A possible antimanic property of the GABA-ergic anticonvulsant valproate was examined by use of a double-blind placebo-controlled ABA design in 5 acutely ill manic patients. In 4 cases a marked improvement was observed after valproate medication whereas one patient showed no response. Seven further patients with frequently recurrent episodes of a manic or maniform schizoaffective psychosis, irresponsive to lithium prophylaxis, were chronically treated with valproate in combination with low doses of lithium (one case only with valproate). Over an observation period of 1 1/2-3 years none of the patients exhibited a relapse. It is proposed that, in general, GABA-ergic anticonvulsants possess antimanic properties and that the specific antimanic effect of lithium is due to a GABA-ergic mode of action. The possible role of GABA-systems in affective disorders and in organic types of psychoses (e.g.,porphyria-psychosis, delirium tremens) is discussed on the basis of pharmacopsychiatric considerations.
It is well known that the concomitant use of different drugs may alter the reactions of the body towards the individual components. This is particularly important in long-term anticonvulsant therapy which is frequently a combined therapy. By carrying out statistical analysis of more than 6000 assays of the serum levels of antiepileptic drugs an attempt was made to gain insight into the possible drug interactions. The following results were obtained: 1. There was an increase in serum levels of diphenylhydantoin when either clonazepam or dipropylacetate (short-term therapy) was given concomitantly. 2. There was a decrease in serum levels of diphenylhydantoin when carbamazepine, primidone or dipropylacetate (long-term therapy) were administered concomitantly. 3. There was an increase in the serum level of phenobarbitone when it was administered together with diphenylhydantoin. 4. There was an increase in the serum level of primidone when it was administered together with clonazepam. 5. There was a decrease in the serum level of primidone if it was administered concomitantly with either carbamazepine or dipropylacetate (long-term therapy).
Eight cases of Legionnaires' disease were identified among the 215 German passengers after a cruise to the Nordic Sea in August 2003. An unmatched case-control study was conducted to identify risk factors and the source of infection. In total, eight passengers fulfilled the case definition, one of these died. Forty-two passengers served as controls. The attack rate was 4%. The mean age was 60 years for cases and 62 years for controls. Prolonged exposure to the spa pool seemed to be a risk factor of infection (OR 4.85, P=0.09). Legionella pneumophila serogroup 1, monoclonal antibody (mAb) subgroup 'Knoxville' was isolated from clinical and environmental samples. DNA sequence-based typing revealed that these isolates were indistinguishable from each other. The investigation showed the importance of an interdisciplinary approach of microbiology and epidemiology as not all sites on the ship that tested positive for L. pneumophila actually posed a relevant risk for the passengers.
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