The therapeutic efficacy of amitriptyline in irritable bowel was studied in a cross-over double-blind trial, employing fourteen patients whose symptoms were rated as Class II or worse on an arbitrarily-defined interval scale and who had not benefited from previous trials of anticholinergics, anticholinergic-sedative combinations, and bulk-forming agents. During the study, patients rated their own symptoms and the interviewer rated their symptoms using the same scale. Average scores for the patients while on drug showed significant improvement compared to pre-test level. No placebo or drug carry-over effects could be demonstrated. Inasmuch as amitriptyline is effective in this context at dosages subtherapeutic with regard to depression, the authors suggest that a central (perhaps anticholinergic) mechanism of action is responsible.
Delirium is a frequently encountered clinical syndrome which can pose serious problems for the physician and patient. Numerous etiological possibilities exist, and each case is usually associated with multiple causal factors. Although the pathophysiology is poorly understood, the clinical presentation is marked either by stupor and hypoarousal or agitation and hyperarousal. Both types of delirium must be treated by searching for and correcting reversible causative factors. In addition, medication may be quite efficacious in managing the clinical aspects of agitated delirium. Most cases of agitated delirium are either of the "sensory overload" or "sensory deprivation" type. The drug treatment of each is discussed with reference to their respective central nervous system physiological correlates.
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