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PubMed2000

Fluphenazine levels during maintenance treatment of recent-onset schizophrenia: relation to side effects, psychosocial function and depression.

RATIONALE: The utility of fluphenazine levels during maintenance treatment of schizophrenia is still unclear. OBJECTIVES: This study investigated the relationship between fluphenazine levels and a variety of clinical measures during maintenance treatment of schizophrenia. METHODS: Fluphenazine levels, side effects, depression and psychosocial outcome were measured at five time points over approximately 1 year in 59 recent onset schizophrenic patients treated with a maintenance dose of injectable fluphenazine decanoate. Negative symptoms were evaluated at the 1-year endpoint. RESULTS: Fluphenazine levels showed marked intraindividual variability even when measurements were restricted to the second 6 months of treatment, by which time steady state levels should have been achieved. No consistent relationship was found between fluphenazine levels and any of the outcome measures. CONCLUSIONS: The results of this study suggest that fluphenazine plasma levels do not routinely add relevant clinical information beyond that of dose in evaluating potential side effects or negative consequences during maintenance treatment with the decanoate form of the medication.

Adult↗
PubMed1999

Biological Control of Water Hyacinth Under Conditions of Maintenance Management: Can Herbicides and Insects Be Integrated?

/ We hypothesized that repeated herbicidal (maintenance) control of water hyacinth infestations in Florida suppressed biological control agent populations, especially the weevils Neochetina eichhorniae and N. bruchi. We therefore sampled water hyacinth and weevil populations at 54 sites distributed statewide. Half were under maintenance control, half were not treated with herbicides. General site conditions were assessed, demographic data were collected on weevil and plant populations, the reproductive condition of the weevils was determined, and plant nutrient and proximate composition of water hyacinth leaves were analyzed. Water hyacinth infestations under maintenance control were minimal when compared to unmanaged sites. Likewise, on a population basis, all weevil cohorts were much lower due to the paucity of plants. Plants at unmanaged sites, where weevil intensities were much higher, suffered high levels of stress and showed low growth potential. Lower percentages of the female weevils were reproductive at unmanaged sites when compared to managed sites, so densities of reproductives and immatures were similar at both site types. Reproductive status of the weevils improved with increased plant quality. Plant quality, in turn, declined as stresses arising from weevil feeding increased. Plant quality was positively correlated with plant growth potential and flower production. Thus, maintenance control improved plant nutritive quality thereby inducing reproductive vigor of the weevils, but ensuring plant regrowth and the need for future control. This suggests that biological and herbicidal controls should be integrated, using herbicides to maintain water hyacinth infestations below management thresholds but in a manner that conserves biological control agent populations. This approach would lead to improved plant nutritional quality that would, in turn, stimulate reproduction in biological control agent populations. KEY WORDS: Eichhornia crassipes; Neochetina eichhorniae; Neochetina bruchi; Phytophagy; Integrated control; Aquatic weeds

Journal Article↗
PubMed2001

Effectiveness of targeted intervention and maintenance pharmacotherapy in conjunction with family intervention in schizophrenia.

A sample of 85 patients with schizophrenia, of whom 34 later dropped out, received randomised treatment. There were no significant differences between treatment-takers and drop-outs in the variables assessed. Patients received either standard-dose maintenance neuroleptic treatment or targeted maintenance pharmacotherapy and all patients received behavioural family therapy. Measures of psychopathology, social adjustment, side-effects, family burden, and expressed emotion were assessed at baseline and then periodically over an 18-month period. The study was designed to compare the two alternative pharmacological maintenance approaches, each of them supported by psychosocial intervention. Any evaluation of the impact of behavioural family treatment on relapse rates and other outcome criteria is exclusively descriptive. A significantly higher rate of relapse was observed at 18 months in patients randomised to targeted treatment compared to those randomised to standard-dose treatment (35% vs 4%). Although patients assigned to the targeted maintenance group received significantly lower mean doses of neuroleptics, there were no significant differences between the two groups with regard to side-effects, global measures of social function, and overall psychopathology. Family burden was higher in the targeted-treatment group at six months, but did not differ at the one-year and eighteen-month time points. However, both groups improved significantly from baseline to 12 or 18 months in almost all variables assessed. Thus, the behavioural family approach did not compensate for the problems associated with the targeted medication strategy.

