scholarly journals Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG Dysrhythmia

2021 ◽  
Vol 12 ◽  
Author(s):  
Alfonso Ceccherini-Nelli ◽  
Elena Bucuci ◽  
Lisa Burback ◽  
Daniel Li ◽  
Maryam Alikouzehgaran ◽  
...  
Keyword(s):  
Side Effects ◽  
Rating Scale ◽  
Violent Behavior ◽  
Psychiatric Inpatients ◽  
Pharmacological Interventions ◽  
Maximum Daily Dose ◽  
Daily Dose ◽  
Index Value ◽  
Age Range

Managing violent behavior is a particularly challenging aspect of hospital psychiatric care. Available pharmacological interventions are often unsatisfactory.Aim: To assess the effectiveness and safety of daytime zopiclone add-on administration in violent and difficult-to-treat psychiatric inpatients.Methods: Chart review of inpatients treated with daytime zopiclone, between 2014 and 2018, with up to 12 weeks follow-up. Effectiveness was retrospectively assessed with the Clinical Global Impression rating scale (CGI) and the frequency and severity of aggressive incidents recorded with the Staff Observation Aggression Scale-Revised (SOAS-R).Results: Forty-five (30 male, 15 female) cases, 18–69 years age range, average (SD) baseline CGI-S score of 5.4 (1.0), and a variety of diagnoses. Sixty-nine percent showed CGI-S improvement of any degree. For patients with at least one aggressive incident within 7 days prior to initiation of zopiclone (N = 22), average (SD) SOAS-R-Severity LOCF to baseline change was −3.5 (2.7) P < 0.0001. Most patients reported no side effects; 24% reported one or more side effects, and 11% discontinued zopiclone due to sedation (4), insomnia (1) or slurred speech (1). No SAEs were recorded. Zopiclone maximum daily dose correlated with CGI-S baseline-to-LOCF change (rho = −0.5, P = 0.0003). The ROC AUC of zopiclone maximum daily dose and improvement on CGI-S was 0.84 (95% CI 0.70–0.93, P < 0.0001). The ROC AUC of zopiclone maximum daily dose and SOAS-R-N improvement was 0.80 (95% CI 0.58–0.92; P = 0.0008) and maximum Youden's index value was achieved at a dose of >30 mg.Conclusions: Zopiclone doses >30 mg daily achieved the best anti-aggressive effect.

A Double-Blind Comparison of Prazepam with Diazepam, Chlorazepate Dipotassium and Placebo in Anxious Out-Patients

1979 ◽  
Vol 7 (2) ◽  
pp. 147-151 ◽  
Author(s):  
Louis F Fabre ◽  
David M McLendon ◽  
Arthur Mallette
Keyword(s):  
Data Analysis ◽  
Side Effects ◽  
Rating Scale ◽  
Double Blind ◽  
Drug Study ◽  
Patient Reported ◽  
Symptom Check List ◽  
Blind Comparison ◽  
Lost To Follow Up ◽  
Age Range

This study compared prazepam with diazepam, chlorazepate dipotassium, and placebo in the treatment of anxious out-patients. Patients were screened for participation in the study to be sure they met the criteria for inclusion. Patients were excluded if they had complicating physical or mental problems. All patients signed an informed consent. Seventy-three patients entered the study, thirteen did not complete at least two weeks of treatment and were not used in the data analysis. Of these thirteen, ten did not return and were lost to follow-up, two entered the hospital for reasons unrelated to the drug study, and one patient on diazepam was terminated because of increased anxiety. Sixty patients were used in the data analysis, thirty-six males and twenty-four females with an age range of 21–61 years. Side-effects were minimal. Drowsiness was reported by two people in the placebo group, one taking chlorazepate dipotassium, three on prazepam and one on diazepam. One diazepam patient reported nausea and vomiting. Scores on the Zung Self-Rating Scale for Anxiety showed all three drug groups to be superior to placebo. The Hopkins Symptom Check-list found prazepam and diazepam to be superior to placebo and chlorazepate. No differences among the groups were found in the Hamilton Anxiety Scale. Prazepam may offer advantages over the other available benzodiazepines since it may be more readily absorbed than chlorazepate and has less side-effects than diazepam.

