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PubMed1978

Ethical problems in clinical psychopharmacology.

The present article originates from some intriguing problems which the author, working as a clinical pharmacologist and psychiatrist, was faced with during clinical investigations. Practical difficulties appearing at first glance as of a rather methodological nature often reveal themselves as ethical questions. Investigation of psychotropic drugs in normal volunteers as well as in psychiatric patients is taken as a model to exemplify certain fundamental ethical aspects of medical research. It is emphasized that the "solution" of ethical problems cannot be achieved by referring to a given code of norms which themselves depend on certain historical circumstances, but rather by recognizing and reasoning the conflicts which result from various moral maxims. Clinical psychopharmacology should not only be conscious of its methodological shortcomings and future goals but also accept the justification of discussions about the ethical and legal questions involved in its dealings and take an active part in these debates. With regard to the relationship between patient and investigator, "solidarity" [23] instead of ongoing paternalism or legal formalism, appears to be a realistic goal. This is also true in the area of psychopharmacological research.

Disclosure↗
PubMedDate not supplied

[AMDP system and clinical psychopharmacology (author's transl)].

A more coherent development of clinical psychopharmacology and a generalisation of its results, limited by the variability and approximation of judgments, become possible through a standardisation of evaluation methods for mental troubles. The AMDP system is a sensible enough instrument to apply statistical methods in clinical psychopharmacology. The french version, elaborated and revised by psychiatrists of different nationality, language and background, should favor communication of informations in this area and should validate it.

Humans↗
PubMed1995

[Psychopharmacological properties of three magnesium salts: pidolate, lactate and aspartate].

The psychopharmacological activities of three organic magnesium salts were estimated on the spontaneous and amphetamine-induced motility, the barbital-induced sleep and the NMDA toxicity of Swiss mice fed with a normal diet, rich in magnesium. Magnesium aspartate had a stimulant effect whereas lactate did not clearly modify the animal behaviour and pidolate induced a clear cut neurosedative effect. None of these salts afforded protection against NMDA toxicity, moreover, aspartate and lactate increased NMDA toxicity. These results indicate that depending on the anion, magnesium salts do not have the same psychopharmacological activities and that pidolate only seems to respect and enhance magnesium basic pharmacological properties.

Animals↗
PubMed1994

A psychopharmacology education program for psychiatry residents--the role of a clinical pharmacist.

The author describes a psychopharmacology education program administered by a psychiatric clinical pharmacist. The program included biweekly lectures and psychopharmacology review rounds for junior psychiatry residents. This teaching program suggests that a psychiatric clinical pharmacist may favorably contribute to the optimum usage of psychotropic drugs, especially in those residency years when prescribing habits are being formed.

Adult↗
PubMed1996

Interethnic psychopharmacologic research in children and adolescents.

Interethnic child and adolescent psychopharmacology research is essentially unstudied. Recently there have been reports of interethnic differences in psychopharmacology research on adults. This article addresses the need to focus research on psychopharmacogenetics, pharmacokinetics, pharmacodynamics, and issues of efficacy and effectiveness in child and adolescent populations of different ethnic groups.

Adult↗
PubMed1977

[Psychopharmacology and psychotherapy: a dynamic therapeutic parallelism to be integrated].

In a brief expose, the author wants to integrate the psychoanalytic data towards a better clinical use of psychopharmacology. Starting from a triadic situation "patient-physician-medication", he proposes a dynamic rather than a static attitude in the patient's approach, aiming at an eventual diadic relation "patient-physician" and, if at all possible, a relative or total independance of the patient. After alluding at the role of the physician, of the patient and of the medication, in such a process, the author refers to intra and extra psychic influence in disease. The concepts of "team approach" and "milieu therapy" are related to the key-role of the psychiatrist and to the availability of competent and well-motivated paramedical professionals in sufficient numbers. The notions of transference, countertransference and control as well as the symbolic of the symptoms are briefly outlined. The author concludes that the complementary elements of psychoanalysis and psychopharmacology will benefit the patient if the clinician knows how to integrate them along with the changing and dynamic process of the illness.

Humans↗
PubMed2003

Tianeptine: a novel strategy of psychopharmacological treatment of children with autistic disorder.

