SOME PHARMACOLOGICAL PROPERTIES OF THIOPROPERAZINE AND THEIR MODIFICATION BY ANTI-PARKINSONIAN DRUGS

The pharmacological properties of a phenothiazine derivative thioproperazine have been compared with those of chlorpromazine, and the modifications by some anti-Parkinsonian drugs of its actions on the central nervous system have been studied. Thioproperazine was less potent than chlorpromazine in lowering blood pressure and antagonizing adrenaline in the cat, in depressing respiratory rate in the rabbit, in producing hypothermia and analgesia and in reducing the minimum anaesthetic dose of hexobarbitone in mice, and in protecting rats from convulsions induced by tryptamine. It was roughly equipotent to chlorpromazine in reducing locomotor activity of mice. Thioproperazine was more potent than chlorpromazine in protecting grouped mice from the acute toxicity of dexamphetamine, in preventing the acute behavioural disturbances produced by dexamphetamine in the rat, in producing a state of experimental catatonia in the rat and in preventing the emetic action of apomorphine in the dog. Hyoscine, benztropine or promethazine greatly reduced the ability of thioproperazine to prevent behavioural changes due to dexamphetamine in the rat and also abolished symptoms of experimental catatonia produced by thioproperazine. In contrast, the antiapomorphine activity of thioproperazine in the dog was not reduced to any extent by hyoscine or benztropine.

A COMPARISON OF IMIPRAMINE, CHLORPROMAZINE AND RELATED DRUGS IN VARIOUS TESTS INVOLVING AUTONOMIC FUNCTIONS AND ANTAGONISM OF RESERPINE

Seven structurally-related compounds consisting of three antidepressant drugs (imipramine, desmethylimipramine and amitriptyline), three tranquillizing agents (promazine, chlorpromazine and chlorprothixene) and a hybrid, desmethylpromazine, have been examined in a series of tests involving autonomic functions and antagonism of reserpine. Activities of the compounds in antagonizing reserpine-induced ptosis in rabbits and prolongation of alcohol hypnosis in mice give good correlation with their clinical actions, whilst their activities in augmenting excitation of rats by amphetamine and yohimbine toxicity in mice, and in reversing reserpine-induced bradycardia in rats offer further evidence for drug-induced sensitization to adrenergic or tryptaminic mechanisms, which is not however specific for antidepressant agents. No evidence has been obtained to indicate that a central parasympatholytic action is an important component of the antidepressant activity of imipramine and related drugs.

THE PRESERVATION OF BRADYKININ BY PHENOTHIAZINES IN VITRO

Chlorpromazine and phenoxybenzamine have been shown to potentiate the actions of bradykinin in vivo. To test whether this phenomenon could be due to inhibition of the enzymatic destruction of bradykinin, bradykinin was incubated with either tissue extracts or with carboxypeptidase B. Bradykinin was rapidly destroyed by acetonedried powders of brain and serum of various animals as well as by purified carboxypeptidase B. The rate of disappearance of bradykinin activity was decreased in the presence of phenothiazine derivatives, phenoxybenzamine and hydroxyzine, but not by compounds of a larger group including other psychotropic drugs, tranquillizers and ganglionic and adrenergic blocking agents. Spectrophotometric studies of the hydrolysis of hippuryl-L-arginine confirmed the presence of a carboxypeptidase B-like activity in brain. The substances that acted as inhibitors of bradykinin destruction were also enzyme inhibitors as measured by this technique. Previous incubation of carboxypeptidase B with phenothiazines and zinc ions greatly reduced the enzymatic inhibition by the phenothiazines, which indicated a possible chelating action by these inhibitors on the metalo-enzyme carboxypeptidase B.

