Quetiapine Add-On Therapy May Improve Persistent Sleep Disturbances in Patients with PTSD on Stabile Combined SSRI and Benzodiazepine Combination: A One-Group Pretest-Posttest Study.

BACKGROUND: To assess potential benefits of quetiapine for persistent sleep disturbances in patients with posttraumatic stress disorder (PTSD) on stable combined SSRI and benzodiazepine therapy, who previously failed to respond to various benzodiazepine and non-benzodiazepine hypnotic adjuvant treatment as well as to first-generation antipsychotic add-on treatment. SUBJECTS AND METHODS: Fifty-two male PTSD outpatients on stable combination treatment with SSRI and benzodiazepines, with persistent sleep disturbances not responding to prescription of zolpidem, flurazepam, nitrazepam, promazine, and levopromazine, were assessed for sleep disturbances improvements after prescription of quetiapine in the evening. Each patient met both ICD-10 and DSM-IV criteria for PTSD. Psychiatric comorbidity and premorbidity were excluded using the Mini-International Neuropsychiatric Interview (MINI). Improvement on the CAPS recurrent distressing dream item, reduction in the amount of time needed to fall asleep, prolongation of sleep duration, and reduction in average number of arousals per night in the last 7 days before the assessment period were used as efficacy measures. RESULTS: All sleep-related parameters improved significantly at the end of a five-week follow-up: sleep duration increased by one hour (p<0.001), sleep latency decreased by 52.5 minutes (p<0.001), median number of arousals per night decreased from two to one (p<0.001), CAPS recurrent distressing dream item median decreased from five to four (p<0.001), and the number of patients dissatisfied with their sleep quality and quantity decreased from 45 to two (p<0.001). CONCLUSION: Quetiapine prescribed in the evening may be successful therapy for persistent sleep disturbances in patients with PTSD and generally good response to an SSRI and benzodiazepine combination, who previously failed to respond to some of the usual hypnotic medication or addition of first-generation antipsychotics: zolpidem, flurazepam, nitrazepam, promazine, and levopromazine.

Use of benzylglycinamide by a HIV-seropositive polysubstance user: The changing pattern of novel psychoactive substance use among youths.

A 24-year old woman with multisubstance use since the age of 13, including opioids and cocaine, and long-standing HIV/HCV seropositivity status, presented with psychosis, agitation, and insomnia at the emergency department of a university hospital. She had been abusive and physically aggressive frequently without specific reasons and was involved in criminal legal cases. She was hospitalized twice. During her first hospital stay she experienced a brief episode of detachment from her environment, similar to episodes reportedly suffered at home. Psychosis had developed following heavy polysubstance abuse. Her mother provided sachets containing benzylglycinamide, a substance with no known psychotropic effects, which were also present in the patient's urine. She was occasionally positive for cannabinoids. She used to buy various novel psychoactive substances (NPSs) from the internet and used experimentally various substances freely made available to her by drug suppliers/dealers. She was unable to explain clearly why she was taking any of the identified NPS. She stated she was taking benzylglycinamide to calm her when smoking synthetic cannabinoids. While it appears that benzylglycinamide is not likely to constitute a novel drug of abuse, her polysubstance use exemplifies trends in NPS use patterns among the youths in the Western world and should alert mental health workers as to the possible dangers of such behavior and its reflection on social behavior and psychopathology.

Exanthema medicamentosum as a side effect of promazine.

Dermatological side effects of psychopharmacological drugs are fortunately not so often. They are mostly presented in the group of mood stabilizers and antiepileptic drugs, particularly the carbamazepine and lamotrigine, and can be manifested through the Stevens Johnson syndrome, Toxic Epidermal Necrolysis (TEN)/Lyell's syndrome with about 30% lethality. According to the literature the group of phenothiazines is the category of drugs with rare appearances of skin reactions. Promazine, aliphatic phenothiazines antipsychotic, including less frequent side effects in the leaflet states increased skin sensitivity to sun, skin rash-associated with contact dermatitis, allergic reactions, cholestatic icterus. The only reported dermatological side effect of promazine is its metabolites deposition in the cornea. Analyzing the e-data basis we have not found references connecting the Exanthema medicamentosum as a side effect of promazine. A forty-two years old female patient was admitted to the Dermatological Clinic because of suspected exanthema, undoubtedly caused by promazine as a medication for Sy. Borderline.

