Biomedical subjects
Publications and source records attributed to W H Wilson.
Twenty-three patients who completed a four-week, double-blind, clinical trial of bromperidol versus haloperidol were treated with bromperidol for eight additional weeks in a continuation study. Over 87 percent of patients maintained their improved status or showed further improvement. Extrapyramidal signs were frequent, but required discontinuation of treatment in only two patients.
Amoxapine, a tricyclic dibenzoxazepine is an antidepressant which in the dosage range of 150-300 mg/day is notable for its rapid onset of action. Because of the rather long, approximately 30-hour, half-life of 8-hydroxyamoxapine, the active metabolite of amoxapine, the possibility was raised that amoxapine therapy may be carried out with single daily dosages. Such a dosage schedule may improve compliance and, if appropriately timed, decrease perception of some of the unwanted effects of the drug. To test the hypothesis that there may be no disadvantages and perhaps even advantages of a once-a-day regimen as compared to a divided dosage schedule, a 6-week double-blind clinical trial was carried out in 35 hospitalized patients with major (18 patients) and minor (17 patients) depressive disorders. While no statistically significant difference was found in overall therapeutic and adverse effects between the groups treated with single or divided daily doses, onset of therapeutic effect appeared a bit faster in the group treated with single daily doses. Of particular relevance for drugs which can be given in single daily doses is their effect on psychomotor performance tests. In view of the findings that a once-a-day dosage regimen with amoxapine may have advantages over divided daily doses, a second study was carried out in which the effects of amoxapine (50 and 100 mg) were compared to an inactive placebo and amitriptyline (50 mg) with and without ethanol in 8 normal male volunteers. The study was double-blind and followed a latin square design. Since the effects of amoxapine on motor reflex, visual-motor coordination and depth perception did not differ significantly from placebo, the results suggest that the effects of amoxapine on the performances measured are clinically insignificant. No significant interaction with ethanol was noted.
In a multicenter series of trials, viloxazine was compared with imipramine, amitriptyline, doxepin and placebo in 123 neurotic and endogenous depressive inpatients and outpatients. While significant period effects reflecting improvement were obtained on the majority of efficacy variables, no significant differences were obtained among the treatment groups or depressive types. Imipramine and amitriptyline exhibited more anticholinergic adverse reactions; while, viloxazine exhibited greater CNS effects. Dizziness and nausea were much more frequent in neurotic depressives which may be related to their psychopathology.
There is evidence to indicate that 15% of patients diagnosed as schizophrenic will become chronically hospitalized, and that worldwide one-third to one-half of all psychiatric beds are occupied by schizophrenic patients. In spite of these figures and the public health problem they represent, little attention is paid to chronic hospitalized schizophrenic patients. Even the most recent classification schemas fail to recognize the heterogeneity, exemplified by differential responsiveness to psychotropic drugs, within the chronic schizophrenic population. One systematic approach to classification which does address this problem has been proposed by Leonhard. In this paper, findings and procedures that demonstrate the clinical relevance of Leonhard's system along with some preliminary results and observations from psychopharmacological studies that indicate Leonhard's different subtypes of chronic schizophrenia may represent biologically distinct populations are presented.
In a double-blind clinical trial with 20 patients suffering from endogenous depression statistically significant changes (improvement) were present in the scores of all assessment instruments. Although no statistically significant differences occurred between the groups, significant improvement on the HAM-D occurred earlier for amitriptyline and significant improvement occurred earlier on HAM-A for viloxazine. 2 patients were discontinued due to adverse reactions; one for nausea and vomiting while receiving viloxazine and one for paroxysmal atrial tachycardia while receiving amitriptyline. The same number of TES occurred for each group with seven unique to viloxazine (numbness, tingling, palpitation, ejaculation difficulty, nausea/vomiting, diarrhea, epigastric pain and gustatory disturbances) and seven unique to amitriptyline (insomnia, irritability, syncope, tremor, nasal congestion, orthostatic hypertension and paroxysmal atrial tachycardia). Other than for 1 patient who developed syncope and orthostatic hypotension and the patient who developed paroxysmal atrial tachycardia, there were no clinically significant changes in pulse rate, blood pressure and weight. There were no clinical laboratory findings with either drug that were judged to be pathological.
