Role Of Pharmacotherapy Research Articles

Drug therapy for delirium in terminally ill patients.

Delirium is a common disorder that often complicates treatment in patients with life-limiting disease. Delirium is described using a variety of terms such as agitation, acute confusional states, encephalopathy, organic mental disorders, and terminal restlessness. Delirium may arise from any number of causes, and treatment should be directed at addressing these causes. In cases where this is not possible, or does not prove successful, the use of drug therapy may become necessary. The primary objective of this review was to identify and evaluate studies examining medications used to treat patients suffering from delirium during the terminal phases of disease. We searched the following sources: MEDLINE (1966 to July 2003), EMBASE 1980 to July 2003), CINAHL (1982 to July 2003), PSYCH LIT (1974 to July 2003), PSYCHINFO (1990 to July 2003) and the Cochrane Library Volume 2, 2003) for literature pertaining to this topic. Prospective trials with or without randomization and/or blinding involving the use of pharmacological agents for the treatment of delirium at the end of life were considered. Two reviewers independently assessed trial quality using standardized methods and extracted data for evaluation. Outcomes related to both efficacy and adverse effects were collected. Thirteen potential studies were identified by the search strategy. Of these, only one study met the criteria for inclusion in this review. This study evaluated 30 hospitalized AIDS patients receiving one of three different agents: chlorpromazine, haloperidol, and lorazepam. Analysis of this trial found chlorpromazine and haloperidol to be equally effective. Chlorpromazine was noted to slightly worsen cognitive function over time but this result was not significant. The lorazepam arm of the study was stopped early as a consequence of excessive sedation. The data from one study of 30 patients would perhaps suggest that haloperidol is the most suitable drug therapy for the treatment of patients with delirium near the end of life. Chlorpromazine may be an acceptable alternative if a small risk of slight cognitive impairment is not a concern. However, there is insufficient evidence to draw any conclusions about the role of pharmacotherapy in terminally ill patients with delirium, and further research is essential.

Review of subjectThe role of pharmacotherapy in the management of behaviour disorders in traumatic brain injury patients

The aim of this paper was to systematically review the research published in English language on the effectiveness of drugs for the treatment of neurobehavioural disorders in patients with traumatic brain injury (TBI). A literature search using Medline, Pre-Medline, Embase, Psychlit and Cochrane Library databases between 1990 and January 2003 as well as a hand search of Brain Injury since 1996 were carried out. Phrases such as ‘head injury’, ‘brain injury’, ‘drug treatment’, ‘drug trials’ and ‘randomized controlled trials’ were used. Sixty-three papers were selected for data synthesis. Of these, 13 were randomized controlled trials, eight were prospective observational studies, four were retrospective studies, 25 were case series and 13 were single case studies. There was a dearth of type I-III evidence. There was no strong evidence either way to suggest that drugs are effective in the treatment of behaviour disorders in patients with TBI. However, there was weak evidence, primarily based on case studies that psychostimulants are effective in the treatment of apathy, inattention and slowness; high dose beta-blockers in the treatment of agitation and aggression; anti-convulsants and anti-depressants (particularly SSRIs) in the treatment of agitation and aggression, particularly in the context of an affective disorder; and possibly a specific neuroleptic methotrimeprazine in the treatment of agitation in the post-acute stage of Acquired Brain Injury. Some drugs that are effective in some patients have been shown to be ineffective in others. Some drugs, particularly lithium and dopaminergic drugs could cause adverse effects and deterioration in some patients.