Adolescent↗
PubMed2003

Cardiovascular calcifications in pediatric patients receiving maintenance dialysis.

Cardiovascular disease is a major cause of morbidity and mortality in adult patients with end-stage renal disease receiving maintenance dialysis. Coronary artery calcifications (CAC) contribute to the high prevalence of cardiac disease and are associated with hyperphosphatemia, an elevated calcium-phosphorus product (CaxP), and prolonged time on dialysis. Chronic inflammation and malnutrition are also associated with an increased risk for development of cardiac calcifications. Young adults receiving maintenance dialysis develop cardiac calcifications at a degree out of proportion to healthy adults of the same age and gender. Many of these young adults initiated dialysis as children or teenagers. Risk factors associated with the development of CAC are also seen in the pediatric dialysis population. To date, reports of cardiac calcifications in pediatric patients receiving maintenance dialysis are limited to post-mortem studies. We present two pediatric patients with ANCA-positive vasculitis diagnosed with cardiac calcifications while receiving maintenance dialysis. Hyperphosphatemia and an elevated CaxP product were seen in both patients and probably contributed to the development of extraskeletal calcifications. In addition, both patients had an underlying systemic inflammatory disease and significant weight loss/malnutrition that may have contributed to the early and rapid onset of cardiac calcifications.

Adolescent↗
PubMed2004

Relationship of acute mania symptomatology to maintenance treatment response.

Most treatment of bipolar disorders addresses maintenance objectives. In the past 4 years, several large, blinded, randomized, placebo-controlled maintenance studies involving more than 3000 patients with bipolar I illness have been published, with analyses of background, symptomatic, and acute treatment factors contributing to maintenance effectiveness. This article summarizes these findings. Generally, indices of greater severity predict lower response rates to most monotherapy treatments. Some findings have been unexpected. Mixed mania did not predict different maintenance response to divalproex or lithium but predicted more side effects with either drug, and reduced efficacy of olanzapine or lamotrigine.

Acute Disease↗
PubMed1986

Maintenance therapy of duodenal ulcer with famotidine. A multicenter United States study.

The decision to treat a patient with duodenal ulcer should be based upon the following: severity of disease; effectiveness of treatment; and risk and cost of treatment. A number of drugs are effective for this condition. When administration of the drug is discontinued, a recurrence of the ulcer occurs most often within three months, with the rate approaching 90 percent at one year. Maintenance therapy has evolved as a method of preventing recurrence. A double-blind, randomized, multicenter study was done to compare 40 mg of famotidine at bedtime, 20 mg of famotidine at bedtime, and placebo in the maintenance treatment of patients with recently healed duodenal ulcer. In 37 centers in the United States, 303 patients received randomly allocated treatment with 40 mg of famotidine at bedtime (107 patients), 20 mg of famotidine at bedtime (97 patients), or placebo (99 patients). The treatment groups were comparable as to the risk factors and other characteristics. Esophagogastroduodenoscopies were scheduled at three, six, and 12 months of treatment. Additional endoscopies could be done at any time if symptoms suggested a relapse. Cumulative relapse rates were significantly lower in the famotidine groups than in the placebo group at all time points (p less than 0.01). The cumulative life-table relapse rates at three, six, and 12 months were 9.2, 20.9, and 24.8 percent for the 40-mg famotidine group; 13.5, 16.1, and 23.3 percent for the 20-mg famotidine group; and 39.3, 51.5, and 56.8 percent for the placebo group. No significant difference between the two famotidine groups was observed. Within each period, the relapse rate was lower with famotidine than with placebo. Famotidine is more effective than placebo as maintenance therapy. It is generally well tolerated for periods of up to one year. A dose of 20 mg at bedtime is proposed as the maintenance dose. Fewer relapses occurred in non-smokers, in females, and in patients in whom healing occurred with placebo. More relapses occurred in patients under 40 years of age, patients with a long ulcer history, or patients who were younger than 40 years of age at onset of ulcer disease.

