated patients presented significantly more day-time-interdose anxiety than zopiclone as assessed by the weekly HARS and Clinical Global Assessment of Anxiety. Although daytime-interdose anxiety was observed with both drugs, this treatment emergent symptom was more frequent and severe with triazolam. Side-effects were of a mild to moderate intensity for both zopiclone and triazolam; however, taste perversion frequently appeared with zopiclone. Although both drugs share similar pharmacological properties and bind to benzodiazepine receptors, they differ significantly with respect to side-effects and daytime anxiety.

Adult↗
PubMed1990

Articulatory impairment associated with tardive dyskinesia.

The speech of two patients with tardive dyskinesia was studied, and one neuroleptic-treated patient having no signs of overt tardive dyskinesia served as control. A structured interview, including reading, repetition of sentences, and spontaneous conversation, was performed. A phonetic transcription and analysis of abnormal phonemes was done by a linguist under blind conditions. Both patients with tardive dyskinesia had abnormal phonemes whereas the control patient had none. These differences could not be explained by age, direct neuroleptic effect, or neuroleptic exposure time. The abnormal phonemes were all consonants. The authors conclude that tardive dyskinesia may cause articulatory communication problems.

Adult↗
PubMed1990

A controlled dose-ranging study of remoxipride and haloperidol in schizophrenia--a Canadian multicentre trial.

The efficacy and side-effect profile for three dose ranges of remoxipride were compared with haloperidol in 242 schizophrenic inpatients in 13 centres. All patients were in a productive phase of schizophrenia according to DSM-III criteria. Relative efficacy of low dose (30-90 mg daily) vs middle dose (120-240 mg daily) vs high dose (300-600 mg daily) was compared with the standard dose of haloperidol (15-45 mg daily), as were the side effects. It was concluded that the therapeutic efficacy of remoxipride was comparable to that of haloperidol for acute episodes of schizophrenia; that the low dose range was significantly less effective than the higher ranges; that there was a clear advantage of remoxipride over haloperidol with respect to incidence and severity of extrapyramidal symptoms. The general safety profile of remoxipride as assessed from clinical chemistry, haematology, and cardiovascular variables suggests that remoxipride in the dose ranges studied can be used safely for the treatment of schizophrenic patients.

Acute Disease↗
PubMed1990

A placebo-controlled clinical trial of remoxipride and chlorpromazine in newly admitted schizophrenic patients with acute exacerbation.

We carried out a four-week double-blind placebo-controlled study comparing remoxipride (n = 20) to chlorpromazine (n = 21) and placebo (n = 21) in the treatment of newly admitted schizophrenic patients with acute exacerbation. Chlorpromazine was found to be significantly better than remoxipride on the dropout rate due to inefficacy, Clinical Global Impression (CGI) of severity of illness and Brief Psychiatric Rating Scale (BPRS). Chlorpromazine tended to be better than placebo on the dropout rate related to inefficacy, Nurse's Global Impression (NGI) of severity and on the BPRS measures of positive symptoms (hallucinatory behaviour and thinking disturbance factor). We were unable to detect a difference between remoxipride and placebo except that remoxipride was better in patients who had previously responded well to neuroleptics. Both drugs induced significantly more parkinsonism than placebo, but differently so: chlorpromazine induced both types of parkinsonism hypo- and hyper-kinetic symptoms, whereas remoxipride induced hyperkinetic symptoms. Chlorpromazine caused more tachycardia, drowsiness, orthostatic dizziness, and dry mouth than the other two treatments, while patients on remoxipride suffered more from insomnia than those on the other two treatments.

Acute Disease↗
PubMed1990

Neuroleptic-induced supersensitivity psychosis in patients with bipolar affective disorder.

Clinical syndromes thought to arise from neuroleptic-induced dopamine receptor supersensitivity are well described in psychiatry. Tardive dyskinesia may arise from neostriatal supersensitivity and supersensitivity psychosis may arise from mesolimbic supersensitivity in schizophrenics chronically treated with neuroleptics. The authors present 5 cases of supersensitivity psychosis that developed in patients with bipolar affective disorder. The clinical syndrome is described and the implications for the long-term course of bipolar affective disorder are discussed.

Adult↗
PubMed1990

[The anti-koro effect of a tricyclic antidepressant].

The authors are reporting a case of koro syndrome which was associated with major depression. Koro syndrome is a rare disease which manifests itself with a severe anxiety associated with the fear of having the penis shrinking and disappearing in the abdomen. The case reported was treated with trimipramine, a tricyclic antidepressant, at a dose of 150 mg/day associated with bromazepam, a benzodiazepine. In addition, the patient received psychotherapy, which allowed him to deal with the situation and to eliminate guilt feelings. It is hypothesized that the tricyclic antidepressant, by treating the depression, had a curative effect on the koro syndrome.

