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Biomedical subjects

P A Jansen

Publications and source records attributed to P A Jansen.

At least 19 recordsLinked to original sources
PubMed2001

Antipsychotic-induced extrapyramidal syndromes. Risperidone compared with low- and high-potency conventional antipsychotic drugs.

AIM: To compare the risk of extrapyramidal syndromes (EPS) between patients using risperidone and those using low-potency conventional antipsychotic drugs (APDs) in outpatient clinical practice, as measured by the use of anticholinergic medication. We tried to replicate results from previous clinical trials that compared risperidone with high-potency APDs. METHOD: Data was obtained from the PHARMO database containing filled prescriptions of 450,000 community-dwelling people in The Netherlands from 1986 to 1998. From the patients aged 15-54 years who had been newly treated with APDs, we defined mutually exclusive cohorts according to the APD first prescribed to a patient. APD exposure was followed until the first prescription of anticholinergic medication and was censored when APD prescribing was interrupted or switched. We estimated relative risks between risperidone and commonly used low-potency and high-potency APDs using Cox proportional hazards models, adjusting for age, gender, dose and other potential confounders. RESULTS: In 4094 patients who had been newly prescribed antipsychotic drugs, the overall incidence rate of anticholinergic drug therapy was 556 per 1000 person-years, which was dose dependent. Prescribed doses of all antipsychotics were low. While, in accordance with previous trials, risperidone showed a lower risk of EPS than the high potency APDs such as haloperidol (RR 0.26; 95% CI 0.10-0.64), we did not observe a lower EPS rate than low-potency APDs (risperidone vs thioridazine RR 1.73, 95% CI 0.49-6.13; risperidone vs pipamperone RR 2.50, 95% CI 0.78-8.04). CONCLUSION: The reduced EPS rates observed when comparing risperidone with high-potency antipsychotics such as haloperidol may not apply to comparisons with low-potency drugs.

Adolescent↗
PubMed2001

Risk of extrapyramidal syndromes with haloperidol, risperidone, or olanzapine.

OBJECTIVE: To compare the risk of extrapyramidal syndrome (EPS) between risperidone, olanzapine, and haloperidol, taking into account patients' past antipsychotic drug use and past EPS. METHODS: Data were obtained from the PHARMO-database, containing filled prescriptions of 450,000 community-dwelling people in the Netherlands from 1986 through 1999. We defined cohorts of first-time users of haloperidol, risperidone, or olanzapine aged 15 to 54 years. In the first 90 days of treatment, we assessed the occurrence of EPS, defined as first use of any antiparkinsonian agent. We estimated relative risks of EPS for risperidone and olanzapine versus haloperidol using a Cox proportional hazards model. Patients were subdivided according to prior use of antipsychotic and antiparkinsonian drugs. RESULTS: We identified 424 patients starting treatment with haloperidol, 243 with risperidone, and 181 with olanzapine. Prior use of antipsychotic plus antiparkinsonian medication was significantly more frequent among users of risperidone and olanzapine than in those using haloperidol (36.2%, 40.3%, and 4.5%, respectively; p < 0.001). Within most subgroups of comparable treatment history, patients using risperidone and olanzapine showed reduced risks of EPS compared with haloperidol, although some of these findings did not reach statistical significance (RR 0.03-0.22). However, this was not observed for patients using risperidone who had experienced EPS in the past (RR 1.30; 95% CI 0.24 to 7.18). CONCLUSIONS: In general, we observed reduced risks of EPS for risperidone and olanzapine compared with haloperidol within subgroups of patients with a similar treatment history. However, the added value of risperidone in patients who have experienced EPS in the past needs further study.

Adolescent↗
PubMed2000

Muscle strength, functional mobility and vitamin D in older women.

Vitamin D deficiency may lead to loss of type II muscle fibres, and thereby to atrophy of proximal muscles with an increased risk of falling and bone fractures. The aim of the study was to determine if six months of vitamin D treatment (0.5 microg alphacalcidol) could positively influence values for muscle strength and functional mobility in vitamin D-deficient older women. Twenty-seven women entered the study which took place at a teaching hospital outpatient department. Ten vitamin D-deficient (serum 25(OH)D3 <20 nmol/L) older (>70 years) women and 13 age-matched female subjects with normal vitamin D levels (serum 25(OH)D3 >30 nmol/L) completed the study. Preand post-treatment data were obtained for isometric knee extensor strength, handgrip strength and functional mobility (walking distance over 2 minutes and the timed i'Up & Go" test). Six months of treatment with alphacalcidol led to significant improvements (compared to the controls) in values of isometric knee extensor strength (left leg: 14.6% +/- 5.7%. p=0.03; right leg: 11.5% +/- 5.0%, p=0.02) (mean +/- SEM). The achievements in the timed "Up & Go" test and 2-minute walking test did not improve in the alphacalcidol group compared to the controls after 6 months. However, within the vitamin D-deficient group, 6 months of alphacalcidol treatment led to a significant increase in the walking distance over 2 minutes (increase from 137.6 +/- 12.6 to 151.3 +/- 11.2 meters, p=0.03). The controls, with normal vitamin D levels, did not exhibit improvements in performance of any of the tests over a period of 6 months. Summarized, alphacalcidol seems to improve muscle strength and walking distance over 2 minutes in vitamin D-deficient older women.

