Lithium ratio, phospholipids and the incidence of side effects.

The main aims of our Lithium Centre, which has been operating since 1985, are as follows: 1. the treatment of affective disorders and particularly the recurrent ones; 2. the emphasis of the Li-ratio as a predictive index of therapeutic effects on the one hand, and of the appearance of side effects on the other hand; 3. the prevention and pharmacological control of side effects and research about their mechanism of arising.; 4. organization of a computerized bibliographic service.

[Abrupt shift to zolpidem, a new imidazopyridine hypnotic, in insomniac patients previously treated with benzodiazepine hypnotics]. / Passaggio ex-abrupto a zolpidem, nuovo ipnotico imidazopiridinico, in pazienti insonni già in trattamento con ipnotici benzodiazepinici.

Zolpidem is a new imidazopyridine hypnotic with a pharmacological profile substantially different from benzodiazepines. In this observational multicenter study the possibility of shifting to zolpidem (10 mg at N1, 15 or 20 after N1) insomniac patients previously taking (for at least 15 days and not longer than 3 months) standard posology of triazolam (0.125-0.25 mg), lorazepam (1 mg) or lormetazepam (1 mg) was assessed. For ethical reasons the patients were mandatorily to be insomniacs despite their taking hypnotics or not tolerating them. Patients enrolled were 299 of whom 276 evaluable (139 males and 136 females; mean age 48.67 +/- 14.64, range 18-83). Study duration was 7 nights with visits at N0 (baseline), N1 (after 1st night), N3 (after 3rd night) and N7 (final evaluation); on each visit the Saint Mary Hospital Sleep Questionnaire and the benzodiazepine withdrawal symptom's rating scale were administered; moreover, after N7, investigators were asked a judgement of feasibility of such a shift. In 229 (83.5%) out of 274 patients such a shift to zolpidem was considered successfully (no occurrence of symptoms and/or signs of previously taken hypnotic withdrawal); in the remaining 45 patients, just 17 (6.2%) seemed to be real unsuccessful cases (reactions mild and transient, anyhow). In conclusion abrupt shift to zolpidem appeared to be largely feasible in the patients studied.

[Evaluation of effectiveness and tolerance of the long-term treatment with bromoperidol decanoate in psychotic disorders]. / Valutazione dell'efficacia e della tollerabilità del trattamento a lungo termine con bromperidolo decanoato nei disturbi psicotici.

An open study in 20 patients (7 M, 13 F, mean age 40 years) has been performed in order to evaluate the effectiveness and the safety of bromperidol decanoate in the long-term treatment of psychotic disorders. Patients were selected according to DSM-III-R diagnostic criteria (schizophrenia, residual type: 6 patients; disorganized type: 4; paranoid type: 5; undifferentiated type: 2; atypical psychosis: 3) and treated with bromperidol decanoate 150 mg i.m. (single administration) every month for 6 months. The BPRS scores significantly decreased at the end of the therapy with respect to the beginning (-39.5%; p less than 0.01 Friedman analysis between times); this improvement was already significant at the first month control. The results obtained from a clinical global impression, evaluated from the Visual Analogical Scale (VAS), showed that all patients improved at the end of the therapy (p less than 0.01 ANOVA between times). The side effects, mainly extrapyramidal ones, were mild and did not interfere with the therapy; in fact none patient dropped-out from the treatment. Bromperidol decanoate showed to have a good efficacy and safety in the therapy of psychotic disorders, with a stabilizing effect on the depressive mood.

[Predictive value of the ajmaline test in dysfunction of the sinus node. Prospective 4-year follow-up relative to 77 patients]. / Valore predittivo del test all'ajmalina nelle disfunzioni del nodo del seno. Follow-up prospettico di 4 anni relativo a 77 pazienti.

