The possible role of environmental stress in precipitating the onset or relapse of acute schizophrenia was investigated by Brown and Birley (1968), Birley and Brown (1970). They enquired about events which could be dated to a definite point in time and which usually involved either actual or threatened danger or important fulfilments or disappointments. They distinguished between independent events, which were outside the control of the subject, and possibly independent events, which were not so clearly out of his control but which seemed unlikely to be produced by unusual behaviour of the subject himself. In their main group of patients a significant concentration of independent events (about 60 per cent) was found in the three weeks preceding onset or relapse of schizophrenia. In examining two small sub-groups they found that 4 of 13 patients (31 per cent) who relapsed after reducing or discontinuing phenothiazine therapy had experienced a life event in the three weeks before relapse, compared with 3 of 5 patients (60 per cent) who had been taking phenothiazines regularly at the time of relapse. Although these proportions are very different, the numbers in the groups are too small for the difference to reach significance. Furthermore the groups were not matched in any way, and there may be important differences between patients who discontinue medication themselves and those who carry on taking it regularly.
13to anticholinergic drugs, is treatable with equal or greater efficiency by L-dopa alone.In our series the patient's age, the severity and duration of the disease, and the time since the last operation did not influence the therapeutic response. One limiting factor in both the "surgical" and "non-surgical" groups of patients was hypertension. Pre-existing hypertension (diastolic B.P.> 100 mm Hg but <110 mm Hg) was found in 100% of patients showing little or no response and in only 2504 and 33 % respectively of those showing a marked or moderate response to treatment. No other obvious cause of a poor response was found; the average daily dose of L-dopa attained by this poorly-responding group was 3-3 g which is similar to the average final dose in the whole series (3-1 g).Controllable side effects were seen in almost all patients; a note of caution is sounded by the occurrence of femoral neck fractures in two women, one during the trial and one shortly afterwards when the drug was reintroduced. Both were postmenopausal and both had been severely restricted in their activities by akinesia and rigidity. Both showed considerably increased mobility, and perhaps this sudden bound in activity against a background of disuse and of postmenopausal osteoporosis was sufficient to overstress the femur; in one case there was no apparent trauma and in the other it was minimal. under their care, and we are grateful to Mrs. Brenda Welsh and Miss Gillian Lough for carrying out the occupational therapy assessments. Some of the early mood assessments with use of the Hildreth self-rating scale were performed by Dr. Andrew Rabavilas.
Among a group of patients referred to the psychiatric out-patient departments of the Maudsley and King's College Hospitals primarily for emotional disorders, 40 patients who were at least 15 per cent above their ideal weight (Metropolitan Life Insurance Co., 1959, Statistical Bulletin, 40, 1) were selected for weight reduction. There were thirty-one women and nine men in the sample, and they were aged 25 to 54. The psychiatric diagnoses given were: anxiety (20), depression (17), and personality disorder (3).
Plasma levels of amitriptyline and nortriptyline were measured in volunteers after one week of daily dosage with either 25 mg t.i.d. of standard amitriptyline tablets or a single 75-mg capsule of a new pelletized form of amitriptyline. Concentrations of both compounds were essentially equal at the end of one week's dosage with either dosage form but were somewhat higher throughout the dosing time interval for the pelletized drug.
A study was carried out in 6 healthy volunteers to test the hypothesis that weight gain associated with amitriptyline treatment may be due to hypoglycaemia caused by increased circulating blood insulin. Subjects were treated with 50 mg amitriptyline b.d. for 28 days. Estimations made of serum levels of amitriptyline and its metabolite nortriptyline showed a steady state by the 10th day. No significant weight-gain was observed in any of the volunteers, although 2 reported an increase in appetite. There were no significant differences in any of the glucose tolerance curves, fasting or peak insulin levels or in the glucose/insulin curves for Days 0, 14 and 28.
SYSNOPSISPlasma amitriptyline and nortriptyline concentrations were measured in a group of five adult subjects who each received two different dosage regimes of amitriptyline (Tryptizol) for 14 day periods—namely, 25 mg three times daily and 75 mg once nightly. Mean steady-state plasma concentrations during the two dosage regimes were in close accord. The daily variation in drugplasma concentrations were only minimal during the thrice daily dosage regime but during the once nightly dosage regime there was an average decline in total drug plasma concentrations (amitriptyline plus nortriptyline) of about 30%. It was concluded that antidepressant medication with amitriptyline using a single nightly dose schedule might be more reliably taken by patients without there being any significant reduction in therapeutic efficacy.
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