Role of amantadine in the management of neuroleptic-induced extrapyramidal syndromes: overview and pharmacology.
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Biomedical subjects
Publications and source records attributed to R M Allen.
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Anxiety dreams and night terrors have been reported as complications of single-dose bedtime administration of both tricyclic antidepressants and neuroleptics. Five cases are presented that demonstrate the effectiveness of diazepam and its close relative clorazepate in controlling this problem. The clinical usefulness and possible mechanisms of action of these agents in treating sleep disorder are discussed.
The author presents six cases which suggest a palliative effect of combination amantadine/neuroleptic in tardive dyskinesia. The six patients all met criteria for definite tardive dyskinesia, and did not have coexistent pseudoparkinsonism. Serial addition and subtraction of amantadine with fixed low-dose neuroleptic points to a specific amantadine effect. Previous studies are reviewed and speculation about the mechanism of action of the combination is discussed.
The author presents six cases of pseudodementia of varying degrees of severity that illustrate the difficulty in making purely clinical diagnoses of pseudodementia and demonstrate the usefulness of ECT in this condition in treatment-resistant patients. In addition, issues of cerebral laterality are raised by one case in which the patient paradoxically regressed to a preference for an acquired language (English) while pseudodemented and reverted to her native tongue (Spanish) after remission, with preservation of her ability to speak English.
In this report evidence is presented that amantadine hydrochloride greatly reduced the development of dopaminergic receptor hypersensitivity in the striatum, which normally results following chronic haloperidol administration using both a stereotyped behavior bioassay and a [3H]spiroperidol receptor binding assay. Amantadine prophylaxis reduced maximal ligand binding to near control levels and also significantly reduced apomorphine induced stereotypy. These results clearly demonstrate that amantadine greatly reduced haloperidol-induced striatal dopamine receptor hypersensitivity and support the hypothesis that amantadine given concurrently with neuroleptic agents might serve to prevent the development of human tardive dyskinesia.
Rat liver tissue was used to examine the effect of an exogenous succinyl-CoA-generating system on the radiochemical assay for delta-aminolevulinic acid synthase (succinyl-CoA:glycine C-succinyltransferase (decarboxylating), EC 2.3.1.37) activity developed by Ebert et al. (Ebert, P.S., Tschudy, D.P., Choudry, J.N. and Chirigos, M.A. (1970) Biochim. Biophys. Acta 208, 236--250). In the absence of exogenous succinate thiokinase, 34--62% (average 55%) of the radioactivity in the final column eluate could be attributed to delta-amino-[4-14C]levulinic acid, as assessed by conversion of delta-aminolevulinic acid in the eluate to a pyrrole. The addition of succinate thiokinase markedly enhanced the formation of the contaminant(s), as succinyl-CoA was metabolized to a compound or compounds that eluted chromatographically with delta-amino-levulinic acid. This effect was abolished by 10 mM EDTA, probably because the generation of succinyl-CoA was suppressed due to the chelation of Mg2+. These observations indicate that this radiochemical assay should be carefully examined for each set of assay conditions employed.
Progesterone levels in the milk of cows were determined by two radioimmunoassay methods. Excellent correlation (r = 0.95) was found between the method using an iodinated radioligand and that using a conventional tritiated tracer.
Fasting serum total bile acid (SBA) levels were estimated by enzymatic fluorometry (EF) in 36 subjects without liver disease, 28 with hepatic lesions and impaired hepatic function, and 79 with hepatic lesions and normal function. Fasting and postprandial EF-SBA levels were compared in nine normal subjects and nine patients with cholestasis, and SBA assays by EF and gas-liquid chromatography (GLC) were compared in 28 patients with hepatic lesions and impaired function. Levels of SBA were below 9 mumole/L in all but two of the 36 subjects without liver disease, and above that level in all 28 with impaired hepatic function and 17 (24%) of the 70 with hepatic lesions and normal liver function. In most subjects, EF detected notable postprandial rises in SBA. Enzymatic fluorometric and GLC-SBA values were closely correlated (coefficient of correlation, 0.869).
The authors report a case of acute organic brain syndrome in a patient being treated with clonidine and fluphenazine that cleared when clonidine was discontinued. Theoretical considerations of dopamine-norephinephrine interactions are discussed in the context of the drug-drug interaction.