A Comparative Trial of Opipramol and Chlordiazepoxide in the Treatment of Anxiety

1973 ◽  
Vol 1 (3) ◽  
pp. 145-150 ◽  
Author(s):  
K Jepson ◽  
G Beaumont
Keyword(s):  
Clinical Trial ◽  
General Practice ◽  
Side Effects ◽  
Rating Scale ◽  
Comparative Trial ◽  
Anxiety Score ◽  
Double Blind ◽  
Somatic Anxiety ◽  
Daily Dose ◽  
The Difference

A daily dose of 200 mg of opipramol (Insidon, Geigy) and 30 mg of chlordiazepoxide (Librium, Roche) were compared in a clinical trial in general practice. The trial was double blind and a stratified randomisation technique was employed. Twenty four patients received opipramol and twenty six chlordiazepoxide for four weeks. A total anxiety score and separate ‘psychic’ anxiety and ‘somatic’ anxiety scores were recorded, using a rating scale initially and after two and four weeks treatment. No overall difference in efficacy was found between the two drugs—opipramol producing a 76% improvement and chlordiazepoxide 64% by the end of the study. There was no difference in the relief of psychic anxiety. Although opipramol appeared to give more relief of somatic anxiety, the difference was not statistically significant. Again although opipramol relieved more individual symptoms than chlordiazepoxide, none of the differences were significant. 70% of patients on opipramol and 74% of those on chlordiazepoxide were classified ‘better’ globally by both doctor and patient by the end of the trial. The total number of side effects recorded was similar on both drugs although drowsiness occurred twice as frequently on chlordiazepoxide as it did on opipramol.

The Use of Oestrogens for Postcoital Contraception

1977 ◽  
Vol 9 (1) ◽  
pp. 83-90 ◽  
Author(s):  
Ruth Coles
Keyword(s):  
Side Effects ◽  
Unprotected Intercourse ◽  
Expected Time ◽  
Postcoital Contraception ◽  
Daily Dose ◽  
Ethinyl Oestradiol

SummaryOestrogens as postcoital contraception have been prescribed for 282 women at the Brook Advisory Centre (Avon) since January 1973. A daily dose of 50 mg diethylstilboestrol for 5 days started within 72 hr of unprotected intercourse was used from January 1973. This was changed to 5 mg ethinyl oestradiol in May 1974. There were no pregnancies nor any serious side effects. Follow-up showed that most women had their next period at the expected time.

scholarly journals Comparison between Allopurinol and Febuxostat in management of gout patients - a prospective study

2012 ◽  
Vol 10 (4) ◽  
pp. 257-259 ◽  
Author(s):  
KK Singal ◽  
S Goyal ◽  
P Gupta ◽  
BK Aggawal
Keyword(s):  
Side Effects ◽  
Serum Urate ◽  
End Point ◽  
Daily Dose ◽  
Group A ◽  
Baseline Values ◽  
Group B ◽  
A Prospective Study ◽  
Gout Flare

Aim:To assesses the efficacy of a relatively new drug-Febuxostat in management of gout and its comparison with allopurinol. Method: A comparative study of both Allopurinol and Febuxostat was done on 100 patients of gout. Both were studied for efficacy. side effects and for gout flare up. Results: Primary efficacy end point (baseline values) - a serum urate concentration of less than 6.0mg per deciliter at the last three measurements was reached by 54 %( 27/50) of group A patients taking 80mgs of febuxostat and 25 %( 12/50) of group B patients taking allopurinol 300mgs per day (P<0.001) Secondary efficacy end point(follow up values)- At first visit( after 2 weeks of onset of study), the proportions of subjects with serum urate concentration of less than 6.0mg/dl was significantly higher in the group A receiving febuxostat than the group B receiving allopurinol(P<0.001)[Tableno-1]. Conclusion: Febuxostat, at a daily dose was more effective than allopurinol at the commonly used fixed daily dose of 300 mg in lowering serum urate. Results of side effects and gout flare up were similar in both groups. Key words: Allopurinol; febuxostat; uric acid; goutDOI: http://dx.doi.org/10.3329/bjms.v10i4.7522 BJMS 2011; 10 (4): 257-259

