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PubMed2006

Induction of inducible cAMP early repressor expression in nucleus accumbens by stress or amphetamine increases behavioral responses to emotional stimuli.

Previous research has shown that cAMP response element (CRE)-mediated transcription is activated in the nucleus accumbens, a major brain reward region, by a variety of environmental stimuli and contributes to neuroadaptations to these stimuli. CRE-binding protein (CREB) is the most studied activator of CRE transcription and has been implicated in this brain region as a gating mechanism for behavioral responses to emotional stimuli. Little attention, however, has been given to naturally occurring inhibitors of CRE-mediated transcription, such as the inducible cAMP early repressor (ICER), an inhibitory product of the CRE modulator gene. In the present study, we investigated the extent to which ICER is induced in the nucleus accumbens by two types of environmental stimuli, stress and amphetamine, and characterized how induction of ICER in this region affects complex behavior. We show that stress and amphetamine each induces ICER expression and that overexpression of ICER in the nucleus accumbens, using viral-mediated gene transfer, increases behavioral responses to both rewarding and aversive emotional stimuli. For example, ICER overexpression increases sensitivity to amphetamine-stimulated locomotor activity as well as to natural rewards such as sucrose and social grooming. However, ICER overexpression also increases measures of anxiety in the elevated plus maze and neophobia to novel tastes. Finally, ICER produces an antidepressant-like effect in the forced swim test, further indication of an enhanced active response to stress. These results suggest that ICER is an important mechanism for modulating CRE-mediated transcription in the nucleus accumbens.

Amphetamine↗
PubMed2006

[Symptomatic treatment of migraine with zolmitriptan: experience with 82 patients].

OBJECTIVES: To analyze our experience with the new, 5 mg intranasal formulation of zolmitriptan in the symptomatic treatment of migraine attacks. PATIENTS AND METHODS: This series includes 82 patients who had treated an average of 7 migraine attacks. Eighty patients had taken oral triptans and 20 subcutaneous sumatriptan. The main reasons for using nasal zolmitriptan were: poor efficacy of oral triptans (41.5 % of the patients), use of subcutaneous sumatriptan (24.4%) or medical criteria (34.5%). RESULTS: Among the 80 patients who had been treated with oral triptans, 50 (62.5 %) preferred nasal zolmitriptan, 14 (17.5 %) oral triptans and the remaining 16 (20 %) did not express any preference. The main reasons for this preference were shorter speed of action and better efficacy. Within those 20 patients who were using subcutaneous sumatriptan, 8 (40 %) preferred subcutaneous sumatriptan, 5 (25%) nasal zolmitriptan and 7 (35%) did not express any preference. The reasons for preference of intranasal zolmitriptan over subcutaneous sumatriptan were greater convenience, better tolerability and lower price. A total of 55 patients noticed efficacy within 60 min. Half experienced at least one adverse event, always mild. The most frequent were local: bad taste (n=23) or nasal irritation/itching (n=8). CONCLUSIONS: The new intranasal formulation of 5 mg zolmitriptan is a good option for the symptomatic treatment of migraine, which could be considered as an intermediate between oral triptans and the subcutaneous formulation of sumatriptan.

Administration, Intranasal↗
PubMed1991

Perceived control, drive for thinness, and food consumption: anorexic tendencies as displaced reactance.

Although loss of perceived control has been implicated in the development of eating disorders, previous research has not directly tested the relationship between perceived control and food consumption. This study investigated the hypothesis that individuals with anorexic tendencies react to low perceived control by restricting food intake as a means of regaining a sense of control. Forty female undergraduates who scored either low or high on the Drive for Thinness Scale (Garner & Olmsted, 1984) were led to believe they would be participating in two separate studies. Perceived control was experimentally manipulated such that half of the subjects experienced low control and half experienced high control over a social situation. Under the guise of a second experiment, subjects tasted breakfast cereals and completed measures relevant to eating and body image. Results showed that subjects who were high in drive for thinness (DT) who experienced low control ate less sweetened cereal and planned to eat less at dinner than high DT subjects who experienced high control. Low DT subjects were unaffected by the control manipulation. The results are discussed in terms of displaced reactance.

Adult↗
PubMed2006

Bosma arhinia microphthalmia syndrome.