Adult↗
PubMed1994

Persistent effects of antidepressants: EEG sleep studies in depressed patients during maintenance treatment.

Electroencephalographic (EEG) sleep studies represent a research tool that can be used to examine depressed patients over different phases of their illness. We examined the long-term effects of imipramine on EEG sleep in 27 subjects who completed 3 years of maintenance treatment on imipramine without experiencing a recurrence. The analyses were performed on EEG sleep data collected prior to acute treatment, after 3 months in maintenance, and every 3 months thereafter. The major aim was to examine specific changes in rapid eye movement (REM) and slow-wave sleep (SWS) as they unfolded over the course of illness and recovery during long-term drug maintenance. The acute changes in the sleep profile produced by antidepressants remained essentially the same throughout the entire period of drug administration. The REM sleep parameters, which were affected immediately, remained essentially unchanged thereafter, even as long as 3 years into maintenance treatment. A rapid redistribution of slow-wave sleep in the first part of the night was also observed without an increase in the total amount of slow-wave sleep throughout the night. The application of spectral analysis confirmed that the sleep changes following drug administration remained stable throughout all phases of drug treatment. Thus, it appears that sustained clinical improvement is accompanied by persistent sleep alterations on tricyclic antidepressant medication.

Adult↗
PubMed1989

Ischaemia-induced and reperfusion-induced arrhythmias differ in their sensitivity to potassium: implications for mechanisms of initiation and maintenance of ventricular fibrillation.

The effects of four different K+ concentrations (2, 4, 6 or 8 mM) on arrhythmias resulting from ischaemia, and from reperfusion (after 3, 5, 7, 10, 15 or 30 min of ischaemia), in isolated perfused rat hearts were examined. A randomized experimental design with blind analysis was used. Regional myocardial ischaemia was produced by occlusion of the left main coronary artery. The incidence of ischaemia-induced ventricular fibrillation (VF) was inhibited by elevating K+ concentration, as reported previously. Furthermore, this effect was linearly and inversely related to the log of the K+ concentration (r = 0.99, P less than 0.001), a finding which has not been reported previously. This finding implies that the antiarrhythmic effect may result from depolarization in the non-ischaemic tissue, since resting membrane potential is also linearly related to the log of the K+ concentration. The maintenance of ischaemia-induced VF (its tendency to sustain) was also influenced by K+, in that a significantly higher incidence of sustained VF (defined as VF still present at the end of the period of ischaemia) was seen with 2 mM K+ compared with higher K+ concentrations (P less than 0.05). In contrast with its effect on the incidence of ischaemia-induced VF, K+ was without effect on the incidence of reperfusion-induced VF, indicating that reperfusion initiates VF independently of the K+ concentration in the perfusion fluid. However, the maintenance of reperfusion-induced VF was K+-dependent (in a similar manner to the maintenance of ischaemia-induced VF). In summary, the effects of K+ on ischaemia-induced VF were different from its effects on reperfusion-induced VF. We conclude that ischaemia-induced VF and reperfusion-induced VF are unlikely to be initiated by a common electrophysiological mechanism since only the former was influenced by K+. The mechanisms of maintenance of ischaemia-induced VF and reperfusion-induced VF might, however, be common, since the tendency for spontaneous defibrillation to occur (as reflected by the incidence of sustained VF) was equally sensitive to K+ in both settings. Finally, the nature of the time course of susceptibility to ischaemia-induced VF compared with that of reperfusion-induced VF raises the possibility that the reperfusion-induced VF may be clinically relevant as a cause of sudden death only when ischaemia-induced VF is suppressed.

Animals↗
PubMed1994

Design of a desipramine dosing regimen for the rapid induction and maintenance of maximal cortical beta-adrenoceptor downregulation.