Flunarizine in Common Migraine: Italian Cooperative Trial. I. Short-Term Results and Responders' Definition

Cephalalgia ◽  
1985 ◽  
Vol 5 (2_suppl) ◽  
pp. 149-153 ◽  
Author(s):  
Gian Camillo Manzoni ◽  
Giorgio Bono ◽  
Tommaso Sacquegna ◽  
Vincenzo Manna ◽  
Marina Lanfranchi ◽  
...  
Keyword(s):  
Side Effects ◽  
Rating Scale ◽  
Short Term ◽  
The Third ◽  
Cooperative Trial ◽  
Hamilton Rating Scale

In order to assess the effects of flunarizine in long-term prophylaxis of common migraine, 120 subjects (90 female and 30 male) were treated with 10 mg at bedtime and followed-up for two years. The effectiveness of the drug was assessed by investigating the variations of the Headache Index (HI) and of the intake of analgesics. The patients considered responders were those with an at least 60% reduction of the HI compared with the baseline value. To assess side effects, on each follow-up examination the patients were weighed and submitted to the Hamilton Rating Scale for Depression, Toulouse-Pieron test for attention, and arousal test. By the third month of therapy, the average monthly HI had decreased from a baseline value of 16.5 ± 7.0 to 7.5 ± 4.2. Also by the third month, 60 subjects had proved responders and 50 non-responders; 10 had dropped out of the study because of side effects or for other reasons. The only statistically significant differences between responders and non-responders were in the baseline HI, which was higher among responders, and in the baseline intake of analgesics, which was higher in non-responders.

MRI-guided focused ultrasound thalamotomy in non-ET tremor syndromes

Neurology ◽  
2017 ◽  
Vol 89 (8) ◽  
pp. 771-775 ◽  
Author(s):  
Alfonso Fasano ◽  
Maheleth Llinas ◽  
Renato P. Munhoz ◽  
Eugen Hlasny ◽  
Walter Kucharczyk ◽  
...  
Keyword(s):  
Side Effects ◽  
Essential Tremor ◽  
Focused Ultrasound ◽  
Rating Scale ◽  
Invasive Technique ◽  
Sustained Improvement ◽  
Future Studies ◽  
Mri Guided

Objective:To report the 6-month single-blinded results of unilateral thalamotomy with MRI-guided focused ultrasound (MRgFUS) in patients with tremors other than essential tremor.Methods:Three patients with tremor due to Parkinson disease, 2 with dystonic tremor in the context of cervicobrachial dystonia and writer's cramp, and 1 with dystonia gene–associated tremor underwent MRgFUS targeting the ventro-intermedius nucleus (Vim) of the dominant hemisphere. The primary endpoint was the reduction of lateralized items of the Tremor Rating Scale of contralateral hemibody assessed by a blinded rater.Results:All patients achieved a statistically significant, immediate, and sustained improvement of the contralateral tremor score by 42.2%, 52.0%, 55.9%, and 52.9% at 1 week and 1, 3, and 6 months after the procedure, respectively. All patients experienced transient side effects and 2 patients experienced persistent side effects at the time of last evaluation: hemitongue numbness and hemiparesis with hemihypoesthesia.Conclusions:Vim MRgFUS is a promising, incision-free, but nevertheless invasive technique to effectively treat tremors other than essential tremor. Future studies on larger samples and longer follow-up will further define its effectiveness and safety.Clinicaltrials.gov identifier:NCT02252380.Classification of evidence:This study provides Class IV evidence that for patients with tremor not caused by essential tremor, MRgFUS of the Vim improves the tremor of the contralateral hemibody at 6 months.

