RESUMEN
The results of complete thyroid function testing were normal in four desipramine nonresponders who were converted to responders by addition of L-triiodothyronine (T3). These findings suggest that the effectiveness of T3 is not due to correction of subtle thyroid deficiencies.
Asunto(s)
Trastorno Depresivo/tratamiento farmacológico , Desipramina/uso terapéutico , Pruebas de Función de la Tiroides , Triyodotironina/uso terapéutico , Adulto , Trastorno Depresivo/complicaciones , Trastorno Depresivo/fisiopatología , Desipramina/farmacología , Sinergismo Farmacológico , Quimioterapia Combinada , Femenino , Humanos , Hipotiroidismo/complicaciones , Hipotiroidismo/fisiopatología , Masculino , Persona de Mediana Edad , Radioinmunoensayo , Glándula Tiroides/fisiopatología , Hormona Liberadora de Tirotropina , Tiroxina/sangre , Triyodotironina/farmacologíaRESUMEN
In a double-blind study, 49 elderly patients with primary major depression, with or without cardiovascular disease, were treated with maprotiline or doxepin. Holter monitors, 12-lead ECGs, and orthostatic blood pressure measurements were used. Maprotiline was associated with decreased PVCs in patients with a "high" baseline rate, while doxepin was associated with increased PVCs in this group. There were no significant differences in orthostatic blood pressure changes between treatment and nontreatment phases or between the two drugs. Small but significant increases in heart rate and prolonged PR interval were noted with both drugs. QRS interval was prolonged by maprotiline but decreased by doxepin. Neither drug produced untoward effects in patients with stable angina or an old myocardial infarction. Maprotiline may have an antiarrhythmic effect which could be beneficial in the treatment of depression with concomitant PVCs. Conversely, doxepin may be more appropriate for depressed patients with heart block or intracardiac conduction delays. Further research is necessary to confirm these suggestions.
Asunto(s)
Antracenos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Doxepina/uso terapéutico , Corazón/efectos de los fármacos , Maprotilina/uso terapéutico , Anciano , Angina de Pecho/complicaciones , Angina de Pecho/fisiopatología , Presión Sanguínea/efectos de los fármacos , Complejos Cardíacos Prematuros/complicaciones , Complejos Cardíacos Prematuros/fisiopatología , Ensayos Clínicos como Asunto , Trastorno Depresivo/complicaciones , Método Doble Ciego , Doxepina/farmacología , Electrocardiografía , Femenino , Corazón/fisiopatología , Sistema de Conducción Cardíaco/efectos de los fármacos , Sistema de Conducción Cardíaco/fisiopatología , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Maprotilina/farmacología , Persona de Mediana Edad , Monitoreo Fisiológico , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , PosturaRESUMEN
Most major actions of the antipsychotic drugs stem from one of the four antagonistic functions common to all these drugs. Antidopaminergic activity in the mesolimbic system results in the primary desired effect, control of psychosis. Antidopaminergic activity also occurs in other brain areas. Dopamine blockade in the nigrostriatal pathway results in extrapyramidal symptoms and tardive dyskinesia. Blockade in the tuberoinfundibular tract of the hypothalamus causes elevated circulating prolactin. Central H1 histaminic receptors are also blocked by these drugs, causing sedation. The anti-alpha adrenergic activity of the antipsychotics results in orthostatic hypotension, and antimuscarinic activity results in the atropinic picture commonly seen with these drugs. The mnemonic "the anti-fours" is used to order the four major pharmacological effects: anti-dopaminergic, anti-H1 histaminic, anti-alpha adrenergic, and anti-muscarinic.
Asunto(s)
Antipsicóticos/farmacología , Antagonistas Adrenérgicos alfa/farmacología , Encéfalo/efectos de los fármacos , Antagonistas de Dopamina , Tractos Extrapiramidales/efectos de los fármacos , Antagonistas de los Receptores Histamínicos H1/farmacología , Humanos , Receptores Muscarínicos/farmacología , Esquizofrenia/tratamiento farmacológicoAsunto(s)
Trastorno Depresivo/diagnóstico , Metilfenidato/uso terapéutico , Hormona Liberadora de Tirotropina , Adulto , Trastorno Depresivo/sangre , Trastorno Depresivo/tratamiento farmacológico , Dexametasona , Femenino , Humanos , Hidrocortisona/sangre , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Tirotropina/sangreRESUMEN
The author presents four cases of antipsychotic drug-induced enuresis preceded by occult symptoms of mild uninhibited bladder. Pre-existing uninhibited bladder may facilitate some cases of antipsychotic drug-induced enuresis.
Asunto(s)
Antipsicóticos/efectos adversos , Enuresis/inducido químicamente , Vejiga Urinaria Neurogénica/complicaciones , Adulto , Antipsicóticos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Trastorno Depresivo/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Encephalopathy (acute organic brain syndrome) superimposed on functional psychosis may be overlooked because the physician assumes that any exacerbation is due to fluctuation in the psychosis. Correct diagnosis requires a high index of suspicion and a firm knowledge of the signs of encephalopathy. A careful diagnostic approach permits the recognition of encephalopathy and separates it from functional disorders such as schizophrenia.
Asunto(s)
Trastornos Neurocognitivos/diagnóstico , Trastornos Psicóticos/complicaciones , Adulto , Atención , Cognición , Humanos , Masculino , Trastornos Neurocognitivos/complicaciones , Orientación , Pruebas Psicológicas , Psicosis Inducidas por Sustancias/complicaciones , Psicosis Inducidas por Sustancias/diagnósticoRESUMEN
Individuals with the borderline personality disorder are less stable than neurotics but do not have sustained psychotic decompensations. These patients are socially insensitive, impulsive, resentful and chronically depressed, and may display fits of anger. Borderline patients experience the greatest difficulty in dealing with intense relationships. Medical problems that require sustained follow-up may bring about a doctor-patient relationship intense enough to stir up turmoil. The cornerstone of treating such patients is maintaining a limited relationship.