Dimensionality, responsiveness and standardization of the Bech-Rafaelsen Mania Scale in the ultra-short therapy with antipsychotics in patients with severe manic episodes.

Objective: Typical antipsychotics have their indication in the ultra-short (first week) treatment of severe episodes of mania. In this setting the Bech-Rafaelsen Mania Scale (MAS) was psychometrically compared with the Clinical Global Impression scale (CGI) to assess its ability to measure response.

Method: Ratings on patients with marked to severe mania (n = 80) who participated in the clinical trials to evaluate the ultra-short antimanic effect of zuclopenthixol acetate were assessed.

A controlled Nordic multicentre study of zuclopenthixol acetate in oil solution, haloperidol and zuclopenthixol in the treatment of acute psychosis.

Zuclopenthixol acetate--a new injectable formulation with a duration of action of 2-3 days--was compared with conventional intramuscular and oral formulations of haloperidol and zuclopenthixol in the initial treatment of acutely disturbed, psychotic patients. The patients were stratified into 3 diagnostic categories: acute psychoses (48 patients), mania (22 patients), and exacerbation of chronic psychoses (73 patients). The patients were rated on the Brief Psychiatric Rating Scale (BPRS), the Bech-Rafaelsen Mania Rating Scale (BRMAS) (only manic patients) and globally on the Clinical Global Impression (CGI).

Thyroid function and ultrasonically determined thyroid size in patients receiving long-term lithium treatment.

Thyroid function was investigated in 100 manic-depressive patients. Goiter was more common in patients treated with lithium for 1-5 years (44%) or more than 10 years (50%) than in patients who never received lithium (16%). Smoking contributed significantly to thyroid size and goiter.

Psychotropic medication in the elderly. A survey of prescribing and clinical outcome.

Due to the increasing elderly population, an increased number of elderly patients requires treatment for mental and behavioural disorders. There are relatively few clinical studies of the prescribing of psychotropic drugs in patients over 65 years of age. A prospective study was undertaken at three centres caring for the elderly, encompassing patients from general nursing homes and a psychiatric department.

Zuclopenthixol acetate in Viscoleo--a new drug formulation. An open Nordic multicentre study of zuclopenthixol acetate in Viscoleo in patients with acute psychoses including mania and exacerbation of chronic psychoses.

Eighty-three acutely disturbed, psychotic patients were included in an open multicentre study. The aim of the study was to evaluate the clinical effect of zuclopenthixol acetate in Viscoleo (CPT-A). Each patient received from one to four intramuscular injections of CPT-A during the 6-day study period.

Renal function in 153 manic-depressive patients treated with lithium for more than five years.

Renal function was examined in 153 manic-depressive patients treated with lithium for more than 5 years, mean 10 years. No significant change was detectable in plasma creatinine. Glomerular filtration rate (GFR) decreased slightly, but significantly, and not until after 17 years of treatment did the regression line reach the lower confidence limit in the reference material.

Zuclopenthixol decanoate in schizophrenia: serum levels and clinical state.

Serum concentrations of zuclopenthixol were determined in a group of 20 patients treated with a depot preparation, zuclopenthixol decanoate in Viscoleo. Clinical assessments according to a Clinical Global Impression (CGI) scale, Comprehensive Psychological Rating Scale (CPRS), 16-item subscale for schizophrenia, and the UKU side effect scale were performed on 3 consecutive days of injection. The serum concentrations showed a limited individual variation and a high and significant correlation between dose and serum concentration.

Flupenthixol decanoate in recurrent manic-depressive illness. A comparison with lithium.

The hypothesis that flupenthixol decanoate may serve as an alternative to prophylactically administered lithium in recurrent manic-depressive illness, bipolar and unipolar type, was tested in two groups of patients. In Group I the patients were allocated randomly to maintenance treatment with either lithium or flupenthixol decanoate. The patients in Group II had previously been given lithium and were switched to flupenthixol decanoate because of unsatisfactory prophylactic effect of lithium, doubtful tablet compliance, troublesome side effects, or fear of later harmful effects.

Development of 'primary' hyperparathyroidism during lithium therapy: longitudinal study.

The bone mineral content and the serum levels of immunoreactive parathyroid hormone (iPTH), and protein-corrected calcium and magnesium were measured in 13 manic depressive patients before and during treatment with lithium. Initially all four parameters were normal. During the treatment the bone mineral decreased and the serum levels of iPTH, calcium, and magnesium increased.

Calcium metabolism in schizophrenic patients on long-term neuroleptic therapy.