Pharmacotherapy of Early Onset Eating Disorders

Free AccessPharmacotherapy of Early Onset Eating DisordersSandra FismanSandra FismanSearch for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/capn.8.6.1.23081PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutSuggested ReadingsRoerig , James L., Mitchell, James E., Cook Myers, Tricia, & Glass, John B. (2002). Pharmacotherapy and medical complications of eating disorders in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 11, 365–385. Crossref, Google ScholarAmerican Psychiatric Association Practice Guidelines Work Group on Eating Disorders: Practice Guidelines for the Treatment of Patients with Eating Disorders (Revision). American Journal of Psychiatry, 157, 1 January 2000, Supplement. Google ScholarKotler , Lisa A., Devlin, Michael J., & Walsh, B. Timothy (2002). Eating disorders and related disturbances. Practical Child & Adolescent Psychopharmacology. Ed. S. Kutcher, Cambridge University Press. Google ScholarMayer , L. E. & Walsh, B. T. (1998). The Use of Selective Serotonin Reuptake Inhibitors in Eating Disorders. Journal of Clinical Psychiatry, 59 (suppl 15), 28–34. Google ScholarBacaltchuk , J., Hay, P., & Trefiglio R. (2002). Antidepressants versus placebo for people with bulimia nervosa. Antidepressants versus psychological treatments and their combination for bulimia nervosa. Evidence Based Mental Health, 5(3), 74–75. Crossref, Google ScholarPeterson , Carol B., & Mitchell, James E. (1999). Psychosocial and Pharmacological Treatment of Eating Disorders: A Review of Research Findings. Psychotherapy in Practice, 55(6), 685–697. Google ScholarJarry , Josée L., & Vaccarino, Franco J. (1996). Eating Disorder and Obsessive-Compulsive Disorder: Neurochemical and Phenomenological Commonalities. Journal of Psychiatry and Neuroscience, 21(1). Google Scholar Next article FiguresReferencesRelatedDetails Volume 8Issue 6Sep 2003 Information© The Guilford PressPDF download

The role of pharmacotherapy in assisting smoking cessation.

Tobacco use represents the single most important preventable health hazard world-wide. Its consumption confers substantially increased mortality and morbidity due to cardiovascular, cerebrovascular and respiratory disease, and malignancy in a number of sites. A key goal towards improving public health in developing and developed countries alike is to reduce tobacco use across populations. Despite this, current data suggest that global tobacco use is increasing. There have been recent pharmacological advances that offer the hope of achieving more effective tobacco cessation and reduced consumption among established tobacco users. These are discussed in further detail, with reference to evidence supporting their use in clinical practice.

Clinical review 154: The role of pharmacotherapy in perioperative management of patients with acromegaly.

The major complications of acromegaly, including cardioand cerebrovascular disease and respiratory and metabolic dysfunction, are associated with a significant increase in morbidity and mortality (1–3). These complications are well known to be major risk factors in perioperative patients, especially the elderly (4–8). Therefore, controlling cardioand cerebrovascular disease, pulmonary dysfunction, and hyperglycemia is important in patients undergoing anesthesia and surgery. This review evaluates the rationale for administering somatostatin analog treatment before either transsphenoidal resection of a GH-secreting pituitary adenoma or any other surgical procedure requiring general anesthesia in the patient with uncontrolled acromegaly.

Pharmacotherapy of childhood anxiety disorders.

Anxiety disorders are among the most common psychiatric disorders of childhood, yet limited data is available regarding the use of psychotropic medications for these conditions. Until recently, much of the data on the pharmacologic treatment of pediatric anxiety disorders has consisted of case reports and small open-label studies, with the exception of pediatric obsessive-compulsive disorder (OCD), which has had a comparatively rich literature consisting of several double blind trials. This void has been lessening, however, with four double blind, placebo-controlled studies published in the past year alone. Although the majority of pharmacologic studies of pediatric anxiety continue to focus on the treatment of OCD, additional reports on treatment of generalized anxiety disorder, panic disorder, social anxiety disorder, and separation anxiety disorder have recently been published. This article will review significant pharmacologic studies published in the prior year, and the role of pharmacotherapy in the treatment of pediatric anxiety disorders.

Invited Review: The Medical Management of Obesity and the Role of Pharmacotherapy: An Update

The prevalence of obesity in the United States has been increasing since the 1980s and has become a public health concern. The etiology of obesity is complex and includes a host of genetic influences in addition to overconsumption of energy and a sedentary lifestyle. Obesity is strongly associated with several chronic diseases, such as cardiovascular disease and diabetes, and thus accounts for significant morbidity and mortality. The previous failures of short‐term therapy for obesity have led experts to recognize that obesity is a chronic disease that should be treated with long‐term programs to ensure the best chance for maintenance of weight loss. In addition, clinical studies have demonstrated that a modest weight loss of 5% to 10% can produce significant decreases in comorbidities. This articles summarizes the current medical approach to the treatment of obesity and includes strategies for diet modification, exercise therapy, and lifestyle change. The rationale and appropriateness of pharmacotherapy are discussed, followed by case histories that highlight the management of obesity and its comorbidities by using diet, exercise, and pharmacotherapeutic modalities.

