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Biomedical subjects

P J Perry

Publications and source records attributed to P J Perry.

At least 109 records · Page 6Linked to original sources
PubMed1982

Amoxapine neurotoxicity: a case report with long-term follow-up.

At this time, because of the lack of knowledge and experience in the treatment of amoxapine toxicity, it is impossible to formulate any conclusions concerning this drug's true toxic potential and capabilities. In toxic situations, amoxapine appears to produce some of the expected sequelae associated with TCAs. Neurotoxicity appears to be amoxapine's greatest toxic liability; the drug seems to have the ability to produce unusual neurological alterations, as well as a tendency to induce severe seizure activity. Procedures generally utilized for treatment of TCA or neuroleptic overdoses may prove inappropriate for dibenzoxazepine overdoses. It appears that intervention should include combating initiation of seizure activity and maintaining functional acid-base status. It has yet to be determined whether amoxapine or other dibenzoxazepine derivatives have a greater potential than other TCAs for inducing metabolic acidosis in toxic situations. However, observations from cases presented here would indicate this to be a distinct possibility.

Adult↗
PubMed1982

Lithium nephrotoxicity.

Lithium-induced nephrotoxicity was first predicted in laboratory animals more than 30 years ago. Evidence in humans, however, did not begin to accumulate until the 1970s. By 1977, anecdotal information was available to suggest that lithium intoxication was not necessarily a prerequisite for the development of nephrotoxicity and that renal damage also could occur as a result of chronic lithium therapy. Since then, several factors have been identified that could influence the risk of nephrotoxicity during treatment with lithium. These include number of daily doses, type of lithium formulation, and the incidence of renal disease in patients with manic-depressive illness.

Creatine↗
PubMed1981

Side effects of corticosteroid therapy. Psychiatric aspects.

We reviewed the literature to determine the characteristics of corticosteroid-induced mental disturbances. We conclude that (1) while dosage may be correlated to the risk of developing mental disturbances, neither dosage nor duration of treatment seems to affect the time of onset, duration, severity, or type of mental disturbances; (2) euphoria, depression, and psychotic reactions are the common manifestations of corticosteroid-induced mental disturbances; (3) females seem to be more prone to these disturbances than males; (4) patients with past mental illness are not necessarily predisposed to such disturbances; and (5) corticosteroid-induced mental disturbances are usually reversible on dose reduction or discontinuation of the drug. At present there are no simple models to explain the psychotic reactions, anxiety, or agitation seen in corticosteroid-induced mental disturbances.

Adolescent↗
PubMed1981

Sedative-hypnotic tolerance testing and withdrawal comparing diazepam to barbiturates.

A study was conducted to assess the feasibility of substituting diazepam for pentobarbital and phenobarbital in sedative-hypnotic tolerance testing and withdrawal of tolerant patients. Nineteen patients potentially dependent on sedative-hypnotics were tolerance tested with either diazepam or pentobarbital and, if tolerant, were withdrawn with diazepam or phenobarbital, respectively. Seventy-eight subjects previously described in the literature with drug dependencies similar to the diazepam and barbiturate groups provided a basis for comparing the diazepam group to untreated patients to determine whether diazepam was able to prevent abstinence symptoms. Withdrawal was successfully completed in all patients. The expected and observed incidence of seizures, delirium, and minor withdrawal for the barbiturate group and seizures and delirium for the diazepam group did not differ significantly, although a large type II error compromised these conclusions. A significant difference was seen between the observed and expected incidence of minor withdrawal symptoms in the diazepam-withdrawn patients.

Adult↗
PubMed1981

Lithium kinetics in single daily dosing.

The feasibility of single daily dosing of lithium carbonate was tested in eight recurrent manic-depressives being treated with lithium prophylaxis. The patients received their entire 24-h maintenance dose at 8:00 p.m. for 12 consecutive days. The suitability of single daily dosing was determined by comparing 1) lithium through levels; 2) lithium kinetic parameters of half-life, clearance, and volume of distribution; and 3) renal function parameters of serum creatinine, creatinine clearance, and mean 24-h urine output during the initial divided daily dosage trial and the subsequent single daily dosage trial. The observation of no significant changes in either serum half-lives or renal lithium clearance levels supports the conclusion that the average steady-state lithium serum concentration (Cpss) is unchanged by conversion to single daily doses. No significant changes were observed in either serum creatinine or creatinine clearance. However, a significant decrease in the 24-h urine output was noted on the single daily dose.

Adult↗
PubMed1978

Absorption of oral intramuscular chlordiazepoxide by alcoholics.

The effect of chronic alcoholism on oral and intramuscular plasma levels of chlordiazepoxide (CDX) was assessed. A 50-mg oral dose of CDX resulted in significantly higher plasma levels in the 2 hr following CDX than a 50-mg intramuscular dose administered to acute withdrawing alcoholic subjects. The same CDX dose was administered 7 days later and the same differences were observed between the mean oral and intramuscular plasma levels during the first 2 hr after administration of CDX. Peak concentration occurred significantly sooner after the oral than intramuscular dose of CDX in both the initial dose and the dose given a week later. It was also observed that the areas under the curve for CDX were significantly greater initially than 1 wk later. It is suggested this effect may be at least partially the result of the longer CDX half-lives initially than a week later. The active metabolite, N-desmethylchlordiazepoxide, peaked significantly earlier with the oral dose than with the intramuscular dose after the patient was alcohol free for a week.

