Despite preclinical studies suggesting that isradipine may antagonize the abuse liability of cocaine, pretreatment with sustained-release isradipine did not reduce euphoric mood in cocaine-using volunteers. This double-blind, within-subject, crossover laboratory study determined whether maximal dose-loading with isradipine could antagonize effects of cocaine in 12 cocaine-dependent research volunteers administered intravenous cocaine doses (0, 0.325, and 0.65 mg/kg) on different days after 5 days of treatment with isradipine or placebo. Isradipine dose was 30 mg sustained release nightly plus 15 mg immediate release 2 hr before cocaine infusion. Cocaine produced dose-related increases in cocaine's subjective effects and a behavioral measure of reinforcement. Isradipine enhanced, rather than antagonized, subjective effects, indicating that isradipine does not antagonize cocaine's abuse liability in dependent research volunteers.

s of the AMERSA National Conference, November 2002: New Challenges, New Directions

In the human central nervous system, the gamma-aminobutyric acid (GABA) type A receptor complex undergoes changes with both acute and chronic exposure to sedative-hypnotic drugs. These changes contribute to both the acute effects of these drugs as well as the chronic effects of sedative-hypnotic dependence, withdrawal, and drug craving. Clinically these chronic effects are difficult to treat in patients dependent on ethanol or benzodiazepines. Valproate may return the GABA type A receptor function to a state more closely resembling its normal function. By this mechanism, it is possible to reduce the symptoms of sedative-hypnotic withdrawal and relapse.

Twenty‐one inpatients on a psychogeriatric unit were assigned randomly to a haloperidol or oxazepam treatment group. Drug effects were assessed with three psychiatric rating scales and direct behavioral observation. The behavioral microanalysis employed two separate systems of observation: aberrant behaviors were assessed by recording the frequency of behaviors per hour, and the activities assessment (eg social interaction, sleeping) sampled each resident's behaviors during two 10‐min intervals per day. Results showed no differences between drug groups on any of the assessments, except for engagement in activities from the activities assessment. A modest non‐significant decrease in symptoms was noted on all psychiatric assessments. The behavioral observations showed very low pretreatment levels of aberrant behaviors. Non‐significant post‐treatment decreases were observed for disruptive vocalizations, paranoid verbalization, and non‐compliance; rates of physical aggression and psychomotor agitation increased somewhat. The potential role of behavioral microanalysis in nursing homes is discussed in light of new HCFA guidelines.

We performed a prospective, naturalistic study using standardized clinical rating scales to characterize the effect of electroconvulsive therapy (ECT) on mood, cognition, and medical status in late-life depression. Over a 16-month period, 40 patients aged 60 years and over who fulfilled DSM-III criteria for a major depressive episode received a total of 42 ECT courses. Three patients (7%) developed significant medical complications: one had a syncopal episode due to arrhythmia, and two had symptomatic vertebral compression fractures. Confusion was noted during 13 courses (31%) and persisted at discharge in four (10%). More than half the patients were either psychotic or demented on admission, and all but three had been either unresponsive or intolerant to pharmacotherapy. All patients experienced a decrease in their depressive symptoms and more than two thirds were in complete or partial remission at discharge. Patients with psychotic depression experienced a greater improvement than patients with nonpsychotic depression, and patients with organic mental disorders experienced the same improvement as other patients. This study confirms that ECT is a safe and effective treatment of depression in late life.

The Mini-Mental State Examination (MMSE) is a commonly used instrument for assessing mental impairment. Previous proposals for its underlying structure have focused on scores obtained from a single administration of the test. Because the MMSE is widely used in longitudinal studies, we examined the pattern of relations among the rates of chance of the items. Data were obtained from 63 subjects for 1.5 years or more. The relations among the rates of change of the MMSE items were described by a five-factor solution that accounted for 75% of the variance and comprised factors pertaining to orientation and concentration, obeying commands, learning and repetition, language, and recall. This was in contrast to the structure of the scores obtained from a single administration of the MMSE, which was best described by a two-factor solution. In order to provide a clinical validation, factor scores derived from the MMSE factors were used to predict scores on the Memory and Behavior Problems Checklist and the Brief Cognitive Rating Scale.

