The interactions between Ca(2+)-channel blockers (verapamil and gallopamil) and synaptic plasma membranes (SPM) from bovine brain or human lymphocyte and platelet plasma membranes were studied. Changes in binding parameters of [3H]imipramine, [3H]desmethylimipramine and [3H]gallopamil were determined after addition of unlabelled verapamil or imipramine and after addition of phosphatidylserine (PS) (PS-stimulation). Specific binding of [3H]imipramine to SPM was decreased and [3H]desmethylimipramine binding was increased by 1 microM verapamil. [3H]gallopamil binds specifically to SPM as well as to platelet and lymphocyte membranes. [3H]gallopamil binding to SPM or lymphocyte plasma membranes was PS-stimulated in contrast to platelet plasma membranes without PS effect on binding. Imipramine inhibited both [3H]gallopamil binding and PS-stimulated [3H]gallopamil binding to SPM or lymphocyte plasma membranes. Mutual effects of tricyclic antidepressants and Ca(2+)-channel blockers on their binding sites require relatively high drug concentrations. Mechanism of Ca(2+)-channel blockers action in the treatment of depression may be connected rather with changes in signal transduction through serotonin and catecholamine receptor systems than with direct interaction of drugs with binding sites for tricyclic antidepressants.
The author gives a historical account of patient's rights and in particular the development of codes of rights of psychiatric patients during the past twenty years. He describes differences in attitudes to rights of psychiatric patients in different societies and the different emphasis on patient's rights, as compared with rights of society. Briefly the so far most elaborated account of rights of psychiatric patients submitted by the American Psychiatric Association is described.
In a review of the literature the author outlines the basic ethical problems of contemporary European gerontopsychiatry, as apparent at international congresses of gerontopsychiatric societies in Berlin (1993 and 1994) and Amsterdam (1994). Ethical dilemmas include in the first place abuse of old people, ethics of drug trials with insane patients and the right of a dignified death of psychiatric patients in general and insane patients in particular. The author holds a critical view of the legalization of euthanasia. A substantial part of the paper is devoted to the development of discussions regarding the legalization of euthanasia in Holland. It seems that as long as euthanasia will be restricted to the terminal stages of generalized malignities, it could be adopted also in other European countries incl. the Czech Republic. The author has a very critical and negative attitude to frequently practised dysthanasia, not only in the mentally healthy but also in psychiatric patients. He refutes inadequate medical intervention from the sphere of heroic medicine in particular in insane patients in the terminal stages of degenerative brain diseases.
The author explains in detail new legal regulations on admission to and detention in health institutions of citizens of the Czech Republic, as applied to people with mental disorders. The author describes three stages of implementation as regards admission of a person to a psychiatric in-patient department, i.e. prerequisites for involuntary psychiatric hospitalization, the stage of the intervention and the stage of admission to and detention in a psychiatric in-patient department. Attention is drawn to the fact that in the legal regulations are some inaccuracies and that practical implementation of involuntary hospitalization of the mentally sick is associated with some difficulties. It is recommended that after evaluation of experience with the implementation of the new regulations which are valid since Jan. 1, 1992 some of the regulations should be amended.
In 1992 new regulations were issued as regards admission of patients to inpatient care without their consent. The basic change is the duty of the court to investigate every admission of patients without their consent and to take a decision on the justification of admission within seven days. In practice this new legal regulation is most frequently the concern of psychiatrists. When these legal norms are applied in the care of the mentally sick, some problems may arise. The purpose of the presented paper is to draw attention to some.
