[Citalopram in depression (results of an open multicenter study in phase IV of the clinical trial)]. / Citalopram u depresí (Výsledky otevrené multicentrické studie v rámci IV. etapy klinického hodnocení).

249 depressed patients were treated by 35 psychiatrists in an open multicenter trial during 6 weeks with citalopram. The protocol enabled that naturalistic treatment conditions could be kept. The results were rated with the help of the Clinical Global Impression (CGI) scale. The treatment was successful in 77% of the patients. 5 patients dropped out because of adverse effects, 8 patients did not finish the trial due to insufficient efficacy. In 160 patients (64.2%) no adverse effects were registered. Transient mild headaches in 8.4% and nausea in 4% were the most frequent adverse events. The best effects were observed in patients who were rated as moderately ill (82.8% ameliorated) at pretreatment. Nevertheless, also 66.7% of those rated as severely ill before the treatment improved substantially. In patients treated with higher doses than 20 mg/day, the improvement rate was not higher than in those treated with 20 mg daily.

A survey of psychotropic medications not available in the United States.

The range of psychotropic medications available in the U.S. for the treatment of serious mental illnesses is limited. Many agents have been "me too" drugs, offering primarily side-effect differences, instead of new indications or mechanisms. As a result, patients refractory to the original drugs are not helped. Other patient populations (both mentally ill and addicted) have "fallen through the cracks" of the current U.S. psychotropic drug development process. The recent approval of chlorimipramine and clozapine demonstrates that real benefits for U.S. patients can be realized from judicious introduction of non-U.S. drugs. Many more psychotropic drugs developed and used in other countries are not available in the United States. Industrial and regulatory obstacles could be surmounted by the legislative innovation proposed. This survey identifies some specific non-U.S. drugs of interest.

Neuroscience in Czechoslovakia.

The collapse of the communist regime in Czechoslovakia revealed not only the disastrous state of the Czechoslovak economy but also the serious problems that Czechoslovak science faces. Understanding the present situation and determining the best way to improve it requires careful analysis of the development of science during the past 40 years.

Effects of drug administration in pregnancy on children's school behaviour.

Files with prescription data were used to assess possible behavioural changes in children, whose mothers used benzodiazepines or neuroleptic drugs during the second half of their pregnancy. Prescriptions, bearing the identification number of women resident in one district of Prague, filed in pharmacies during 1974 and the first three months of 1975 represent the first part of the data. During 1984, children born in the appropriate earlier period were searched and linked with the earlier prescription data. A group of 68 children with possible exposure to neuroleptics and a group of 15 children possibly exposed to diazepam during the second half of their intrauterine development were found. Two groups of 55 and 7 children, respectively, born of mothers without exposure to these drugs, were chosen as controls. The teachers of classes attended by these children were addressed by a letter and asked to evaluate their behaviour at school. This was done by means of a form containing analogue scales evaluating different features of behaviour. Each child was compared with its control. The statistical evaluation with Student's t-test, regression analysis and analysis of variance did not reveal any significant difference between both groups and their controls.

Smokers need higher doses of neuroleptic drugs.

There is indirect evidence that smoking induces higher enzymatic activity which accelerates the metabolism of many drugs. This influence is inferred from the frequency and magnitude of drug side effects. We could demonstrate that smokers need higher doses of neuroleptic drugs than nonsmokers.