Antitussive effects of diphenhydramine on the citric acid aerosol-induced cough response in humans.

This controlled crossover study in twenty healthy volunteer subjects utilized the citric acid aerosol-induced cough response as a means to demonstrate the effectiveness of 25 mg of diphenhydramine as an antitussive. Entry was limited to only those subjects who manifested a consistent, quantitatively definable response to a 5% citric acid challenge. Subjects were initially dosed with either a placebo vehicle or 25 mg diphenhydramine in a 10 ml formulation. Following drug ingestion, subjects were challenged at 15, 30, 45, 60, 120, and 240 minutes. Three days later, subjects were administered the alternate treatment and rechallenged at the same time points. Diphenhydramine was effective at the earliest time point assessed, 15 minutes, and continued to be as effective over the entire 4-hour duration of the test period. For the placebo vehicle, the mean cough counts did not change significantly from baseline. Neither the putative soothing effect of a liquid formulation nor accommodation to the citric acid spray can account for all the early and consistently significant activity of diphenhydramine in suppressing the cough response. The early onset of activity of diphenhydramine may be due to its local anesthetic properties or may indicate that the dose of diphenhydramine required for effective antitussive activity is lower than that required for effective antihistaminic activity. These results require further corroboration in direct comparisons of various doses of diphenhydramine with positive controls in both this model and clinical cough counting models employing pathologic cough indices. A 25 mg dose of diphenhydramine appears to be effective as an antitussive agent.

A patient with panic disorder eventuating in psychosis: nosologic implications.

The DSM-III-R subclassifies panic disorder (PD) under the anxiety disorders (or anxiety and phobic neuroses) along with phobic, obsessive compulsive (OCD), generalized anxiety and posttraumatic stress disorder (PTSD). Although allowances are made for the specification of the current degree of impairment as severe, e.g., at least eight panic attacks monthly, avoidance behavior resulting in being completely house-bound or compulsions being the major life activity, the anxiety disorder category does not provide for the simultaneous occurrence of associated psychotic features as part of the disorder. In fact, depending on the circumstances, diagnostic hierarchial principles, in the DSM-III-R, require dual diagnoses or a diagnosis of the more pervasive disorder only, if elements of both anxiety and psychosis are present. In contradistinction to the anxiety disorder category, the DSM-III-R recognizes a myriad of psychotic features, including delusions, hallucinations, thought insertion and broadcasting, as extreme manifestations of the affective syndromes. The following case report of a patient with panic disorder, culminating in a florid psychosis, puts into question current official nosology. Conflicting outcome data from the schizophreniform disorders may be due, in part, to the mislabelling of patients with psychoses secondary to severe anxiety disorders as schizophreniform.

Chronic Vietnam PTSD and acute civilian PTSD. A comparison of treatment experiences.

Many types of external trauma have been linked to the genesis of posttraumatic stress disorder (PTSD) and yet recent reports have focused almost exclusively on PTSD occurring in the Vietnam veteran (PTSD/veteran). The extent to which treatment experiences with PTSD/veteran can be generalized to other traumatized patients, for example, acute civilian populations, has not been investigated. Clinical observations comparing PTSD precipitated by a motor vehicle accident with PTSD/veteran suggested there were major differences between these two groups on the following variables: source of referral, age, sex, socioeconomic level, nature of stressor, timing of the stressor, character of the intrusive and avoidance symptoms, and treatment noncompliance behavior. These differences were of sufficient magnitude to call into question the feasibility, at this time, of constructing generalizations regarding PTSD utilizing only the PTSD/veteran population.

Psychotropic agents in opiate addiction: a brief review.

Psychotropic agents are frequently utilized in the detoxification and maintenance of opiate addicts as well as in the treatment of their underlying psychopathology. Review of reports of studies conducted to data indicates that schizophrenia, depression, and anxiety in opiate addicts appear to respond to appropriate treatment with psychotropic drugs. Although nonaddictive psychoactive compounds cannnot be completely substituted for methadone in detoxification, their effects on the rate of methadone withdrawal warrant further study. To evaluate the results of treatment of addicts with psychoactive compounds, parameters that should be studied include the effects of these compounds on illicit drug use, methadone requirements, relapse and dropout rates, and social behavior.