We reviewed the log book of our university-based electroconvulsive therapy (ECT) service for the years 1981 to 1987. We identified 10 patients treated with monthly maintenance electroconvulsive therapy (ECT-M). These 10 patients received 3% of the ECT treatments given in this 7 year period. The review of their charts suggests that ECT-M is generally reserved for patients who are older (i.e., over 60 years of age), suffering from delusional depression and/or depressive pseudodementia, and have a history of poor response or tolerance to medications but good response to ECT. The patients had fewer hospitalizations in the 18 months after initiating ECT-M than during the 18 months preceding ECT-M (mean of 3.1 vs. 0.3, respectively, p < 0.001). However, this apparent efficacy of ECT-M may be confounded by the concurrent use of medication. A review of the literature reveals only descriptive studies on ECT-M and shows that our data are congruent with these published studies. The relative value of maintenance ECT and its specificity remain unknown. Its apparent impact on hospitalization rates and safety warrant controlled trials.

Back to table of contents Previous article Next article ArticleNo AccessDo Not Go Gently Into That Good Night: More About the Junior Faculty Academic DilemmaBEN ZIMMER, and JOE THORNTONBEN ZIMMERSearch for more papers by this author, and JOE THORNTONSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.146.9.1236-bAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Do Not Go Gently Into That Good Night: More About the Junior Faculty Academic Dilemma." American Journal of Psychiatry, 146(9), pp. 1236-b–1237 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byAcademic Psychiatry, Vol. 17, No. 2 Volume 146Issue 9 September 1989Pages 1236-b-1237 Metrics PDF download History Published online 1 April 2006 Published in print 1 September 1989

We report preliominary findings from an ongoing, open trial of maintenance nortriptyline pharmacotherapy in 27 elderly depressed patients (median trial length: 18 months). While patients were on maintenance nortriptyline (mean dose: 50 mg/day) with steady-state plasma levels in the range of 50–150 ng/ml, 58% of Q-6 monthly ratings on the Hamilton Rating Scale for Depression have been 10 or lower, Folstein Mini-Mental State ratings have remained above 27, and a minimal level of side effects with no increase over time has been observed. Four of 27 patients (14.8%) have suffered recurrences and have required rehospitalization at 6, 9, 10, and 13 months. Survival analysis showed an 85% survival rate (without recurrence) at 12 months and 81.5% at 18 months. Mean survival time without recurrence is 21.3 months to date. Although our pilot experience with maintenance nortriptyline in late-life depression appears more favorable than outcomes reported in earlier naturalistic studies (where no attempt was made to keep patients in systematic maintenance therapy), the need for controlled studies of maintenance therapies in late-life depression is nonetheless underscored by the current data and other naturalistic data from the United Kingdom.

Research, clinical service, and social support are inextricably linked in the battle against Alzheimer's disease. Each of these areas must be addressed in order to effectively treat the syndrome.

We conducted a single-blind trial of gamma-vinyl-GABA (GVG) in nine patients: seven with tardive dyskinesia, one with Meige syndrome, and one with Tourette syndrome. Five tardive dyskinesia patients completed the entire 11-week study and, as a group, demonstrated significant decreases in dyskinesia scores. Four of these five tardive dyskinesia patients showed clinically evident improvement, with approximately 30% reduction in dyskinetic symptoms. Other patients had no clinical benefit from GVG. Three patients had transient exacerbation of psychiatric symptoms after sudden withdrawal of GVG, and one patient experienced dose-related confusional episodes. Our results suggest that GABAergic drugs may have a role in treating patients with tardive dyskinesia.

The authors describe a case of tardive dyskinesia and parkinsonism associated with amoxapine. Patients who develop acute parkinsonism while taking amoxapine may be at higher risk for tardive dyskinesia. The authors recommend that amoxapine be prescribed as carefully as other neuroleptics.

A 16 h immunofluorescence microplaque reduction assay for herpes simplex virus (HSV) was compared with a plaque reduction assay to assess its feasibility as a rapid technique for determining viral sensitivity to drugs. A drug‐sensitive HSV strain (HSV‐1 Patton) and a drug resistant strain (HSV‐1‐P‐ACG‐R), both grown in cell cultures, were compared against serial dilutions of adenine arabinoside (Ara‐A) and acycloguanosine (ACG). Similar studies were done with virus obtained directly from experimentally infected rabbit corneas. The microplaque assay yielded results similar to the plaque assay and has the advantage of speed, which may be useful in clinical situations.