Implications of Recent Findings in Posttraumatic Stress Disorder and the Role of Pharmacotherapy

Recent evidence suggests that an etiologic model of posttraumatic stress disorder (PTSD) must include both vulnerability factors (presumably related to dysregulation of stress responses and/or failure of normal restitutive mechanisms following trauma) and factors related to trauma severity. The fact that rates of PTSD increase with the severity of trauma suggests that normal adaptive mechanisms may become overwhelmed even in the absence of vulnerability factors. Consistent with this view, efforts to demarcate normative from disordered reactions to severe trauma, such as the new diagnosis of acute stress disorder, have had limited success. Debate over the moral and scientific implications of receiving a trauma-related diagnosis has further complicated the issue and perpetuated a false dichotomy concerning normative responses. The literature on clinical trials in PTSD is reviewed. The range of treatment responses, and the categorical breadth of compounds studied, requires interpretation before the literature as a whole can be understood. One of the many limitations of this new literature is the absence of treatment-outcomes research on individuals with the common comorbidity of substance abuse. The most recent findings with selective serotonin-reuptake inhibitors and related compounds indicate a more optimistic outlook for pharmacological treatment of PTSD than was suggested by earlier trials. Given these observations, investigators will hopefully be encouraged to pursue study and development of treatment models that include both pharmacological and psychosocial interventions.

Implications of recent findings in posttraumatic stress disorder and the role of pharmacotherapy

Recent evidence suggests that an etiologic model of posttraumatic stress disorder (PTSD) must include both vulnerability factors (presumably related to dysregulation of stress responses and/or failure of normal restitutive mechanisms following trauma) and factors related to trauma severity. The fact that rates of PTSD increase with the severity of trauma suggests that normal adaptive mechanisms may become overwhelmed even in the absence of vulnerability factors. Consistent with this view, efforts to demarcate normative from disordered reactions to severe trauma, such as the new diagnosis of acute stress disorder, have had limited success. Debate over the moral and scientific implications of receiving a trauma-related diagnosis has further complicated the issue and perpetuated a false dichotomy concerning normative responses. The literature on clinical trials in PTSD is reviewed. The range of treatment responses, and the categorical breadth of compounds studied, requires interpretation before the literature as a whole can be understood. One of the many limitations of this new literature is the absence of treatment-outcomes research on individuals with the common comorbidity of substance abuse. The most recent findings with selective serotonin-reuptake inhibitors and related compounds indicate a more optimistic outlook for pharmacological treatment of PTSD than was suggested by earlier trials. Given these observations, investigators will hopefully be encouraged to pursue study and development of treatment models that include both pharmacological and psychosocial interventions.

Current Concepts in Smoking Cessation and Preventive Strategies

The purposes of this chapter are to present current concepts that are central for clinicians to provide effective smoking cessation treatment. Emphasis will be placed on clinician-delivered cessation management, and will include a discussion of how to deliver treatment. The role of pharmacotherapy during treatment for smoking cessation will be presented and the advantages and disadvantages of a variety of nicotine replacement products will be discussed. Individualized treatment, via combination products will be addressed. Attributes of effective cessation programs will also be provided. Finally, preventive strategies for implementation with adolescent populations will be presented, both for clinicial practice and from a public policy perspective.

Prescription data as a tool in pharmacotherapy audit (II). The development of an instrument.

In many countries, prescription data are used as an instrument to provide feedback on prescribing. This article describes the development and implementation of a computer program as a tool for pharmacotherapy audit meetings and it illustrates the possibilities of such a program. The program was developed to support the optimisation of prescribing in the various stages of behavioural change. It enables pharmacists to make sophisticated overviews of prescribing by physicians in their audit group and furthermore, pharmacists can conduct drug utilisation studies or pharmaco-epidemiological studies in their own patient population. Forty percent of Dutch pharmacies have purchased the computer program since its introduction; it was distributed together with a technical handbook and a course book, which elaborated on the types of graphs available and their interpretation. An educational course was developed regarding the optimal selection and interpretation of graphs. Examples of prescription data as a tool to support various aims of audit meetings are given. The program is acknowledged as a welcome contribution to pharmacotherapy audit and to the pharmacists' advisory role in pharmacotherapy.

Atorvastatin: a hydroxymethylglutaryl-coenzyme A reductase inhibitor.