Bosma et al. [1981] delineated a syndrome affecting two unrelated males with severe hypoplasia of the nose and eyes, palatal abnormalities, deficient taste and smell, inguinal hernias, hypogonadotropic hypogonadism with cryptorchidism, and normal intelligence. Other patients with this syndrome have been reported as cases of arhinia with associated defects. During embryonic development, the nasal placodes form 28 days after conception shortly after the optic vesicles makes contact with the overlying surface ectoderm at 26-27 days, and both layers invaginate to form the eyes between 34 and 44 days. Mice with homozygous mutations of Pax6, manifest underdevelopment of ocular and nasal structures, and a network of developmentally regulated genes function downstream of Pax6 to form nasal, ocular, and pituitary structures. These genes represent candidate genes for this disorder, and familial recurrence of Bosma syndrome has been reported to occur. This report describes two sporadic unrelated cases of this rare syndrome and briefly reviews the findings in previously reported cases.

Abnormalities, Multiple↗
PubMed2006

Evaluation of quality of life and psychiatric morbidity in patients with malignant tumours of the skull base.

In general, patients with malignant tumours of the skull base have a poor prognosis. Treatment may have a disfiguring physical and disabling mental effect on patients. To evaluate the effect of treatment on physical and mental quality of life in patients with skull base malignancy, we conducted a cross-sectional patient survey of 18 patients treated for such tumours, using the University of Washington (version 4) quality of life questionnaire and the hospital anxiety and depression scale. The total quality of life score (median value) was 980 (550-1125). Patients with anterior skull base malignancy scored lower than those with lateral skull base malignancy (p=0.003). In general, the worst individual domain scores were: mood (64 per cent); activity (69 per cent); and, specifically for patients with anterior skull base malignancy, taste (54 per cent, p=0.004) and anxiety (60 per cent, p=0.034). One-third of skull base cancer patients were at risk of suffering from mental distress and psychiatric morbidity (indicated as a score of more than seven on the hospital anxiety and depression scale).

Adult↗
PubMed2006

Sumatriptan nasal spray in adolescent migraineurs: a randomized, double-blind, placebo-controlled, acute study.

OBJECTIVE: To compare the efficacy and tolerability of sumatriptan nasal spray (NS) (5, 20 mg) versus placebo in the acute treatment of migraine in adolescent subjects. BACKGROUND: Currently, no triptan is approved in the United States for the treatment of migraine in adolescent subjects (12 to 17 years). In a previous randomized, placebo-controlled study of 510 adolescent subjects, sumatriptan NS at 5, 10, and 20 mg doses was well tolerated. However, the primary efficacy analysis for headache relief with 20 mg at 2 hours did not demonstrate statistical significance (P = .059). A second study was initiated to evaluate the efficacy of sumatriptan NS in this population. METHODS: This was a randomized (1:1:1), placebo-controlled, double-blind, parallel-group study. Overall, 738 adolescent subjects (mean age: 14 years) with > or = 6-month history of migraine (with or without aura) self-treated a single attack of moderate or severe migraine. The primary endpoints were headache relief at 1 hour and sustained relief from 1 to 24 hours. Pain-free rates, presence/absence of associated symptoms, headache recurrence, and use of rescue medications were also assessed. Tolerability was based on adverse events (AEs) and vital signs. RESULTS: Sumatriptan NS 20 mg provided greater headache relief than placebo at 30 minutes (42% vs. 33%, respectively; P = .046) and 2 hours (68% vs. 58%; P = .025) postdose, but did not reach statistical significance at 1 hour (61% vs. 52%; P = .087) or for sustained headache relief from 1 to 24 hours (P = .061). Significant differences (P < .05) in favor of sumatriptan NS 20 mg over placebo were observed for several secondary efficacy endpoints including sustained relief from 2 to 24 hours. In general, sumatriptan NS 5 mg percentages were slightly higher than placebo but the differences did not reach statistical significance. Both doses of sumatriptan NS were well tolerated. No AEs were serious or led to study withdrawal. The most common event was taste disturbance (2%, placebo; 19%, sumatriptan NS 5 mg; 25%, sumatriptan NS 20 mg). CONCLUSIONS: This study suggests that sumatriptan may be beneficial to some adolescents and is generally well tolerated in the acute treatment of migraine in this population.

Acute Disease↗
PubMed2006

Eszopiclone for the treatment of insomnia.