ANTI-EMETIC ACTIVITY OF PHENOTHIAZINES IN RELATION TO THEIR CHEMICAL STRUCTURE

Twelve phenothiazine derivatives have been studied for anti-emetic potency in dogs against emesis induced by apomorphine. The PD(50)s of all the compounds were determined and the activities compared with chlorpromazine hydrochloride as standard. Thioproperazine methanesulphonate was 300 times more active than chlorpromazine hydrochloride and twice as active as perphenazine sodium citrate. The anti-emetic activity of the compounds has been correlated with their chemical structure.

THE INCREASE IN THE TOXICITY OF YOHIMBINE INDUCED BY IMIPRAMINE AND OTHER DRUGS IN MICE

In mice, yohimbine appears to accentuate the normal "alarm" reactions (alerting, flight) to external stimuli. Imipramine increases this effect and at the same time converts a non-lethal dose of yohimbine into a lethal one. The effect of imipramine is greatly reduced by adrenalectomy or by treatment with reserpine, syrosingopine, ganglion-blocking drugs or adrenaline antagonists acting on sympathetic beta-receptors. Hypnotic, anti-convulsant or anaesthetic agents, tetrabenazine or antagonists of 5-hydroxytryptamine do not reduce the imipramine effect. A variety of drugs which, like imipramine, are known to interfere with the tissue binding of noradrenaline also increase the toxicity of yohimbine. Yohimbine significantly reduces brain noradrenaline content; adrenal catechol amines are slightly reduced. The results suggest that yohimbine releases noradrenaline from stores or nerves as a consequence of increased central sympathetic activity. Imipramine increases the actions and toxicity of yohimbine by increasing the effects of the released noradrenaline on beta-receptors. The lethal effects of a high dose of yohimbine alone are not reduced by any of the treatments tested, and appear not to result from activation of sympathetic mechanisms.

Sales of tranquillizers, hypnotics/sedatives and antidepressants and their relationship with underprivileged area score and mortality and suicide rates

OBJECTIVE

This study analyses the correlation between the Swedish underprivileged area score and sales of tranquillizers, hypnotics/sedatives, neuroleptics and antidepressants, and the correlation between these sales and mortality and suicide rates, with the aim of using sales data to identify areas with poor socioeconomic conditions.

SETTING

Southern Sweden, 33 municipalities in Skåne, 1987 and 1994.

DESIGN

Ecological study. Determined and undetermined cases of suicide were taken from the local death register for the years 1987-1993. Suicide rates (determined and undetermined cases) were calculated as the ratio between observed and expected number of suicides. Mortality for people aged 20-64 years was calculated from life tables for the decade 1981-1990. The underprivileged area score was calculated for municipalities using the proportion of persons in the following groups: elderly living alone, under 5 years of age, one-parent families, unskilled, unemployed, living in crowded households, those moving house in the previous year, and ethnic groups. After transformation (square root of arc sine) and standardization, each of the eight variables was weighted by the British general practitioners average weighting and added to give the underprivileged area score. The selection of the eight variables was based on general practitioners' perceptions of the effect of the social characteristics of the populations in their respective residential areas on their workload or pressure on services. The total drug sales figures for tranquillizers, hypnotics/sedatives, neuroleptics and antidepressants are expressed in Defined Daily Doses per 1000 inhabitants per day. The relationship between these variables was analysed using Pearson's correlation coefficient.

RESULTS

There was a moderate correlation (0.41-0.68) between the sales expressed as in Defined Daily Doses per 1000 inhabitants per day of tranquillizers and hypnotics/sedatives and underprivileged area score. Furthermore, the sales of tranquillizers and hypnotics/sedatives seemed to be moderately correlated with both mortality (0.44-0.67) and suicide (0.47-0.58).

CONCLUSION

Sales of tranquillizers or hypnotics/sedatives could be used with caution as markers for socioeconomic conditions on the basis of their moderate ecological correlation with a composite socioeconomic index such as the Swedish underprivileged area score and their moderate correlation with mortality and suicide.

