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Biomedical subjects

K Rickels

Publications and source records attributed to K Rickels.

At least 127 records · Page 7Linked to original sources
PubMed1987

Emotional and psychosocial factors in follow-up of women after IVF-ET treatment. A pilot investigation.

One hundred and fifty-six women who enrolled for treatment in an in vitro fertilization (IVF-ET) program were interviewed, 15 months (mean interval) after the last program contact. Perceptions of treatment stress, decisions about further treatment and the extent of resolution of the infertility crisis were investigated. Standard self-report instruments were used to assess emotional status, self-esteem and marital adjustment. The results showed that only about half the couples who did not achieve pregnancy had decided to terminate treatment. Resolution of infertility was significantly correlated with coping with infertility and with the decision to abandon treatment. Although most patients described treatment as extremely stressful, this did not itself result in emotional distress or dysfunction following treatment, and psychiatric syndromes were infrequent. A deeper understanding of the interactions of these identified factors would help all couples who confront unwanted infertility.

Adult↗
PubMed1987

Gepirone in anxiety: a pilot study.

Ten patients suffering from generalized anxiety disorder were treated, after a single-blind placebo washout week, with the nonbenzodiazepine anxiolytic gepirone in a 6-week open label trial. Mean Hamilton Anxiety scores improved from 24.8 to 7.1 (p less than 0.01). Other physician- and patient-rated scales showed comparable improvement on a mean maximal dose of 41 mg of gepirone. The medication appeared to be nonsedating and well tolerated. The anxiolytic effect of the medication was very marked in several cases, and gepirone appears to have promise as an anxiolytic agent.

Adult↗
PubMed1987

Antianxiety therapy: potential value of long-term treatment.

Although short-term therapy for patients with anxiety disorders has been the accepted mode of therapy, it has become increasingly evident that certain patients with generalized anxiety disorder, panic disorder, and chronic illness may require longer-term therapy. Therapeutic goals for such patients include reducing anxiety symptoms, returning the patient to normal or near-normal functioning, and improving quality of life. Clinicians must choose the appropriate drug regimen with regard to duration, continuous versus intermittent treatment, and administration on a daily versus as-needed basis. Because of the nature of some anxiety disorders, intermittent therapy very often may be preferred. Benzodiazepines are highly effective and safe anxiolytics, but with continuous use these agents have demonstrated psychologic and physical dependence problems. Other agents, such as tricyclic antidepressants and monoamine oxidase inhibitors, also relieve anxiety, although they have been shown to be unsuited for indiscriminate use. Buspirone, a newer anxiolytic, seems to be both effective and without abuse or dependence potential. In all cases, the prudent clinician should combine good patient management within the context of a good doctor-patient relationship.

Anti-Anxiety Agents↗
PubMed1987

Serum progesterone levels following vaginal administration of progesterone during the luteal phase.

We measured serum progesterone (P) levels after administration of 400 mg P vaginal suppositories to women during the luteal phase of the menstrual cycle. Blood samples were obtained before suppository insertion and at five intervals up to 8 hours after insertion. On the first day of treatment with P suppositories, there was a substantial elevation in serum P above baseline after insertion. However, on subsequent days of administration a smaller increment in serum P was observed. In 4 women studied on days 1 and 8 of the same treatment cycle in the luteal phase, a smaller rise in serum P following suppository administration on day 8, compared with day 1, was found. Overall, a highly significant negative correlation between change in serum P from baseline and duration of vaginal suppository treatment was found. This observation does not appear to be related to the achievement of a pharmacokinetic steady state. Possible mechanisms for this observation are discussed.

Administration, Intravaginal↗
PubMed1986

Imipramine and chlordiazepoxide in depressive and anxiety disorders. I. Efficacy in depressed outpatients.

We randomly assigned 425 outpatients, independently classified as primarily depressed by two trained psychiatrists, to double-blind treatment with Imipramine hydrochloride, chlordiazepoxide hydrochloride, or placebo. Those patients who remained at least moderately depressed (following a two-week placebo washout period) were treated for an additional eight weeks. An endpoint analysis of 387 patients who completed two or more weeks of medication disclosed early therapeutic advantages of chlordiazepoxide. By week 4 of treatment, however, imipramine produced more improvement than did placebo and chlordiazepoxide. By six and eight weeks a general, marked therapeutic advantage was found for imipramine relative to placebo and to chlordiazepoxide on measures of depression, anxiety, anger-hostility, interpersonal sensitivity, and global improvement. Chlordiazepoxide-treated patients generally did significantly better on sleep difficulty but significantly worse on anger-hostility and interpersonal sensitivity than did imipramine- or placebo-treated patients.