Adult↗
PubMed1990

A guide to benzodiazepine selection. Part I: Pharmacological aspects.

Since absorption rates, volumes of distribution and elimination rates differ greatly among the benzodiazepine derivatives, each benzodiazepine has a unique plasma concentration curve. Although the time to peak plasma levels provides a rough guide, it is not equivalent to the time to clinical onset of effect. Two half-lives can be described: the alpha half-life, the rate of decline in plasma concentrations due to the process of drug redistribution from the central to the peripheral compartment, and the beta half-life, the rate of decline due to the process of drug elimination due to metabolism. The frequent classification of benzodiazepines into long, intermediate, and short-"acting" categories based on their terminal beta half-lives is unfounded; the duration of action is much more dependent on the alpha half-life. Benzodiazepines with short beta half-lives are commonly thought to be preferable because they accumulate less. However, with repeated use, sedation and cognitive neuromotor impairment usually diminish progressively despite stable or even rising benzodiazepine plasma concentrations, whereas anxiolytic effects generally persist over time.

Anti-Anxiety Agents↗
PubMed1990

Antidepressant efficacy of sertraline: a double-blind, placebo- and amitriptyline-controlled, multicenter comparison study in outpatients with major depression.

A double-blind, placebo- and amitriptyline-controlled comparison study was performed to evaluate the antidepressant efficacy of sertraline, a specific serotonin uptake inhibitor. Patients with DSM-III-defined major depression randomly received either sertraline (N = 149), amitriptyline (N = 149), or placebo (N = 150) once daily for the 8-week study period. The mean final daily medication dose for the all-patients group was 145 mg and 104 mg for the sertraline- and amitriptyline-treatment groups, respectively. As measured by the Hamilton Rating Scale for Depression and the Clinical Global Impressions Scale, both the sertraline and amitriptyline treatment groups showed a significantly greater improvement from baseline (p less than or equal to .001) than the placebo group. The sertraline group had a higher proportion of gastrointestinal complaints and male sexual dysfunction than either the amitriptyline or the placebo group. The amitriptyline group showed a higher proportion of anticholinergic and sedative side effects and dizziness compared with patients who received either sertraline or placebo.

1-Naphthylamine↗
PubMed1990

Results of a double-blind placebo controlled trial of a new serotonin uptake inhibitor, sertraline, in the treatment of obsessive-compulsive disorder.

Eighty-seven patients with a DSM-III diagnosis of obsessive-compulsive disorder (OCD) without depression were entered into a double-blind, placebo-controlled study of the efficacy of sertraline, a new serotonin uptake inhibitor. After a 1-week washout period, patients were randomly assigned to receive either placebo or sertraline. After a 2-week titration period in which the once-daily sertraline dose was increased from 50 mg/day to a maximum of 200 mg/day, dosage was maintained until the end of the eighth week, then patients were titrated off medication over the next 2 weeks. Efficacy was measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), NIMH General Obsessive-Compulsive Scale, Maudsley Obsessive Compulsive (MOC) Inventory, and Clinical Global Impressions (CGI) Severity and Improvement scales. Results on the MOC Inventory showed trends in favor of active drug that were not statistically significant compared with placebo. Results of the Y-BOCS total score, the NIMH score, and the global severity and improvement scores demonstrated a statistically significant superiority of sertraline compared with placebo.

1-Naphthylamine↗
PubMed1990

Treatment of supersensitivity psychosis with antiepileptic drugs: report of a series of 43 cases.

Supersensitivity psychosis has emerged as a potential side effect of long-term neuroleptic therapy that may be similar to tardive dyskinesia. Schizophrenic patients with supersensitivity psychosis and considered to be drug-resistant were treated with anti-epileptic medication. Forty-three separate trials were conducted on a total of 35 patients. Over half improved on clinical global impression, some of them considerably. We propose that antiepileptic drugs ameliorate supersensitivity psychosis and so-called "drug-resistant" schizophrenic patients by correcting a pharmacological kindling effect in the limbic system which results from chronic neuroleptic therapy.

Adult↗
PubMed1989

A randomized clinical trial of haloperidol decanoate and fluphenazine decanoate in the outpatient treatment of schizophrenia.

We carried out an 8-month double-blind clinical trial comparing haloperidol decanoate with fluphenazine decanoate in the maintenance treatment of 72 schizophrenic outpatients. A parallel-groups design was used with stratification by sex and injection interval (2, 3, or 4 weeks). The initial injection interval was based on pretrial maintenance treatment with fluphenazine esters. The dosage equivalency of haloperidol decanoate (1.5 cc or 75 mg) to fluphenazine decanoate (1 cc or 25 mg) used was 3:1. This remained approximately the same throughout a 2-month titration period with a flexible dose regimen, and a further 6-month period with a fixed dose regimen. No statistically significant differences in therapeutic effect were found between the drugs. Both drugs had a similar profile for drug-induced parkinsonism, but there was a trend for differences in masking tardive dyskinesia. Haloperidol and prolactin plasma concentrations were well correlated with dosage, with the exception of haloperidol concentrations in patients receiving injections at 2-week intervals.