Chronic administration of desipramine to rats causes a gradual reduction in cortical beta-adrenoceptor density. We examined the relationship between the duration of treatment with desipramine, and the rate and intensity of cortical beta-adrenoceptor downregulation. Male Sprague-Dawley rats were administered a 3.75 mg/kg/12 hr dose of desipramine for 4, 8 or 16 days. After 4 and 8 days of treatment, cortical beta-adrenoceptor density was reduced by 14 and 26% respectively. After 16 days of treatment, cortical beta-adrenoceptor density was maximally reduced by 36%. In our next series of experiments, we tested the hypothesis that the dose of desipramine required to rapidly induce maximal beta-adrenoceptor downregulation was higher than the dose required to maintain maximal beta-adrenoceptor downregulation. Initially, cortical beta-adrenoceptors were rapidly, and maximally downregulated with a four day, 10 mg/kg/12 hr induction regimen of desipramine. Trough, steady-state brain/cortical concentrations of desipramine plus desmethyldesipramine at the end of this regimen were approx 4000 ng/gm. Subsequently, maintenance desipramine regimens of 3.75 mg/kg/12 hr and 1.87 mg/kg/12 hr or vehicle were initiated for the next four days. Inspite of a 20-fold drop in brain/cortical concentrations of desipramine plus its metabolite, the 3.75 mg/kg maintenance regimen sustained maximal cortical beta-adrenoceptor downregulation. The 1.87 mg/kg maintenance regimen did result in a marked (25%) but non-significant recovery in the density of beta-adrenoceptors. Animals administered a vehicle maintenance regimen showed a large (50%) and statistically significant recovery of cortical beta-adrenoceptor density.

Animals↗
PubMed1996

The composition of the maintenance diet alters flavor-preference conditioning by intragastric fat infusions in rats.

Prior studies indicate that intragastric (IG) fat infusions condition only weak flavor preferences in chow-fed rats using brief daily training sessions. The present study attempted to facilitate fat conditioning by feeding rats a high-fat maintenance diet or by adding an oily flavor to the conditioning stimuli. In Experiment 1, rats were fed restricted rations of either a chow-corn oil mixture (48% energy as fat, HF group) or regular chow (12% fat, LF group). During 1-bottle training sessions, drinking a flavored (CS+, e.g., cherry) saccharin solution was paired with IG fat (7.1% corn oil emulsion). On other days, an alternate flavor (CS-, e.g., grape) was paired with IG water. In subsequent 2-bottle tests between the CS+ and CS- flavors, the HF rats displayed a stronger CS+ preference than the LF rats (90% vs. 62%). Experiment 2 tested the effect of a semisynthetic HF maintenance diet (48% fat energy), using a conditioning procedure similar to that of Experiment 1. The rats displayed only a moderate (72%) CS+ preference. When switched to the chow-oil maintenance diet and retrained with new CS flavors, they developed a 90% CS+ preference. In Experiment 3, chow-fed rats were trained and tested with oily CSs (i.e., 2% corn oil was added to flavored saccharin solutions). They failed to show a preference for the CS+ paired with IG oil. Thus, increasing the level of fat in the maintenance diet can greatly enhance preference conditioning with IG fat, but the amplitude of the effect is influenced by the composition of the high-fat food. In contrast, adding a fatty flavor to the conditioning stimuli did not improve fat conditioning.

Animals↗
PubMed1987

Extrapulmonary effects of maintenance corticosteroid therapy with alternate-day prednisone and inhaled beclomethasone in children with chronic asthma.

