Citalopram in patients with unsatisfactory response to neuroleptics: an open follow-up study.

There is clinical evidence that antidepressants have beneficial effects on certain symptom clusters of psychotic patients. Specific serotonin reuptake inhibitors like citalopram provide a new possibility to selectively influence brain neurotransmission. We studied the effects of citalopram (20-60 mg daily) in 36 psychotic or borderline patients receiving neuroleptic treatment without satisfactory response. Particular attention was paid to negative symptomatology, anxiety, and impulsiveness. 22 of the patients (65%) were assessed to react to citalopram treatment in a clinically significant manner. Initially, the responders tended to have higher scores in withdrawal-retardation, anxious-depression, and hostile-suspiciousness factors of the Brief Psychiatric Rating Scale (BPRS), with a lower degree of thinking disturbances. In the responder group, a significant decline in all symptom clusters was recorded. The mean decrease was 38% in Clinical Global Impression (CGI) and BPRS scales. The most prominent change (52%) was seen in hostile-suspiciousness factor of the BPRS inventory. In light of the positive results achieved in this open-label trial, controlled trials with patients not responding satisfactorily to neuroleptics are warranted.

Ultrasonic device in bone cutting. A histological and scanning electron microscopical study.

The immediate and the long-term effects on bone produced by an ultrasonic cutting device and an oscillating saw were compared histologically and by scanning electron microscopy. The long bones and scapulas of rabbits were used as experimental material. By scanning electron microscopy the osteotomy surface produced by the ultrasonic saw was observed to be rougher than that produced by oscillating saw, but there were no microfractures. Histologically the early regeneration of the bone tissue was delayed to some degree after ultrasonic cutting, but the regeneration process as a whole was found to be the same after cutting with either of the saws.

Citalopram as an adjuvant in chronic schizophrenia: a double-blind placebo-controlled study.

The effects of citalopram--the most selective serotonin reuptake inhibitor on the market--on psychopathological symptoms were studied in chronic schizophrenic patients on a stable regimen of neuroleptic medication. Outpatients suffering from schizophrenic disorder (DSM-III-R) with Positive and Negative Symptom Scale (PANSS) scores higher than 50 were included in a double-blind placebo-controlled add-on study. The daily dose of citalopram was 20 mg in the first week and 40 mg for the remaining period. A total of 90 patients (45 patients receiving citalopram and 45 receiving placebo) completed the 12-week trial. There were no changes in neuroleptic plasma levels during the trial. There was a significant decrease in total PANNS scores during the trial, although no statistically significant differences between the citalopram group and the placebo group were revealed. The number of responders in terms of severity of illness (CGI) was higher and the increase in subjective well-being (VAS) was greater in patients on citalopram than in those receiving placebo. There were no significant differences in the occurrence of side-effects. It is concluded that, in chronic schizophrenic out-patients, citalopram has no clear effect on the psychopathological symptoms; it may improve the general clinical condition, and it appears to increase the subjective well-being of these patients. Citalopram appears to be safe when used to treat schizophrenic patients who are receiving concomitant neuroleptic treatment.