Phenoxybenzamine in the treatment of causalgia

1984 ◽  
Vol 60 (6) ◽  
pp. 1263-1268 ◽  
Author(s):  
Salim Y. Ghostine ◽  
Youssef G. Comair ◽  
Donn M. Turner ◽  
Neal F. Kassell ◽  
Camille G. Azar
Keyword(s):  
Cauda Equina ◽  
Blocking Agent ◽  
Nerve Injuries ◽  
Duration Of Treatment ◽  
Content Type ◽  
Maximum Daily Dose ◽  
Greater Occipital Nerve ◽  
Daily Dose ◽  
Fine Print

✓ Forty consecutive cases of causalgia treated during a 7-year period are presented. The patients ranged in age between 17 and 55 years, and all patients were males who received their nerve injuries from missile or shrapnel wounds. The greater occipital nerve was involved in two cases, median nerve in 10, sciatic nerve in 12, brachial plexus in seven, cauda equina in five, and multiple nerves in four cases. Each patient was treated with phenoxybenzamine, a postsynaptic α1-blocker and presynaptic α2-blocking agent. The drug was given orally in gradually increasing increments until a maximum daily dose of 40 to 120 mg was reached. Duration of treatment was usually 6 to 8 weeks. Total resolution of pain was achieved in all cases. The follow-up period ranged between 6 months and 6 years. Side effects of phenoxybenzamine were minimal and transient, consisting primarily of mild orthostatic hypotension and ejaculatory problems. We conclude that oral phenoxybenzamine is a simple, safe, and effective treatment of causalgia.

Dose increases in patients with chronic myeloid leukemia (CML) treated with imatinib mesylate (IM): Estimated using administrative claims data in a US managed care population

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16014-16014
Author(s):  
C. C. Davis ◽  
P. Hines ◽  
G. Devercelli ◽  
S. Ray ◽  
S. Cheng ◽  
...  
Keyword(s):  
Managed Care ◽  
Median Time ◽  
Primary Objective ◽  
Administrative Claims ◽  
Dose Increase ◽  
Maximum Daily Dose ◽  
Starting Dose ◽  
Daily Dose ◽  
One Year

16014 Background: Dose increase is often the first step when resistance is encountered in CML patients treated with IM. The primary objective of this study is to determine the proportion of CML patients who experienced a dose increase from their starting dose within one year after initiation of IM therapy. Methods: Patients ≥18 years of age diagnosed with CML (ICD-9-CM code = 205.1) between 2001 and 2003 and treated with IM were identified in the Pharmetrics Integrated Claims Database which covers a US managed care population. Eligible patients had at least two claims for IM and were continuously enrolled for at least six months following their first IM prescription. Follow-up was one year after their first IM prescription. Results: A total of 113 CML patients using IM were identified. Eighty-four percent of these patients started IM at 400 mg/day; eight percent started at doses ≥ 600 mg/day; remaining started at doses < 400 mg/day The mean daily dose of IM used by the study group was 419 mg (SD = 91). Nineteen percent of users required at least one dose increase from their starting dose within one year. The first dose increase was most frequently 200 mg/day (mean daily dose = 574 mg (SD = 199). The median maximum daily dose reached by patients experiencing dose increases was 600 mg/day (25th– 75th percentile: 500, 750 mg). The median ending dose in these patients was 600 mg/day (25th–75th percentile: 400, 600 mg). Median time to first dose increase was 5.8 (25th–75th percentile: 2.0, 7.4 months). Median time to maximum dose from initial IM dose was 6.5 (25th–75th percentile: 2.7, 7.4 months). Conclusions: Nearly 20% of all IM-treated CML patients required a dose increase of approximately 200 mg/day within one year. Of those dose increases, 50% occurred within the first 6 months. No significant financial relationships to disclose.

