Three case reports of acute paroxysmal excitement associated with alprazolam treatment.

Three patients receiving alprazolam developed, within days after beginning treatment, acute excitatory states with features more suggestive of mania than of disinhibition syndrome. The authors suggest a neurochemical link between mania and disinhibitory states.

Continuation and maintenance treatment trials of adjunctive imipramine therapy in patients with postpsychotic depression.

Four of five patients who had had an operationally defined syndrome of postpsychotic depression, which had been responsive to adjunctive imipramine added to an ongoing regimen of fluphenazine decanoate and benztropine, suffered a return of depressive symptomatology following the tapering of the adjunctive imipramine 6 months after the initial response to imipramine therapy. Four comparison patients who were not tapered experienced no such reexacerbations (p = .04). The authors discuss implications of this finding for maintenance adjunctive antidepressant treatment strategies.

Stability of the postpsychotic depression syndrome.

Fifteen consecutively identified patients with syndromally defined postpsychotic depression were followed prospectively over three consecutive weekly ratings to assess the stability of that syndrome. In 8 cases, the condition persisted with undiminished intensity. Five cases remitted spontaneously, and in 2 cases the syndrome appeared to be a harbinger of psychotic relapse. The implications for the timing of therapeutic interventions in patients with postpsychotic depressions are discussed.

Fluphenazine decanoate dose and severity of depression in patients with post-psychotic depression.

The authors examined the fluphenazine decanoate dose and the fluphenazine plasma levels in comparison with measures of severity of depression in schizophrenic and schizoaffective patients. All patients were selected for study on the basis of having stable, syndromally defined, antiparkinsonian non-responsive syndromes of post-psychotic depression. No meaningful relationships were found. The implications of this observation with regard to the notion that depressive symptomatology in such patients is neuroleptic-induced is discussed.

Thyroid releasing hormone test in schizophrenic patients with post-psychotic depression.

1. TSH response to TRH was assessed in 25 patients meeting operationalized criteria for the post-psychotic depression syndrome and in an age and sex matched control group of 34 primary depressed patients. 2. A blunted TSH response was observed in 36% of the patients with post-psychotic depression. 3. The rate of blunted TSH response was similar for patients with secondary post-psychotic depression to those patients with primary depressions. 4. Demographic and clinical parameters did not distinguish those post-psychotic depressed patients who had a blunted response from those who did not. 5. A blunted TSH response to TRH did not predict which patients were more likely to have a favorable response when adjunctive imipramine was added to their on-going fluphenazine decanoate and benztropine regimen.

Cricoid pressure training: how useful are descriptions of force?

Cricoid pressure has been used for over 200 years. During that time, training in the technique has not changed greatly, despite the well-documented potential for complications if performed improperly. Typically, training relies on quantitative or qualitative descriptions such as "firm" pressure, a number of Newtons of force or equivalent force to that causing pain while pressing on the nose. This study tests the value of these descriptive methods in training to apply cricoid pressure. Fifty subjects were asked to apply cricoid pressure after receiving a description of the force required and again after having tested how much finger pressure on the bridge of their nose was required to cause discomfort. Initial force, force at 45 seconds, minimum force, and maximum force was recorded. The results were analysed using the Wilcoxon signed ranks test, which showed no significant difference in performance between the two types of training. One subject maintained pressure in the range of 25 to 35 Newtons for the entire 45 seconds of the first attempt but no subject performed this well on the second attempt. The use of qualitative and quantitative descriptors of the appropriate pressure does not appear useful in the training of the technique of cricoid pressure. Training incorporating force feedback is recommended.

Comparison of 6- with 9-week trials of adjunctive imipramine in postpsychotic depression.

Outcome at 6 weeks versus outcome at 9 weeks was compared in 23 patients with syndromally defined episodes of postpsychotic depression who underwent a trial of adjunctive imipramine added to their continuing treatment with fluphenazine decanoate and benztropine. The global outcome after 9 weeks was found to be superior. The implications of this finding for the treatment of secondary depressions in patients with schizophrenia and schizoaffective disorder is discussed.