Alcohol use, drug use, and well-being in older adults in Toronto

This paper reports a study of alcohol- and drug-use by older clients in relation to their health and well-being. The sample of 349 persons was drawn from adults aged 60 and over living in senior citizens apartments in Toronto. Interviews were done in several languages. The results indicated that males and those aged 60 to 65 were less happy and healthy, had fewer social supports, and more alcohol-related problems. Drug-related problems were less numerous but occurred equally for both sexes. These results indicate that new alcohol programs are needed for the elderly, and these should focus on males, especially the younger elderly in transition from work to retirement.

Dimensional characteristics of the SCL-90-R: evaluation of gender differences in dually diagnosed inpatients

The dimensional characteristics of the SCL-90-R were assessed for both male and female dually diagnosed inpatients. Subjects included 402 males and 227 females who presented with concurrent psychiatric and substance use disorders at a private psychiatric hospital. Confirmatory factor analyses resulted in the rejection of four previous measurement models for both genders including the original nine symptom dimensions. Subsequent principal component analyses resulted in four- and seven-component solutions for males and females, respectively; the majority of item covariation was accounted for by the first component. These results are consistent with previous research that has suggested a primary global distress factor and are in contrast to studies that have demonstrated factorial invariance across gender.

Placebo effect on the circadian rhythm period tau of temperature and hand-grip strength rhythms: interindividual and gender-related difference

Two different medications, one assumed to be a tranquilizer and the other an antifatigue agent, were tested. Both were found to be ineffective and thus were viewed as placebos and named P1 and P2. The effect of P1 and P2 on the circadian rhythms of a set of variables (e.g., sleep/wake, oral temperature and grip strength of both hands) were monitored by five to 10 measurements per day over three consecutive 8- to 10-day spans. The first documented span was a control (no medication), and the second and third spans (in randomized order) were under P1 and P2. Healthy subjects volunteered for the studies: nine men and seven women (median age 28 years) in study 1 and 12 men and 12 women (median age 36 years) in study 2. They were synchronized with diurnal activity from 07:00 h (+/- 30 min) to 00:00 h (+/- 1 h) and nocturnal rest. De Prins' method was used to obtain the prominent period tau in each (control, P1, and P2) individual time series. The chi 2 test was used to test group and subgroup differences. All 40 subjects exhibited a significant sleep/wake rhythm with a tau = 24 h in control, P1, and P2 series. During the control span a gender-related statistically significant difference was observed: fewer men than women exhibited a temperature rhythm desynchronized from 24 h. In addition, more women than men had a tau < 24 h during control. The gender-related difference was obliterated by placebos. Similarly desynchronized circadian rhythms of left and right hand-grip strength were observed in both men and women during the control span, which were all obliterated by placebo but only in men. Results are discussed with regard to a genetic model of human dyschronism as proposed by the authors.

Lifestyle factors and risk of cerebrovascular disease in women. The Copenhagen City Heart Study

BACKGROUND AND PURPOSE

The purpose of the present analysis was to determine how lifestyle influences the risk of cerebrovascular disease in women participating in the Copenhagen City Heart Study.

METHODS

A random sample of a white, lower and middle-class, urban population selected in 1976 was invited to two cardiovascular examinations at 5-year intervals. The present analysis was based on 7060 women invited to an initial examination from 1976 through 1978, aged 35 years or more, and without previous stroke or transient ischemic attack. At the initial examination, potential risk factors were recorded. The 265 first cases of stroke and transient ischemic attack were ascertained at a second examination 5 years later and through hospital records and death certificates through 1988. The Cox regression model was used to estimate the influence of the factors recorded on the risk of cerebrovascular disease.

RESULTS

The relative risks of cigarette smoking and lack of physical activity were 1.4 and 1.45; 95% confidence limits, 1.02 to 1.94 and 1.01 to 2.08, respectively). The relative risk of daily consumption of tranquilizers was 1.25 (95% confidence limits, 0.96 to 1.62). No significant influence was found for number of cigarettes, body mass index, or alcohol intake. In postmenopausal women, there was a statistically significant interaction (P < .041) between smoking and hormone replacement therapy. Smokers receiving this therapy had a 28% lower risk of cerebrovascular disease than smokers not receiving it.