scholarly journals Prescribing Patterns of Psychotropic Drugs and Risk of Violent Behavior: A Prospective, Multicenter Study in Italy

2020 ◽  
Vol 23 (5) ◽  
pp. 300-310
Author(s):  
E di Giacomo ◽  
A Stefana ◽  
V Candini ◽  
G Bianconi ◽  
L Canal ◽  
...  
Keyword(s):  
Aggressive Behavior ◽  
Psychotropic Drugs ◽  
Rating Scale ◽  
Violent Behavior ◽  
Prescribing Patterns ◽  
Overt Aggression ◽  
History Of ◽  
Axis I ◽  
Overt Aggression Scale

Abstract Background This prospective cohort study aimed at evaluating patterns of polypharmacy and aggressive and violent behavior during a 1-year follow-up in patients with severe mental disorders. Methods A total of 340 patients (125 inpatients from residential facilities and 215 outpatients) were evaluated at baseline with the Structured Clinical Interview for DSM-IV Axis I and II, Brief Psychiatric Rating Scale, Specific Levels of Functioning scale, Brown-Goodwin Lifetime History of Aggression, Buss-Durkee Hostility Inventory, Barratt Impulsiveness Scale, and State-Trait Anger Expression Inventory-2. Aggressive behavior was rated every 15 days with the Modified Overt Aggression Scale and treatment compliance with the Medication Adherence Rating Scale. Results The whole sample was prescribed mainly antipsychotics with high levels of polypharmacy. Clozapine prescription and higher compliance were associated with lower levels of aggressive and violent behavior. Patients with a history of violence who took clozapine were prescribed the highest number of drugs. The patterns of cumulative Modified Overt Aggression Scale mean scores of patients taking clozapine (n = 46), other antipsychotics (n = 257), and no antipsychotics (n = 37) were significantly different (P = .001). Patients taking clozapine showed a time trend at 1-year follow-up (24 evaluations) indicating a significantly lower level of aggressive behavior. Patient higher compliance was also associated with lower Modified Overt Aggression Scale ratings during the 1-year follow-up. Conclusion Both inpatients and outpatients showed high levels of polypharmacy. Clozapine prescription was associated with lower Modified Overt Aggression Scale ratings compared with any other antipsychotics or other psychotropic drugs. Higher compliance was associated with lower levels of aggressive and violent behavior.

Prestim in the Management of Mild to Moderate Essential Hypertension in General Practice

1983 ◽  
Vol 11 (3) ◽  
pp. 186-189 ◽  
Author(s):  
K Peacock ◽  
B Hodge
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Maximum Dose ◽  
Fixed Dose ◽  
Dose Titration ◽  
Timolol Maleate ◽  
Daily Dose ◽  
Dose Combination ◽  
Lost To Follow Up

Fifty-three hypertensive patients from one practice, of whom forty-two were new patients, were treated with Prestim — a fixed dose combination of 10 mg timolol maleate and 2·5 mg bendrofluazide. After a 2-week placebo run-in period, dose titration took place at weekly intervals up to a maximum of 4 tablets daily. Stabilized patients were followed-up at 3 months and approximately 1 year. At the 3-month follow-up, forty-nine patients were evaluated. Forty-two patients (85%) were well controlled (diastolic blood pressure below 95 mm Hg) on Prestim at a mean daily dose of 1·4 tablets. Four patients stopped therapy due to side-effects and in three patients the blood pressure was uncontrolled on the maximum dose of 4 tablets daily. After 1 year, thirty-four patients (75%) were still well controlled on a mean dose of 1·3 tablets daily. A further two patients were lost to follow-up and six other patients stopped therapy during the last nine months of the study. There were no unexpected side-effects and the general biochemical profile remained unaltered.

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