Promazine in the treatment of delusional parasitosis.

Delusional parasitosis (DP) is an uncommon and complex to treat form of delusional disorder, somatic type. The syndrome may occur in association with a number of psychotic disorders, such as schizophrenia, organic mental disorder, or even in dementia with behavioral and psychological symptoms. Evidence of efficacy of treatment options is weak and there is little known about the specific use of typical and atypical antipsychotics. We report on a case of primary DP in a 75-year-old Caucasian woman with a 3-year-long history of dermatological consultations due to unspecified complains who responded to the typical antipsychotic promazine. This case is unique in pharmacological respect as it presents the first reported DP treatment with promazine. It also raises the issue of efficacy and safety of low-potency typical antipsychotics in the elderly population.

Use and misuse of antipsychotic drugs in patients with dementia in Alzheimer special care units.

The objective of this study was to estimate the prevalence of antipsychotic use and investigate their association with behavioural and psychological symptoms of dementia (BPSD) and other clinical predictors. Patients with dementia, aged 65 and above and resident in 35 Alzheimer special care units were sequentially enrolled into a 18-month prospective observational study. Data on sociodemographic, cognitive, functional, behavioural and clinical characteristics and drug exposure were collected at baseline and at 6-month intervals up to 18 months. The prevalence of antipsychotic use and the association with BPSD and clinical predictors were analysed. Of the 349 patients with dementia enrolled in the study, 209 (60%) were taking at least one antipsychotic. Risperidone and promazine were the most frequently prescribed antipsychotic; 40.7% simultaneously received a benzodiazepine, 20% an antidepressant. More than 50% were still taking antipsychotics at 18 months of follow-up. No associations were found between antipsychotic use and level of cognitive impairment, basal activity of daily living disability and comorbidity. Multivariate analysis showed that the use of antipsychotics was highest in patients in the highest quartiles of Neuropsychiatric Inventory Scale score (III quartile, odds ratio: 1.63; 95% confidence interval: 1.19-2.23; IV quartile, odds ratio: 2.27; 95% confidence interval: 1.61-3.26). This study found high rate of use of antipsychotics in patients with dementia resident in Alzheimer special care units, frequent associations with other psychotropic medications and a strong correlation with BPSD.

Comparison of the efficacy of new and conventional antipsychotic drugs in the treatment of behavioral and psychological symptoms of dementia (BPSD).

This double-blind study evaluated the efficacy and safety of risperidone or olanzapine vs. promazine in the treatment of behavioral and psychological symptoms in dementia(BPSD). Patients were required to be 65 years or older, to have DSM-IV diagnoses of Alzheimer's disease (AD), vascular dementia (VD) or a combination of both. A brain computerized tomography (CT) was performed for all the patients; 60 demented patients,27 men (45 %) and 33 women (55 %) were selected for this study. The University of California Los Angeles neuropsychiatric inventory (NPI) was administered at baseline, then after 4 and 8 weeks. Patients had at least a score of 24 or more. The Hoehn and Yahr scale was used for evaluating parkinsonism. The scales were administered by an examinator who was not aware of the kind of treatment of the patients. After a wash-out period of 10 days,20 patients, 9 men and 11 women, mean age 76.6 +/- 6.0 years, were randomly assigned torisperidone 1 mg daily in divided doses (morning and bedtime) (Group A); 20 patients, 9 men and 11 women, mean age 82.5 +/- 9.3 years were randomly assigned to olanzapine 5mg at bedtime (Group B), and 20 patients, 9 men and 11 women, mean age 77.6 +/- 4.6 years, were randomly assigned to promazine 50 mg daily (morning and bedtime) (Group C). In case of lack of clinical response, after 4 weeks, the dose could be increased to 2 mg/day of risperidone, 10 mg/day of olanzapine, and to 100 mg/day of promazine in the respective groups. Repeated measures ANOVA was used for the statistical analysis of rating scales over time (baseline, 4 and 8 weeks). At the end of the 8th week, a global improvement was obtained in 80% of patients treated with risperidone and olanzapine, vs. 65 % of patients treated with promazine (p < 0.01). The results show that risperidone in doses of 1-2 mg/day and olanzapine in doses of 5-10 mg/day are effective and safe in the treatment of BPSD. Risperidone presents a major and dose-dependent antidopaminergic action and seems to be preferable when hallucinations and delusions are prevailing symptoms, even if it gives good results on aggression and wandering. Olanzapine seems to be faster in its sedative effect, probably for H1 receptor blockade. Moreover, 5-HT6 antagonism may favor acetylcholine release and this explains why these patients have not presented a cognitive worsening. However, both drugs are comparable or even superior to promazine, with significantly fewer side effects of both anticholinergic and extrapyramidal character.

