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Biomedical subjects

R M Post

Publications and source records attributed to R M Post.

At least 199 records · Page 11Linked to original sources
PubMed1991

The puzzle of noncompliance in the manic patient.

Patients with affective disorders may be seriously compromised by failure to comply with prescribed medication regimens. At the time of his hospitalization, the patient discussed here had a severe bipolar disorder characterized by disruptive and repetitive manic episodes that were generated by medication noncompliance and substance abuse. Through an understanding of the longitudinal and progressive development of this rapidly cycling disorder, the consultant emphasizes the importance of long-term maintenance pharmacotherapy in the context of environmental restructuring to attempt to reverse the malignant nature of the patient's affective disorder.

Adult↗
PubMed1990

Depression, anxiety, and temporal lobe epilepsy. Laterality of focus and symptoms.

The association between anxiety, depression, and lateralization of an epileptogenic focus was explored in 18 adult patients with a left temporal lobe focus, 21 with a right focus, 20 with bilateral temporal foci, and 16 individuals with absence seizures. No significant difference in the level of anxiety was found among the groups. However, patients with left-sided temporal lobe epilepsy scored significantly higher than other groups on self-ratings for depression. This could not be accounted for by factors such as duration of epilepsy, employment status, education, age at seizure onset, or medication status. The left temporal lobe epilepsy group had a nonsignificantly larger number of males and left-handed subjects. The possible interactions between gender, handedness, seizure focus, and vulnerability to depression are described.

Adult↗
PubMed1990

Differential autonomic nervous system activity in multiple personality disorder.

The cardinal feature of multiple personality disorder (MPD) is the existence of two or more alter personality states that exchange control over the behaviour of an individual. Numerous clinical reports suggest that these alter personality states exhibit distinct physiological differences. We investigated differential autonomic nervous system (ANS) activity across nine subjects with MPD and five controls, who produced "alter" personality states by simulation and by hypnosis or deep relaxation. Eight of the nine MPD subjects consistently manifested physiologically distinct alter personality states. Three of the five controls were also produced physiologically distinct states, but these differed from those of the MPD subjects. A habituation paradigm demonstrated carryover effects at the ANS levels from one state to the next for both groups.

Adult↗
PubMed1990

Sensitization and kindling perspectives for the course of affective illness: toward a new treatment with the anticonvulsant carbamazepine.

Successive episodes of affective illness often show an accelerating frequency of recurrence. Two very different preclinical models (behavioral sensitization to psychomotor stimulants and electrophysiological kindling) may be used as indirect analogies or non-homologous models for conceptualizing mechanisms underlying the progressive and evolving aspects of manic-depressive illness. These models focus on phenomena involved in the longitudinal course of illness and on novel treatment implications. Literature is reviewed on the acute and long-term effectiveness of the anti-convulsant carbamazepine, particularly in treatment of lithium-refractory bipolar illness. Potential mechanisms of carbamazepine's acute anticonvulsant and antinociceptive and delayed psychotropic actions are discussed. alpha-2 adrenergic and peripheral-type benzodiazepine receptors, and stabilization of type-2 sodium channels are likely involved in the anticonvulsant effects of carbamazepine. GABAB mechanisms are thought to be related to the antinociceptive but not anticonvulsant or psychotropic effects of carbamazepine. A large number of neurotransmitters remain candidates for the psychotropic effects and a novel animal model requiring chronic administration of carbamazepine in order to show efficacy is reported (Weiss et al., 1989). It is hoped that further understanding of the mechanism of action of the anti-convulsant agents in comparison and contrast with traditional psychotropic agents will help in generating new treatments and in uncovering the basic defects of manic-depressive illness.

Carbamazepine↗
PubMed1990

Factors associated with relapse during maintenance treatment of affective disorders.

Five case studies were selected from a group of 22 patients with affective illness who have been followed during carbamazepine prophylaxis in an NIMH naturalistic prospective followup study. They highlight several factors which may be associated with relapse during maintenance treatment: (1) noncompliance; (2) breakthrough episodes with dose reduction; (3) illness exacerbation during psychosocial stress; and (4) progressive emergence of the illness or tolerance to therapeutic effects of psychotropic medications. Attention to these factors may lead to new and better management, as illustrated in case 5. The utility of a life charting approach is emphasized in delineating past and present course of illness, considering the relevance of cycling pattern and past treatment efficacy in selection of present pharmacological interventions, and helping to formulate a multifactorial concept of the interplay of biological and psychosocial factors in the evolution or exacerbation of mood disorders. Clinical recommendations and new areas of study are offered for a more comprehensive approach to maintenance treatment of affective disorders.

Adult↗
PubMed1990

Addition of lithium carbonate to carbamazepine: hematological and thyroid effects.

In view of the increasing use of lithium-carbamazepine combination therapy for refractory psychiatric disorders, the authors assessed the clinical laboratory effects of adding lithium to carbamazepine in 23 patients with affective disorders. Lithium produced a robust reversal of carbamazepine-induced leukopenia, increasing WBCs, predominantly neutrophils, to levels significantly above placebo baseline values. The combination produced additive antithyroidal effects, resulting in greater decreases in T4 and free T4 than with carbamazepine alone; the addition of lithium was associated with the emergence of a modestly higher TSH level. The authors discuss clinical and theoretical implications of these findings.

