Treatment Of Acute Episodes Research Articles

Verapamil treatment for women with bipolar disorder

Background: Additional pharmacological treatments are needed for patients with bipolar disorder. We describe our experience with verapamil in an inclusive, sequential series of outpatient women (some pregnant) with bipolar disorder. Methods: All women who were prescribed verapamil for bipolar disorder ( n = 37) were included. We used the criterion of 50% reduction in scores on the Mania Rating Scale or the Hamilton Rating Scale for Depression to define response for women who were treated for an acute episode of bipolar hypomania/mania or depression, respectively. For euthymic women who chose verapamil maintenance treatment, we evaluated whether they met criteria for a recurrent episode during therapy. Results: Treatment for acute episodes was initiated in 28 women. Of women with depression and mania, 39% and 100% responded, respectively. Seven of the nine patients (77%) with mixed states responded: all seven improved to response criterion on the mania scale, and two responded on the depression scales as well. Six of eight patients who received continuation therapy remained well. Conclusions: These data provide evidence that verapamil is effective for mania. The response rate for mania compares favorably to that for other mood stabilizers. After decades of case reports and underpowered clinical trials, we must definitively study verapamil for efficacy and gender specificity in bipolar disorder.

Delayed pharmacological effects of antidepressants.

Although antidepressants may not be primary mood stabilizers, they are efficacious in the prophylaxis of recurrent depressive illnesses, as well as in the treatment of acute episodes. Pharmacological effects that may contribute to the prophylactic effects of these drugs are not understood. Studies have been carried out in which antidepressants have been given to laboratory animals, such as rats, for periods of up to 3-4 weeks. Data obtained in such studies are thought to be important for their beneficial effects in depressive episodes, but also may be relevant to their prophylactic effects. Results are presented showing that when selective inhibitors of serotonin or norepinephrine uptake are given for such time periods, they still produce selective effects on serotonergic or noradrenergic parameters. For example, long-term administration of selective norepinephrine reuptake inhibitors causes a down-regulation of beta(1) adrenoceptors. Selective serotonin reuptake inhibitors do not produce this effect. Long-term administration of selective serotonin reuptake inhibitors causes down-regulation of the serotonin transporter, but not the norepinephrine transporter. In contrast, selective norepinephrine reuptake inhibitors down-regulate the norepinephrine transporter but not the serotonin transporter. Substantial loss of serotonin transporter binding sites takes 15 days to occur and is accompanied by a marked reduction of serotonin transporter function in vivo.

Calcium pyrophosphate crystal deposition disease and other crystal deposition diseases

"Tumoral" calcium pyrophosphate dihydrate (CPPD) crystal deposition in the ligamentum flavum is rare and can lead to compression myeloradiculopathy in the cervical spine and to spinal canal stenosis in the lumbar spine. CPPD crystal deposition disease is rarely associated with Bartter's syndrome and hypomagnesemia. Intramuscular corticotropin has proved effective in the treatment of acute episodes of pyrophosphate arthritis in patients with multiple medical illnesses in whom nonsteroidal anti-inflammatory drugs are contraindicated. IgG binding to CPPD crystals enhances neutrophil activation (by increasing intracellular cytoplasmic calcium levels) and seems to play a greater role in pyrophosphate than in urate crystal-induced inflammation. Transforming growth factor-beta 1 stimulates intracellular pyrophosphate generation by articular chondrocytes. The effect is inhibited by probenecid, an anion transport blocker, through interfering with the active transport of intracellular pyrophosphate to cartilage matrix where crystals form. Calcific tendinitis associated with underlying cortical bone erosions is an uncommon manifestation of apatite crystal deposition disease. Closed-needle tidal irrigation proved beneficial in two patients with Milwaukee shoulder syndrome. Two patients with nodular subcutaneous cholesterol crystal deposition are described.

Nitrate therapy and the development of tolerance

The efficacy of organic nitrates in the treatment of acute episodes of angina pectoris is unquestioned. However, long-term use of these agents is associated with the development of tolerance or of reduced efficacy over time when given in doses or formulations that maintain therapeutic blood levels for 24-hour periods. Thus, the role of long-term use of nitrates in prophylactic treatment of stable angina has been questioned. The purpose of this brief review is to evaluate nitrate tolerance, a key issue in the prophylactic use of nitrates, as well as to review what is known about clinical rebound. These issues are discussed, and ways of preventing tolerance development are explored. Intermittent therapy involving a dose-free interval during each 24-hour period helps prevent tolerance.

Genital herpes: natural history and treatment of acute episodes.

Genital herpes is a common, distressing infection whose incidence has been underestimated. Recent serological surveys, employing type-specific antibody assays, show a rising prevalence of previous herpes simplex virus (HSV) type 2 infections in post-adolescent populations in developed countries; many of these infections have been asymptomatic. In some geographical locations, HSV-1 infections are a common cause of first episodes. They may occur in stable, monogamous relationships and are less likely to recur than genital infections caused by HSV-2. The clinical features of first episode genital herpes show marked individual variation in severity; they tend to be more severe in women than in men. Local and distant complications are common in immunocompetent individuals and may be life-threatening in those who are immunocompromised. The psychological and social consequences which result from the life-long infection and its risks of transmission to new sexual partners often prove more disabling to affected individuals than do the milder physical symptoms associated with recurrent episodes. Counselling, support, and patient education are essential components of management. Acyclovir is clearly established as the first choice therapy in both first and recurrent episodes of genital herpes. This drug has potent antiviral effect and provides significant clinical benefit in first episodes. Systemic therapy for initial episodes does not prevent either the establishment of latency or the development of future recurrences even when used in high or prolonged dosage. Episodic treatment of recurrences, with either oral or topical acyclovir, requires early patient initiation of therapy to provide significant clinical benefit.

