The implication of cytochrome P450 CYP2D6 enzyme activity in the metabolism of the antipsychotic drug risperidone has been reported in vitro and in studies of healthy volunteers. Around 7% of Caucasians have inherited impaired capacity of this enzyme (poor metabolisers). These subjects might be prone to higher plasma concentrations of risperidone. The aim of the study was to determine the relationship between the debrisoquine metabolic ratio (MR), a marker of CYP2D6 enzyme activity, and risperidone plasma levels in psychiatric patients.A population of 40 Spanish and Hungarian schizophrenic patients was studied. The possible inhibition of CYP2D6 enzyme was also evaluated in a subgroup of patients co-medicated with inhibitors of CYP2D6. The risperidone/9-hydroxy-risperid one ratio correlated significantly with debrisoquine MR (p < 0.001). In patients co-medicated with strong inhibitors of CYP2D6, the plasma levels of risperidone (p < 0.05) and debrisoquine MR (p < 0.01) and risperidone/9-hydroxy-risperidone ratio were higher compared to patients with monotherapy. According to the present data, the evaluation of the risperidone/9-hydroxy-risperidone ratio may reflect the actual enzyme activity of CYP2D6. Therefore, the use of this ratio may help to assess potential pharmacokinetic interactions and to improve risperidone treatment.

Depressive symptoms can often be observed after stroke. We prospectively evaluated patients at a stroke unit in order to determine the occurrence and severity of depressive symptoms in the acute phase of stroke in 82 patients 7 ± 2 days after admission to the stroke unit. Severity of stroke was evaluated by the Scandinavian and Orgogozo scales and the Barthel index. Severity of depressive symptoms was measured by the 13-item Beck scale. Mean age of the patients was 65.8 years. No gender difference was observed in the severity of stroke or depressive symptoms. DSM-IV criteria of adjustment disorder with depressed mood were fulfilled by 27% of the patients. In this group, stroke was significantly more severe by the Barthel, Orgogozo, and Scandinavian scales (p < 0.001). Whereas Beck score was at least 10 in 19.5%, severe depressive symptoms (Beck score ≥15) occurred in less than 5% of patients with acute stroke. Those who could not walk by themselves or who were aphasic had significantly higher mean Beck scores (6.3 ± 5.1 vs 2.4 ± 3.1, p < 0.001, and 7.0 ± 5.8 vs 3.4 ± 3.9, p = 0.002). Significant correlation was found between the severity of stroke and that of the depressive symptoms (r = −0.56, −0.58, and −0.54 for the Scandinavian, Orgogozo, and Barthel scales, p < 0.001).

Patients were consecutively enrolled in a cross-sectional study to determine the severity of depressive symptoms and the rate of treated depression in a patient population returning to a stroke outpatient service during a 10-week period for a regular check-up examination after their stroke. Of the 143 stroke patients, 119 fulfilled the inclusion criteria. The 13-item Beck Depression Inventory was used to screen for depressive symptoms. The score was at least 5 in 53%, 10 or above in 26%, and 15 or above in 11% of patients. Severity of depressive symptoms did not depend on gender, age, time elapsed from stroke, or the site of the cerebral lesion. Most patients with considerable depres sive symptoms did not receive antidepressant medication at the time of the screening. (J Geriatr Psychiatry Neurol 1999; 12:194-199).

In order to clarify the relative contribution of the liver to the short term disposition of propofol, hepatic blood flow was measured during induction of anaesthesia with an i.v. bolus dose of propofol 2 mg kg-1. Total clearance of the drug was 2390 (SD 340) ml min-1, hepatic extraction 82% and hepatic clearance 1060 (260) ml min-1. During the 60-min period of observation, hepatic extraction of propofol increased from 79% to 92%. It is concluded that, within 1 h, only 44% of the administered dose is removed by the liver. Consequently, drug accumulation may occur with repeated dosing or infusion of propofol. The increase in extraction results presumably from slow release of propofol from the soy-bean emulsion.

In 50 duodenal ulcer out-patients and 50 non ulcer dyspeptic patients suffering from low to moderate epigastric painful symptoms the intolerance of 39 foods were significantly increased compared to a group of 50 healthy subjects. Food intolerance was not different between duodenal ulcer and non ulcer dyspeptic patients. Intolerance was related in the majority of nutrients to aversion and pain or to an increased incidence of aversion alone in patients and normals. In duodenal ulcer, coffee and fruit juice were associated with an elevated incidence of pain.

Of the 18,219 live births registered in Bek6s County (Hungary) in the period 1970-72, 523 infants came to treatment for congenital dislocation of the hip.The diagnosis was verified by radiography.The incidence of 28 7 per 1,000 live births is consistent with the values noted in a previous study conducted in Budapest.Differences in applying diagnostic criteria, the high proportion of first-born infants, the unhealthy swaddling customs, and the supposedly higher occurrence of genetic predisposition to congenital dislocation of the hip may account for the high incidence, which is much greater than values reported in countries of Western Europe and North America.