Eszopiclone, a single-isomer, non-benzodiazepine hypnotic agent, is approved for use in the US for the treatment of insomnia for patients who have difficulty falling asleep (sleep latency) as well as for those who have difficulty staying asleep (sleep maintenance). Efficacy in sleep maintenance has not been consistently demonstrated with previous hypnotics, and long-term efficacy and safety data are lacking for these agents. In clinical trials, eszopiclone 3 mg significantly improved objective and subjective sleep measures in transient and chronic insomnia in adults. Nightly treatment with eszopiclone 1 mg effectively induced sleep in elderly patients and the 2-mg dose effectively induced and maintained sleep. The ability of eszopiclone 2 mg to significantly improve next-day functioning and daytime alertness (as demonstrated by a reduction in the number and duration of naps) in the elderly is an important finding in clinical trials, and is unique to the class of hypnotic agents for the treatment of insomnia. Eszopiclone was well tolerated in clinical trials < or = 12 months duration, with no clinically significant evidence of pharmacological tolerance, rebound insomnia or dependence. The most frequently reported adverse event was unpleasant taste. Eszopiclone is the only non-benzodiazepine sedative-hypnotic (in the Schedule IV class under the Controlled Substances Act) to be evaluated as a long-term treatment for chronic insomnia.

Adult↗
PubMed1986

Zopiclone. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy as an hypnotic.

Zopiclone is the first of the cyclopyrrolones, a new class of psychotherapeutic agents possessing a pharmacological profile of high efficacy and low toxicity similar to that of the benzodiazepines. Binding is thought to occur to the benzodiazepine receptor complex, or to a site closely linked to this complex. Although zopiclone exhibits anticonvulsant, muscle relaxant and anxiolytic properties in animals, it finds better use as an hypnotic because of marked sedating effects. In clinical trials, zopiclone (usually 7.5 mg) improved sleep in chronic insomniacs similarly to nitrazepam 5 mg, flurazepam 15 to 30 mg, triazolam 0.5 mg and temazepam 20 mg, but in a single study was slightly less effective than flunitrazepam 2 mg in some evaluation criteria. Sleep induction before surgical procedures in hospitalised patients is satisfactory with zopiclone, but when the drugs are administered a few hours before surgery, diazepam appears to be more effective in alleviating preoperative anxiety. Minimal impairment of psychomotor skills and mental acuity occurs in the morning after a bedtime dose of zopiclone, which has a short half-life of about 5 hours and no long acting metabolites. No serious side effects have been reported in the relatively small number of patients studied to date; the development of 'bitter taste' does not deter patients from continuing therapy. Thus, with its short duration of action zopiclone is a useful alternative to other hypnotics, especially in patients intolerant of residual effects the morning after taking an hypnotic.

Anti-Anxiety Agents↗
PubMedDate not supplied

Subjective distresses of nasogastric tube feeding.

Health care professionals assume that tube feeding is an unpleasant, distressing experience for patients, which is only partially substantiated by experience. Thirty patients were interviewed via a tube feeding and hospital experience checklist (a 47-item interview schedule). Common experiences were operationally defined as those felt by at least 50%; subjectively distressful experiences were those identified by patients as causing distress. The most common and most distressful experiences of nasogastric tube feeding were: sensory irritations and sensory deprivation. The psychosensory irritation experiences were: thirst, sore nose or throat, dry mouth, runny nose, a tube in the nose, taking food through a tube, breathing through the mouth, breathing with a tube in the nose, taking food in a treatment type container, and taking food with a different texture and smell than usual. The psychosensory deprivation experiences were: an unsatisfied appetite for certain foods, deprivation of tasting, chewing, swallowing food, and drinking liquids, limited mobility, and deprivation of regular food. Except for burping, gastrointestinal symptoms were not common though they were usually distressful. This information has been used to develop teaching programs which are being tested for effectiveness in reducing distress associated with nasogastric tube feeding.

Adult↗
PubMedDate not supplied

Multiple-attack efficacy and tolerability of sumatriptan nasal spray in the treatment of migraine.