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Eight homologous and heterologous 125I-radioligand systems for the radioimmunoassay of progesterone were examined. Using an antiserum raised to 11alpha-hydroxyprogesterone 11-succinyl-bovine serum albumin, standard curves were set up with the homologous radioligands, 11alpha-hydroxyprogesterone 11-succinyl-[125I]-iodotyramine, -[125I]-iodohistamine and -[125I]-iodotyrosine methyl ester. Heterologous bridge systems were represented by progesterone-11alpha-oxycarbonyl-[125I]-iodotyrosine methyl ester and 11alpha-hydroxyprogesterone 11-phthalyl-[125I]-iodotyrosine methyl ester, and heterologous site systems by progesterone-3-(O-carboxymethyl)oxime-[125I]-iodotyramine, progesterone-12-(O-carboxymethyl)oxime-[125I]-iodotyramine, and progesterone-20-(O-carboxymethyl)oxime-[125I]-iodohistamine. The preparation of the steroid derivatives and iodination by a two-phase method are described. The curves obtained from the homologous radioligands were relatively insensitive compared with a tritiated system, with the tyrosine methyl ester derivative providing a more sensitive assay than the corresponding tyramine or histamine analogues. The heterologous bridge systems gave more sensitive curves than the homologous tracers whilst the 3- and 12-(O-carboxymethyl)oxime derivatives of progesterone furnished curves as sensitive as the tritiated reference. Progesterone-20-(O-carboxymethyl)oxime-[125I]-iodohistamine was not bound by the antibody.
During a 13-month period, 9 patients with phencyclidine-induced psychosis were admitted to Darnall Army Hospital. They exhibited hostility agitation, and tangentiality and had delusions of influence and religious grandiosity. Six subjects reported auditory hallucinations, and 4 were disoriented in at least 1 sphere. Despite treatment with antipsychotic medication, the psychotic episodes often persisted for more than 30 days. Our clinical finding of prolonged psychotic reactions, together with previous reports of the effects of phencyclidine, suggests that phenycyclidine provides an intriguing drug model for schizophrenia.
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Fasting serum bile acid levels were measured by gas-liquid chromatography in 56 patients with primary biliary cirrhosis. Of these, 52 (93%) had increased levels (greater than 2mug/ml), including 14 of the 18 with normal serum bilirubin concentrations. The four patients with normal bile acid levels had early lesions as judged by histological and clinical criteria. With progression of the disease, as indicated by the histological features of the lesions, total bile acid levels increased, and the ratio of serum cholic-to-chenodeoxycholic acid decreased. Ratios of serum cholic-to-chenodeoxycholic acid below 1 occurred predominantly in patients with advanced or terminal disease. These studies suggest that serial measurement of serum bile acids may aid in the evaluation of primary biliary cirrhosis.
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Another approach was indicated for understanding the intellectual functioning of the person considered to be retarded from the viewpoint of measured intelligence. Rather than utilizing the standard, usually academically-oriented, test, the inkblot method was used to differentiate how the individual deals with familiar and unfamiliar problems. The emphasis was not on the predetermined responses and verbal meanings of the test constructor, but the language and mode of perceiving, organizing, and responding of the individual to the problems presented to him.
The effects of differential reinforcement on reaction times to two intensities of reaction signal were investigated in 36 developmental retardates. One group was reinforced for reaction times to the higher intensity signal; a second group was reinforced for reaction times to the lower intensity signal; a third group received no reinforcement. Reaction time decreased as signal intensity increased and decreased over sessions as a function of reinforcement. Likewise, reinforcement either exaggerated or reversed differences in reaction times to each signal depending on the particular reinforcement contingency. Results were discussed in terms of attentional and motivational explanations of effects of signal intensity on reaction times of retardates.
The Adaptive Behavior Checklist was administered annually to the residents of the Miami (FL) Sunland Training Center for 4 consecutive years. As a means of assessing adaptive behavior, this checklist, was used to provide feedback as to the progress made by the residents, thus monitoring the effectiveness of the institution in achieving certain behavioral objectives. Data from a longitudinal study are presented along with the means by which the results were communicated to the staff. Correlations of the checklist with standard IQ scores were discussed as was the effectiveness of a revision of the Adaptive Behavior Checklist.