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Biomedical subjects

L A Opler

Publications and source records attributed to L A Opler.

At least 37 records · Page 2Linked to original sources
PubMed1992

Akathisia, suicidality, and fluoxetine.

BACKGROUND: The propose link between fluoxetine and suicidal ideation is explained by fluoxetine-induced akathisia and other dysphoric extrapyramidal reactions. METHOD: The following literature is reviewed: (1) the subjective response of schizophrenics to akathisia, including evidence that akathisia gives rise to suicidal ideation; (2) the subjective reports of patients taking fluoxetine; and (3) preclinical studies describing the role of serotonin in the extrapyramidal system and suggesting a mechanism whereby fluoxetine can induce extrapyramidal side effects. RESULTS: The literature suggests that fluoxetine-induced extrapyramidal reactions may be a mediator of de novo suicidal ideation. CONCLUSION: We propose a syndrome which we name Extrapyramidal-Induced Dysphoric Reactions, one extreme manifestation of which is the emergence of suicidal ideation. We further propose a heuristic "Four Neuron Model of the Extrapyramidal Motor System" in which increased serotonin activity, by inhibiting the nigrostriatal dopamine tract, is capable of inducing extrapyramidal side effects.

Akathisia, Drug-Induced↗
PubMed1991

The role of pimozide in clinical psychiatry: a review.

Pimozide, a diphenylbutylpiperidine neuroleptic which is FDA-approved as a backup treatment for Gilles de la Tourette's syndrome, has been used abroad for many years as a treatment of schizophrenia and has been recently reported to be particularly effective in treating monosymptomatic hypochondriacal psychosis and delusional jealousy. Pimozide may also have a role in the treatment of negative schizophrenic symptoms, pain syndromes, and obsessive compulsive disorder. After reviewing the relevant clinical literature supporting these indications, the authors review preclinical studies that provide points of departure regarding biochemical mechanisms underlying this unique therapeutic profile.

Chronic Disease↗
PubMed1990

Neurological signs and the positive-negative dimension in schizophrenia.

Schizophrenic patients have been observed to manifest a variety of abnormal neurological signs, but the nature of their association with differing clinical presentations is less well established. To address this issue, we administered a newly compiled neurological inventory to 28 well-characterized chronic schizophrenic inpatients and separately assessed them on the Positive and Negative Syndrome Scale and on control variables that included measures of global pathology, chronicity of illness, neuropsychological and intellectual integrity, and extrapyramidal dysfunction. We found, first, that our neurological battery provided statistically independent measures of apraxia, fine motor function, and prefrontal, parietal, and nonlocalizing signs. A significant association emerged between negative symptomatology and neurological signs of prefrontal impairment (p less than 0.01), which could not be accounted for by any of the control variables. Positive symptoms were associated with an absence of parietal and nonlocalizing signs; however, these correlations were mediated by higher neuroleptic doses in these patients. There was no association between any neurological sign and age, extrapyramidal symptoms, general neuropsychological integrity, education, IQ, or severity or chronicity of illness. We concluded that the negative syndrome in schizophrenia represents a distinct dimension of psychopathology that is related specifically to prefrontal deficit.

Adult↗
PubMed1990

Visual information processing in positive, mixed, and negative schizophrenic syndromes.

The purpose of this study was to determine whether schizophrenics with positive, mixed, and negative syndromes are distinguished in terms of visual stimulus registration thresholds and efficiency of information processing. Forty-five schizophrenic inpatients were classified accordingly into groups of 15 each and compared with one another and with 15 normal control subjects on a visual backward masking task. Repeated-measures analysis of variance revealed that all three schizophrenic groups were less efficient information processors than were normal subjects. Relative to the positive group, the negative group displayed significantly longer registration thresholds, fewer correct target stimulus detections, and longer time intervals to achieve their first significant improvement in performance and to first exceed chance response levels. The three syndrome groups were not significantly different in their rates of improvement over trials. Secondary correlational analyses showed that the information-processing measures were unrelated to a variety of demographic, psychiatric, and cognitive developmental variables, although shorter recognition thresholds and shorter unmasking interval scores were associated with faster psychomotor rates. Complex interrelationships were uncovered between the information-processing measures, positive and negative symptomatology, and general psychopathology. The results were interpreted as supporting the validity of the positive-negative distinction for explaining some of the heterogeneity in schizophrenia.

Adolescent↗
PubMed1990

Significance of cocaine history in schizophrenia.