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, interactions, and formulary considerations of atorvastatin relative to other hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are discussed. Atorvastatin calcium, a synthetic stereoisomer of a pentasubstituted pyrrole, prevents the conversion of HMG-CoA by competitive and selective inhibition of HMG-CoA reductase. This limits cholesterol formation. Atorvastatin undergoes extensive first-pass metabolism; the first-pass effect is saturable at higher doses. Time to maximum plasma concentration ranges from one to four hours. The plasma elimination half-life is considerably longer than for other statins. Like other statins, atorvastatin reduces low-density-lipoprotein cholesterol (LDL-C) and total cholesterol in patients with hypercholesterolemia. However, the reductions achieved with atorvastatin exceed those for other statins. Atorvastatin recipients are more likely to achieve LDL-C goals and to do so more quickly. Atorvastatin also moderately reduces triglyceride levels in patients with hypertriglyceridemia and may play a role in the management of familial hypercholesterolemia. Adequate lipid control with atorvastatin monotherapy may preclude the need for combination drug therapy in some patients. The adverse effects of atorvastatin include mild gastrointestinal disturbances, increased liver enzyme levels, and myalgia. Drug interactions involving atorvastatin can be expected to parallel those of other statins metabolized via CYP3A4. Atorvastatin has become a popular addition to hospital formularies, even though formal pharmacoeconomic analyses are lacking. Atorvastatin effectively reduces blood lipids and may offer some advantages over other statins, but more studies are needed to clarify its optimal role in pharmacotherapy.

Case study: Amantadine: a potential treatment for the minimally conscious state

Pharmacologic strategies have been advocated to enhance the neurorehabilitation of persons with severe traumatic brain injury. Dopaminergic pathways have been felt to play a significant role in arousal. Employing single case design methodology we present the case of a survivor of severe traumatic brain injury who appeared to have a dose dependent response to the pro dopaminergic medication amantadine. Further research is necessary to clarify the role of pharmacotherapy in the improvement of functional outcome.

Addictive Disorders: An Integrated Approach: Part Two-An Integrated Treatment

ABSTRACT In Part One of this two-part paper, a framework for understanding addictive disorders was presented that centered on the underlying addictive process: compulsive dependence on external actions as a means of regulating one's internal states. In Part Two, an integrated system for treatment of addictive disorders is outlined. This treatment system was designed to address both addictive behavior and the addictive process. Addictive behavior is addressed through behavioral symptom management, which includes relapse prevention and other cognitive-behavioral techniques. The addictive process is addressed through treatments that promote self-regulation and development of meaningful interpersonal connections. These include psychoanalytic (exploratory-expressive) psychotherapy and therapeutic group experience. The role of pharmacotherapy (medication treatment) also is discussed. The proposed treatment system brings together these therapeutic methods in one theoretically coherent, clinically unified approac...

Conference Summary: Consensus Conference on Alcohol Dependence and the Role of Pharmacotherapy in its Treatment

Alcoholism, a major public health problem throughout the world, causes enormous damage to health and quality of life and undermines the well-being of families and society. It is associated with liver disease, cancer, cardiovascular problems, accidental deaths, suicides, and homicides. Because of the internationally recognized severity of this disease, this consensus conference was convened to bring together leading international experts to share ideas with regard to current research in the areas of alcohol dependency and treatment, and to discuss the future directions for the pharmacotherapy of alcoholism. The work presented at this conference points to a substantial evolution in the ability of researchers to understand the mechanism by which alcohol acts on the brain and reinforces the concept that alcoholism is a disease of brain chemistry, with a hereditary predisposition that is triggered by psychological and/or environmental factors that are thus far unidentified. The consensus statements proposed by the participants at the close of the conference highlight the definition, etiology, and prevention of alcoholism, as well as current and potential treatments and recommendations that can be used to guide future pharmacologic research.

Separation of Hydrophobic, Positively Chargeable Substances by Capillary Electrophoresis

The electrokinetic separation behavior of positively chargeable substances with various hydrophobicities over the pH range 2-11 is described, using plain aqueous buffers, binary media with organic solvents, and systems with surfactants at concentrations between 0.0005 and 75 mM or other buffer additives. Examples studied include dextromethorphan, methadone, ketoconazole, itraconazole, amiodarone, and desethylamiodarone, compounds that play an important role in pharmacotherapy. Electrokinetic chromatography systems comprising dynamically formed micelles or ionic buffer additives that can form ion pairs with the solutes are shown to be unsuitable for the separation of highly hydrophobic, positively chargeable compounds, including the latter three drugs investigated. However, capillary zone electrophoresis (CZE) in binary systems with organic solvents (40-80%, v/v) at a buffer pH near or lower the solute's pK a values or CZE at low pH in the presence of an electrically neutral complexing agent, such as β-cyclodextrin, can be employed effectively. Data presented illustrate that pK a values in binary systems with organic solvents that are more basic than water are smaller than those in aqueous media. Furthermore, somewhat less hydrophobic and positively chargeable compounds can be sufficiently dissolved in aqueous buffer at pH < pK a and can therefore be analyzed by CZE without any buffer additives.

