Phencyclidine and the dissociatives.
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Biomedical subjects
Publications and source records attributed to W A Price.
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The relationship between premenstrual tension syndrome and dietary intake was studied in a population of 20 young adult women. Caloric intake was measured during the 10 days preceding and following the menstrual cycle. Those women with more severe symptoms recorded a greater increase in caloric intake. Caloric intake during the premenstrual period also increased with age. It is hypothesized that this caloric intake may be due to increased beta-endorphin levels.
Patients with phencyclidine psychosis were treated with two 50 mg injections of either chlorpromazine (N = 10) or meperidine (N = 10). The chlorpromazine-treated group responded more rapidly, but the meperidine-treated group had greater overall improvement. It is suggested that meperidine may have a role in the emergency treatment of phencyclidine psychosis. These findings may provide support for the hypothesis that dopaminergic psychosis is mediated by opioids.
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Volunteers (N=71) with premenstrual syndrome (PMS) were given the Peck-Abraham PMS Questionnaire and separated by resulting scores into mild, moderate, and severe groups. Fourteen subjects were randomly selected from each group. Pseudocholinesterase serum levels were measured on the first day of menses for all group members. Trait anxiety was measured by the State Trait Anxiety Inventory (STAI). Pseudocholinesterase, a possible marker for trait anxiety, was found elevated in 6 of 14 (43%) of the severe PMS subjects, in 2 of the 14 (14%) moderate PMS subjects, and in none of the mild PMS subjects. Trait anxiety was found in 8 of these subjects. None of the subjects with mild PMS showed trait anxiety, while 25% of those with moderate PMS and 75% of those with severe PMS showed trait anxiety. No subject with mild PMS had trait anxiety. In this study PMS is treated as a trait-dependent form of anxiety.
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Phencyclidine has a wide range of deleterious effects. Drug users may not even know that they have taken PCP since it is so easily disguised. Physicians should look for decreased reality testing, erythema, dry skin and other manifestations. The varied signs and symptoms of acute intoxication can be dealt with quickly and effectively. Management strategies include acidification of the urine and diuresis, as well as more specific antidotes, depending on the neurotransmitter system most affected.
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The authors propose that premenstrual tension syndrome (PMS) is the result of beta-endorphin withdrawal. Sixteen women were included in this study which measured beta-endorphin levels on the 7th and 24th day of each woman's menstrual cycle. A significant decline in beta-endorphin levels was noted during the progression of the cycle. The severity of symptoms, however, was inversely proportional to the amount of decline in beta-endorphin levels. It is hypothesized that the attenuation of endorphin decline may be a compensatory mechanism to moderate the severity of PMS symptoms.
When the authors compared the antimanic effects of verapamil, lithium carbonate, and placebo, no differences were seen between lithium and verapamil and both were more effective than placebo in reducing symptoms. No major side effects emerged during the study.
Of 32 patients with unipolar or bipolar affective disorder, significantly more bipolar patients had mitral valve prolapse. The prevalence of mitral valve prolapse among bipolar patients was also significantly greater than that in the general population.
Two patients are described who experienced seizures while on therapeutic doses of amoxapine. It is suggested that the structural similarities of amoxapine to the neuroleptics may account for side effects similar to the neuroleptic compounds, including seizures. Caution is encouraged in prescribing amoxapine to patients with a history of seizure disorder.
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Danazol is a widely used drug that causes few major adverse reactions, most of which are rapidly reversible upon cessation of therapy. While the list of pharmacologic agents capable of causing hearing loss continues to grow, no published reports have ever implicated danazol. We treated a patient for bilateral sensorineural hearing loss due to danazol therapy. The hearing loss resolved promptly after withdrawal of the medication.
Verapamil, a potent calcium antagonist, possesses varied systemic effects, including smooth muscle relaxation leading to both peripheral and coronary artery vasodilation, slowed atrioventricular nodal conduction and decreased insulin release from the pancreatic B cells. Reports concerning the effects of acute intoxication with verapamil are scarce. A case is presented of a 22 year old woman who developed profound hyperglycemia and metabolic acidosis after the inadvertent overdose of thirty 80 mg tablets (2,400 mg) of verapamil. This case illustrates the need for physicians to be aware of verapamil's inhibitory effects on insulin release and to exercise special care when prescribing verapamil in patients with preexisting diabetes mellitus.
As the divorce rate climbs, more and more children are affected by divorce. For some of these children, the personal losses they suffer are too great to overcome. Young children are particularly vulnerable to feelings of guilt, shame, inferiority, and distrust, which may lead to more serious problems later in life. Dr Price and colleagues offer suggestions to primary care physicians on counseling children of divorce and their parents, with emphasis on a holistic, empathic approach to therapy.
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