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Biomedical subjects

K Rickels

Publications and source records attributed to K Rickels.

At least 109 records · Page 6Linked to original sources
PubMed1989

A placebo-controlled, double-blind, clinical trial of paroxetine in depressed outpatients.

A placebo-controlled, randomized, double-blind study was carried out in outpatients suffering from major unipolar depressive disorder to assess the efficacy and tolerability of paroxetine in the treatment of depression. The study lasted for six weeks. After a placebo washout period of 4 to 14 days patients took 20mg of paroxetine or matched placebo as a morning dose for one week; thereafter the dose of paroxetine could be titrated between 10 and 50mg/day. Patients were evaluated at baseline, weekly during the first four weeks of the study, and at the end of six weeks; patients who entered a six-week extension phase were evaluated at 9 and 12 weeks. Evaluations were carried out using HAMD (including ECDEU factors), MADRS, HSCL, Covi anxiety and Raskin depression scales, CGI, and a seven-point rating of global improvement. Adverse events and laboratory values were also recorded at each assessment. One hundred and eleven patients entered the study, and efficacy data were available for 102 of these (49 on paroxetine and 53 on placebo). Efficacy measurements demonstrated significantly greater clinical improvement with paroxetine than placebo after two weeks of treatment, and this became even more marked after six weeks. Patients who continued treatment for a further six weeks maintained their clinical improvement. When adverse events were examined, statistically significant differences between paroxetine and placebo were seen only for sweating, diarrhoea, nausea, and somnolence. No significant changes were seen in any of the laboratory parameters measured. If these results are confirmed in future studies, paroxetine will represent an important addition to the treatments available for depression.

Adult↗
PubMed1989

Benzodiazepine dependence and withdrawal in elderly patients.

Severity of withdrawal symptoms and clinical outcome were compared in 19 elderly and 22 younger benzodiazepine-dependent patients matched for benzodiazepine half-life, dosage, and duration of treatment. During gradual taper of benzodiazepine doses, the elderly patients showed significantly less severe withdrawal symptoms on several clinical measures and a comparably favorable outcome. Approximately half of each group remained benzodiazepine free for at least 4 weeks. Both groups of patients tolerated drug discontinuation without serious consequences such as seizures or psychosis. Tapered benzodiazepine withdrawal did not appear to be more risky for the elderly group than for the younger patients.

Adult↗
PubMed1989

A pooled, double-blind comparison of the effects of buspirone, diazepam and placebo in women with chronic anxiety.

Pooled data were analyzed for 367 female patients enrolled in a double-blind, placebo-controlled, multi-centre trial comparing buspirone, a non-benzodiazepine anxiolytic, and diazepam in the treatment of generalized anxiety disorder. After a 4 to 7-day wash-out period, patients were allocated at random to receive one or other of the trial medications or placebo over a 4-week period. Mean daily dosages were 24.5 mg for buspirone and 20.8 mg for diazepam (range 10 mg to 60 mg for both drugs). Patients were assessed on entry and at weekly intervals using the Hamilton Anxiety Rating Scale, and at the end of treatment both patients and physicians gave an overall opinion of response to treatment. Details of adverse events were also recorded. The results showed that both buspirone and diazepam were approximately equal in efficacy and superior to placebo. Menstruation and the occurrence of premenstrual tension did not alter the anxiolytic activity of either drug. Patients taking diazepam had significantly more adverse effects, i.e. drowsiness, weakness, fatigue, inco-ordination and depression, than did those in the buspirone group. In a separate commentary, the anxiety disorder and the data from the study are reviewed to place them in the overall perspective of gynaecological care.

Adolescent↗
PubMed1988

Long-term treatment of anxiety and risk of withdrawal. Prospective comparison of clorazepate and buspirone.

Risk of withdrawal was investigated in a prospective, double-blind comparison of clorazepate dipotassium, a benzodiazepine with a long half-life, and the nonbenzodiazepine buspirone hydrochloride in the long-term treatment of anxious outpatients. Patients were treated with therapeutic doses of clorazepate dipotassium (15 to 60 mg/d) or buspirone hydrochloride (10 to 40 mg/d) for six continuous months before their tranquilizer therapy was blindly and abruptly stopped. There was a significant increase in symptom severity consistent with a withdrawal reaction for the clorazepate group but not the buspirone group. For the clorazepate group, there was a suggestion that previous discontinuous exposure to benzodiazepines might sensitize patients to subsequent withdrawal effects. For the buspirone group, a higher dropout rate raised questions about patient satisfaction with therapy in this rather chronically anxious population.