Extrapulmonary effects of alternate-day prednisone and inhaled beclomethasone dipropionate therapy were examined in 24 and 32 children with asthma, respectively. Early morning serum cortisol values were significantly lower among patients receiving alternate-day prednisone than among patients receiving inhaled beclomethasone dipropionate and control subjects at 24 hours but not at 48 hours after an alternate-day prednisone dose. Urinary-free cortisol output during the second 24 hours of the alternate-day prednisone regimen were similar to values among patients receiving inhaled beclomethasone and were significantly lower than among control subjects for both groups. Mean heights among patients before being placed on maintenance corticosteroids were at the thirty-fifth percentile and were similar for both regimens. This was significantly lower than initial measurements for control subjects who, on average, were near the fiftieth percentile for both children with asthma not requiring maintenance corticosteroids and normal healthy Iowa children. Mean heights for both corticosteroid-treated groups remained at the thirty-fifth percentile after more than a 2-year average duration of follow-up. Heights of children with chronic asthma not requiring maintenance corticosteroids were initially significantly higher (fifty-first percentile) than the patients who subsequently required maintenance corticosteroids and increased significantly to the sixty-first percentile during a mean 2.7-year follow-up. Heights of healthy Iowa children remained near the fiftieth percentile during a mean 7-year follow-up. Disproportionate weight gain, although it was not consistently present, was significantly more likely with the alternate-day prednisone. Other extrapulmonary effects of the corticosteroid regimens appeared not to be of clinical importance during the time period of the study.

Administration, Inhalation↗
PubMed1988

Survival in acute myeloblastic leukemia is not prolonged by remission maintenance or early reinduction chemotherapy. The Toronto Leukemia Study Group.

A role for post-induction chemotherapy for adult patients with acute myeloblastic leukemia in remission has not been established. We have studied 125 patients with acute myeloblastic leukemia in complete remission to determine the effect on survival of remission maintenance therapy and of early reinduction therapy given at the time of predicted imminent relapse. Following remission induction with 6-thioguanine, cytosine arabinoside and daunorubicin (TAD), all patients received consolidation therapy with these same three drugs. Forty-three patients were randomized to arm A, continuing chemotherapy; 40 patients were randomized to arm B, no further chemotherapy until morphological relapse; and 42 patients were randomized to arm C, no further chemotherapy until an increase in myeloblast associated antigens was detected in bone marrow by means of antimyeloblast heteroantisera. The median durations of complete remission, age adjusted, for the three groups are not significantly different: 15.7 months for group A, 16.2 months for group B and 14.1 months for group C. The age adjusted median survivals for the three groups are also not significantly different: 17.6 months for group A, 21.8 months for group B and 18.8 months for group C. Quality of life was determined to be superior for patients having no further maintenance therapy (arms B and C). We conclude that our patients receiving induction and consolidation therapy with TAD did not benefit from remission maintenance or early reinduction chemotherapy, and had an improved quality of life if no maintenance therapy was given.

Adolescent↗
PubMed1981

Psychosocial disability during maintenance hemodialysis.

Overall psychosocial functioning was assessed in 21 maintenance hemodialysis patients. The Ruesch Social Disability Scale, which provides an overall Social Disability (DS) score as well as subscores for Physical Impairment (PI), Behavioral Impairment (BI), and Social Modifiers (MS), was utilized. A majority of the patients (13) experienced Major Social Disability and the mean DS score of this sample was in the Major Social Disability range (mean = 52.1 +/- 10.9). There were no differences between the mean DS score of men and women. Married patients had DS scores significantly lower than those who were divorced or never married (P less than .05). Patients with more than five years of maintenance hemodialysis had a mean DS score significantly higher than those with less then five years of maintenance hemodialysis (P less than .03). In those patients with more than five years of hemodialysis, the MS scale was significantly elevated (P less than .01) in comparison with their counterparts, whereas the BI and PI scores were not different. The data suggest that serious psychosocial impairment is a common sequela of maintenance hemodialysis, especially for long-term patients and those who are not married. Therapeutic approaches directed toward improved social functioning are indicated.

Disability Evaluation↗
PubMed1993

Comparison of full-dose versus half-dose pharmacotherapy in the maintenance treatment of recurrent depression.

Recent evidence points to the prophylactic efficacy of maintaining recurrent unipolar patients on the same dose of antidepressant medication that was used to treat the acute episode (Frank et al., 1990; Kupfer et al., 1992). Therefore, the question of whether such patients should be tapered to a lower maintenance dose after successful resolution of an acute episode is clearly important. In this report we describe a small randomized clinical trial in which patients were assigned to either full-dose or half-dose maintenance treatment for a period of 3 years. Survival analysis suggests that superior prophylaxis can be achieved with a full-dose as compared to a half-dose maintenance treatment strategy (p < 0.07). Mean survival time for the full-dose subjects was 135.17 (SE 19.75) weeks as compared to 74.94 (SE 19.78) weeks (median of 43.1 weeks) for the half-dose subjects. We conclude that for patients who have suffered several recurrences, full-dose maintenance treatment is the more effective prophylactic strategy.