To establish the usefulness of Ajmaline test for the evaluation of sinus node function, 77 pts (47 M, 30 F, mean age +/- SD = 61 +/- 15 yrs) first underwent an electrophysiologic study and then were followed-up for a mean period of 46.3 months. The following parameters were determined before and after i.v. administration of Ajmaline (1 mg/kg in 1 minute): sinus cycle length (SCL), corrected sinus node recovery time (CSNRT) and sino-atrial conduction time (SACT). The pts were divided into 3 groups: Group A: 10 pts without clinical or electrocardiographic signs of sinus node dysfunction (SND) and with normal control CSNRT and SACT (less than or equal to 500 and less than or equal to 120 msec, respectively); Group B: 46 pts with clinical-electrocardiographic signs of suspected or apparently not severe SND (sinus bradycardia greater than or equal to 40 beats/min and/or syncopes with positive vagal manoeuvres) and/or slightly abnormal control CSNRT (greater than 500 less than or equal to 600 msec) and/or SACT (greater than 120 less than or equal to 150 msec); Group C: 21 pts with clinical-electrocardiographic signs of apparently severe SND (sinus bradycardia less than or equal to 39 beats/min, sino-atrial block, sinus arrest) and/or definitely prolonged control CSNRT and/or SACT (greater than 600 and greater than 150 msec, respectively). The Ajmaline test was considered negative for the presence of a severe SND if SCL was not prolonged after the administration of the drug more than 20% and CSNRT and SACT were not prolonged more than 50% compared to the control values. Otherwise the Ajmaline test was considered positive. Twenty-seven out of the 77 pts studied underwent permanent pacemaker implantation (23 immediately after the electrophysiologic study and 4 during the follow-up). The following results were obtained: the Ajmaline test was negative in 100% of group A, 87% of group B and 48% of group C pts and positive in 0% of group A, 13% of group B and 52% of group C pts; during the follow-up a negative test resulted predictive in 56 out of 60 pts (92%) and a positive test in 16 out of 17 pts (94%). The predictive accuracy of the test was, therefore, 93.5%. These results indicate that Ajmaline test is an useful provocative test for disclosing, during electrophysiologic studies, pts who have severe SND and for selecting those who need pacemaker implantation.

[Intrinsic function of the sinus node in patients with syncope and positive vagal maneuvers]. / La funzionalità intrinseca del nodo del seno nei pazienti con sincopie manovre vagali positive.

This study was undertaken to establish the nature (intrinsic or extrinsic) of sinus node dysfunction in patients presenting with syncope and abnormal response (sinus pause greater than 3'') to vagal manoeuvres (carotid sinus massage and/or eye-ball compression). To this purpose 29 patients (20 males, 9 females, aged 18-79 yrs, mean = 60) underwent an electrophysiologic study. In all we measured before and after autonomic blockade with Propranolol (0.2 mg/kg) and Atropine sulfate (0.04 mg/kg) the following parameters: sinus rate, corrected sinus node recovery time and sino-atrial conduction time. According to the presence or absence of electrocardiographic signs of sinus node dysfunction the patients were divided into three groups: Group A: 11 patients without electrocardiographic signs of sinus node dysfunction; Group B: 13 patients with borderline electrocardiographic signs of sinus node dysfunction (sinus bradycardia between 40 and 60 beats/min); Group C: 5 patients with definite electrocardiographic signs of sinus node dysfunction (sinus bradycardia less than or equal to 39 beats/min and/or sinoatrial block and/or sinus arrest). Fifteen patients (52%) had signs of organic heart disease. The main results obtained were: At least one electrophysiological test (sinus rate, corrected sinus node recovery time or sino-atrial conduction time) was abnormal in 10 patients (34,5%) before autonomic blockade and in 8 patients (27%) after autonomic blockade. Two of these 8 patients belonged to Group A (18%), 1 to Group B (8%) and 5 to Group C (100%). Six of these 8 patients were suffering from an organic heart disease and 2 were not.(ABSTRACT TRUNCATED AT 250 WORDS)

Amitriptyline: comparison of three different dosage schedules in neurotic depression.

Three groups of neurotic depressed patients were treated with amitriptyline, one group receiving the customary three daily doses, another a single dose in the morning, and the third a single dose at night. All three groups showed significant decrements of total scores on the Hamilton Scale for Depression and the Zung Self-Rating Depression Scale without significant differences. Patients taking the drug at night showed a lower incidence of side effects.