Adult↗
PubMed1986

Imipramine and chlordiazepoxide in depressive and anxiety disorders. II. Efficacy in anxious outpatients.

A double-blind, placebo-controlled comparison at three collaborating university sites included 242 patients diagnosed as having anxiety disorders. A two-week placebo washout period preceded random assignment to eight weeks of imipramine hydrochloride, chlordiazepoxide hydrochloride, or placebo treatment. Antianxiety effects of imipramine were superior to those of the other two agents by the second treatment week; these effects became more clearly significant thereafter and were independent of degree of both baseline depression and anxiety. Excluding patients with possible panic-phobic syndromes from the analyses removed most significant antiphobic and antidepressant effects of imipramine but left intact imipramine's significantly superior antianxiety effects.

Adult↗
PubMed1986

Chronic use of benzodiazepines and psychomotor and cognitive test performance.

The performance of 43 long-term users (average = 5 years) of benzodiazepine (BZ) medications was examined on a battery of behavioral tasks, cognitive tests, and subjective mood rating scales. The performance of the chronic BZ users did not differ significantly from age- and sex-matched anxious subjects, except that critical flicker fusion (CFF) thresholds were lower and subjective ratings of tranquilization were higher in the BZ users. Twenty-two subjects were reexamined in order to determine the acute effects of BZ medications in long-term users. The acute administration of BZ medications significantly increased CFF thresholds, improved digit-symbol substitution test performance, impaired the delayed recall of verbal material, increased subjective ratings of tranquilization, and reduced physical sedation. Motor performance tests were not impaired and subjective feelings of sedation were not increased after the acute administration of BZs by chronic users. During withdrawal from long-term BZ use (17 subjects), CFF thresholds were elevated, subjective ratings of physical sedation and anxiety were increased, but performance on other psychomotor and cognitive tests was not altered. The results suggest that tolerance develops selectively to different behavioral and subjective effects of BZ medications with their continued use. Tolerance failed to develop to the antianxiety effects, the reduction of CFF threshold, and to the impairment of short-term memory caused by BZs. However, chronic users of BZ medications failed to demonstrate psychomotor-impairing or sedating effects to BZ medications. The results have implications for evaluating the safety of the long-term use of BZ medications.

Adult↗
PubMed1986

Adinazolam, a new triazolobenzodiazepine, and imipramine in the treatment of major depressive disorder.

This study evaluated the clinical efficacy and safety of a new triazolobenzodiazepine, adinazolam, and imipramine in 40 patients with carefully diagnosed major depressive disorder. Overall, adinazolam was found to be as effective as imipramine. In addition, when patients with more severe, melancholic, subtype of depression were examined, adinazolam was also as effective as imipramine. With the exception of sedation, adinazolam patients demonstrated fewer overall adverse events than imipramine subjects. These results suggest that adinazolam may represent an interesting antidepressant compound.

Adolescent↗
PubMed1986

Brotizolam, a triazolothienodiazepine, in insomnia.

Sixty-three outpatients with chronic insomnia were treated for 3 weeks under double-blind conditions with either brotizolam (n = 29) at a dose of 0.25 mg or 0.5 mg or placebo (n = 34). A 3-day placebo period preceded and followed the double-blind treatment phase. Brotizolam consistently produced significantly more sleep improvement than placebo but also more adverse effects. In those patients switched abruptly from brotizolam to placebo, rebound insomnia was observed, being most marked at the first post-brotizolam placebo night.

Adult↗
PubMed1986

Possible nonlinear pharmacokinetics of desipramine after once daily dosing.

