Morning fluoxetine plus evening mianserin versus morning fluoxetine plus evening placebo in the acute treatment of major depression.

In a randomized clinical study the combination of fluoxetine 20 mg daily and mianserin 30 mg daily was compared to fluoxetine 20 mg daily and a mianserin placebo. In total, 34 patients with major depression were randomized, of whom 16 received fluoxetine plus mianserin; 18 patients received fluoxetine plus placebo. Of these patients, 69% completed the planned trial of six weeks in the fluoxetine plus mianserin group while 61% completed in the fluoxetine plus placebo group. In the efficacy analysis (excluding dropouts from the first two weeks of treatment) the combination of fluoxetine and mianserin was superior to fluoxetine and placebo both in observer ratings of depression and in quality of life ratings. However, in the intention-to-treat analysis this difference was not statistically significant. No major side effects were reported. After four weeks of treatment headache was most often seen in the fluoxetine and mianserin combination, while sweating was most often seen in the fluoxetine plus placebo group. No pharmacokinetic interaction in terms of fluoxetine plasma levels was found in the mianserin-treated patients.

[Lumbar disk prolapse surgery with or without free fat transplantation. A prospective triple-blind randomized study]. / Lumbal diskusprolaps-operation med eller uden fri fedt-transplantation. Prospektivt tripelblindt randomiseret studie.

The aim of this prospective triple-blind randomized study was to determine if a free fat transplant used in operation in lumbar disc herniation could reduce the degree of intraspinal scar tissue and to evaluate whether the scar tissue could lead to symptoms. Ninety-nine patients were subsequently examined after median 376 days. The clinical outcome was scored using the Low Back Pain Rating Scale. Enhanced CT-scanning was assessed regarding the degree of scar tissue and survival of the fat transplant. There was no difference in the clinical outcome between the two groups. Significantly fewer had dural scarring in the group who had a free fat transplantation, but there was no difference regarding the degree of radicular scarring. The transplant was shown on CT-scan at the follow-up examination in 66% of the patients who had a fat transplantation. Free fat transplantation can reduce the degree of dural scar tissue after operation for lumbal disc herniation, but does not result in a clinically better outcome.

[Psychiatric therapeutic programs--practical design]. / Psykiatriske behandlingsplaner--praktisk udformning.

As a consequence of the introduction of the Danish law concerning involuntary commitment and treatment in Psychiatry of 1989, the Danish psychiatric units were required to establish so called treatment programmes (t.p.) for all patients within seven days after admission. In order to establish in which ways and to what degree these t.p. were carried out, a questionnaire was sent to all 49 Danish psychiatric units for adult patients. All were returned, giving a response rate of 100%. In practice, the t.p. was noted in the following ways: 1) In 24 departments (46%) the t.p. was written into the case notes. 2) In 17 departments (33%) the t.p. was written on a separate (coloured) paper with printed headlines and filed with the case notes. 3) In 11 departments (21%) a self-adhesive label with printed headlines was fixed onto the case file. The advantages and problems related to these different approaches are discussed, and it is concluded, that the use of the self-adhesive label is a relatively quick, cheap and practical way to establish the t.p.

First-time operation for lumbar disc herniation with or without free fat transplantation. Prospective triple-blind randomized study with reference to clinical factors and enhanced computed tomographic scan 1 year after operation.

STUDY DESIGN: This prospective triple-blind randomized study of 99 patients concerned the use of free fat transplantation for operation for lumbar disc herniation. OBJECTIVE: To subsequently examine the patients after median 376 days who were subjected to enhanced computed tomographic scan. SUMMARY OF BACKGROUND DATA: In studies on experiments with animals, the degree of intraspinal scar tissue has shown to be reduced in connection with free fat transplantation. Scar tissue is seen frequently after operation for lumbar disc herniation, but it is uncertain whether the scar tissue can lead to symptoms. METHODS: The clinical outcome was scored using the Low Back Pain Rating Scale. Enhanced computed tomographic scan was assessed regarding the degree of scar tissue and survival of fat transplant. RESULTS: There was no different in the clinical outcome between the two groups. Significantly fewer patients had dural scarring in the group who had a fat transplantation, but there was no difference regarding the degree of radicular scarring. The transplant was shown on computed tomographic scan at the follow-up examination in 66% of the patients who had a fat transplantation. CONCLUSIONS: Free fat transplantation can reduced the degree of dural scar tissue after operation for lumbar disc herniation but does not result in a clinically better outcome.

Peroperative prednisolone fails to improve the clinical outcome following surgery for prolapsed lumbar intervertebral disc. A randomized controlled trial.

Ninety three patients undergoing their first conventional hemilaminectomy for lumbar disc protusion were randomized to a double blind clinical trial. Half of the patients were treated immediately following surgery with prednisolone; 50 mg per day for fourteen days and then 25 mg per day for another 14 days. The other patients were treated for the same time period with placebo tablets. Assessments using subjective and objective outcome criteria at 26 weeks, 52 weeks and 156 weeks of follow-up, demonstrated no statistically significant differences between the randomized groups. It is concluded that systemic prednisolone administration in the pre- and postoperative period does not in this study improve the clinical outcome after first time lumbar discectomy.

Satisfaction with care reported by psychiatric inpatients. Relationship to diagnosis and medical treatment.

In this survey, 274 patients were sent a questionnaire concerning satisfaction with psychiatric treatment and the ward 1 month after their discharge from hospital. Fifty-two percent of the patients responded. Answers to the 56 items of patient satisfaction were analyzed in relation to patient diagnoses and treatment given. Patients who were diagnosed as suffering from affective disorders or from reactive psychoses were more satisfied than patients with schizophrenia or paranoia or with transitory adjustment reactions. Patients who had no personality disorder diagnosis and patients with character neurosis were more satisfied than patients with antisocial or borderline personality disorders. Patients on antidepressant medication were much more satisfied than other patients. The results of the study are discussed with regard to the need of further research in this area and to quality assurance.