Adult↗
PubMed1988

The effect of anxiolytic drugs on memory in anxious subjects.

The benzodiazepines (BZs), represented by diazepam, are the class of drugs used most frequently to treat clinical anxiety disorders. Since it is known that acute BZ intake impairs memory function, the effects of BZs on memory were evaluated in chronic users of BZ medications. In addition, the acute effects of diazepam were compared with those of the non-BZ anxiolytic buspirone on memory function in anxious subjects. Memory function was evaluated by a free verbal recall procedure where subjects recalled a list of 16 noncategorized nouns immediately after the word list was read (immediate recall) and again 20 min later (delayed recall). When the chronic BZ users were tested for free verbal recall during their first visit, 4-14 h after their last dose, they did not differ in immediate or delayed recall from an age- and sex-matched group of unmedicated anxious subjects. At a subsequent visit, the acute effects of BZ medications were studied 60-90 min after the subjects took their usual dose. Although acute BZ administration did not alter immediate recall, delayed recall was significantly impaired in the chronic BZ users. Thus, complete tolerance does not develop to the acute memory-impairing effects of BZs after long-term use. Acute administration of the anxiolytic drugs diazepam (5 mg) or buspirone (5 or 10 mg) did not alter immediate recall in another group of unmedicated anxious subjects. Diazepam selectively impaired delayed recall of the word list when compared with placebo. In contrast, neither dose of buspirone altered delayed recall. To the extent that such effects on verbal recall tests are reflected in a patient's daily activities, the failure of buspirone to adversely affect memory function could contribute to its usefulness as an alternative antianxiety therapy.

Adult↗
PubMed1988

Clorazepate and lorazepam: clinical improvement and rebound anxiety.

Sixty-two anxious patients were treated under double-blind conditions for 4 weeks with either clorazepate or lorazepam. Two-thirds of each treatment group were then switched abruptly to placebo for 2 weeks, while one-third continued to receive active medication. Two major findings were obtained. About 70% of the patients maintained improvement during the 2-week placebo period. Some patients, however, experienced rebound anxiety, which appeared to be more intense and occurred earlier when placebo was substituted for a benzodiazepine with a short half-life (lorazepam) than for one with a long half-life (clorazepate). The clinical relevance of these findings is discussed.

Adult↗
PubMed1988

Effects of medical history factors on symptom severity in women meeting criteria for premenstrual syndrome.

Medical history variables were examined to identify their effects on the severity of premenstrual syndrome (PMS) in women seeking medical treatment. Symptoms were monitored daily for two untreated cycles and two placebo-treated cycles to establish the diagnosis of PMS. Data from 60 women who reported moderate to severe premenstrual mood changes and met criteria for PMS were analyzed statistically. Step regression analysis showed that 34% of the variance in symptom severity was explained by four variables: PMS in the patient's mother, low level of exercise, younger age, and more children. These significant relationships with severity of PMS have not previously been identified and suggest a role of familial and daily stress factors in this complex syndrome.

Adult↗
PubMed1987

Alprazolam, diazepam, imipramine, and placebo in outpatients with major depression.

Two hundred forty-one outpatients with a DSM-III diagnosis of major depressive disorder participated in a six-week double-blind therapeutic trial of alprazolam, diazepam, imipramine hydrochloride, and placebo. Side effects were given as a major reason for attrition by patients taking the three active compounds and ineffectiveness was the reason given by patients taking placebo. Imipramine-treated patients reported the most and placebo patients the least number of adverse effects. Imipramine and alprazolam, but not diazepam, produced significantly more improvement in depressed symptomatology than did placebo. Mean diazepam scores frequently assumed an intermediate position between those of imipramine or alprazolam and placebo. These treatment differences were found to be independent of initial severity levels of anxiety and depression.

Adult↗
PubMed1987

Differential effects of the anxiolytic drugs, diazepam and buspirone, on memory function.

The effects of the anxiolytic drugs diazepam (5 mg) or buspirone (5 or 10 mg) were studied in comparison with placebo on memory function in 39 subjects diagnosed with generalized anxiety disorder. Neither drug altered the immediate recall of a list of 16 nouns or impaired digit span, a second test of immediate memory. Diazepam selectively impaired the recall of nouns after a 20 min delay when compared with placebo. In contrast, neither dose of buspirone altered the delayed recall of the word list. The implications of such different effects of anxiolytic drugs on memory function for the clinical treatment of anxiety are discussed.

Anti-Anxiety Agents↗