Adult↗
PubMed1990

Non-lithium treatment for bipolar disorder.

Lithium carbonate is the drug of choice for the management of bipolar disorder, but 20% to 40% of patients do not exhibit adequate response to this agent. Moreover, adjunctive therapy with tricyclic antidepressants and monoamine oxidase inhibitors (for depression) and neuroleptics (for mania) is widely prescribed in most lithium clinics. These agents, however, may precipitate or exacerbate the subsequent phase of the illness. More recently, carbamazepine, an anticonvulsant drug, has shown promise in the management of bipolar illness. Used either alone or in combination with lithium, carbamazepine has been associated with a response rate of approximately 65% in more than 500 patients enrolled in controlled and uncontrolled studies. The drug's antimanic effects have been clearly demonstrated, but its antidepressant effects must undergo further examination. Other anticonvulsants (such as valproate) appear highly effective. The high-potency benzodiazepines (such as clonazepam) and calcium channel blockers (such as verapamil) are also being evaluated in this patient population.

Anticonvulsants↗
PubMed1990

Carbamazepine prophylaxis in refractory affective disorders: a focus on long-term follow-up.

Twenty-four patients with refractory affective disorders who were taking carbamazepine were followed in an open-label fashion for an average of 4 years. Carbamazepine, usually in combination with lithium and other previously ineffective medications, reduced the number and severity of manic and depressive episodes. An overall illness index of morbidity (duration x severity) decreased 72% in the first year and 66% in the second year of carbamazepine treatment. One-half of the patients (N = 11) who were followed for more than 2 years showed a pattern of continued improvement (stable); the other half showed loss of prophylaxis (escape). Those showing the escape pattern had a more rapidly deteriorating course of illness in the 4 years before the study than those showing the stable improvement. Clinical and mechanistic implications of these findings are discussed, including the phenomenon of contingent tolerance as a possible explanation for the emergence of loss of efficacy in a subgroup of patients.

Adult↗
PubMed1990

Treatment of rapid cycling bipolar illness.

Rapid cycling patients (greater than or equal to 4 episodes/year) often show inadequate response to lithium carbonate and are vulnerable to antidepressant-induced switches or cycle acceleration. Treatment with the anticonvulsant carbamazepine is now an accepted adjunct or alternative, and a series of uncontrolled studies also suggest the utility of valproate in this patient population. Clonazepam, suppressive doses of thyroid, calcium channel blockers, and other innovative treatments appear promising and deserve careful clinical investigation.

Bipolar Disorder↗
PubMed1990

Carbamazepine retards the development of cocaine-kindled seizures but not sensitization to cocaine-induced hyperactivity.

The effects of chronic carbamazepine on cocaine-kindled seizures and behavioral sensitization were examined in this study. Rats were fed a diet containing carbamazepine or no drug and then repeatedly administered cocaine (40 and 50 mg/kg intraperitoneally [IP] [117.6 and 147.0 mumol/kg, respectively]). Carbamazepine markedly decreased the development of cocaine-kindled seizures and their associated lethality, but did not affect the development of sensitization of behavioral stereotypies. Carbamazepine consistently decreased the peak stereotypy ratings at the 40 mg/kg but not 50 mg/kg dose. In a 2-day sensitization paradigm chronic carbamazepine did not affect acute cocaine-induced hyperactivity (day 1; 40 mg/kg), nor did it affect sensitization to a low dose challenge of cocaine (day 2; 10 mg/kg [29.4 mumol/kg]). Sensitization of stereotypy and locomotor activity are thought to be related to the psychomotor stimulant properties of cocaine, while seizures may be associated with cocaine's local anesthetic effects. Our data suggest that carbamazepine is inhibiting mechanisms associated with local anesthetic kindling and only minimally affecting the psychomotor stimulant effects of cocaine.

Animals↗
PubMed1989

Adenosinergic modulation of caffeine-induced c-fos mRNA expression in mouse brain.

The adenosine receptor antagonist, caffeine, transiently induced proto-oncogene c-fos mRNA in mouse brain in a dose-dependent fashion. In situ hybridization revealed that caffeine-induced c-fos expression was high in caudate-putamen and olfactory tubercle at both subconvulsive and convulsive doses. The pattern of c-fos mRNA distribution following caffeine administration differs from that reported after seizures induced by electroconvulsive shock (ECS) or other chemical convulsants, and closely parallels the distribution of adenosine A2 receptors. Furthermore, the potent adenosine A2 receptor agonist, 5'-N-ethylcarboxamide adenosine (NECA) blocked caffeine-induced c-fos expression whereas the adenosine A1 receptor ligand, N6-cyclohexyladenosine (CHA), had no effect. This study suggests that the caffeine-induced expression of c-fos mRNA may be mediated by the adenosine A2 receptor in mouse brain.

Animals↗