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Biomedical subjects

M Woerner

Publications and source records attributed to M Woerner.

At least 55 records · Page 3Linked to original sources
PubMed1988

Tardive dyskinesia: prevalence, incidence, and risk factors.

Despite increased attention to the problem of tardive dyskinesia (TD), many questions remain unresolved. There is a consensus that neuroleptics play a substantial role in its development, but other variables must also contribute. Prevalence surveys have helped to define the scope of the problem and suggest risk factors for further study. Their usefulness has been limited by methodological problems including the difficulty of estimating false-negative (masked) dyskinesia and false-positive (movements caused by other neuromedical conditions) rates. A recent large scale survey reported an overall rate of abnormal involuntary movements of 23.4% among neuroleptic-treated psychiatric patients; the range was from 12.3% among outpatients at a Veterans Administration hospital to 37.4% among state hospital inpatients. Rates of covert dyskinesia, obtained by withdrawing medication from 70 TD negative cases, ranged from 17% for the Veterans Administration to 67% at the state hospital (overall rate, 34%). Very few clear false-positive cases were found. The incidence of TD, based on a large prospective study of young adult patients, is 19% after 4 years of cumulative neuroleptic exposure. Higher incidence rates have been found in prospective studies of older patient samples. Age remains the risk factor most consistently associated with TD development; it may also relate to increased persistence. Female sex among older populations, diagnosis of affective disorder, and evidence of neuroleptic-induced pseudoparkinsonism also relate to increased risk. Further work is needed to elucidate the role of dosage and length of neuroleptic treatment, as well as other potential contributory factors.

Dyskinesia, Drug-Induced↗
PubMed1987

Prediction of relapse in schizophrenia.

Despite the proven efficacy of neuroleptic drugs in the acute and maintenance pharmacotherapy of schizophrenia, practical methods for identifying patients who require neuroleptic treatment to prevent relapse are lacking. This study evaluated the use of a methylphenidate challenge test to predict the outcome in 34 stable outpatients with schizophrenia receiving neuroleptic treatment. Patients received two infusions, one of methylphenidate and one of placebo, in randomized order one week apart while receiving neuroleptic treatment and again three weeks after drug withdrawal. Behavioral, cardiovascular, and neurologic responses were evaluated before and after infusion under double-blind conditions. Patients were then followed up without medication for 52 weeks or until symptom recurrence. The results indicate that specific measures, including behavioral response to methylphenidate, presence of tardive dyskinesia, and, under specific pharmacologic conditions, tardive dyskinesia, blink-rate, and pulse-rate responses to methylphenidate, are associated with time and propensity to relapse following neuroleptic withdrawal. These measures may be potentially useful in the identification of candidates for neuroleptic withdrawal and/or dosage-reduction treatment strategies.

Adolescent↗
PubMed1987

Effect of biofeedback-assisted relaxation on blood pressure and cortisol levels in normotensives and hypertensives.

This report examines the relationship between blood pressure and cortisol in normotensives and hypertensives. Both groups received biofeedback-assisted relaxation training. Both groups significantly decreased their muscle tension levels from baseline. Only the hypertensives decreased their blood pressure and cortisol levels after training. Implications for the role of cortisol in the relaxation response and in hypertension are discussed.

Adult↗
PubMed1986

Predictors of success in hypertensives treated with biofeedback-assisted relaxation.

This paper describes differences in response in seventeen patients with essential hypertension who participated in a treatment program consisting of electromyograph biofeedback assisted relaxation training. Responders were found to have higher treatment values of urinary and plasma cortisol, Trait Anxiety and forehead muscle tension compared to treatment failures. Responders also sustained greater decreases in plasma, and urinary cortisol after treatment. These data are discussed in light of the ability to predict which hypertensive patients may be most benefitted by a relaxation based treatment.

Adult↗
PubMed1986

Depot neuroleptics: a comparative review of standard, intermediate, and low-dose regimens.

New research in maintenance drug therapy has been influenced by a need to clarify risk-benefit ratios and determine minimum effective dosages. This research employing controlled study designs and new methods of data analysis has increased our ability to apply findings to specific patients, families, and treatment settings. Results from studies using depot neuroleptics indicate that this methodology may clarify the correlation between dose and blood levels and thus lead to the establishment of generalizable dosage guidelines. Lack of knowledge of maintenance requirements with long-acting injectable drugs may have led to the use of higher doses than necessary and an increased incidence of side effects. Recent studies suggest that with careful clinical observation, substantial reduction of maintenance doses can, for many patients, lead to improvement in some areas of subjective and objective well-being and to a diminution of adverse effects.

Antipsychotic Agents↗
PubMed1985

Tardive dyskinesia: prevalence, incidence, and risk factors.

Tardive dyskinesia remains a major concern in psychiatry. Epidemiologic data suggest that the prevalence of the disorder has increased over the past two decades. The average prevalence of TD across various populations is 15%-20%. Abnormal involuntary movements appear to be at least three times more prevalent in neuroleptic-treated patients than in patients not exposed to such drugs. The incidence of TD in a young adult (mean age 27) population is 14% after 4 years of cumulative neuroleptic exposure. The majority of these cases are mild and the condition does not appear to progress in most individuals despite continued neuroleptic exposure. Age remains the single most important risk factor for the development of TD. Recent investigations suggest that patients with affective illness may also be more vulnerable.

Adult↗
PubMed1985

Cognitive impairment in tardive dyskinesia.

Psychiatric patients in a prospective study on tardive dyskinesia (TD) development were psychometrically evaluated before TD onset to see whether cognitive impairment predisposes an individual to greater risk for TD. It was found that patients with TD showed more preexisting cognitive impairment than did the non-TD controls.

Adult↗
PubMed1983

Low-dose neuroleptic treatment of outpatient schizophrenics. I. Preliminary results for relapse rates.

In an attempt to begin to establish minimum effective dosage requirements for the maintenance treatment of schizophrenia, we undertook a double-blind comparison of low-dose fluphenazine decanoate (1.25 to 5.0 mg/2 wk) with the standard-dose regimen (12.5 to 50.0 mg/2 wk) in outpatient schizophrenics. For the first 126 patients studied, cumulative relapse rates at one year for the low dose were 56% and for the standard dose 7%, a significant difference. Despite the fact that very little dyskinetic symptomatology developed in the sample as a whole, the low-dose treatment appeared to have a significant advantage in producing fewer early signs of tardive dyskinesia. Severity of relapse and total cumulative dosage were also considered.

Adult↗