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Biomedical subjects

J Gerlach

Publications and source records attributed to J Gerlach.

At least 145 records · Page 8Linked to original sources

Sulpiride versus haloperidol, a clinical trial in schizophrenia. A preliminary report.

Sixteen out of 25 hebephrenic and paranoid schizophrenic patients completed a double-blind cross-over study with sulpiride and haloperidol. The patient sample was relatively chronic: Median age was 35 years (range 26-53 years), median duration of illness 10 years (4-35 years), and median duration of neuroleptic treatment 5 years (1-28 years). Each patient was treated with sulpiride/haloperidol in random order for 12 weeks with a drug-free period before each treatment phase. Mean total BPRS (Brief Psychiatric Rating Scale) score was reduced from 25 to 15 (P less than 0.05) during sulpiride (800-2800 mg/day, median 1600 mg/day), and from 28 to 15 (P less than 0.01) during haloperidol (6-18 mg/day, median 12). There were no significant differences between the groups with respect to total BPRS score, single items or symptom clusters. However, in a few, very "chronic", disturbed, and long-term treated patients, haloperidol appeared more beneficial than sulpiride. Autonomic side effects and parkinsonism tended to occur more frequently during haloperidol than during sulpiride, but no significant differences were found. It is concluded that sulpiride, a specific dopamine-2 receptor blocker, has antipsychotic effect, not significantly different from haloperidol, but may produce slightly less side effects.

Adult↗

Sulpiride in tardive dyskinesia.

The pathogenesis of tardive dyskinesia (TD) appears to consist of a combination of a predisposing vulnerability of the patient and an antidopaminergic (neuroleptic) treatment. This combination may result in 1) a relative dopamine hyperreactivity associated with an increased number of dopamine receptors and/or a cholinergic hypo-function (reversible TD), and 2) in long-term treatment, degenerative phenomena leading to a decreased threshold for expressing dyskinetic symptoms (irreversible TD). Sulpiride, a selective D-2 dopamine receptor blocker, is able to suppress TD without producing a reciprocal aggravation in parkinsonism, although in vulnerable patients it may induce/aggravate parkinsonian symptoms. Animal data suggest that sulpiride has less TD-inducing effect than traditional neuroleptics, but long-term clinical studies are still needed to prove this suggestion.

Antipsychotic Agents↗

Effect of gamma-vinyl GABA in tardive dyskinesia.

gamma-Vinyl GABA (gamma-aminobutyric acid), a drug that increases brain GABA via GABA transaminase inhibition, was evaluated in a blind, placebo-controlled trial in 10 patients with stable tardive dyskinesia. Drug effects during active treatment (2 to 6 g/day) and during pre- and posttreatment placebo periods were determined by scoring randomly sequenced videotapes of tardive dyskinesia and parkinsonian symptoms recorded weekly during standardized examinations. Tardive dyskinesia was significantly reduced, and correlated to increased parkinsonism. Eye blinking rates decreased, but psychiatric symptoms were unchanged during treatment.

Adult↗

[Not Available].

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Germany↗

[Not Available].

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History, Modern 1601-↗

The effect of tetrahydroisoxazolopyridinol (THIP) in tardive dyskinesia: a new gamma-aminobutyric acid agonist.

gamma-Aminobutyric acid (GABA) agonists have been proposed for the treatment of tardive dyskinesia, but their therapeutic potential has been limited by side effects and toxicity. To elucidate further the role of GABA in neuroleptic-induced dyskinesias, we evaluated tetrahydroisoxazolopyridinol (THIP), a new, less toxic GABA analog and GABA receptor agonist, in both a dose-finding (single-dose) pilot study with five patients and a longer (four-week) placebo-controlled study with 13 patients. The patients were videotaped during a standardized examination; tardive dyskinesia, parkinsonian symptoms, and eye-blinking rates were rated blindly and randomly. The maximal short-term dose of THIP was 10 to 25 mg, whereas in the longer-term study the highest daily dose ranged from 20 to 120 mg. Tardive dyskinesia was unchanged during THIP treatment, but preexisting parkinsonism increased significantly and eye-blinking rates decreased. Psychiatric symptoms showed no significant changes, although tension and depression lessened. Side effects included sedation, confusion, dizziness, vomiting, and myoclonic jerks. Although THIP is not an effective new treatment for tardive dyskinesia, more specific GABA agonists should be evaluated in future studies of this syndrome.