OBJECTIVES: Many autistic children have problems of eye contact and expressive language that limit the effectiveness of educational and behavioural interventions. Few controlled psychopharmacological trials have been conducted in autistic children to determine which agents may be effective for these associated features. METHODS: Twelve male children (7.3 +/- 3.3 years) with autistic disorder, diagnosed by ICD-10 criteria, completed a placebo-controlled, double-blind crossover trial of tianeptine, which lasted for 12 weeks. Subjects were included in the study if their eye contact and expressive language was inadaequate for their developmental level. Subjects had not tolerated or responded to other psychopharmacological treatments (neuroleptics, methylphenidate, clonidine or desipramine). RESULTS: Teacher ratings on the aberrant behaviour checklist irritability, stereotypy and inappropriate speech factors were lower during treatment with tianeptine than during treatment with placebo. Clinician ratings (children's psychiatric rating scale autism, anger and speech deviance factors; children's global assessment scale; clinical global impressions efficacy) of videotaped sessions were not significantly different between tianeptine and placebo. DISCUSSION: Tianeptine were modestly effective in the short-term treatment of irritability in some children with autistic disorder.

Adolescent↗
PubMed2004

Studies on psychopharmacological effects of Cleome viscosa Linn. extract in rats and mice.

Methanol extract of the entire plant Cleome viscosa Linn. (CVME) was evaluated for different psychopharmacological actions such as general behaviour, exploratory behaviour, muscle relaxant activity and phenobarbitone induced sleeping time and effects on normal body temperature in rats and mice. The extract was found to cause reduction in spontaneous activity, decrease in exploratory behavioural pattern by the head dip and Y-maze test, reduction in the muscle relaxant by rotarod, 30 degrees inclined screen and traction tests and caused significant lowering of body temperature. In addition, CVME significantly potentiated the phenobarbitone-induced sleeping time. Preliminary tests indicate that the methanol extract of Cleome viscosa Linn. in doses of 200-400 mg/kg has significant psychopharmacological activity.

Animals↗
PubMedDate not supplied

Kupalov's concept of shortened conditional reflexes: psychophysiological and psychopharmacological implications.

In the regulation of cortical excitability tonus, Kupalov described a particular acquired, learned mechanism, the shortened conditional Reflex (SCR). SCR is an essential mechanism by which an adequate cortical tonus is established by environmental cues as an anticipatory set-up preparing the individual qualitatively and quantitatively for expected forthcoming events. An original physiological example is given, the conditional "transfer" of motor behavior at cortical electrical stimulation. Three psychopharmacological implications are presented, namely environmental-dependent, stress-related events, environmental-dependent drug conditioning, and drug-tolerance experiments. Future eventual psychophysiological and psychopharmacological lines of research related to the shortened conditional reflex concept are discussed.

Animals↗
PubMed2000

[Schizophrenic psychoses and suicide in the clinic. Risk factors, psychopharmacologic treatment].

For all 5,352 patients treated for schizophrenia at the Psychiatric Hospital of the University of Munich in 1981 and 1992, detailed routine and data processing-assisted documentations were made of the psychopharmacological therapies. Nineteen of the patients committed suicide while undergoing inpatient treatment; the control group consisted of all other patients (n = 5,333). More than 77 sociodemographic and anamnestic variables as well as 195 items from the admission summaries were taken into account while comparing the groups. Furthermore, the pharmacological data were classified according to drug groups and comparison was based on the mean frequency of prescription of each group. We analyzed the mean number of prescriptions for neuroleptics, tranquilizers, and antidepressants, which were further differentiated into sedating and nonsedating types. For frequently administered drugs, mean daily doses were also compared. Bivariate analysis of the data suggests that the suicide cases presented depressive signs, symptoms, and tendencies already present on admission more frequently than with controls; the same applies to previously attempted suicides. Discriminating analysis showed that the variables "feeling of loss of feelings," thought insertion," "visible depression," "free-floating anxiety," "suicidal tendencies," and "previously attempted suicide" have the greatest predictive value with respect to suicide, in descending order. No differences in psychopharmacological treatment between suicides and controls were found, apart from a significantly higher percentage of antidepressive treatments and a higher mean number of antidepressant prescriptions for the suicides.

Adult↗
PubMed2000

Current research highlights in child and adolescent psychopharmacology.

