The long-term use of cyproterone acetate in pedophilia: a case study.

This investigation reports the long-term use of the antiandrogen cyproterone acetate (CPA) in a pedophile, who was studied continuously over 38 months. Measures of sexual arousal, serum testosterone, and gonadotropin levels were significantly reduced by the drug as compared with placebo and no treatment; prolactin levels were significantly elevated. Some workers have observed that long-term administration of CPA (more than one year, which was then discontinued) produced enduring (in some cases apparently permanent) anti-libidinal effects; however, in the case described, within three weeks of stopping the drug, all measures had returned to pretrial levels. The importance of continuous long-term monitoring in sex offenders receiving an antiandrogen is discussed.

Effects of ECT on prolactin, LH, FSH and testosterone in males with major depressive illness.

Fourteen males with major depressive illness (DSM-III) received a course of electroconvulsive therapy (ECT). Serum prolactin (PRL), luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone (T), were measured 15 minutes before and 15 minutes after each treatment. The severity of depression was assessed with the Hamilton Rating Scale for Depression (HRSD) two to three days before the first and two to three days following the last treatment. Post-ECT levels of PRL and LH were significantly higher than pre-ECT levels across every treatment. Changes in FSH and testosterone were not significant. There were no relationships between hormone levels (first versus last ECT) and severity of depression, including sexual functioning. It is argued that the relatively greater increases of LH than FSH is due to an acute antidopaminergic action of ECT which acts selectively on the secretion of the former. The blunted testosterone response to the increase of gonadotropins may be due to ECT-induced hyperprolactinemia.

Strategies for the drug treatment of depression.

Antidepressants are a useful addition to a physician's therapeutic armamentarium, but because they are used to treat disorders of diverse and largely unknown cause, there is a much greater element of chance associated with their use than with the use of many other types of drugs (e.g., antibiotics and analgesics). Nevertheless, empirically derived treatment schemes, applied systematically, increase the odds of a favourable response and are preferred to haphazard prescribing. To date, no one antidepressant has been shown to be more effective than any other, although the newer agents are alleged to be faster acting, more specific and less toxic than the established drugs. However, generally, such claims have not been proven clinically. Unless there are overwhelming contraindications (e.g., intolerable side effects, an idiosyncratic response or coexisting cardiac disease) the established agents, with their proven efficacy, are preferred initially.

A clinical trial of the beta blocker propranolol in premature ejaculation.

Twelve male patients, with a primary complaint of premature ejaculation in a setting of chronic anxiety with prominent somatic manifestations, participated in a double-blind trial: propranolol against placebo. The study consisted of 5 X 4 week phases: run-in, propranolol or placebo--120 mg/day allocated randomly, wash-out; placebo or propranolol and run-out, in a balanced design. Anxiety was rated initially, and every 2 weeks, throughout the trial using the Hamilton Rating Scale. Sitting blood pressure and pulse were also noted. The time to coital ejaculation (every 3 days) was recorded using a stopwatch, and subjects were also required to rate "overall coital satisfaction" and "quality of erection". Neither prematurity nor other signs/symptoms of anxiety improved on the preparations, which were statistically equivalent. Moderate beta-blockade was achieved with propranolol as evidenced by a median reduction in pulse rate of 5 beats/min.

A comparison of biperiden hydrochloride (Akineton) and benzhexol (Artane) in the treatment of drug-induced Parkinsonism.

A single-blind study compared the clinical efficacy of biperiden hydrochloride (Akineton, Abbott) and benzhexol (Artane, Lederle) in the treatment of neuroleptic-induced Parkinsonism. Both drugs were highly effective and all patients responded favourably to medication. No significant difference was observed between the two treatment groups when individual symptoms were examined.

A placebo-controlled study of pyritinol ('Encephabol') in dementia.

A double-blind, placebo-controlled trial was carried out on 40 patients suffering from moderately advanced dementia. The patients were allocated randomly either pyritinol (800 mg daily) or identical placebo for 3 months. Assessments using a modified Crichton Geriatric Behavioural Rating Scale were made pre-treatment and monthly up to 3 months, and then at follow-up at 6 months. Patients on pyritinol showed significantly higher levels of improvement than did those on placebo. Laboratory tests conducted throughout remained within normal limits for both groups.

Clorazepate: double blind crossover comparison of a single nightly dose with diazepam thrice daily in anxiety.

In a double blind cross-over study in 40 patients with mild to moderate anxiety, clorazepate 15 mg at bedtime was as effective as diazepam on global rating and slightly superior on target symptom assessment. There was a significantly higher incidence and frequency of side effects during diazepam treatment. Occurrence of side effect related to plasma diazepam, and anxiolytic effect related to plasma nordiazepam. These results are discussed in relation to convenience of the single dose regimen and psychomotor performance.

Pressure studies and dynamics of ileal conduits in children.

The pressures generated in the ileal conduits of 20 children and their relation to conduit ureteral reflux are investigated. The resting pressure in the ileal conduits was generally low but peaks of high pressure were observed occasionally. Reflux occurred mostly at low pressure. Whether reflux occurred at any one moment depended on the position of the peristaltic wave in the ureter at that time. There was no consistent relationship between the conduit pressures and deterioration of the upper renal tract.

Once-daily treatment for mixed anxiety/depressive states: a comparison of slow release amitriptyline and fluphenazine with nortriptyline.

Patients suffering from mixed anxiety/depressive states referred to a psychiatric out-patient clinic completed a four course of either a once-daily table of 30 mg nortriptyline with 1-5 mag fluphenazine, or a sustained release capsule of 50 mg amitriptyline once daily, on a double-blind basis. Depression improved satisfactorily on either treatment, but there was a greater reduction of anxiety on fluphenazine/nortriptyline, Drowsiness, however, occurred more frequently among the patients on amitriptyline, suggesting the sedative properties of this drug did not substitute adequately for a specific anxiolytic effect. Dry mouth was also noticeably more frequent with amitriptyline. As might be expected on pharmacokinetic and phsyological grounds, the results suggest that the sustained release characteristics of the amitriptyline preparation lead to a maximization of side-effects during the day without conferring any therapeutic advantage.

Vesicoureteral reflux in babies with myelomeningocele.

Reflux was present at birth in 24 per cent of 100 babies with meningomyelocele, indicating a marked tendency toward spontaneous improvement in infancy. Reflux starts in some children after birth but the number is too small to draw definite conclusions on the cause of this onset. Of the children with myelomeningocele 16 per cent had asymptomatic infection of the urine on 1 occasion only and 33 per cent had recurrent infections. There was a greater incidence of upper tract anomalies in patients with a high level spinal lesion.

A placebo controlled trial of viloxazine with and without tranquillizers in depressive illness.

Two double-blind four-way crossover studies are reported, comparing the antidepressant effect of 14-day courses of: viloxazine, viloxazine with a tranquillizer either perphenazine or diazepam or tranquillizer alone, against a placebo. In one study the antidepressant effect of viloxazine at a dose of 150 mg daily was statistically greater than that of placebo, whilst in the second study viloxazine was statistically superior to diazepam (15 mg daily). In depressed patients with a clear anxiety component, viloxazine alone seemed preferable to a combination with a tranquillizer as such a combination did not produce an enhanced clinical effect and the incidence of side-effects was possibly increased. Viloxazine was generally well tolerated and side-effects, when they occurred, were generally a mild upper gastro-intestinal disturbance.