Neuroleptic prescribing to the community elderly in Nottingham.

DESIGN: A cross-sectional pilot survey of computerized prescribing databases and written general practitioner records. Data were abstracted by the first author using a standard proforma. SETTING: Six out of 12 general practices situated in an area of north Nottingham known to have a high density of residential and nursing homes cooperated with the exercise (one was excluded because it lacked a computer system, one because the principal had a specialist commitment to old age psychiatry and four were self-excluded). PATIENTS: Patients recorded as receiving repeat prescriptions of oral preparations of thioridazine, chlorpromazine, promazine, haloperidol or trifluoperazine. MEASURES: Point prevalence rates of neuroleptic repeat prescribing classed by age group and, in the case of the elderly, residential status. For elderly recipients: median (range) duration on neuroleptics, median (range) time since last review and numbers (percentages) having various characteristics. RESULTS: Elderly patients were found to be more likely consumers of neuroleptic medication than their younger counterparts. If these results are extrapolated nationwide, then approximately half the patients receiving repeat prescriptions for the commonest oral neuroleptics emerge as elderly and of these about half are in nursing/residential care. Patients in nursing/residential homes suffering dementia formed the largest group of recipients, but have the least monitoring by psychiatric teams. CONCLUSION: The result highlight a need for a close partnership between primary care, community care facilities and old age psychiatric teams to ensure adequate monitoring and the implementation of psychological strategies to minimize their use.

The duration of the movement aftereffect as an index of psychiatric illness.

The duration of the movement aftereffect (MAE) has sometimes been used to make inferences about the subject's state (for example, their level of arousal). Some studies are reviewed in which visual aftereffects (including the MAE) were measured in schizophrenia, with inconsistent results. Some relevant psychopharmacological and neurological evidence is considered. It is concluded that: (i) Differences in the clinical status of the schizophrenic subjects and whether they were receiving medication, but not the method used to measure aftereffects, may underlie the interstudy disagreements. (ii) The effect of schizophrenia is to increase MAE duration, and this is not due to some peripheral artefact. (iii) Longer MAEs in the illness could result from enhanced neurally signalled contrast and/or from the increased adaptability of cortical neurons.

[Effect of phenothiazine derivative on adrenal cortex response of sheep to repeated emotional stress]. / Wplyw pochodnej fenotiazyny na reakcje kory nadnerczy owiec w czasie wielokrotnego stresu emocjonalnego.

The study was aimed at the evaluation of propiopromazine (Combelen, Bayer), a derivative of phenothiazine, as an agent lowering in sheep the response to stress. The stress of emotional origin was induced in sheep by the isolation from herd lasting 1 hour. The isolation experiments were repeated 6 times on the same group of sheep, first three isolations (1-3) in daily intervals and next three (4-6) in weekly intervals. Propiopromazine was administered before each isolation experiment. The reaction of sheep to the isolation stress was weaker after propiopromazine administration. This was suggested by smaller increase in blood serum cortisol and glucose levels when compared to sheep subjected to isolation but not receiving the drug. Such effect was especially conspicuous during the course of the first isolation experiment; during the next experiments the difference concerning the reaction to stress between the sheep isolated from the herd receiving and not receiving the drug was gradually diminishing. It was shown in addition that propiopromazine administration to the sheep not subjected to stress caused an increase in cortisol level by 125 per cent and that in glucose level by 35 per cent. These results suggest that propiopromazine administration protects the organism against the effects of emotional stress only partially. Moreover, the effect of its administration gradually weakens with repeating of the stress inducing experiment, and propiopromazine itself may act as a stress inducing factor. It seems therefore that the use of propiopromazine and similar compounds as anti-stress agents may be questionable.