Intensive dynamic back exercises with or without hyperextension in chronic back pain after surgery for lumbar disc protrusion. A clinical trial.

Sixty-two patients with chronic low back pain occurring 14-60 months after undergoing discectomy for the first time were randomized to two physical treatment groups: 24 sessions of intensive dynamic back exercises with hyperextension or 24 sessions of intensive dynamic back exercises without hyperextension. At the conclusion of therapy and at one-year follow-up, no difference was seen between the randomized groups, with regard to the combined assessments of pain, disability and objective measurements. A difference for back exercises without hyperextension to be superior to the other treatment regimen was statistically significant at the three-month follow-up. In the patient's qualitative assessment of treatment outcome there were seen no significant differences between back exercises with or without hyperextension. There was a similar and significant improvement of the isometric endurance of back muscles in both groups, but the flexibility of the spine was significantly improved only in the group using hyperextension exercises. The overall response rate of an earlier published investigation was reproduced. It is concluded that chronic back patients after first time discectomy may benefit from an intensive rehabilitation protocol including intensive exercises. The added use of hyperextension exercises does not confer any independent benefit. Furthermore, the training had to continue for more than 2-3 months before a statistical significant decrease in back pain was reported in the patient pain diary.

Serum lithium concentrations around the clock with different treatment regimens and the diurnal variation of the renal lithium clearance.

The serum lithium concentration was determined around the clock in patients treated with conventional tablets given once daily, in the evening, and in patients treated with slow-release tablets given twice daily, in the morning and in the evening. Curve shapes differed markedly in the two groups, with much wider variation of serum concentrations in the former than in the latter. The data were used to calculate for the two patient groups the ratio of the mean serum lithium concentration over the 24-h day to the serum lithium concentration in blood samples drawn 12 h after the last intake of lithium. Around-the-clock determinations of the patients' renal lithium clearance showed about 20% lower values during the night than during the day.

Electroconvulsive therapy: a comparison of seizure duration as monitored with electroencephalograph and electromyograph.

EEG and EMG were monitored simultaneously at 72 ECT sessions in 18 patients. When EMG was recorded from the leg the duration of EMG curve convulsions varied between 43 and 89% of the EEG recorded seizure duration of the same fit. The EMG/EEG seizure ratio varied widely among different patients as well as within the single patient during a series of ECT sessions. EMG recording from the masseter muscles showed EMG seizure duration to be more in accordance with the EEG seizure duration than EMG recordings from the leg. The EMG/EEG seizure ratio (masseter) varied from 65 to 100%, which was significantly higher than the EMG/EEG seizure ratio obtained with EMG recorded from the calf muscles. The use of EEG monitoring of ECT is advocated in order to obtain the most precise evaluation of the cerebral seizure activity. If EEG monitoring is not available EMG recorded from the masseter muscles provides a reasonably accurate and easily applicable method of monitoring the presence and duration of the ECT-induced seizure.

Depression of insulin release by anti-GIP serum after oral glucose in rats.

An oral glucose tolerance test (OGTT), an OGTT after infusion of anti-gastric inhibitory polypeptide (GIP) serum, and an intravenous glucose infusion were performed in unrestrained and unanesthetized rats. In the rats treated with anti-GIP serum the insulin release was significantly depressed. This finding supports the concept that GIP is a physiologically important 'glucose-dependent insulin-releasing peptide'.

Lithium effects on diurnal rhythm of calcium, magnesium, and phosphate metabolism in manic-melancholic disorder.

The diurnal rhythm of plasma phosphate, calcium, and magnesium was studied in 34 lithium treated patients, in 42 other psychiatric patients, and in 47 healthy persons. Seventeen blood samples were drawn from each person during the 24-hour period. Lithium was given at 10 p.m. and in the next few hours plasma phosphate decreased compared with the two control groups. In the same period plasma calcium showed a temporary increase, whereas plasma magnesium was increased during the whole 24-hour period. The lithium treated patients had a reduced urinary calcium excretion during the night, and an increased urinary magnesium excretion during the day, whereas no changes were found in urinary phosphate excretion.

Peroral and parenteral administration of long-acting neuroleptics: a double-blind study of penfluridol compared to flupenthixol decanoate in the treatment of schizophrenia.

Fifty-six out of 60 schizophrenic patients completed a double-blind study of two long-acting neuroleptics, penfluridol (peroral) and flupenthixol decanoate (parenteral). Half of the patients were on maintenance therapy of flupenthixol prior to the study, the other half on penfluridol. The actual double-blind study (12 weeks) was commenced after a preliminary period of 4 weeks, the patients in the two main groups being randomly divided into two further groups, one continuing the medication unchanged, the other changing to the alternative drug. It was found possible to make a sudden switch from penfluridol to flupenthixol decanoate and vice versa without any significant change in the condition of the patient. The same dosage (in 70% of the patients from 40 to 80 mg) of penfluridol was used per week as was employed for flupenthixol decanoate per fortnight. Changes in the intensity of the symptoms (total Brief Psychiatric Rating Scale (BPRS) score) were moe pronounced in the preliminary period (during unchanged treatment) than on changed medication in the blind period. Both drugs induced approximately the same degree of akathisia, Parkinsonism and autonomic side effects. The practical consequences of equipotent therapeutical effect of a peroral and parenteral long-acting neuroleptic are briefly discussed.