Recent efforts to stimulate research in pediatric psychopharmacology have resulted in increased interest in the effects of psychotropic medications in children and adolescents. This interest is reflected in the number of studies that have been reported or initiated during the past year. As a means of providing a brief update on the progress of child psychopharmacology, research reports either published or presented at national meetings in 1999 are selectively reviewed here. Relevant initiatives recently started under the sponsorship of the National Institute of Mental Health (NIMH) are also reviewed. Most studies have been directed at testing treatments of attention deficit hyperactivity disorder (ADHD), but also studies of the selective serotonin reuptake inhibitors in patients with obsessive compulsive disorder, depression, and anxiety disorders are well represented. The efforts of NIMH to focus on effectiveness research and direct comparisons of pharmacologic, psychosocial, and combined treatment modalities are apparent in recent initiatives in ADHD and depression. Research of treatments for youths with bipolar disorder, schizophrenia, autism, and eating disorders is still scanty and in urgent need of expansion.

Adolescent↗
PubMed2004

Psychopharmacology of borderline personality disorder.

Psychopharmacology is widely used in the treatment of borderline personality disorder. However, support for this form of treatment has been largely based on case reports, case series, and open-label clinical trials. This evidence-based review examines the most recent randomized controlled trials of psychopharmacology in the treatment of borderline personality disorder, with a goal of highlighting the most promising pharmacotherapy for use in current clinical practice, as well as for future large-scale research testing. The results and limitations of the randomized controlled trial data are presented along with case vignettes illustrating the complexity of the disorder and the heterogeneity of its treatment. To date, there is at least some evidence-based support for the use of antipsychotics (conventional and atypical), monoamine oxidase inhibitors, serotonin reuptake inhibitors, and omega-3 fatty acids in the treatment of borderline personality disorder.

Aggression↗
PubMed2007

Seizure incidence in psychopharmacological clinical trials: an analysis of Food and Drug Administration (FDA) summary basis of approval reports.

BACKGROUND: Clinical trial data provide an approach to the investigation of the effects of psychopharmacological agents, and psychiatric disorders themselves, on seizure threshold. METHODS: We accessed public domain data from Food and Drug Administration (FDA) Phase II and III clinical trials as Summary Basis of Approval (SBA) reports that noted seizure incidence in trials of psychotropic drugs approved in the United States between 1985 and 2004, involving a total of 75,873 patients. We compared seizure incidence among active drug and placebo groups in psychopharmacological clinical trials and the published rates of unprovoked seizures in the general population. RESULTS: Increased seizure incidence was observed with antipsychotics that was accounted for by clozapine and olanzapine, and with drugs indicated for the treatment of OCD that was accounted for by clomipramine. Alprazolam, bupropion immediate release (IR) form, and quetiapine were also associated with higher seizure incidence. The incidence of seizures was significantly lower among patients assigned to antidepressants compared to placebo (standardized incidence ratio = .48; 95% CI, .36- .61). In patients assigned to placebo, seizure incidence was greater than the published incidence of unprovoked seizures in community nonpatient samples. CONCLUSIONS: Proconvulsant effects are associated with a subgroup of psychotropic drugs. Second-generation antidepressants other than bupropion have an apparent anticonvulsant effect. Depression, psychotic disorders, and OCD are associated with reduced seizure threshold.

Antidepressive Agents↗
PubMed2005

Psychopharmacologic treatment of pediatric anxiety disorders.

This article reviews the psychopharmacologic treatment of child and adolescent anxiety disorders and is divided into the following sections: historical background, general treatment principles, obsessive-compulsive disorder, other anxiety disorders, including separation anxiety disorders, generalized anxiety disorder, and social phobia, elective mutism, and post-traumatic stress disorder and specific phobia. Short-term and long-term psychopharmacologic treatment strategies are reviewed, as are approaches for managing comorbidity and treatment-refractory cases. This article is organized by diagnostic categories rather than by medication classes to emphasize the clinical perspective.

Adolescent↗
PubMed2001

Mood disorders in children and adolescents: psychopharmacological treatment.

Mood disorders are the leading causes of morbidity and mortality in children and adolescence. As a result, many adolescents are treated with psychopharmacologic agents such as antidepressants and mood stabilizers. To date, research into the safety and efficacy of these medications has lagged behind clinical practice. Several controlled trials of antidepressants in this population have recently been completed or are ongoing, yet few controlled trials of mood stabilizers have been conducted. Although acute efficacy of antidepressants is being addressed, many questions remain about pharmacological treatment of early-onset mood disorders. This article will focus on unmet research needs for the psychopharmacologic treatment of child and adolescent mood disorders.

