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Biomedical subjects

G L Stimmel

Publications and source records attributed to G L Stimmel.

33 records · Page 2Linked to original sources
PubMed1976

Tardive dyskinesia with low-dose, short-term neuroleptic therapy.

The development, treatment, and outcome of a case of tardive dyskinesia following short-term, low-dose neuroleptic therapy is described. Thirty weeks of treatment with haloperidol, in doses never exceeding 10 mg daily, produced tardive dyskinesia symptomatology. Upon discontinuing haloperidol, the symptoms decreased significantly in severity within the first four weeks and disappeared completely within 12.5 weeks. This case is compared with the classical description of tardive dyskinesia symptomatology, etiology, response to treatment and degree of reversibility. Atypical features are explained and clinical implications of the case are offered.

Dyskinesia, Drug-Induced↗
PubMedDate not supplied

Antidepressants in chronic pain: a review of efficacy.

Antidepressant drugs have gained widespread clinical usage alone or as adjuncts in the treatment of chronic pain disorders. Of 17 controlled studies of antidepressants in chronic pain, 13 demonstrated significant pain relief with antidepressants compared to placebo. These studies were too different from one another to allow any general conclusions concerning efficacy, however. Five studies of either migraine or chronic tension headache all demonstrated superior efficacy of antidepressants versus placebo, while those of back and arthritic pain yielded mixed results. Of 3 studies of pain of several etiologies, 2 failed to demonstrate efficacy of antidepressants over placebo. These studies do not provide answers to many clinical questions on the use of antidepressants for chronic pain, such as drug of choice or appropriate dosage. Rather, they suggest that these agents may be beneficial in some patients with chronic pain.

Antidepressive Agents↗
PubMedDate not supplied

The role of SSRI antidepressants for treating depressed patients in the California Medicaid (Medi-Cal) program.

This research used paid claims data to investigate the likelihood that patients achieved an adequate course of antidepressant drug therapy and the impact of completed therapy on health care costs. Completed therapy was defined as six or more months of uninterrupted therapy at an adequate dose as determined by AHCPR treatment guidelines. Apparent average daily dose for each prescription filled was calculated from data on the prescription paid claim and allowances were made for titration of dose to therapeutic levels and changes in antidepressant therapy. A total of 1648 new episodes of antidepressant therapy were identified for analysis. The likelihood of achieving an adequate course of antidepressant therapy was 22%. Completion rates varied significantly across antidepressants with fluoxetine achieving the highest completion rate at nearly 51%. Total health care costs were significantly lower for patients who completed therapy (-dollar 1487; P = .0487) due primarily to lower ambulatory care costs (-dollar 1296; P = .0110). Fluoxetine was the only antidepressant therapy which exhibited significantly lower total health care cost per patient relative to the older tricyclic antidepressants (-dollar 3524; P = .0024). The total costs of treating depression in the ambulatory setting were found to vary widely across alternative antidepressants. Most of the cost-savings associated with fluoxetine use were associated with the increased likelihood of completed therapy. Further research is needed to verify if fluoxetine achieves better rates of completed therapy relative to other SSRI antidepressants using data from other settings.

Journal Article↗
PubMedDate not supplied

How to counsel patients about depression and its treatment.

To provide effective counseling for patients receiving drug therapy for depression, one must understand the natural course of mood disorders, the appropriate dose and duration of antidepressant therapy, and how to individualize the discussion of potential adverse effects and use of alcohol. Patients must understand that effective antidepressant treatment requires several weeks before onset of clinical effect, and 6-12 months of therapy is necessary to prevent relapse. Discussion of adverse effects must address what the patient should do if an adverse effect occurs, with the focus on common, expectable effects of the particular drug. Rather than merely telling patients not to drink alcohol, appropriate counseling should focus on the possible consequences of drinking while taking antidepressant drugs.

Alcohol Drinking↗
PubMedDate not supplied

Benzodiazepines in schizophrenia.

Benzodiazepines have a checkered history in the United States; public and professional attitudes about them have ranged from their being wonder drugs in the 1970s to being virtually purged from many formularies as addictive and dangerous in the 1980s. The attitude today is that they are useful for specific indications. In the last 20 years they have been investigated as adjunctive agents to conventional antipsychotic drugs in the treatment of schizophrenia. Benzodiazepines may be effective in schizophrenia because stress is one mediator of relapse in these patients. In addition, inhibition of dopamine neurotransmission through gamma-aminobutyric acid-enhancing activity may provide a direct antipsychotic effect. As monotherapy or adjuncts to antipsychotic agents, benzodiazepines produced antipsychotic effects in schizophrenia in approximately 50% of controlled trials. Although there is no particular benzodiazepine of choice, low-potency compounds with long elimination half-lives are recommended. Adverse effects of concern include sedation and cognitive impairment, behavioral disinhibition, exacerbation of psychotic symptoms, and the potential for dependence, withdrawal, and abuse. The recent arrival of atypical antipsychotic drugs has significantly slowed research and interest in benzodiazepines in schizophrenia beyond their initial beneficial sedative effects for acute psychotic episodes.

Antipsychotic Agents↗
PubMedDate not supplied

Mirtazapine: an antidepressant with noradrenergic and specific serotonergic effects.

Mirtazapine is a unique antidepressant that refines the specificity of effects on noradrenergic and serotonergic systems. It is an antagonist of presynaptic alpha 2-adrenergic autoreceptors and heteroreceptors on both norepinephrine and serotonin (5-HT) presynaptic axons, plus is a potent antagonist of postsynaptic 5-HT2 and 5-HT3 receptors. The net outcome of these effects is increased noradrenergic activity together with specific increased serotonergic activity, especially at 5-HT1A receptors. This mechanism of action maintains equivalent antidepressant efficacy but minimizes many of the adverse effects common to both tricyclic antidepressants and selective serotonin reuptake inhibitors. Mirtazapine has an onset of clinical effect in 2-4 weeks similar to other antidepressants, although sleep disturbances and anxiety symptoms may improve in the first week of treatment. It has minimal cardiovascular and anticholinergic effects, and essentially lacks serotonergic effects such as gastrointestinal symptoms, insomnia, and sexual dysfunction. Sedation, increased appetite, and weight gain are more common with mirtazapine than with placebo. An elimination half-life of 20-40 hours enables once-daily bedtime dosing. The recommended initial dosage is 15 mg once/day at bedtime, with an effective daily dosage range of 15-45 mg. Cases of overdose of up to 975 mg caused significant sedation but no cardiovascular or respiratory effects or seizures.

Antidepressive Agents, Tricyclic↗
PubMedDate not supplied

Reemergence of positive symptoms after initial response to risperidone.

Risperidone was effective in successfully treating a patient's negative symptoms of schizophrenia as well as reducing adverse effects from typical antipsychotic drugs. Auditory hallucinations reemerged after 8 months, however, and again after 24 months of risperidone therapy. Reemergence of psychotic symptoms after initial response might be explained by inadequate dosage, by the natural course of the patient's schizophrenia independent of drug therapy, or by the possibility that, for this patient, risperidone was less effective than chlorpromazine for the positive symptom of auditory hallucinations.

Adult↗