Fifty-one schizophrenic inpatients were divided into two groups, those with and without history of cocaine use, and compared on historical, demographic, cognitive, and psychopathological measures. Patients with a cocaine history were found to be significantly more depressed, less socialized, and more impaired in conceptual encoding and verbal memory, while less disordered in attention. The two groups did not differ in severity of illness or positive and negative syndromes. There were also no differences in control variables such as age, gender, education, intelligence, premorbid adjustment, neuroleptic dose, onset and chronicity of illness, continuity of hospitalization, paranoid subtype, and psychiatric illness in the family. Cocaine history was associated with multiple illicit drug use, but for other substances there was no increased liability for depression or cognitive deficits. The results suggest that the clinical presentation in schizophrenia is significantly associated with prior cocaine experience.

Adult↗
PubMed1989

The safety of switching rapidly from tricyclic antidepressants to monoamine oxidase inhibitors.

Monoamine oxidase inhibitors (MAOIs) are increasingly used for patients who do not respond to an initial trial of tricyclic antidepressants (TCAs). Although there are insufficient data documenting the optimal manner for switching a patient from a TCA to an MAOI, standard references advise a drug-free interval of at least 1 week. In clinical practice, however, such a delay may be difficult to observe. In order to explore the safety of a more rapid switch from TCA to MAOI therapy, we survey members of our department (Columbia University) as to their experience with different methods of switching patients from TCAs to MAOIs. Thirty-three respondents reported having switched an estimated 432 patients over the course of 3 years, with 178 patients switched within 4 days of discontinuing TCA therapy, including 63 who had the MAOI added while still being tapered from the TCA. More experienced psychiatrists tended to be less conservative, some using time intervals of 4 days or less. No adverse reactions were reported, including hypertensive and hyperpyrexic crises. This retrospective survey and an accompanying review of the literature suggest that the recommended drug-free interval of a week or more when switching patients from TCAs to MAOIs may be overly conservative.

Antidepressive Agents, Tricyclic↗
PubMed1988

Reliability and validity of the positive and negative syndrome scale for schizophrenics.

The Positive and Negative Syndrome Scale (PANSS) was developed out of the need for a well-operationalized method of assessing these syndromes in schizophrenia, including their relationship to one another and to global psychopathology. We surveyed 82 acute and chronic schizophrenics to analyze the psychometric properties of the four PANSS scales. The interrater reliabilities were in the 0.80's, and significant correlations emerged with corresponding criterion measures. The PANSS positive and negative scales were inversely intercorrelated once their shared association with general psychopathology had been partialed out. The results support the scales' reliability, criterion-related validity, and construct validity, while cross-validating some of our previous findings.

Adult↗
PubMed1988

High-dose naloxone in tardive dyskinesia.

Tardive dyskinesia (TD) is thought to result from nigrostriatal dopaminergic supersensitivity secondary to prolonged neuroleptic exposure. Preclinical studies have demonstrated that the opiate antagonist naloxone can acutely reverse a haloperidol-induced hyperdopaminergic state. In a trial of high-dose naloxone, 20 patients with TD received i.v. naloxone (20 mg, 40 mg, and placebo) under double-blind conditions. At baseline and at regular postdrug intervals, patients were evaluated using a battery of motor, clinical, and neuropsychological measures to study effects on neurological, behavioral, and cognitive functions. There was a significant improvement in involuntary movements at 30 min postnaloxone, together with improvement in clinical ratings at that time point, as well as some cognitive changes. The implications of these findings for the putative functional relationship between dopaminergic and enkephalinergic systems in the nigrostriatal area are discussed.

Adult↗
PubMed1988

The possible role of dopamine autoreceptors in neuroleptic atypicality.

Different brain pathways have been shown to subserve the therapeutic effects of neuroleptics and their extrapyramidal side effects. Agents which can discriminate between these pathways, therefore, might be able to produce 'atypical' clinical effects. Molindone, a novel neuroleptic of the indoleamine class, has been shown in basic paradigms to discriminate between brain dopaminergic systems by virtue of its ability to preferentially inhibit dopamine autoreceptors (DARs). Clinical studies suggest that molindone may be less likely than traditional neuroleptics to induce tardive dyskinesia and that molindone may preferentially ameliorate some negative schizophrenic symptoms. We suggest that the distinct clinical effects of molindone result from its ability to block DARs.

Animals↗