Neuroleptics are commonly prescribed medications in the geriatric population and have a broader spectrum of indications than in younger patients. In spite of the frequent use of neuroleptics in elderly patients with organic brain syndromes, there are relatively few studies that use double-blind, placebo-controlled methodology. The results of these studies are conflicting; however, there is sufficient evidence that symptoms of agitation, behaviourial dyscontrol, and psychosis are often responsive to neuroleptic treatment. Elderly patients with schizophrenia or other psychotic disorders may also benefit from neuroleptic treatment. As there is a potential for overuse of these medications among the elderly, clear definition of checklist symptoms is imperative. Furthermore, periodic reduction of dose and possible discontinuation of the drug should be considered since many of the checklist symptoms in this age group are environmentally related and time-limited. There has so far been little evidence to support the use of one neuroleptic over another. Side-effect profiles suggest that low doses of the high potency agents are safer and better tolerated in the elderly. Both therapeutic effects 1 and side effects should be assessed at regular intervals.Neuroleptics are commonly prescribed in the geriatric population (1). It has been estimated that more than 90% of nursing home residents have a significant neuropsychiatric disability, and that perhaps 75% of these patients receive neuroleptics (2).0ther studies similarly suggest that the rates of neuroleptic use among the aged are high regardless of diagnosis. Prien (3) estimated in one nursing home sample that 20% of patients received neuroleptics. Gilleard et al. (4) surveyed the use of neuroleptics amongst patients in various settings. They found that the indications varied from setting to setting, and that disturbed mood or behaviour increased the probability of a patient receiving neuroleptics. Overall, 13% of patients in their sample had received neuroleptics in the 24 hours preceding their survey.The population at risk is enormous and increasing. At present about 11% (25 million) of the population of the USA is over the age of 65 years and current estimates suggest that the prevalence of dementia in those over that age is about 4% ( 5 ) and the incidence increases with age (6). Whereas about one million Americans are severely demented, it is estimated that by the year 2000, an additional 300,000 will be so affected (5). Over 75% of patients with dementia have disruptive behaviour or psychotic symptoms (7,8). With such a large population at risk, it is essential that the clinician be well-versed in the use of neuroleptics, and be aware of treatable symptoms.
The rates of release of the various enzymes from PMN leukocytes exposed to MSU crystals were measured. Lysozyme and neutral protease appeared to be released simultaneously and release appeared to be essentially complete by 60 minutes. In contrast, collagenase was detected only after 30 minutes incubation, reached peak concentration at 90 minutes and dropped noticeably by 180 minutes. The presence of these enzymes was not due to cell lysis since only 10% of the total cellular LDH was present in the supernates. The levels of total and active collagenase in the supernatants were measured. In contrast to latent collagenase, active collagenase levels increased continually throughout the incubation period. The gradual increase in level of active collagenase may explain the corresponding drop of latent collagenase in the longer incubation (90 minutes or more) as the latter apparently is converted to active form. The effects of collagenase on Type I collagen were examined by SDS gel electrophoresis.
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