Adolescent↗
PubMed1988

The use of benzodiazepines in the treatment of manic-depressive illness.

The benzodiazepine clonazepam was approved for the treatment of epilepsy in 1976. To study its use in acute mania, the author compared clonazepam with lithium in a crossover trial. Clonazepam proved more effective than lithium in controlling the symptoms of mania and caused fewer manifestations of parkinsonism. Associated side effects included ataxia, drowsiness, and behavioral changes. No treatment-emergent depression was observed. Neither clonazepam nor any other benzodiazepine is recommended in schizoaffective or schizophrenic disorders because of the high risk of dependence in those patients, in contrast to manic-depressives. For the maintenance treatment of bipolar disorder, lithium is recommended as the initial agent, with L-tryptophan added if concomitant medication is needed. Clonazepam can then be added as the anticonvulsant, if necessary. In the treatment of acute mania, clonazepam is recommended for the first week of treatment, and lithium is added in the beginning of the second week, thus avoiding the use of neuroleptics.

Acute Disease↗
PubMed1988

A 5-year prospective longitudinal study of tardive dyskinesia: factors predicting appearance of new cases.

In a 5-year longitudinal study in a cohort of 169 schizophrenic outpatients treated with neuroleptics, we found a twofold increase (from 22% to 44%) in prevalence of tardive dyskinesia (TD) meeting the Schooler and Kane research diagnostic criteria. If we include cases of TD that were considered definite but did not meet the research criteria, the prevalence increased from 31% to 58%. In the cohort of 131 patients who did not present with the disorder in 1975, we found parkinsonism and increase in parkinsonism to be the best predictors of subsequent development of the disorder. Poor schizophrenic prognosis and long treatment duration also appeared to be risk factors. Another finding was the importance of changes in neuroleptic and antiparkinsonian dosage in both covering and uncovering TD.

Adult↗
PubMed1987

Comparison of withdrawal of buspirone and diazepam: a placebo controlled study.

In a 8-week double-blind placebo controlled study, 48 outpatients with generalized anxiety disorder were randomized to diazepam, buspirone, a non-benzodiazepine anxiolytic, or placebo. During the treatment phase of 4 weeks duration diazepam was found to be significantly better than placebo and buspirone. Following abrupt withdrawal by placebo substitution the diazepam group showed a gradual relapse maximal after two weeks while the buspirone and the placebo groups did not differ. There were more cases of rebound anxiety with diazepam as compared to buspirone or placebo. In addition, there were three early terminations related to rebound anxiety in the diazepam group while there were none in the placebo and buspirone groups. There were significantly more new symptoms in the diazepam group than in the placebo or buspirone group.

Adult↗
PubMed1987

Midazolam: kinetics and effects on memory, sensorium, and haemodynamics.

This study aimed not only to compare the pharmacokinetics of oral and intravenous doses of the new water-soluble benzodiazepine, midazolam, but also to study the effects on haemodynamics, sensorium, and memory performance. Eight normal human volunteers each received a single 15 mg dose of midazolam base orally and intravenously in randomized sequence 2 weeks apart. Serial venous samples were obtained for 12 h after dosing. Vital signs, sensorium testing and memory testing using word lists were also performed. Computerized non-linear least squares curve-fitting of the two-compartment open model to the oral and intravenous data simultaneously yielded the following estimates: V1, 0.33 1 kg-1, VdSS, 1.08 1 kg-1, t1/2,lambda, 0.10 h, t1/2,Z, 1.89 h, ka 1.17 h-1 and bioavailability, 49%. The intravenous dose decreased the systolic pressure 22 mm Hg during the first half-hour and the oral dose had 50% less effect. Most subjects became drowsy halfway through the infusion and were only rousable to voice by its end. The sensorium was clear by 2-3 h. After oral dosing the peak sensorium effects of ataxia-dysarthria were seen at 30 min and had cleared by 2 h. Memory testing showed that memory acquisition was markedly impaired for at least 90 min after the intravenous dose and slight recovery was apparent at this time after the oral dose. Memory performance was proportionately more impaired than the sensorium score. We conclude that: midazolam kinetics are characterized by rapid absorption, but incomplete bioavailability and rapid elimination, midazolam intravenously may lower blood pressure significantly, and the level of consciousness correlates poorly with the degree of memory impairment.

Absorption↗