Adult↗
PubMed1995

Cost utility analysis of maintenance treatment for recurrent depression.

This paper presents a cost-utility analysis of three maintenance treatments for recurrent depression: interpersonal therapy (IPT-M), imipramine drug therapy (Drug), and a combination of the two. We base our analysis on the results of the University of Pittsburgh's Controlled Clinical Trial of Maintenance Therapies for Recurrent Depression. We construct a Markovian state-transition model to incorporate clinical effectiveness into cost and quality-of-life impacts; we assign empirical values to the parameters of this model; and we then use Monte Carlo analysis to compare the relative cost effectiveness of the different maintenance treatments. For the patients who met the eligibility standards for the study, Drug maintenance treatment is cost-effective in the strongest sense of the term compared to either a placebo group or IPT-M: it both improves expected lifetime health (measured in quality-adjusted life years, or QALYs) and reduces direct medical costs. This is true even when relatively severe side effects of the drug are considered. Compared to the placebo group, IPT-M and the combination of IPT-M and Drug each improve expected lifetime health, although in neither case are expected direct medical costs reduced. Still, the cost of the resulting health improvements, under $5000/QALY, are very reasonable. A similar conclusion holds comparing Drug and IPT-M to IPT-M alone. All of the above conclusions are quite robust to sensitivity analyses.

Adult↗
PubMed1995

Maintenance treatment with antibiotics in cystic fibrosis patients. Sense or nonsense?

The majority of patients with cystic fibrosis (CF) have chronic lung infection with a variety of organisms. It is accepted clinical practice to treat acute exacerbations of infection with appropriate oral or intravenous antibiotics. The aim of this paper is to review the use of maintenance antibiotics for these patients with chronic pulmonary infection. There is clinical trial evidence to support the use of maintenance treatment for patients chronically infected with Staphylococcus aureus or Pseudomonas aeruginosa. No such evidence is available in the case of Haemophilus influenzae or Burkholderia cepacia. Chronic infection with Staphylococcus aureus is commonly treated with maintenance oral flucloxacillin and chronic infection with Pseudomonas aeruginosa either with 3-monthly intravenous antibiotics or long-term aerosol antibiotics. Further clinical trials need to be performed on many aspects of maintenance treatment for CF patients with chronic pulmonary infection.

Aerosols↗
PubMed1993

Drug use, HIV risk-taking and psychosocial correlates of benzodiazepine use among methadone maintenance clients.

Methadone maintenance clients who used benzodiazepines were compared with other methadone maintenance clients on a range of drug use and psychosocial treatment outcome measures. Despite being on higher methadone doses, benzodiazepine users were more likely to have recently injected, to have used cocaine and amphetamines, to have borrowed or lent used needles and syringes, and to have reported polydrug use in the preceding month. Benzodiazepine users also exhibited higher levels of psychopathology and social dysfunction than other methadone maintenance clients. It is concluded that benzodiazepine-using methadone maintenance clients are a dysfunctional subgroup of the methadone population, who may require more clinical intervention than other clients.

Adolescent↗
PubMed1993

The medical status of methadone maintenance patients in treatment for 11-18 years.

To assess the safety and potential health consequences of long-term methadone maintenance treatment, we identified 111 male patients admitted to methadone maintenance treatment between 1965 and 1968, still enrolled in 1980 and in continuous treatment for at least 10 years. We were able, between 1980 and 1985, to examine patients or review records of 110 patients (99%). Most medical diagnoses, symptomatic complaints, physical examination findings and laboratory test results occurred with similar frequency in the long-term methadone maintenance patients and in a group of 56 long-term heroin addicts. These data suggest that prolonged methadone maintenance treatment is safe and is not associated with unexpected adverse effects.

Adult↗