Prevention of depression: psychological and social measures

The role of pharmacotherapy in the management of depressive disorders is well-established and frequently reviewed. This paper focuses on the prospects for reducing the incidence, prevalence and morbidity of depression through psychosocial interventions. A central requirement in prevention is a knowledge of the epidemiology of the disorder being investigated. This data can be used to identify high-risk groups. By comparing the number of known cases with population levels of morbidity, it allows comment on help-seeking behaviour and accessibility of services. Also, differences in incidence and prevalence rates give some indication of the chronicity of the disorder.

Autism and Associated Behavioral Disorders: Pharmacotherapeutic Intervention

To review the literature on autism and pervasive developmental disorders (PDDs) as well as their respective pharmacotherapies. An Index Medicus, MEDLINE, and bibliographic search of the literature pertaining to autism, PDDs, and respective treatments. Because of the paucity of literature on the treatment of autism and PDDs, the selection of reported data for this review included both controlled and uncontrolled studies, as well as case reports and any other information reported in the literature on the treatment of these disorders. Autism and PDDs are severe developmental disabilities defined by behavioral criteria. These disorders are lifelong in nature and present in varying severity of clinical manifestations. Behavioral manifestations of patients with autism include core deficits in social interaction, communication, and imaginative activities, with a restricted repertoire of activities and interests. The present understanding of the neurochemical basis of the disorder is limited. The role of pharmacotherapy in the management of autism and PDDs is to ameliorate behavioral symptoms that interfere with the patient's ability to participate in educational, social, work, and family systems. Agents that have shown positive clinical effects in the treatment of children with autism and PDDs are reviewed in this article. Autism is a complex developmental disorder representing a heterogeneous group of individuals with similar symptomatologies and multiple biologic etiologies. Present pharmacotherapeutic intervention seeks to resolve behavioral symptoms. Treatment of autism and PDDs requires appropriate delineation of the behaviors and neurobiologic disorders associated with each patient. No single therapeutic agent, or combination thereof, is appropriate for the treatment of all children and adults with autism or PDDs.

Pediatric inflammatory bowel disease

This manuscript highlights recent advances relevant to pediatric patients with inflammatory bowel disease. Four areas are presented: growth failure, diagnosis and pathobiology, therapy, and clinical associations. Articles most likely to affect investigators and clinicians working on issues of importance to children and adolescents with Crohn's disease and ulcerative colitis were selected. Growth failure is a common and frequently serious problem in the pediatric population affected by inflammatory bowel disease. In 1993, both prospective and retrospective studies evaluated the effects of various treatment regimens. The role of pharmacotherapy and hormones in modifying alterations of growth were determined. Cytokines were studied as possible diagnostic tools in the clinical evaluation of disease and their role in the pathogenesis of mucosal inflammation became somewhat better defined, but much more complicated. The relationship between immunology, genetics, and clinical disease became clearer with the introduction of antineutrophil cytoplasmic antibodies in differentiating between Crohn's disease and ulcerative colitis. Therapy with immunosuppressive agents and reassessment of the role of surgical management of inflammatory bowel disease in children were the major therapeutic advances, although new agents appropriate for children are on the horizon. An interesting series of case reports highlighted aspects of the disease that are unique to the pediatric population.

Current Perspectives on Drug Therapies for Anorexia Nervosa and Bulimia Nervosa

Anorexia nervosa and bulimia nervosa are eating disorders that strike a significant number of adolescent and young adult women and carry a significant morbidity and mortality. Over the last 30 years, virtually every class of psychiatric drug as well as atypical agents have been tested in the management of these vexing and often chronic disorders. For anorexia nervosa, there is in 1991 little if any role for pharmacotherapy. Drugs used to promote food intake and weight gain, such as cyproheptadine, amitriptyline, clonidine and opiate antagonists, have provided disappointing results. For bulimia nervosa, double-blind placebo-controlled clinical trials have confirmed an antibulimic effect for tricyclic antidepressants, such as imipramine and desipramine. Monoamine oxidase inhibitors, while having a significant antibulimic effect, require careful adherence to a dietary regimen which may limit patient compliance. Newer antidepressants such as trazodone, amfebutamone and fluoxetine may prove useful if further study substantiates preliminary beneficial results. Other agents such as anticonvulsants, benzodiazepines, lithium, fenfluramine and opiate antagonists also require additional study, indicating that the optimal integration of pharmacotherapies with other treatments awaits further research.