[Drug therapy of so-called postherpetic neuralgia, the only valid alternative. Clinical experience in 43 treated cases]. / La terapia farmacologica della cosiddetta nevralgia post-erpetica unica valida alternativa. Esperienza clinica di 43 casi trattati.

The efficacy of tricyclic antidepressants in association with neuroleptics having been demonstrated in patients suffering from so-called tardive post-herpetic neuralgia, 43 patients were given this treatment either alone or in association with transcutaneous nerve stimulation (TENS). Of the 33 patients given drug treatment alone, 25 found relief from pain in 3-18 months, 5 produced a partial result and in 3 the treatment failed. The results obtained suggest that this is the most effective treatment as long as it is continuous and given for at least 3-6 months. The use of TENS produced no benefit.

[Inpatient withdrawal treatment of heroin dependence with neuroleptics--an approach to addicts]. / Stationäre Entzugsbehandlung bei Heroinsucht mit Neuroleptika--Ein Weg zum Süchtigen.

The authors present a setting for abrupt withdrawal treatment with the following targets: 1. To facilitate the addicts the voluntary use of medical and psychiatric service. 2. To develop methods for withdrawal treatment, as riskless and easy to handle as possible. 3. To use the time of inpatient treatment for building up confidence in psychiatric services to motivate the patients for a following therapy. Drugs and dosage of peroral and intravenous neuroleptic treatment and possible complications are discussed. Peroral treatment has the advantage of lower doses, easier handling and lower complication rates. The setting and the used drugs seem to be attractive enough for many addicts to contact the clinic on their own account.

[The value of EEG after sleep deprivation for the diagnosis of epileptic seizures, epilepsy and other cerebral disorders]. / Wertigkeit des EEG nach Schlafentzug für die Diagnostik epileptischer Anfälle, von Epilepsien und anderen zerebralen Störungen.

114 electroencephalographic and 49 clinical criteria of 1010 patients, including 64 healthy volunteers, were evaluated by means of a computer. In 549 patients with epileptic seizures spike wave (sw) paroxysms were seen in 13.3%. Following a 24-hour period of sleep deprivation sw paroxysms were present in 24.2% cases which represents an increase of 82.0%. The number of cases with focal discharges increased in this group from 21.3% initially to 27.5% after sleep deprivation, representing an increase of only 29.1%. The percentage increase in sw paroxysms and focal discharges following sleep deprivation was approximately as marked also in patients without epileptic seizures, so that sleep deprivation was found to be equally useful in patients with non-epileptic cerebral disorders. The rate of activation is higher in children and juveniles than in adults. Similarly, it is higher in patients with awaking epilepsy than in patients with sleep epilepsy. The influence of sleep deprivation and that of sleep, respectively, upon the provocation of EEG changes was not sharply differentiated. By counting sw paroxysms in the EEG before sleep deprivation, in the waking EEG following sleep deprivation, as well as in the subsequent sleeping EEG further evidence was obtained, however, supporting the suggestion that special significance may be attributed to sleep deprivation as a provocation method. If the activation of sw paroxysms and focal changes is related to sleep and sleep stages it can be shown that their frequency decreases from stage 1 to stage 4. In particular, the short fluctuations in vigilance, the waking reactions frequently occurring under routine laboratory conditions and the transitions between sleep stages were seen to assume trigger functions.

Failure of pyridoxine to effect neuroleptic-induced hyperprolactinemia in psychotic patients.

The effects of acute and repeated administration of pyridoxine on serum prolactin levels were studied in 18 chronic schizophrenics, 10 women and 8 men, in whom hyperprolactinemia had been induced by long-term treatment with phenothiazines, haloperidol, sulpiride or clopentixol. The patients were divided into 5 groups: group 1 received 300 mg of the vitamin per os in a single dose; group 2 received 300 mg of the vitamin per os for 7 days; group 3 received 300 mg of the vitamin iv as a single bolus; group 4 received 600 mg of the vitamin iv as a single bolus; group 5 received 1200 mg of the vitamin per os in a single dose. Prolactin levels were examined before and 15, 30, 60, 90, 120 and 150 min after the single administration of pyridoxine, either iv or per os, and on days 3,5, 7 of the chronic administration. There was no decrease in prolactin levels either after oral or iv administration of the drug, given in single or repeated doses. Therefore, this treatment is not useful for the suppression of hyperprolactinemia induced by neuroleptics.