OBJECTIVE: Sumatriptan hemisulfate nasal spray may provide a useful therapeutic option for patients with migraine who find injectable medications inconvenient or uncomfortable and for patients whose migraine-associated nausea and vomiting preclude the use of oral medication. This study was the first US trial to evaluate the effects of sumatriptan nasal spray administered for multiple migraine attacks. DESIGN/INTERVENTIONS: Sumatriptan nasal spray (5, 10, or 20 mg) was administered via a 1-shot nasal applicator into either nostril for up to 3 migraine attacks occurring over 6 months in a randomized, double-blind, parallel-group, placebo-controlled study. SETTING: Fifty-six outpatient clinical centers in the United States. PATIENTS: A total of 1086 men and women diagnosed with migraine with or without aura per International Headache Society criteria. MAIN OUTCOME MEASURES: Percentage of patients with headache relief (moderate or severe predose pain reduced to mild or none); percentage of patients with no or mild (vs moderate or severe) clinical disability; percentage of patients with nausea, vomiting, photophobia, or phonophobia; adverse events; clinical laboratory test results. RESULTS: Across attacks, headache relief in the 20-, 10-, and 5-mg drug and placebo groups was experienced 120 minutes postdose by 60%, 54%, 44%, and 32% of patients, respectively (P<.05 for each sumatriptan nasal spray group vs placebo, for the 10-mg vs 5-mg drug group, and for the 20-mg vs 5-mg drug group). Two thirds of the 20-mg patients treating 3 attacks experienced relief at 2 hours postdose for at least 2 of 3 attacks. Clinical disability scores at 120 minutes in the 20-, 10-, and 5-mg drug and placebo groups reflected no or mild impairment in 70%, 67%, 57%, and 50% of patients, respectively (P<.05 for the 10- or 20-mg drug group vs placebo group, and for the 20-mg vs 5- mg drug group). Similar efficacy rates were observed for nausea, photophobia, and phonophobia. For all parameters, individual-attack efficacy rates did not differ from across-attack rates. The incidence of adverse events was not dose related. The most frequently reported adverse event in the active treatment groups was taste disturbance (bad, bitter, or unpleasant). CONCLUSIONS: Sumatriptan hemisulfate nasal spray (5, 10, or 20 mg) is effective and well tolerated in the treatment of multiple migraine attacks. The 20-mg dose was associated with the highest efficacy rates across the greatest number of parameters.

Administration, Intranasal↗
PubMed1988

Childhood trichotillomania treated indirectly by punishing thumb sucking.

Trichotillomania was treated in a developmentally normal three-year-old by punishing thumb sucking. A behavioral analysis indicated a chain of behaviors that began with hair pulling and terminated in thumb sucking. The parents punished the thumb sucking by applying a bad tasting substance to the thumb. Both hair pulling and thumb sucking were rapidly eliminated. The child remained symptom free at 40 month follow-up. This study represents the third time trichotillomania has been treated in a preschooler indirectly by targeting finger sucking as the behavior to change. The significance of treating trichotillomania indirectly is discussed.

Behavior Therapy↗
PubMed2003

Topiramate in the preventive treatment of episodic migraine: a combined analysis from pilot, double-blind, placebo-controlled trials.

The safety and efficacy of medications for preventive treatment of migraine is the subject of current concern and investigation in health care. Two single-center, double-blind, placebo-controlled studies were conducted to evaluate the efficacy and safety of topiramate for migraine prophylaxis. Seventy patients with a diagnosis of migraine were randomly assigned to topiramate-treated and placebo groups. The studies consisted of a 4-week baseline phase, a 6-8 week titration, and 8-12 weeks of maintenance. Topiramate was titrated from an initial dose of 25 mg/day to a target dose of 100 mg BID. The primary efficacy measure, the mean 28-day migraine frequency, was lower in topiramate-treated patients than in the placebo group (3.2 versus 3.8, P=.001). Similarly, topiramate treatment resulted in a significantly greater mean reduction in migraine frequency than did placebo (1.55 versus 0.47, P=.001) and a significantly higher responder rate (35.3% versus 8.3%, P=.008). Paresthesia was the most common side effect reported with topiramate treatment. Other topiramate-associated adverse events included altered taste, memory impairment, diarrhea, and appetite suppression/weight loss. The rates of discontinuation were similar for the topiramate group (n=10) and the placebo group (n=8). These results suggest that topiramate is effective and well tolerated in the preventive treatment of migraine headaches.

Adult↗
PubMed1981

Evaluation of food selection patterns and preferences.

Recently, studies related to food preferences and selection patterns are gaining more importance because of their multidimensional scope and application. Data from these studies are widely applicable in areas ranging from consumption, forecasting and menu planning in hospitals, restaurants, schools, etc. to nutrition evaluation. Also, they are immensely useful in studies related to various diseases and disorders, particularly cardiovascular diseases and obesity. Evidently, there is considerable lack of information available on this subject, especially on the applicable methodology. This article, is therefore, designed to present in a nutshell an up-to-date review on research, methodology and applications of food patterns and preferences, with emphasis on their nutritional impact.

Appetite↗
PubMed1984

Oral manifestations of drug reactions.

