Depression in the long-term care patient: new tools for evaluation and treatment.
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Biomedical subjects
Publications and source records attributed to I Katz.
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Twenty-eight subjects with chronic respiratory disease were investigated for clinical data, ciliary beat frequency of nasal mucosa (10 cases), and ciliary ultrastructure. The cases were divided into two groups: those considered compatible with primary ciliary dyskinesia (genetic), and those not fitting into this category (others). A case was defined as genetic if one or more of the following were present: dextrocardia, ciliary beat frequency less than 10 Hz, or an average dynein arm count (outer, inner, or both) of less than two per ciliary cross-section. In each of the genetic cases at least two of these parameters were present. The percentage of malformed microtubules was calculated from the total number of evaluated cross-sections for each case. Ciliary microtubular abnormalities of any kind were no more frequent in cases of primary ciliary dyskinesia than in other cases. The same was true for transposition and radial spoke defects.
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The investigation was designed to study plasma drug concentration and prolactin response determined by two different doses of haloperidol, a standard one and four-fold higher the other, and to explore the relationships between clinical effects and pharmacokinetic and physiological variables in psychotic patients. 24 psychotic patients received haloperidol during 40 consecutive days. During the first 10 days they received 0,25 mg/kg b.w. During the next 20 days they were given 1 mg/kg b.w. Finally they received 0,25 mg/kg b.w. during the last ten days. The patients were clinically assessed and plasma haloperidol and prolactin concentrations were determined on days 0, 5, 10, 20, 30 and 40. In the range of dose studied, the use of higher than conventional doses of haloperidol results in an increased concentration in the cellular site of action and in a more complete blockade of central dopamine receptors. Prolactin response was positive correlated with serum haloperidol concentration. Clinical remission was not direct correlated, neither with serum neuroleptic concentration nor with prolactin level. Those patients who reached higher levels of plasmatic neuroleptic and prolactin concentrations were more susceptible to develop severe extrapyramidal side-effects. Pharmacokinetic and pharmacodynamic monitoring of neuroleptic treatment could be useful to identify these patients.