Desipramine (DMI) plasma concentrations were measured in depressed outpatients treated with desipramine hydrochloride. Plasma level determinations were measured 24 hours after a single dose of DMI 50 mg, and then at weekly intervals thereafter while receiving once daily bedtime dosing with DMI 150 mg or 200 mg. The 24 hour DMI concentration was significantly, and rather closely correlated with steady state DMI levels (r = 0.74, p less than .001) (prediction coefficient [r2] = 55%). However, steady state plasma levels of DMI were higher than would be predicted based upon prior studies which also examined the relationship between steady state and 24 hour desipramine plasma concentrations. We speculate that the single bedtime administration of DMI in the present study may have led to saturation of metabolic hepatic enzymes during the first pass of the drug through the liver. The possibility of nonlinear DMI pharmacokinetics may be of clinical importance to some patients receiving a single, daily, high dose of medication.

Adult↗
PubMed1986

A double-blind comparative trial of zimelidine, amitriptyline, and placebo in patients with mixed anxiety and depression.

We performed a randomized, double-blind clinical trial comparing the efficacy and safety of zimelidine with amitriptyline and placebo in outpatients with major depression, in particular patients with mixed anxiety/depressive symptomatology. Overall, amitriptyline was more effective than zimelidine and placebo after 4 weeks of treatment. However, when those patients with more severe depression were specifically examined, both antidepressants were equal in efficacy and superior to placebo. We also found no evidence for a greater likelihood of a zimelidine-induced peripheral neuropathy in this study. The present results suggest that zimelidine may be more effective in the treatment of severely depressed patients, rather than those with more mild mixed anxiety/depressive syndromes.

Adult↗
PubMed1986

The clinical use of hypnotics: indications for use and the need for a variety of hypnotics.

Insomnia may be categorized as difficulty falling asleep, frequent awakening, early awakenings or a combination of each. The ideal hypnotic must promote rapid sleep onset and maintain sleep throughout the night while allowing the patient to awake refreshed the following day. Several benzodiazepines, with differing pharmacokinetic and pharmacodynamic profiles are presently available. All are clinically effective and not only elimination half-life but also dosage prescribed and pattern of distribution are important factors for determining treatment response. Hypnotics have been divided into those with long elimination half-lives (e.g. nitrazepam, flunitrazepam, flurazepam), those with intermediately long half-lives (brotizolam, loprazolam, lormetazepam, temazepam) and those with short half-lives (midazolam and triazolam). Carry-over effects into the morning such as excessive daytime sleepiness or drowsiness are related to drug half-life, dosage and pattern of distribution. In equipotent dosages most controlled clinical trials have found no significant differences between the various benzodiazepine hypnotics. Nevertheless, clinicians in general tend to use long half-life benzodiazepines in patients who have difficulties maintaining sleep and short half-life benzodiazepines for treating sleep onset insomnia. Intermediately long half-life, benzodiazepines are used for both indications and most clinicians feel that the choice of hypnotic should not only be influenced by elimination half-life or the dosage used, but by individual patient preference. Hypnotics should be used for only short periods of time and in those patients for whom a more chronic use is indicated, they should be used only on an intermittent basis.

Anti-Anxiety Agents↗
PubMed1986

Failure of buspirone to manage benzodiazepine withdrawal.

Fifteen patients with 146 cumulative years of tranquilizer use were withdrawn from their benzodiazepine (nine gradually and six abruptly), and buspirone, a new nonbenzodiazepine anxiolytic, was substituted. The addition of buspirone did not appear to lessen the intensity of the withdrawal state. This finding supports preclinical studies indicating that buspirone has no clinically significant benzodiazepine receptor activity.

Anti-Anxiety Agents↗
PubMed1986

Insulin-induced hypoglycemia and panic attacks.

To investigate whether hypoglycemia might trigger panic attacks, the authors administered intravenous insulin to 10 patients with panic disorder. All subjects developed hypoglycemia but no panic anxiety. They reported symptoms of adrenergic hyperactivity but differentiated them from spontaneous panic attacks.

Adult↗
PubMed1986

The dexamethasone suppression test in generalised anxiety disorder.

The dexamethasone suppression test was performed on 79 patients with a diagnosis of generalised anxiety disorder. A non-suppression rate of 27% was obtained, comparable to that found in out-patient major depression but notably higher than previous reports in panic disorder. No good clinical predictors of non-suppression were discovered, nor was the co-occurrence of depression sufficient to account for the finding.

Anxiety Disorders↗