CONCLUSIONS

The statistically significant and equally potent effects on the risk of cerebrovascular disease were found for cigarette smoking and lack of physical activity. The risk associated with smoking seemed to be influenced by hormonal replacement therapy.

Dysequilibrium in older people

The Council on Scientific Affairs of the California Medical Association presents the following inventory of items of progress in neurology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of these items of progress in neurology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Neurology of the California Medical Association, and the summaries were prepared under its direction.

Further course of mental health and use of alcohol and tranquilizers after cessation or persistence of cannabis use in young adulthood: a longitudinal study

The main question addressed in this study is how cessation or persistence of cannabis use is related to use of legal drugs and mental health problems. In a longitudinal study a representative sample of young people in Norway, age 17-20 years (n = 1997), participated in a postal survey in 1985 and was followed up again in 1987 and 1989. The results showed a decrease in alcohol consumption among men both among those who ceased to use cannabis and those who continued their use, whereas among women who continued cannabis use the alcohol consumption increased. The use of tranquilizers was significantly reduced among those who ceased to use cannabis compared with those who continued cannabis use, while mental health problems were unchanged. The results indicate that use of tranquilizers for self medication is mainly related to a polydrug use in the cannabis using culture.

Chemical restraint for surgery in the standing horse

Chemical restraint can be a useful pharmacologic tool to assist the veterinarian performing surgery in the standing horse. The agents discussed impose minimal adverse side effects and are considered relatively safe when administered in the doses described. Acetylpromazine, the most widely used tranquilizer, produces mild sedation but no analgesia. The use of tranquilizers for surgical procedures requires the combined use of either a local anesthetic technique or a sedative-hypnotic or opiate to provide analgesia. Sedative-hypnotics such as xylazine and detomidine or opiates such as morphine and butorphanol are commonly used. The sedative-hypnotics also can induce deep CNS depression and may be sufficient alone for many procedures. Opiates may be used to supplement the analgesia produced by sedative-hypnotics or provide analgesia to the tranquilized horse. Opiates are not useful alone because of their potential to cause CNS excitement in the horse. The combination of detomidine and butorphanol is probably the most effective drug combination to facilitate painful surgery in the standing horse.

Effects of R51163 on intake and metabolism in moose

R51163, a newly synthesized purine alkyl piperidine that produces reliable sedation in cattle, was tested in five adult bull moose (Alces alces). Compared with controls, all animals dosed with 0.4 mg/kg BW ate significantly (P less than 0.05) less dry matter for at least 1 wk after treatment. Median estimates of resting metabolism, measured the day of injection, did not differ between treatment and control groups, although the coefficient of variation was almost two times larger for drugged (15%) versus control (8%) individuals. Dose response was allometric, with larger animals exhibiting longer effects.

Intravenous anesthesia

Anticholinergics, tranquilizers, and sedative-hypnotics are the usual agents used for preanesthetic sedation of the horse. Of these drugs, the anticholinergics are of little importance in the horse. Acepromazine is the most useful and widely used tranquilizer, whereas xylazine is a safe and popular sedative. A newer sedative recently made available to the veterinarian for clinical use in horses is detomidine. Thiobarbiturates are seldom used alone any longer but are still useful when combined with guaifenesin for induction and maintenance of anesthesia. Other, more contemporary drug combinations that have largely replaced thiobarbiturates and chloral hydrate include xylazine with ketamine, xylazine with Telazol, detomidine with Telazol, and guaifenesin with ketamine and xylazine.

