1 The effects of verapamil (0.15/kg) and fendiline (3 mg/kg) were studied in anaesthetized, thoracotomised dogs with a critical constriction of the left anterior descending coronary artery, paced in excess of the initial rate by 60-70 beats/min. Epicardial ST-segment elevation and changes in lactate uptake were used to assess the severity of myocardial ischaemia. 2 Both drugs prevented the ST-segment elevation and the reduced lactate uptake that resulted from atrial pacing. 3 The anti-ischaemic effect of fendiline is mainly due to its negative chronotropic action, whereas that of verapamil is due in part to bradycardia and in part to the reduced preload and afterload. In addition, both agents increase coronary flow to the ischaemic area and thus improve the myocardial oxygen supply/oxygen requirement ratio.
A 17 year old with probable schizophrenia, who showed a therapeutic response to clozapine (12.5 mg t.i.d.), was treated for sinusitis with a routine dose of ampicillin (a semisynthetic penicillin). Within a day, the patient became sleepy, appeared distractible, performed routine activities slowly, and exhibited hypersalivation. There was no evidence of delirium, other neurotoxic or autonomie signs, or metabolic dysregulation. These changes disappeared promptly on replacement of ampicillin with a chemically unrelated antibiotic. Especially in view of the hypersalivation, a characteristic side effect of clozapine, it was hypothesized that there may be a drug interaction between clozapine and ampicillin. This hypothesis was further explored by use of differential absorption spectrophotometry to investigate the possibility of a molecular interaction between these two agents in vitro. Spectrophotometric findings suggest that clozapine interacts in vitro with ampillicin, as well as with penicillin G; a different type of drug interaction was observed with tetracycline, but there was no apparent interaction with streptomycin. Although the hypothesized drug interaction has not been fully demonstrated in a clinical setting, physicians may wish to be aware of the theoretical possibility of drug interactions between clozapine and certain antibiotics.Clozapine, an atypical NEUROLEPTic whose use in treating schizophrenia in adults is well established (Bunney 1992), is being increasingly used in adolescent psychiatry in Europe and the United States. Although publications about its possible side effects are becoming more frequent (Schmidt et al. 1990, Amminger et al. 1992, Birmayer et al. 1992, Remschmidt et al. 1994, this is the first report of a possible drug interaction between clozapine and the commonly used antibiotic ampillicin.
CASE REPORTA 17-year-old boy was hospitalized following presentation with delusions and suicidal ideation. His father had schizophrenia, and both parents had mental retardation. Parents were unable to care for the child, and he was placed in a foster home at age 2 years. At age 4 years, he was evaluated for daytime
International comparisons of child and adolescent psychiatry services are rarely reported in the literature. The present study arose out of a TEMPUS collaborative project between the University Departments of Child and Adolescent Psychiatry in Szeged, Hungary, and Glasgow, Scotland. Using the Glasgow Audit Questionnaire, a profile of each service was obtained, including basic demographic data, types of disorders referred, treatment modalities used, and a measure of outcome. The results of this descriptive study indicate that although the two centres were broadly similar, there were major differences in the treatment modalities used. Reasons for the findings are discussed, as are the limitations of the study.
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