Medical treatment of acute episodes of rheumatic fever

Eight patients, four males and four females, age five to 13 years old (average: 11 years) have undergone surgery in the acute phase of rheumaticfever. The patients presented a history of rheumatic activity characterized by the presence of migratory arthritis and carditis. All patients had severe acute mitral insufficiency, while one of them had associated aortic insufficiency. Laboratory examinations revealed the presence of an acute inflammatory condition. All patients had acute heart failure and were treated initially with high doses of diuretics, peripheral vasopressor and vasodilator amines, together with cardiotonic drugs, without improvement. Surgical treatment was indicated after a period of observation between 24 hours and five days. In five patients, the Doppler echocardiogram revealed rupture and elongation of tendinous cords. Two of them had acute dilatation of the mitral ring, and one had isolated acute dilatation of the mitral ring. Five patients underwent valvar replacement and, in three, valvar repair was carried out. Two patients, who were in cardiogenic shock at the time of their referral, died in the operating room following replacement of the mitral valve. All patients who underwent repair of the mitral valve were in good condition at the last follow-up, six to 27 months after surgery.

Surgical treatment of acute episodes of rheumatic fever

AbstractEight patients, four males and four females, age five to 13 years old (average: 11 years) have undergone surgery in the acute phase of rheumaticfever. The patients presented a history of rheumatic activity characterized by the presence of migratory arthritis and carditis. All patients had severe acute mitral insufficiency, while one of them had associated aortic insufficiency. Laboratory examinations revealed the presence of an acute inflammatory condition. All patients had acute heart failure and were treated initially with high doses of diuretics, peripheral vasopressor and vasodilator amines, together with cardiotonic drugs, without improvement. Surgical treatment was indicated after a period of observation between 24 hours and five days. In five patients, the Doppler echocardiogram revealed rupture and elongation of tendinous cords. Two of them had acute dilatation of the mitral ring, and one had isolated acute dilatation of the mitral ring. Five patients underwent valvar replacement and, in three, valvar repair was carried out. Two patients, who were in cardiogenic shock at the time of their referral, died in the operating room following replacement of the mitral valve. All patients who underwent repair of the mitral valve were in good condition at the last follow-up, six to 27 months after surgery.

Bilateral deep vein thrombosis in a pregnant woman with antithrombin III deficiency: Treatment of acute episodes and preparation for delivery with replacement treatment

Bilateral deep vein thrombosis in a pregnant woman with antithrombin III deficiency: Treatment of acute episodes and preparation for delivery with replacement treatment

Toward an Integrated Approach to the Treatment of Schizophrenia

Long-term outcome studies have shown that schizophrenia is an illness whose course is usually characterized by exacerbations and remissions. This chapter summarizes pertinent literature regarding treatment of acute episodes; early intervention to prevent the development of full relapse; and pharmacological, behavioral, and psychotherapeutic strategies designed to decrease the amount of stress and patients' vulnerability to stress and thus decrease the likelihood of relapse. An emphasis is placed on a comprehensive treatment approach involving continuity of care.

789 CONTRASTS IN CAKE OF CHILDHOOD ASTHMA. BY PHYSICIANS AND MOTHERS

Differences between parents and physicians in how asthma should be managed may impact on the treatment of acute episodes. Hence, we studied differences between pediatricians' perceptions and parents' reports of hctre management of childhood asthma. 46 pediatricians from two urban teaching hospitals were asked to estimate the proportion of parents who employed specific management techniques. Appropriateness of management was tested in a random sample of families seeking care for a child with acute asthma (n=148) in an urban emergency room. Pediatricians tended to overestimate the specific medical knowledge possessed by families: pediatricians estimated that 30% of parents could count respiratory rate, whereas only 11% of families possessed this knowledge (p<.001); pediatricians estimated that 48% of patients attended an allergy clinic but only 19% actually did (p<.05). However, families used “common sense” techniques such as rest and giving liquids 30% more often than pediatricians' estimates (p<.001). A larger proportion of families (80%) stated that they understood instructions for home care than was estimated by pediatricians (62%) (p<.001), and smaller proportion of families (11%) used non-prescription drugs than physicians estimated (45%) (p<.05). We conclude that substantial incongruity exists between families' use of asthma hone care techniques and physician perceptions of management by families.

Maple syrup urine disease: treatment of the acutely ill newborn.

Three patients with maple syrup urine disease were treated during the acute neonatal stage. Multiple exchange transfusions proved to be a satisfactory means of achieving rapid clinical and biochemical improvement during this phase. On the other hand, evidence is provided suggesting that in addition to exchange transfusions, a high calorie intake above 150 Cal/kg body weight/day is necessary to lower the plasma concentration of the branched chain amino acids to near-normal levels. As long as this calorie intake was not provided, further exchange transfusions failed to lower the plasma leucine concentration to below 17 mg/100 ml in one patient. It is assumed that this high calorie intake is necessary to prevent the breakdown of endogenous protein. Treatment of acute episodes in maple syrup urine disease should therefore not only eliminate the elevated alpha-keto acids and branched chain amino acids quickly (i.e. by multiple exchange transfusions or peritoneal dialysis), but in addition should provide a high calorie intake.