Chemical restraint and analgesia in the horse

Chemical restraint in the standing horse is used for a variety of procedures in veterinary medicine. The choice of agent depends on the physical status, temperament, and size of the patient; the procedure to be performed; and safety for the patient, veterinarian, and owner. The combination of certain agents may provide more desirable restraint and analgesia than does the use of individual agents. The use of analgesics in the horse is not without side effects, some of which may be detrimental to the patient's condition. Analgesics should be chosen with these untoward effects in mind. Draft breeds possess differences that may provide a challenge to the practitioner. One such difference is their clinically apparent increased sensitivity to tranquilizers and sedative-hypnotics; consequently, reduced dose regimens for chemical restraint should be employed initially.

Towards a sociology of tranquillizer prescribing

This paper outlines a sociological approach to benzodiazepine tranquillizer prescribing. The analysis focuses on both the micro level of the doctor-patient relationship and the macro level of those political, economic and cultural factors which structure the prescribing process. This makes it possible to account for both the overall decline in benzodiazepine prescriptions in the 1980's and the fact that they are still being prescribed on a long-term basis to a significant number of people.

Analgesia and anesthesia during labor in Japan and developed countries

Analgesia and anesthesia during labor were surveyed by the use of a questionnaire sent to university hospitals in USA, UK, France, FRG, GDR, Japan, and also other types of institutions in Japan. A rather negative attitude toward analgesia and anesthesia during labor was encountered less often in Japan than in USA, UK, and FRG, but the actual frequency of use was much less in Japan. Narcotics and/or tranquilizers were most frequently used in the first stage of labor. The only exception was France where lumbar epidural anesthesia was actually used as a method of choice at 70% of the institutions. Lumbar epidural anesthesia or some other regional block was the method of choice in the second stage except in UK where inhalation of nitrous oxide was the method of choice at 48% of the institutions. Augmentation of labor was much more frequent and the number of annual deliveries were much less in Japan. Higher C-section rate was seen in USA.

Can regional differences in consumption of tranquillizers and hypnotics be explained by variations in general practitioners' threshold of prescribing? A methodological study

Large differences exist in the consumption of tranquillizers and hypnotics within and between countries. The present study investigates the hypothesis that regional differences in the utilization of tranquillizers and hypnotics are associated with corresponding differences in thresholds of prescribing. A questionnaire that described in a standardized manner 12 patients with a symptomatology of anxiety and insomnia was sent to all general practitioners in two regions (south/north) in Norway. In the south, tranquillizers and hypnotics are used much more frequently than in the north. Based on written simulations of patients, no differences in thresholds of prescribing was found between the general practitioners in the two regions. Neither could the doctors' choice of drugs, nor their recommendations for dosage and duration of treatment, explain the different consumption of tranquillizers and hypnotics in the two regions. The method could, however, be criticized for insufficient validity, since our case stories were less controversial with respect to psychotropic drug prescribing than intended.

[Outcome of a sample of heroin addicts 2 years after the beginning of treatment (project EMETHYST)]

The Multicentric Study for the Evaluation of Treatment and Follow-up of Narcotic Addicts (EMETYST project) recruited 311 heroin addicts who asked for treatment between March and July, 1985, and who have been followed for two years. The sample was obtained from 16 specialized outpatient drug-free clinics. 78% of patients were males, their mean age was 24 years, and 73% lived with their parents or relatives. During the last year, 53% had been working and 17% had been in jail, 61% had started treatment for the first time. Throughout the follow up a reduction in the use of heroin, cannabis and tranquilizers was observed, as well as an improved psychological status and a reduction in illegal activities. By contrast, the use of cocaine, alcohol and tobacco did not change. There was no increase, either, in the proportion of persons who either studied or worked, and their judicial status, as measured by the number of police arrests, trials and imprisonments, showed a deterioration. The improvements found after 6 months persisted throughout the follow up. After 2 years, 54% abstained from heroin use. The patients that remained more than 90 days on therapy and those without previous judicial procedures had a better overall outcome.