Adolescent↗
PubMed1999

Artificial neural networks: a study in clinical psychopharmacology

Controlled trials in clinical psychopharmacology may fail to provide reliable information about the benefit of treatment when the patient is viewed in a real-life setting rather than as part of a well-defined sampling procedure. A viewpoint, rooted in systems theory, is proposed based on the identification of complex relationships among such dimensions as clinician's reasoning, drug properties, and patient's condition. Artificial Neural Network (ANN) technology provides efficient tools for data analysis within a systems-oriented approach. This study proposes a way to predict the outcome of psychopharmacological treatment. Analysis was conducted on retrospective data from clinical records of psychiatric patients treated with moclobemide. Twelve pharmacological, diagnostic, and topological variables were identified as the decisional items considered by six clinicians: age at onset, sex, previous treatment, duration and dose of moclobemide treatment, other drugs, psychiatric diagnosis and other clinical features. Data were binarily coded and transformed into observed frequencies in the sampling space; treatment outcome was binarily scored as the model's target. A Back-Propagation ANN based on the Delta rule with logistic transfer function was used. ANN correctly classified all cases of successful treatment (n = 51, 100%) but only half of the unsuccessful cases (n = 14, 52%). Patterns of response and areas of uncertainty were analyzed in a topological approach.

Journal Article↗
PubMed2001

Culture and psychopharmacology.

In this brief review the authors strive to provide a broad overview of various factors that impinge on psychopharmacotherapeutic practices. The literature revealed an impressive progress in research focusing on the delineation of the biologic mechanisms responsible for cross-ethnic variations in psychotropic metabolism and effects. With the field progressing at an accelerating pace, there is little doubt that in the coming decade clinicians will be provided with a detailed map showing the prevalence and distribution of genetic polymorphisms of most, if not all, of the drug-metabolizing enzymes, and clinicians also will have an overall picture on what these polymorphisms mean clinically. At the same time, clinicians should also start to have a good grasp on the meaning of the variations of the genes that encode therapeutic targets of psychotropics (e.g., neurotransmitter transporters and receptors). Such genetic fingerprinting, which will soon become a clinical reality, will provide tremendous help in ensuring that pharmacotherapies are increasingly more individually tailored, taking into consideration each patients genetic makeups that vary substantially across ethnic groups. As exciting as these new developments will be, they are dwarfed by the challenges ahead on the cultural side of the equation. Issues that are still awaiting further clarification include the following: How do we assess patients' beliefs and expectations related to psychotropic treatment? How do we minimize the communication gaps between patients and clinicians who are often from divergent sociocultural backgrounds? To what extent, and in what ways, do cultural (environmental) factors interact with biologic factors, and what might be the most efficient way to systematically assess such interactions? Data that have emerged in the past several decades clearly indicate the importance of culture and ethnicity in influencing patients' psychopharmacological response. It is expected that continuing progress in the near future will bring a better understanding on the way these cultural and biologic processes, separately and in interaction with each other, mediate treatment responses. Such knowledge will be crucial for the optimal pharmacotherapeutic care of for the majority of patients who will increasingly be of diverse ethnic and cultural backgrounds and will represent a significant contribution to the field of psychopharmacology as a whole.

Cross-Cultural Comparison↗
PubMedDate not supplied

A behavioral diagnostic paradigm for integrating behavior-analytic and psychopharmacological interventions for people with a dual diagnosis.

Aberrant behaviors exhibited by people with developmental disabilities have been well documented. Often, psychotropic medications, especially neuroleptics, have been used to control behaviors such as self-injury, physical aggression, property destruction, and hyperactivity. Serious side effects of these medications have occurred, resulting in litigation and regulation of their use by courts, surveyors, and accrediting bodies. Rules and regulations have been developed requiring that behaviors/symptoms necessitating that medication usage be clearly delineated, that behavior programs be developed and implemented to reduce need, and that the interdisciplinary team approach be used to monitor effectiveness of interventions. Currently, little guidance exists on how behavioral and psychopharmacological interventions should be applied or combined. This paper presents a paradigm for integrating behavior-analytic and psychopharmacological treatment interventions in the treatment of persons with developmental disabilities that meets applicable standards. Our model is consistent with the least restrictive, yet effective treatment philosophy. Implications for research and treatment are presented.

Behavior Therapy↗