Buspirone in the treatment of tardive dyskinesia.

Eight patients with mild to severe tardive dyskinesia (TD) were treated for 12 weeks with buspirone in dosages of up to 180 mg/day in an open-label study. Changes in TD severity were assessed by the Abnormal Involuntary Movement Scale. The rater was blind to buspirone dosage. Buspirone was well tolerated by most subjects. A within-subjects comparison of pretreatment and post-treatment Abnormal Involuntary Movement Scale scores revealed a mean improvement of 4.4 (p < 0.01). Improvement was also observed in neuroleptic-induced extrapyramidal side effects such as parkinsonism and akathisia. Scores on the Hamilton Rating Scale for Anxiety and the Brief Psychiatric Rating Scale did not change during the 12-week study. The results of this open-label pilot study suggest that relatively high doses of buspirone may be efficacious in the treatment of TD.

The use of carbamazepine to treat benzodiazepine withdrawal in a geriatric population.

Rapid withdrawal of short to intermediate half-life benzodiazepines may be hazardous, particularly in the elderly. The use of carbamazepine to facilitate withdrawal has been reported in younger patients. We describe four elderly patients (average age, 72.5 years) who had each experienced at least one unsuccessful attempt at alprazolam withdrawal and who were subsequently successfully withdrawn via the use of carbamazepine over a period ranging from 2 to 6 days. These geriatric patients experienced no major withdrawal symptoms, but mild symptoms were common. There was no correlation between dose or duration of alprazolam use and extent of withdrawal symptoms. We recommend use of this treatment regimen in a hospital setting only, where close monitoring can occur.

Toxic cannabis psychosis is a valid entity.

One hundred black men admitted to hospital with acute psychiatric symptoms were investigated for the presence of urinary cannabis metabolites in order to delineate the psychiatric role played by 'dagga', the potent South African cannabinol, in the study population and to determine the diagnostic value of the entity 'toxic psychosis (dagga)'. Cannabinoids were present in 29% of patients, and 31% were discharged with a diagnosis of toxic psychosis (dagga). Clinical and demographic material was gathered for all patients and no consistent differences were found between dagga-positive and dagga-negative patients or toxic dagga psychotic patients and 'functional' psychotics other than a history of recent dagga use and the dagga screening test result. The latter measure was found to be both more sensitive and more specific than the history of dagga use alone. The findings support the routine use of a simple screening test for dagga in the sample population studied. The study demonstrated the heterogeneous nature of the toxic dagga psychosis syndrome by documenting a variety of different clinical presentations, which included schizophrenia (42%), paranoia (26%), maniform psychosis (16%) and organic psychosis (16%).

Cannabis--its clinical effects.

The range of clinical, intoxicating, psychological and psychiatric effects of cannabis ('dagga') are reviewed. Controversial subjects, such as the entities of toxic cannabis psychosis and the cannabis amotivational syndrome, are discussed.

Carbamazepine in nonresponsive psychosis.

Nonresponsive psychosis encompasses heterogeneous psychotics who are symptomatic despite adequate trials of neuroleptic medication. A proportion of those patients are schizophrenic. A second subgroup are symptomatic in that they have specific target features. The use of carbamazepine is discussed in the context of searching for active target symptoms and features that may imply its appropriate application as adjunctive medication in nonaffective, nonepileptic psychotics. Despite a dearth of studies in the literature, two studies, those of Neppe and of Klein, appear to be of theoretical relevance and are used as starting points to compare the other blind and nonblind literature available. It appears that carbamazepine is worthwhile in patients with some aggression and interpersonal difficulties who are refractory to neuroleptics alone and who exhibit instability and agitation. The role of temporal-lobe symptomatology and temporal-lobe foci is unclear, and the mechanism of action of carbamazepine is apparently not directly antipsychotic and may relate to an antikindling-like mechanism. The role of psychodynamics should not, however, be ignored. A great deal more research is required.

Fundamentals of carbamazepine use in neuropsychiatry.

Carbamazepine, mainly used as an anticonvulsant but also used for trigeminal neuralgias and other neuralgic pains, is now being used experimentally for affective disorders, nonresponsive psychoses, and dyscontrol. However, carbamazepine dosage must be carefully monitored because low initial doses are equivalent to higher later doses, and the drug's addition to a regimen of other drugs may increase carbamazepine's serum levels. Given alone to a pharmacologically naive inpatient, initial dosage of carbamazepine 200 mg/day can be increased by 100 mg every day or every second day; an outpatient can have the dosage increased by 100 mg every third day. Serum levels and side effects should be monitored. White cell counts usually decrease about 25%, but the decrease is not clinically related to the very rare occurrence of agranulocytosis. A side effect of concern is hepatic toxicity, but few such cases have been reported. The most common side effect is allergic rash, which occurs in about 5% of all patients receiving carbamazepine; antihistamines sometimes bring about a remission of the rash. Generic carbamazepine may cause more problems than Tegretol.

Modern perspectives on epilepsy in relation to psychiatry: behavioral disturbances of epilepsy.

In this paper, the second of a two-part series on current psychiatric aspects of epilepsy, the authors consider the classification and management of the various kinds of psychoses and other behavior disturbances associated with some cases of epilepsy. After discussing the common aspects of epilepsy and schizophrenia, they describe attempts to categorize epileptic psychoses, focusing on a classification of ten kinds of psychoses that they believe has broadest application. They present guidelines for psychopharmacological management of epilepsy accompanied by behavior disturbance, with emphasis on anticonvulsant monotherapy, and they discuss possibly related seizure disorders and possible etiologies of behavioral symptoms of epilepsy.

Modern perspectives on epilepsy in relation to psychiatry: classification and evaluation.

This paper begins a two-part series on current psychiatric aspects of epilepsy. Part I focuses on the current classification of epileptic seizures; the possible relationships of epilepsy, especially temporal lobe epilepsy, with psychopathology; and the difficulties of evaluating epileptic conditions through electroencephalography. Part II, to be published in the April issue, will cover the management of epilepsy that is accompanied by behavior disturbance.

Neurology and psychiatry.

There has been a long historical relationship between neurology and psychiatry. This relationship has been nurtured by the common interest in the central nervous system and disturbed behavior associated with dysfunctions of the nervous system. This paper reviews the formal relationships between neurology and psychiatry and particularly looks at the behavioral aspects of neurological disease. For the past 10 years, both from a clinical and a theoretical viewpoint, the importance of understanding central nervous system functioning and dysfunctioning has become increasingly apparent to psychiatrists.