Aged↗
PubMed2000

Lactic acid bacteria associated with the digestive tract of Atlantic salmon (Salmo salar L.).

The present study reports the effect of excessive handling stress and starvation on the lactic acid bacteria associated with the digestive tract of Atlantic salmon (Salmo salar L.). A relatively low population level (approximately 2 x 103 bacteria per gram wet tissue) of viable adherent heterotrophic bacteria was associated with the digestive tract (foregut, midgut and hindgut). Of the 752 bacterial isolates isolated from diet, water and the digestive tract, 201 isolates belonged to the carnobacteria. Of these isolates, one from the diet, one from the rearing water and 80 from the gastrointestinal tract, were further identified on the basis of 16S rDNA sequence analysis. All these isolates were identified as being Carnobacterium piscicola-like. Daily repeated stress and starvation of the fish over 11 d had no influence on the total culturable bacterial numbers or population level of C. piscicola associated with the digestive tract. C. piscicola-like isolates colonizing the various intestinal regions (foregut, midgut and hindgut) were also screened for their ability to produce growth inhibitory compounds active against the fish pathogen Aeromonas salmonicida. Of the 199 C. piscicola isolates tested, 139 inhibited growth of the pathogen.

Aeromonas↗
PubMed1997

Effect of a program of diverse activities on disturbed behavior in three severely demented patients.

The effects of a daily program of various activities on disturbed behavior were studied prospectively in three patients with severe dementia. Prior to the study, patients had not responded to treatment with benzodiazepines and/or neuroleptics. The study consisted of three periods, each lasting for 4 weeks: i.e., baseline, intervention, and follow-up. During each period, behavior was assessed by means of observation scales: GIP, SDAS, and CGI. Psychotropic medication was held as constant as possible. During intervention, the patients took part in a program of activities, including group, musical, physical, and social activities. During baseline and follow-up, patients followed the regular ward activities. The patients showed different responses, probably related to personal interests. Possible implications for the treatment of patients with dementia, complicated by disturbed behavior, and suggestions for future research are discussed. The enthusiasm of the nursing staff dealing with these patients was a promising result.

Aged↗
PubMed1994

The population age structure and reproductive biology of Gyrodactylus salaris Malmberg (Monogenea).

Gyrodactylus salaris has recently become a major pathogen of Atlantic Salmon (Salmo salar) in Norway. The survivorship, population age structure and pattern of insemination of G. salaris were studied to determine the extent to which this species reproduces sexually. The age-specific mortality schedule of G. salaris could be described by an exponential model but day to day variations were large, with an increase in mortality after each birth. Modelling population growth using the best fit mortality schedule indicated that, at stable age structure, 35% of the population would consist of newborn and pre-1st birth flukes. Using testis, penis and embryo development, pre-1st birth and immediately post-1st birth flukes could be unambiguously identified, and established infections were found to contain 35% pre-1st birth flukes, as predicted. The proportion of pre-1st birth flukes in newly established infections was significantly smaller, probably because of differences in the rate of transmission between newborn and older flukes. Gyrodactylus salaris is relatively long-lived, and more than 40% of the population may survive to give birth for the third time. As gyrodactylids are protogynous, and the first daughter is probably produced asexually, this long-lived strategy ensures that a large part of the G. salaris population possesses a functional male system, and that the asexually derived flukes are a smaller component of the total population in this species. Flukes with whorls of inseminated spermatozoa within the seminal receptacle were found in all age groups possessing a functional male system, and were interpreted as having been cross-inseminated.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1994

[Drug use on admission and discharge in a geriatric department of a psychiatric hospital].

Change in medication use was studied in patients admitted to a short-stay geriatric ward of a psychiatric hospital. One hundred ten patients were followed up until discharge from the short-stay ward, or, after transfer, until discharge from the medium-stay ward to home or to a nursing-home. Mean drug use on admission was 2.6 drugs; at discharge mean use was 2.1 drugs. Drugs most prescribed at admission were neuroleptics (41%) and benzodiazepines (39%). At discharge 15% used neuroleptics and 22% benzodiazepines. A reduction in use of cardiovascular drugs, and especially of digoxin, was found. Prescription of laxatives and vitamins, especially folic acid and vitamin B12, increased. In comparison with studies on two other geriatric wards in general hospitals in The Netherlands the most marked difference was a reduction of 17% in this study of the number of patients using benzodiazepines on discharge in contrast to an increase of 18 and 3% in the two other studies. The number of patients using neuroleptics on discharge decreased in the present study with 26%; in the two other studies respectively a decrease of 7% and a constant prescription level was found.