A rational approach to anaesthetic premedication

Rational use of premedication for anaesthesia must always be modified and updated to keep pace with the evolving fields of anaesthesiology and surgery, as well as to meet changing patient needs and preferences. It is no longer axiomatic that all patients require, and therefore should receive, premedication. Unfortunately, a variety of traditional reasons have been proposed to justify routine premedication in many institutions. Smoothing induction, decreasing reflexes and arrhythmias, decreasing nausea and vomiting, decreasing pain, decreasing secretions, and producing sedation and amnesia have all been claimed historically as beneficial results of premedication. Modern anaesthetic agents and techniques have come a long way towards eliminating the routine need for premedication. In the preoperative period, the goal of an anxiety-free patient who is physiologically uncompromised requires an individualised approach based on experience and an adequate knowledge of current pharmacology. As our knowledge of potential problems associated with anaesthesia has expanded, we have added other classes of drugs such as the H2-histamine receptor blockers and antacids to our premedicant armamentarium. Outpatient and short-stay patients have further challenged our preoperative goal of an anxiety-free patient by requiring individuals to be 'street ready' within a brief period of time after surgery. Even for in-house elective procedures, not every patient is a candidate for routine premedication. A frank preoperative discussion is all that is necessary to effectively allay anxiety in many persons. In these and other special situations, this article will hopefully guide the reader toward a more rational approach to premedicating patients.

Studies on the mechanism of the sedational state; "tranquilization" evoked by bradykinin or kallikrein in rats

The mechanism of the sedative state "tranquilization" evoked by bradykinin(BK) or kallikrein(Kal), was studied. The drugs were injected intracerebroventricularly(icv) into the lateral ventricle, according to Yaksh's procedure. The behavior of a rat was estimated comparatively by the spontaneous movement. Two groups of animals were examined; one group was pretreated with prostaglandin (PG)-synthesis inhibitors, and the other group was not pretreated. The tranquilization was observed at the period of 12 to 16 min after BK or Kal injection. Almost of the PG-synthesis inhibitors reduced the tranquilization. On the contrary, eugenol or guaiacol, elongated the tranquilization. The levels of monoamines and PGs in the rat brain at the tranquilization, 15 min after BK injection detected with HPLC (high performance liquid chromatography). The levels of almost monoamines in the rat brain were decreased, however, PGE2 was increased considerably. Those results suggest that PGs is greatly involved in tranquilization evoked by BK or Kal.

[Pathogenetic role of the dependence potential of drugs of the hypnotic and tranquilizer type with special reference to the iatrogenic factor]

The author considers dependency on hypnotics/sedatives and tranquilizers as a complex phenomenon in which the main emphasis is placed on the potential for becoming dependent on medicines (self-inducing drugs), that is, their contribution to causing the development of the illness. Personality structure and social factors can play a favourable role here. From this the danger of iatrogenia (the practice of over-subscribing) can arise. The phenomena of cross tolerance and rebound are considered. With respect to therapy the leading role of psychotherapeutic practices, above all, group therapy is emphasized.

The use of meperidine hydrochloride for chemical restraint in certain cetaceans and pinnipeds

Meperidine HCl was administered intramuscularly by hand-syringe to a number of individuals representing several species of cetaceans (n = 95) and pinnipeds (n = 36). Dosage administered was 0.11 mg/kg, 0.23 mg/kg or 0.45 mg/kg, with the majority of animals receiving the middle dosage. Meperidine HCl provided moderate restraint in cetaceans without obvious deleterious effects. Restraint was achieved rapidly, with maximum effect occurring 20 min after intramuscular injection and lasting for 2 to 3 hr. Analgesia appeared to last as long as 4 hr and was sometimes accompanied by a restoration of appetite in animals suffering from physical discomfort. Higher doses produced increased sedation and analgesia without noticeably depressing respiration. Meperidine HCl provided moderate restraint for phocids and walrus (Odobenus rosmarus) without apparent detriment. California sea lions (Zalophus californianus) showed little restraint, but demonstrated profound respiratory depression.