Absorption↗
PubMed1978

Anticholinergic psychosis.

A case of anticholinergic psychossis in a 17-year-old male following suspected ingestion of an unknown amount of benztropine mesylate is discussed. The borderline mentally retarded patient exhibited acute psychosis and physical signs common to anticholinergic and amphetamine intoxications such as mydriasis, tachycardia and hypertension. Intramuscular chlorpromazine hydrochloride and oral haloperidol were administered to sedate the patient. The differential diagnosis of anticholinergic intoxication was based on the patient's physical and mental symptoms, the short duration of the psychosis and a negative urine assay for amphetamine. The neuropsychiatric signs of and treatment for anticholinergic psychosis are discussed. Physostigmine salicylate is the drug of choice for reversing the signs and symptoms of anticholinergic poisoning. Benzodiazepines may be used if sedation is indicated, but use of phenothiazines for this purpose should be avoided.

Adolescent↗
PubMed1977

Water intoxication, psychosis, and inappropriate secretion of antidiuretic hormone.

A review of the literature and the three presented cases indicate that multiple factors are often involved in the development of water intoxication in the psychotic. Although the syndrome of inappropriate secretion of antidiuretic hormones (SIADH) is one of these factors, it is usually associated with other causes of the SIADH. Evidence is lacking that the SIADH is an essential feature of a psychotic illness.

Delusions↗
PubMed1977

Drug therapy reviews: tricyclic antidepressant and monoamine oxidase inhibitor combination therapy.

Combinations of monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) are discussed with regard to general toxicity, drug interactions, animal studies, clinical reports, efficacy of combination therapy and usage conditions. Although MAOI-TCA combinations are usually considered contraindicated, informed opinion has shifted to cautious recommendation for the combination. Only refractory patients in whom less hazardous treatment has failed should be considered for combination therapy. The preferred dosage regimen is administration of the MAOI t.i.d. during the day and the entire TCA dose at bedtime. Patients should be informed of the immediate need for medical advice should side effects occur. It is concluded that the simultaneous administration of these agents is potentially efficacious and safe is carefully monitored and controlled.

Animals↗
PubMed1977

Amphetamine psychosis.

A case report of amphetamine psychosis in a 16-year-old female that closely resembled paranoid schizophrenia following the possible ingestion of a large quantity of amphetamine tablets is presented. The symptoms associated with amphetamine psychoses, the criteria used for differentiating amphetamine psychoses from schizophrenia, and the treatment of this drug-induced reaction are discussed. Treatment recommendation include the use of a dopamine antagonist such as haloperidol and the use of ascorbic acid to accelerate the renal elimination of amphetamines.

Adolescent↗
PubMed1977

Concomitant administration of haloperidol and lithium carbonate in acute mania.

Prospective and retrospective studies of 55 psychotic patients treated concomitantly with oral haloperidol and lithium carbonate did not reveal any evidence of permanent brain damage or persistent dyskinesias; adverse reactions were transient and without sequelae. Results in these patients afford further evidence that combined use of haloperidol and lithium is safe and effective in the treatment of mania. Careful management is essential to minimize the risk of serious adverse reaction.

Acute Disease↗
PubMedDate not supplied

Clozapine's effect on negative symptoms in treatment-refractory schizophrenics.

Clozapine has proven to be more effective than typical antipsychotics in treatment-refractory schizophrenic patients, and some evidence suggests that it may be particularly useful in treating the negative symptoms of schizophrenia. However, it is unclear whether this observation reflects improvement in "primary" or "secondary" negative symptoms. We hypothesized that a portion of clozapine's effect on negative symptoms would be related to an improvement in positive (psychotic and disorganization) symptoms, a decrease in extrapyramidal side effects (EPSE), and/or a decrease in depressive symptoms. The remainder of its effect would be related to a direct effect on the neural circuits or pathologic processes responsible for the negative symptoms. Twenty-nine treatment-refractory schizophrenics treated with clozapine for 6 weeks were studied. The core negative symptoms measured by the Scale for the Assessment of Negative Symptoms ([SANS] affective flattening, anhedonia/asociality, avolition/apathy, and alogia) all improved with clozapine treatment. Overall, there was a 31% improvement in negative symptoms, a 32% improvement in psychotic symptoms, and a 35% improvement in disorganization. The improvement in negative symptoms was correlated with improvement in disorganization, but not with improvement in psychotic symptoms, depression, or drug-induced EPSE. Although there was a correlation between improvement in negative symptoms and improvement in disorganization, there was a suggestion that the two are changing in parallel, but are independent of each other. It appears that at least a portion of clozapine's effect on core negative symptoms is mediated through a direct effect on the underlying pathophysiology of schizophrenia associated with negative symptoms.

Adult↗
PubMedDate not supplied

Cost-benefit analysis of prospective pharmacokinetic dosing of nortriptyline in depressed inpatients.

A retrospective chart review was conducted on depressed inpatients to determine the economic impact of prospective pharmacokinetic dosing vs. empirical dosing of tricyclic antidepressants. The benefit/cost ratio of 2.5 indicated that the benefits of prospective dosing more than doubled the cost. The prospectively dose patients were discharged significantly earlier, i.e. 6.1 days than the empirically dosed patients and they also returned to work significantly earlier, i.e. 55.4 days than the control group.

Adult↗