Aged↗
PubMed1991

Temperature-dependent reproduction and survival of Gyrodactylus salaris Malmberg, 1957 (Platyhelminthes: Monogenea) on Atlantic salmon (Salmo salar L.).

The relationship of survival and reproduction of Gyrodactylus salaris Malmberg on the Atlantic salmon (Salmo salar) to water temperature (2.5-19.0 degrees C), was studied on the basis of temporal sequence of births and age at death of individual parasites on isolated salmon, and of infrapopulation growth on isolated and grouped salmon. Mean life-span of the parasite was negatively correlated with water temperature: 33.7 days at 2.5 degrees C and 4.5 days at 19.0 degrees C. The average number of offspring per parasite peaked between 6.5 and 13.0 degrees C, and was approximately 2.4 at these two temperatures. Both the period between the successive births of the offspring (max 4) and the estimated generation time were negatively correlated with temperature. The innate capacity for increase (rm) was positively correlated with temperature: from 0.02 (/parasite/day) at 2.5 degrees C to 0.22 (/parasite/day) at 19.0 degrees C. Growth of the infrapopulations was positively correlated with water temperature and was higher on isolated fish than on grouped fish, though less than the potential parasite population growth estimated from rm. In the infrapopulations the mean intensity of parasites continued to increase throughout all the experiments on both isolated fish and on grouped fish.

Analysis of Variance↗
PubMed1990

[Lithium in the treatment of depressed elderly patients].

In the geriatric department of a Dutch psychiatric hospital the charts of 65 patients treated with lithium for depression were reviewed. We assessed efficacy and adverse effects. The sample included 65 patients, 12 men and 53 women, mean age 77 (64-91) years. A complete or partial response was seen in 30 out of 43 patients (70%) treated with lithium in addition to a cyclic antidepressant. Six out of 22 patients treated with lithium as a sole antidepressant responded completely or partially. During lithium therapy 16 patients suffered from severe adverse effects. In our view and in spite of severe adverse effects, with expert monitoring lithium can be of value in the treatment of (very) old and depressed patients.

Aged↗
PubMed1990

Lithium augmentation in geriatric depression.

In the geriatric department of a Dutch psychiatric hospital the charts of 51 patients treated with lithium in addition to cyclic antidepressants were reviewed. A response was seen in 33 patients (65%). For patients with recurrent depressive episodes, a statistical trend was found towards more responders with more complete responses, compared to patients with first depressive episodes. During lithium augmentation, 10 patients suffered from severe adverse effects 12 times. In spite of adverse effects, with expert monitoring lithium augmentation can, in our opinion, be of value in the treatment of older depressed patients.

Aged↗
PubMed1988

Blood pressure and both venous and urinary catecholamines after cerebral infarction.

Blood pressure, both venous and urinary catecholamines and plasma renin activity (PRA) were studied in 10 patients (6 men and 4 women, mean age 70 +/- 10 years) on the first three days after cerebral infarction. Blood pressure fell significantly (p less than 0.02) on the second and third day after stroke. There was a small but significant (p less than 0.01) decrease in plasma epinephrine concentration on the third day. The norepinephrine values remained constant on the three days. The PRA showed a significant (p less than 0.01) rise on the third day. No significant correlation was detected between the course of the blood pressure and the plasma catecholamines or PRA. When blood pressure was correlated with the urinary catecholamines, however, a significant correlation with epinephrine (r = 0.45; p less than 0.05) and with norepinephrine (r = 0.44; p less than 0.05) was found. We conclude that the changes in blood pressure after stroke are at least partly mediated by the changes in catecholamine production.

Aged↗
PubMed1988

Pharmacokinetics of high-dosage naproxen in elderly patients.

After multiple oral doses of 500 mg naproxen twice daily, eight young healthy male volunteers and six male and female elderly patients participated in a pharmacokinetic study. Serum naproxen levels were measured by high-pressure liquid chromatography; protein-unbound drug was determined after equilibrium dialysis. A significantly lower maximal serum concentration (Cpeak), smaller area under the curve during one dose interval [AUC(0-12)], larger total body clearance (CL/F) and apparent volume of distribution (V/F body wt-1) were found for the total drug in elderly patients. The pharmacokinetics of the protein-unbound drug showed higher trough and peak concentrations, larger AUC(0-12)u, and smaller (CL/F)u and (V/F)u in the elderly patients. The unbound fraction (less than 1% of total naproxen) showed concentration dependency; in the elderly, a larger unbound fraction was found. Pharmacokinetic differences between the elderly and the young may be explained by a lower serum albumin concentration in the aged, together with a decrement in binding affinity of naproxen to albumin; moreover, the clearance of unbound drug was significantly reduced in the elderly (281 +/- 96 l/h) as compared with the young (713 +/- 164 l/h). We conclude that age-related factors increase serum unbound naproxen concentrations. It is, therefore, advisable to start treatment with naproxen in the elderly at a low dosage.

Adult↗