In a four week, double-blind clinical trial, 20 patients with endogenous depression were randomly assigned to treatment with either viloxazine or imipramine. Statistically significant improvement was observed on the Hamilton Psychiatric Rating Scales for Depression and Anxiety for both treatment groups. There were no differences between the two treatment groups in the type, incidence, or severity of treatment emergent symptoms. No medication-related abnormalities in clinical laboratory values occurred in either treatment group.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The right to refuse medication is a legal right now being extended by federal courts to many voluntary and involuntary mental patients. However, little is known of the insight that chronically ill mental patients bring to the decision of whether or not to accept prescribed medication. In this study, the authors interviewed 45 chronic schizophrenic inpatients to determine their understanding of their illness, need for admission, and need for medication and other treatment. Only 13 per cent understood they were mentally ill, and only 27 per cent of the patients understood that they needed medication. The findings suggest that many chronically mentally ill patients lack sufficient insight into their condition to make sound judgments about medication and treatment. Moreover, even those patients who improved with medication did not improve in their insight into their need for treatment.
In a six-week, double-blind clinical study of 35 hospitalized patients with the diagnoses of endogenous depression (18 patients) and depressive neuroses (17 patients), two dosage schedules of amoxapine were compared. While no statistically significant difference in overall therapeutic and adverse effects between the groups treated with single daily doses and divided daily doses were found by the end of the six weeks investigational period, onset of therapeutic effect was faster in the group treated with single daily doses. There was a significantly greater improvement in Anxiety-Somatization and Sleep Disturbance (HAM-D factors) in the group with depressive neurosis than in the group with endogenous depression.
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Mianserin hydrochloride is a tetracyclic antidepressant with an EEG and clinical activity profile similar to amitriptyline. To investigate the drug's optimal dosage range, a 6-week open comparative trial sequentially assigned 12 depressed patients to one of three dose ranges (60, 90 and 120 mg). Improvement occurred in depressive symptomatology in all three treatment groups. There was no differential improvement noted in any group; however, the incidence of adverse effects was greater in the middle (90 mg) and high (120 mg) dose ranges.
In animal pharmacological studies viloxazine has shown similarities to imipramine. The antidepressant effects of the substance were independently recognized in seven uncontrolled clinical trials and verified in 11 published standard controlled clinical studies in which viloxazine in the dosage range from 150- to 300-mg dosage was equal in overall therapeutic efficacy to imipramine and amitriptyline, but produced a lower incidence of side effects.
Amoxapine, a new antidepressant, is a tricyclic debenzoxazepine compound, the demethylated metabolite of the neuroleptic loxapine. In animal pharmacological studies, amoxapine has shown striking similarities to imipramine. In contrast to the prototype antidepressant drug, however, amoxapine does not interact with serotonin. In 10 uncontrolled clinical trials amoxapine was shown to have antidepressant effects in the dosage range of 100-300 mg/day. This was verified in 10 published standard, and placebo and standard controlled clinical studies in which amoxapine was superior to placebo and equal in overall therapeutic efficacy to imipramine and amitriptyline. Side effects were similar to the reference drugs.
In a 4-week double-blind trial, 33 patients with depressive neurosis were randomly assigned to either viloxazine, imipramine or placebo. Statistically significant improvement was observed in all treatment groups. Imipramine exhibited significant improvement earlier in depressive symptoms, while viloxazine showed significant improvement earlier in anxious symptoms. The same frequency of treatment emergent symptoms occurred in the treatment groups. Premature termination as a consequence of adverse reactions was required in only 1 viloxazine and 1 placebo patient.