The bone mineral content (BMC) in both forearms (highly related to total body calcium) was measured in a large group of schizophrenic patients receiving neuroleptic drugs. The mean BMC value was 86% of normal (p less than 0.001), and the decrease was independent of type of neuroleptic treatment.

Endocrine effects of lithium. III. Hypermagnesaemia and activation of the renin-aldosterone system.

Hypermagnesaemia is a well-known but as yet unexplained concomitant of lithium treatment. Prior suggestions implicating a role for aldosterone in magnesium homoeostasis prompted this study of plasma renin, plasma aldosterone and serum magnesium in 17 maniodepressive patients on long-term lithium treatment. In addition to hypermagnesaemia (P less than 0.

Endocrine effects of lithium: II. 'Primary' hyperparathyroidism.

Ninety-six manic-depressive patients were studied during long-term lithium treatment. Highly significant elevations were observed respecting the levels of serum immunoreactive parathyroid hormone (P less than 0.001) as well as the protein-corrected levels of serum calcium (P less than 0.

Calcium metabolism in lithium-treated patients. Relation to uni-bipolar dichotomy.

The bone mineral content (BMC) together with biochemical indices of calcium metabolism were measured in 83 manic-depressive patients on long-term lithium therapy. The patients were diagnosed and divided into a unipolar and a bipolar group according to strict symptomatic course criteria. The patients with bipolar course had a significantly decreased BMC (88% of normal, P is less than 0.

Lithium treatment of Huntington's chorea. A placebo-controlled clinical trial.

The therapeutic effect of lithium in Huntington's chorea was tested in six patients through a double-blind cross-over comparison of lithium and placebo, each administered for 6 weeks. Four of the patients received neuroleptic drugs at the same time. Lithium and placebo periods did not differ as regards motor skills, hyperkinesias, or total ward situation, all rated quantitatively with the use of scales.

Adverse reactions in treatment with lithium carbonate and haloperidol.

Hospital records of 425 patients who had been treated simultaneously with lithium carbonate and haloperidol were examined. Adverse reactions in these patients were the same as in patients given lithium alone or haloperidol alone. None of the patients developed a syndrome resembling that described by others in patients treated with a lithium and haloperidol combination.

Therapeutic control of plasma concentrations and long-term effect of nortriptyline in recurrent affective disorders.

Based on the evidence that therapeutic plasma concentration range in fact exists for the tricyclic antidepressant drug, Nortriptyline (range 50-150 ng/ml), three different investigations were under taken in order to clarify some clinical pharmacological problems during long-term treatment with this drug. The possible prophlactic effect of the drug in recurrent affective disorders was specially examined in a group of patients with a high risk of episodes in their unipolar manic-depressive disease. The results highly demonstrate the value of monitoring plasma levels in achieving therapeutic control.

Self-inhibiting action of nortriptylin's antidepressive effect at high plasma levels: a randomized double-blind study controlled by plasma concentrations in patients with endogenous depression.

Below the toxic plasma level of nortriptyline (NT) an upper therapeutic limit has been postulated in patients with endogenous depression. If so the clinical significance is obvious and a double-blind, randomized study was performed in order to solve this problem. Two groups of patients were controlled at different plasma levels (less than 150 ng/ml and less than 180 ng/ml).

Relationship between antidepressant effect and plasma level of nortriptyline. Clinical studies.

Strong evidence has been found for the assumption that NT inhibits its own antidepressive effect at high, but non toxic plasma levels in patients suffering from endogenous depression. Based on three investigations we will recommend an optimal therapeutic plasma range for NT between 50 and 150 ng NT/ml.

Osteopenia and dysregulation of divalent cations in lithium-treated patients.

The bone mineral content (BMC) in both forearms (highly correlated to total body calcium) was measured by photon absorptiometry in a representative sample of manic depressive patients receiving lithium treatment. The mean BMC values were 93% of normal, and the mean increases in serum levels of calcium and magnesium were 2mg/l. The incidences of osteopenia, hypercalcaemia and hypermagnesaemia were 16, 12, and 30%, respectively.

[Schizoaffective psychosis and the lithium therapy of patients suffering from schizoaffective schizophrenia].

The historic aspects of the term "schizo-affective psychoses" is considered. On the basis of the results obtained in therapeutic and prophylactic use of lithium it is concluded that it is today hardly possible to create a homogenous nomenclature of mental diseases and that in the indication for the use of lithium in the treatment of schizo-affective psychoses have to be evaluated for each patient depending on the character of the affective components of the pathological picture.