The clinical manifestations of oral reactions to the more commonly prescribed drugs have been presented. These reactions include the following conditions: stomatitis, ulceration and necrosis, opportunistic infections, hemorrhage, gingival hyperplasia, pigmentation, altered salivary function, and altered taste sensation. A patient who complains of any of these signs and symptoms should be thoroughly questioned regarding medication. If an offending drug can be identified, its alteration or elimination, in consultation with the prescribing clinician, will often result in resolution of the clinical problem.

Antineoplastic Agents↗
PubMed1984

A follow-up study of screwpost-retained amalgam crowns.

A follow-up study of amalgam crowns retained with brass screwposts (Dentatus) has been performed. The teeth had been restored by undergraduates at the Department of Cariology, School of Dentistry, Stockholm, during the years 1970-1976. Radiographs of the teeth made at the time of insertion of posts were available in all cases. The material comprised 56 teeth with altogether 69 screwposts. Average observation time was 7.8 years. Anamnestic data were collected and clinical and radiographic investigations of the restored teeth and surrounding tissues were carried out. Of the 56 teeth, 8 teeth containing altogether 11 screwposts had been lost by extraction. Annotations from the treating dentists were available in all cases and showed that five of the extractions had been necessary because of extensive caries, one because of parodontitis and two because of root fractures. No corrosion of screwposts had been observed in the fractured teeth. The anamnestic investigation revealed sporadic tenderness and metallic taste in only a few cases. The most frequent clinical findings were discoloration and pitting of amalgam surfaces and discoloration of tooth substance and gingiva. The discolorations of the gingiva were related to restorations extending below the gingival margin. No clinical or radiographic signs of corrosion of screwposts were found in the investigated teeth.

Crowns↗
PubMed2000

Radiofrequency (pacing and thermic effects) in the treatment of sleep-disordered breathing.

Radiofrequency, whether it is used for pacing or for its thermal liberation properties, has been investigated as a treatment for sleep-disordered breathing. Diaphragmatic pacing has a long history. The problems associated with pacing, which are related to patient selection, equipment failure, disturbances at the electrode/nerve interface, neuromuscular function failure, muscle fatigue, and the physiological consequences of stimulation, will have to be resolved with XIIth nerve stimulation. Radiofrequency thermal ablation has been applied on the tongue of an animal model. In man, turbinates, soft palate tissue and the base of tongue have been treated. These feasibility studies have demonstrated that obstructive sleep apnea syndrome and upper airway resistance syndrome can be completely controlled using radiofrequency thermal ablation in some subjects. These results can be obtained without complications related to speech, taste or swallowing. The treatment can be administered as an outpatient procedure, but many applications are needed, and treatment may span 6 months. Too high a level of radiofrequency will cause pain or otherwise avoidable complications. The determination of which patients will benefit most from these procedures will require further multi-center, placebo-controlled studies.

Ambulatory Care↗
PubMed1983

The olfactory detection of sodium and lithium salts by sodium deficient cattle.

With development of Na+ depletion in cattle enhancement in the specific ability to smell very low concentrations of salt occurs. At the same time a behaviour pattern develops, in which increased locomotory activity is seen, directed towards searching for sodium salts. Following the initial successful location of a sodium source the pattern once learned, is consolidated by repetition and by consummation of the salt reward. Our data shows that olfactory and gustatory receptors are able to detect minute amounts of sodium salts as biochemical disruption develops with Na+ depletion but the central input from smell and taste receptors remain distinct. Salt appetite does not appear to be pleasurable (hedonic) in cattle, for salt appetite which is a feature of Na+ depletion does not persist when the ionic deficit is restored. The innate behaviour which develops with increased salt appetite in cattle may account for the evolutionary success and worldwide distribution of ruminants.

Animals↗
PubMed1991

An ethopharmacological approach to the development of drug addiction.

In a rat model of alcoholism, different stages of the development towards a drug addiction can be discriminated. During the phase of "controlled" intake, drug consumption is reversibly modified by the social situation (housing conditions) and the individual's social role (in particular his dominance rank). In Wistar rats, this period lasts about half a year. During the next few months, the consumption of ethanol rises without a concomitant loss of its behavioral effects. After an abstinence period of nine months, the rats maintain a high preference for alcohol which cannot be suppressed by adulteration with (unpleasantly tasting) quinine. Ethanol-taking behavior can no longer be modified by external stimuli or by dominance rank. This irreversible state is called "behavioral dependence." It is drug-specific (i.e., other drugs like diazepam cannot substitute the alcohol) and not related to physical dependence. In behaviorally dependent rats, the effects of ethanol are altered; very low doses tranquillize the rats, higher ones stimulate them.

Animals↗