The Journal of clinical psychiatry
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Clinical Trial Controlled Clinical Trial
Oral physostigmine treatment for patients with presenile and senile dementia of the Alzheimer's type: a double-blind placebo-controlled trial.
Twelve patients aged 53 to 89 years with presenile or senile dementia of the Alzheimer's type participated in a treatment trial of oral physostigmine. Patients first received the drug during an open dose-finding phase. ⋯ Intergroup differences in response to physostigmine were nonsignificant. Age at onset of the disease did not differentiate partial responders from nonresponders.
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Status epilepticus (SE) is defined as a continuous seizure that lasts more than 30 minutes or as serial seizures in which the patient does not regain a premorbid level of consciousness. This condition exists primarily in two forms: convulsive (focal or generalized) and nonconvulsive (absence or partial complex) SE. Protracted or serial convulsive seizures represent a medical emergency with a current mortality rate of 10%. ⋯ Concurrent intravenous loading with phenytoin is usually necessary for sustained control of seizures. Phenobarbital may be required as a third drug if seizures persist or recur. In cases of refractory status epilepticus, barbiturate coma, continuous anticonvulsant intravenous infusion, or general anesthesia may be necessary.
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More than 2,000 medically ill patients with delirium have been treated by intravenous administration of a combination of haloperidol and lorazepam. The protocol was developed over 8 years at two major cancer centers in the United States and Canada. The addition of the potent benzodiazepine to the neuroleptic produces rapid and safe symptomatic sedation in emergency conditions and allows the use of lower doses of haloperidol. ⋯ Patients generally respond to the first one or two doses and, in most cases, less than 100 mg/day of each drug is required. The addition of the opioid hydromorphone makes the combination ideal for the treatment of intractable pain in terminally ill cancer patients. This polypharmacological approach is advocated as the method of choice for emergency sedation of the delirious patient as well as for palliative care.
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Four of five patients who had had an operationally defined syndrome of postpsychotic depression, which had been responsive to adjunctive imipramine added to an ongoing regimen of fluphenazine decanoate and benztropine, suffered a return of depressive symptomatology following the tapering of the adjunctive imipramine 6 months after the initial response to imipramine therapy. Four comparison patients who were not tapered experienced no such reexacerbations (p = .04). The authors discuss implications of this finding for maintenance adjunctive antidepressant treatment strategies.
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The authors present a study in which 33 chronic schizophrenic patients who, when withdrawn from antipsychotic drug treatment for more than 2 weeks, presented with concurrent signs of akathisia and tardive dyskinesia; however, signs of akinesia, facial masking, rigidity, or dystonia were not concurrent with the patients' akathetic presentation. In a subsequent study phase, these patients were treated with antipsychotics for up to 6 weeks. The dyskinetic signs that had been dramatically more severe in those patients exhibiting akathisia following withdrawal from antipsychotic medication continued for up to 6 weeks following the renewal of antipsychotic drug therapy. These findings help to confirm a relationship between tardive dyskinesia and a persistent akathisia of later onset known as tardive akathisia.