Adult↗

High-dose destyrosine-gamma-endorphin in tardive dyskinesia.

Destyrosine-gamma-endorphin (DTGE) has purported neuroleptic properties, although the findings have been conflicting. Four chronic psychotic inpatients with neuroleptic-induced dyskinesias were treated with single injections of placebo and DTGE in high doses (20-120 mg). No consistent differences were found in tardive dyskinesia, parkinsonism, eye-blinking rates, or mental status. Laboratory tests were unchanged. It is concluded that acute DTGE treatment has no beneficial effect in drug-induced dyskinesia.

Adult↗

Levodopa and receptor sensitivity modification in tardive dyskinesia.

Tardive dyskinesia (TD), a syndrome of involuntary hyperkinetic movements, purportedly involves the development of dopamine (DA) receptor hypersensitivity following long-term receptor blockade with neuroleptic drugs. It has been proposed that through a process of receptor hypersensitivity modification, TD can be treated by reversing the receptor hypersensitivity with DA agonists. Thirteen patients with TD were treated for 4--8 weeks with levodopa plus benserazide, a peripheral decarboxylase inhibitor (Madopar, Roche, Basel, Switzerland) over a wide dose range corresponding to 3.0--9.0 g/day levodopa. Drug effects was assessed by blind evaluations of randomly sequenced videotapes made before, during, and for 6 weeks following treatment. TD scores moderately increased during levodopa. After the drug was discontinued, TD scores returned to pretreatment baseline levels without further improvement in those patients receiving concurrent neuroleptic medications (N = 9), but in the neuroleptic-free patient TD scores decreased 25% in three patients and were resolved in one younger patient. Psychological effects of depression or increased psychotic symptoms occurred at higher drug doses. These results do not support the proposal that receptor sensitivity modification with levodopa is an effective therapeutic approach to TD, though selected patient and drug treatment variables, including other DA agonists, are considerations for further investigation.

Adult↗

[The occurrence of clinically unrecognized tuberculosis in autopsy material].

By means of a statistic examination of the autopsy material, the frequency of clinically unrecognized tuberculosis of the years 1951-1957 was compared with the cases of the years 1964-1970. In inactive and active pulmonary tuberculosis the clinically unrecognized cases decreased with high statistic significance. In extrapulmonary and miliary tuberculosis this tendency could not be confirmed, the clinically unrecognized cases relatively increased somewhat. All the cases of tuberculosis in combination with silicosis were clinically recognized. The high percentage of clinically unrecognized cases of extrapulmonary and miliary tuberculosis points to the fact, that this disease must be included in the differential diagnosis of obscure symptoms, especially in the elderly.

Age Factors↗

[The radioiodine test for the evaluation of iodine deficiency in the district of Karl-Marx-Stadt and in East Germany].

The values of the per cent 24 h radioiodine uptake in the GDR are above 60--70% and speak for a low alimentary intake of iodine or renal excretion of iodine below 40 micrograms J/d. Like the struma prevalences they show a tendency increasing from north to south and characterize the whole European situation of iodine deficiency including its decrease from west to east. The mean values of radioiodine uptake of 71.7 +/- 13.2% (n = 110) in euthyroids of the district of Karl-Marx-Stadt correspond to the iodine deficiency as it occurs approximately in the districts of Erfurt, Dresden, Munich or Freiburg/B. The alimentary iodine intake of 38.4 +/- 17.2 micrograms J/d and the renal iodine excretion of 29.9 +/- 16.1 micrograms J/d, calculated from the 24 h radioiodine accumulation values of 40 euthyroid persons by means of a mathematical model developed by Oddie and co-workers were low. The latter only slightly differed (P less than 0.05) from its chemically estimated excretion of iodine in the urine: 23.1 +/- 16.9 micrograms J/g creatinine (n = 73). Between the calculated and chemically estimated excretion of iodine there was a relatively strict correlation of r = 0.68 (n = 26; P less than 0.001). The introduction of an iodine prophylaxis is regarded as an urgent necessity. Later on a new estimation of the regional "normal values" is necessary for the per cent radioiodine uptake.

Germany, East↗