First-case postpartum psychoses in Eastern Turkey: a clinical case and follow-up study.

OBJECTIVE: The aim of this study was to investigate the clinicodemographic features and long-term course of postpartum psychosis (PPP). METHOD: A total of 64 in-patients with psychotic postpartum disorder, who were admitted for the first time to a psychiatry clinic, were reexamined retrospectively and then compared with 64 control patients. Follow-up investigation was carried out either by interviewing the patients personally or with the help of general practitioners (GPs). All patients were rediagnosed according to DSM-IV. RESULTS: The majority of PPP patients were young, married, primiparae, had a low educational level and were living in rural areas. The mean onset time of PPP after delivery was 3.62 weeks. More than 75% of the patients with PPP had further psychotic episodes during the follow-up period of 11 years; 42% of the puerperal cases were diagnosed as schizophrenia at the follow-up investigation, and 59.3% of the patients had confuso-oneiroid syndrome. CONCLUSION: These findings, unlike those of the Western studies, demonstrate that PPP is not uniform in different populations.

Prochlorperazine as a doxorubicin-efflux blocker: phase I clinical and pharmacokinetics studies.

Doxorubicin (DOX) efflux in drug-resistant cells is blocked by phenothiazines such as trifluoperazine (TFP) and prochlorperazine (PCZ) in vitro. The present phase I study was conducted in 13 patients with advanced, incurable, nonhematologic tumors to determine whether PCZ plasma levels high enough to block DOX efflux could be achieved in vivo. The treatment schedule consisted of prehydration and i.v. administration of 15, 30, 50, and 75 mg/m2 PCZ followed by a standard dose of 60 mg/m2 DOX. The hematologic toxicities attributable to DOX were as expected and independent of the PCZ dose used. Toxicities attributable to PCZ were sedation, dryness of the mouth, cramps, chills, and restlessness. The maximal tolerated dose (MTD) of PCZ in this schedule was 75 mg/m2. Pharmacokinetic analysis indicated a large interpatient variation in peak plasma PCZ levels that ranged from 95 to 1100 ng/ml. The three plasma half-lives of PCZ were: t1/2 alpha (+/- SE), 20.9 +/- 5.3 min; t1/2 beta, 1.8 +/- 0.3 h; and t1/2 gamma, 21.9 +/- 5.3 h. The volume of distribution (Vd), total clearance (ClT), and area under the curve (AUC) for PCZ were 2254 +/- 886 l/m2, 60.2 +/- 13.5 l m-2 h-1, and 1624 +/- 686 ng ml-1 h, respectively. DOX retention in tumor cells retrieved from patients during the course of therapy indicated the appearance of cells with enhanced DOX retention. The combination of DOX and high-dose i.v. PCZ appeared to be safe, well tolerated, and active in non-small-cell lung carcinoma.

Chemical pleuritis as the cause of acute chest pain following high-dose methotrexate treatment.

This report describes the clinical and roentgenographic features of a pleuritis seen following the administration of high-dose methotrexate (HDMTX). Among 210 patients who received 3130 courses of HDMTX from 1977 through 1980, the incidence of this clinical entity was 8.5% (n = 18). The sudden onset of chest pain occurred only after the third or fourth HDMTX treatment and usually lasted between three and five days; the pain was often quite severe and led to extensive clinical examination before recognition of the benign transient nature of this syndrome. Roentgenographic examination of the chest revealed thickening of the intralobar pleura, most prominent on the right side. Our observations support the hypothesis that this adverse drug reaction occurs more frequently than assumed, but is often ignored or misinterpreted.