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Biomedical subjects

Shigehiro Hirose

Publications and source records attributed to Shigehiro Hirose.

4 recordsLinked to original sources
PubMed2003

The causes of underdiagnosing akathisia.

This article reviews what causes clinicians to overlook or underdiagnose akathisia. The causes are considered to be related to both the patient's symptoms and the clinician's attitude toward akathisia. The patient factors include mild severity of akathisia, lack of apparent motor restlessness, no voluntary expression of inner restlessness, no clear communication of inner restlessness, restlessness in body parts other than the legs, atypical expressions of inner restlessness, other prominent psychic symptoms, and absence of other extrapyramidal signs. The clinician factors include emphasis on objective restlessness, failure to consider akathisia during antipsychotic therapy, failure to fully implement antiakathisia treatments in ambiguous cases, and strict adherence to research diagnostic criteria. Akathisia is likely to be overlooked or underdiagnosed when both patient and clinician factors are present. Currently, there may be two major problems with underdiagnosis: (1) symptoms that fulfill the diagnostic criteria for akathisia are overlooked, and (2) conditions that do not fulfill the diagnostic criteria but can still benefit from antiakathisia measures are underdiagnosed.

Antipsychotic Agents↗
PubMed2002

Immediate effect of intravenous diazepam in neuroleptic-induced acute akathisia: an open-label study.

BACKGROUND: Neuroleptic-induced akathisia can be severely distressing to some patients. and rapid treatment would be preferable. However, there have been relatively few studies conducted regarding the rapid treatment of akathisia. The effect of intravenous diazepam at the beginning of treatment for akathisia was studied in an open clinical trial. METHOD: The subjects were 18 patients with schizophrenia or bipolar I disorder (DSM-IV criteria) who developed neuroleptic-induced acute akathisia during antipsychotic medication and who required immediate relief from the distress of akathisia. Diazepam was given intravenously to the patients at a rate of 5 mg per 30 seconds. RESULTS: All 18 subjects experienced immediate relief from akathisia after the injection of diazepam (mean +/- SD dose = 12.6 +/- 2.6 mg; range, 10-17 mg). They reported no serious adverse effects. CONCLUSION: The results suggest that intravenous diazepam could be used in the treatment of patients with severely distressing akathisia who require immediate relief.

Acute Disease↗
PubMed2002

An open pilot study combining risperidone and a selective serotonin reuptake inhibitor as initial antidepressant therapy.

BACKGROUND: Atypical antipsychotics such as risperidone or olanzapine have been reported to be effective when added to a selective serotonin reuptake inhibitor (SSRI) in cases of depression in which treatment with an SSRI alone is not effective. It is possible that the combination of an SSRI and an atypical antipsychotic may be efficacious as an initial treatment for major depression. METHOD: Thirty-six subjects who fulfilled DSM-IV diagnostic criteria for major depressive disorder were given fluvoxamin, 50 or 75 mg/day, with risperidone, 0.5 or 1 mg/day, at the start of treatment. The dose of fluvoxamine was increased to 100 or 150 mg/day on the fourth day of the treatment and maintained thereafter. Hamilton Rating Scale for Depression (HAM-D) scores were obtained at base-line and every week for 6 weeks. Remission and response were defined, respectively, as > or = 75% and 50%-74% reduction from baseline in HAM-D score. RESULTS: Of 30 subjects who completed the 6-week study, 23 (76%) achieved remission, 5 (17%) achieved response, and 2 (7%) were nonresponsive. Of the 6 patients who did not complete the study, 3 showed remission, 1 showed response, and 2 showed minimal or no response by the time of dropout. The reported adverse effects were mild, and none of the 36 subjects enrolled in the study manifested or reported extrapyramidal symptoms, nausea, or vomiting. CONCLUSION: The results suggest that the combination of risperidone and fluvoxamine from the beginning of antidepressant therapy enhances the therapeutic response rate in depression.

Adolescent↗