Biomedical subjects
Publications and source records attributed to G Tollefson.
An elderly woman developed a high serum digoxin concentration resulting in toxicity when alprazolam was added to her digoxin therapy. The reduced renal clearance of digoxin is postulated as the mechanism for this interaction.
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A variety of immune phenomena have been associated with chlorpromazine. One such factor, the lupus-like anticoagulant, while nonspecific, has been reported in 26 to 75% of chronic chlorpromazine recipients, although the exact incidence is unknown and requires further investigation. Such patients may have an enhanced risk of bleeding profiles (hemophilia-like) or, conversely, thrombotic events. A case of such a lupus-like anticoagulant with a circulating inactivator of coagulation is discussed in light of the recent literature.
Atrial flutter developed in an 80-year-old woman after 10 days of treatment with maprotiline at therapeutic concentrations. This cardiac irregularity is extremely rare with the conventional antidepressants. Evidence is reviewed to suggest that the likely mechanism was reuptake blockade of noradrenergic amines stimulating reentrant excitation within the atria.
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Benzodiazepines are effective anxiolytic agents when used properly. They have a high therapeutic-to-toxic ratio and a relatively low rate of physical dependency if the duration of use is limited. They are most effective in ameliorating generalized and post-traumatic anxiety and in relieving the anxiety associated with adjustment reactions. They are less effective for panic attacks and for phobic and obsessive anxiety disorders. The rate of absorption and type of metabolism determine the onset and duration of action.
A case of nonketotic hyperglycemic coma associated with the recent introduction of loxapine is presented. Drug discontinuation led to a return of normal fasting blood glucose. Later challenge with amoxapine was also associated with acute hyperglycemia. Their common metabolite, 7-OH amoxapine, is implicated.
We have observed two cases of chlorpromazine-induced neuroleptic malignant syndrome (NMS); both were transiently responsive to intravenous diazepam challenge, but not to blind placebo or amyobarbitol. The interrelationship, via feedback between central dopaminergic and gamma-aminobutyric (GABA) systems is reviewed. A theoretical role for a relative DA-GABA imbalance during NMS and treatment implications are discussed.
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At least 35,000 persons kill themselves each year in the United States. Many of the victims saw their family doctors during the month before death. Suicide assessment and subsequent intervention may help prevent these deaths. Suicidal behavior is associated with alcoholic intoxication and with feelings of hopelessness. Low brain serotonin is under investigation as a possible etiologic factor.
The spectrum of contemporary antiepileptics are categorically reviewed with reference to adverse behavioral sequelae. These iatrogenic disturbances may have peripheral (eg. heptatic dysfunction, blood dyscrasia, or lupus-like syndromes) or central (eg. altered neurotransmission) manifestations. Whether an idiosyncratic reaction, toxic circumstance, or untoward drug interaction, there is scant understanding of the predisposing factors or recognition of the neuropsychiatric influence of anticonvulsant therapy.
Time estimations of 1-min. intervals using the method of reproduction by 112 Navajo children were measured under neutral and reward conditions in a repeated-measures design. Anticipated reward (a piece of candy) significantly reduced the accuracy of time estimations. In contrast to previous research the girls were more accurate than the boys; however, the effect of reward was more pronounced for girls than for boys. These data suggest that motivating factors play an important role in the reproduction of time by Navajo children.
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The long-term maintenance of major affective disorders with tricyclic antidepressants is of obvious interest. However, discrete predictors identifying subgroups 'at-risk' for higher recurrence rates have infrequently been cited. The clinical course of 32 major recurrent depressive patients was monitored over 2 years. Analysis of the total tricyclic concentration and the parent: desmethylated ratio revealed that those subjects in a depressive recurrence previously had had a lower imipramine: desipramine ratio (despite matched dosing and nonsignificant total plasma concentrations) than nonrecurrents. Several hypotheses are discussed.