Loxapine succinate as a neuroleptic agent: evaluation in two populations of elderly psychiatric patients

Loxapine succinate, a newly developed neuroleptic drug, was administered to two groups of geropsychiatric patients: (a) 12 with psychosis and organic brain syndrome, and (b) 14 with chronic schizophrenia. After a two-week baseline period, loxapine was given for 12 weeks. The moderate therapeutic effect of loxapine in the "responders" was similar to that of other neuroleptic drugs. The therapeutic dosage range was found to be from 10 to 80 mg daily--about half that used for younger patients. The chief side effects were drowsiness, mild extrapyramidal symptoms, and a slight increase in blood pressure.

High- and low-potency neuroleptics in elderly psychiatric patients

The efficacy and side effects of a low-potency neuroleptic, thioridazine hydrochloride, and those of a high-potency neuroleptic, fluphenazine hydrochloride, were compared in 30 elderly chronic schizophrenic patients. Through a crossover design, each patient received both drugs with an intervening washout period. Although both drugs produced a similar degree of improvement, their side effects differed. Fluphenazine caused slightly more extrapyramidal effects than thioridazine, though few occurred with use of either drug. Thioridazine caused weight gain, blood pressure decreases, and ECG changes. High-potency neuroleptic agents appear to be the drugs of choice for elderly schizophrenic patients.

Clinical and plasma level characteristics of intramuscular and oral loxapine

The intramuscular and oral forms of loxapine succinate were compared in their clinical, side effect, and blood level characteristics in ten hospitalized chronic schizophrenic patients. The first phase of the study determined the single dose that produced moderate sedation (i.e., the sedation threshold), and this dose was essentially the same for the two forms. Continuous administration of the two forms using the individualized sedation threshold dosage also failed to indicate any clinical or side effect differences in the two forms. The blood level characteristics, however, did differ between the two forms. The kinetic studies indicated that there was a larger are under the loxapine curve with the intramuscular form than with the oral form, while the 8-OH loxapine area was larger with the oral form. The steady-state studies also showed that the i.m. form had higher loxapine levels than the oral form. The significance of these findings, both clinically and in terms of the relative activity of loxapine and its metabolites, is discussed.

Clozapine in tardive dyskinesia

Clozapine, which has had limited clinical testing in the U.S.A., was evaluated in 12 chronic schizophrenic patients with tardive dyskinesia. Its antipsychotic activity was again demonstrated and it suppressed the symptoms of tardive dyskinesia with a marked rebound occurring in these symptoms when it was withdrawn; there was no rigidity or other Parkinsonian symptoms. However, out of a total of 12 patients, neutropenia (800 and 1120) occurred in two patients, convulsion in one patient, marked withdrawal effects in three patients, and a hypotensive collapse with atrial fibrillation in one patient. If these adverse effects are confirmed in a larger sample size, then despite the novel desirable effects of clozapine it would seem unlikely that it will gain widespread or routine use.

Removing a sewing needle from the pelvic cul-de-sac with an operative laparoscope

A case is reported of an unusual foreign body, a sewing needle, found in the pelvis beneath the peritoneum of the cul-de-sac and its successful removal via laparoscopy. The preoperative radiologic localization techniques are discussed. The use of the laparoscope for removing accessible foreign bodies can obviate the need for a more extensive surgical procedure.

Extraosseous osteogenic sarcoma following an intramuscular injection

A 29-year-old white male with an extraosseous osteogenic sarcoma is reported. He first noted a nodule at the site of eventual tumor development some eight years previously, following an intramuscular penicillin injection. Treatment consisted of wide surgical excision and radiation therapy, and he remains healthy some 8 months later. To our knowledge this represents the first case of extraosseous osteogenic sarcoma occurring at the site of a previous intramuscular injection.

Adverse effects of intravenous cannabis tea

Adverse effects occurred in four youths after intravenous injection of an aqueous cannabis-seed tea, which was prepared by boiling the seeds. The effects were immediate and included nausea, vomiting, abdominal pain, watery diarrhea, chills, fever, hypovolemic shock, hypotension, and non-oligemic transitory renal failure. Other manifestations included persistent hypoglycemia, tachycardia, gastrointestinal bleeding, conjunctival hemorrhage, injury, jaundice, splenomegaly, leucocytosis, myalgia, arthralgia, motor weakness, and prostration. Ischemia was noted on electrocardiogram (EKG). All manifestations appeared to reverse within weeks, but these effects had been potentially fatal.

Deanol in the treatment of tardive dyskinesia

Ten hospitalized chronic psychotic patients with symptoms of tardive dyskinesia were given deanol and placebo, each for 8 weeks following a double-bline, crossover design. No psychotropic agents were administered during the trial. Improvement occurred in all patients during the first treatment phase regardless of which drug the patients received; seven patients were on deanol and three on placebo during this time. The possible reasons for this decrease were discussed. It was concluded that deanol may have contributed to the decline but that its effect on the disorder was not dramatic.

An unusual complication of corticosteroid therapy for sarcoidosis

This report describes the rapid development of an amoebic liver abscess in a patient receiving prednisone by mouth for hypercalcaemia associated with sarcoidosis. The diagnosis and treatment of amoebiasis in this setting are discussed.

Two dosages of imipramine in hospitalized endogenous and neurotic depressives

Fifty-one newly hospitalized depressed patients participated in a double-blind comparison of two dosage levels of imipramine hydrochloride (150 mg vs 300 mg daily). Although some patients were suffering from neurotic depressions, they, together with the endogenous depressives, were a severely depressed group who required hospitalization. Improvement occurred with both dosage regimens, although a greater and more consistent improvement was noted in the 300-mg group than in the 150-mg group. There were a few differences between the response of the endogenous and that of the neurotic depressives, as assessed by the physician and self=rating scales. However, endogenous depressives who received 150 mg were overrepresented in the treatment failure group. A comparison of the response of deluded and nondeluded depressives indicated that the deluded patients responded less well than the nondeluded depressives, although half of the delusional group did respond to the treatment.

Therapeutic failure of oral thyrotropin-releasing hormone in depression

A double-blind investigation of the psychological and hormonal responses to orally administered thyrotropin-releasing hormone (TRH) in a dosage range of 200 to 300 mg daily was conducted in a group of 11 depressed patients hospitalized for an initial 10-day period and followed as outpatients for the balance of a 30-day period of observation. The study was purposely restricted to depressives conventionally classed as reactive, neurotic, or characterologic, the groups most commonly encountered clinically. Contrary to some reports of TRH as an effective antidepressant, our results indicated not only failure of benefit but actual antitherapeutic effects in 3 of 6 treated patients as compared with placebo controls. Excessive CNS arousal with psychomotor activation produced dysphoric mental and behavioral effects in these patients.

Lithium in tardive dyskinesia

A single blind trial and a placebo controlled double blind trial of lithium were carried out in elderly patients with tardive dyskinesia. In the pilot study, neuroleptics were continued: in the controlled trial, neuroleptics were discontinued. The results of both studies were essentially negative. Thus, the suppression effect of neuroleptics is much more dramatic than anything seen in the two studies. Several reasons for this were discussed namely, the severity and chronicity of the symptoms.

Once versus thrice daily thiothixene in the treatment of schizophrenic in-patients

Reports have been accumulating in the literature attesting to the failure of patients, particularly out-patients, to take medication as prescribed (Stewart and Cluff, 1972; Moulding et al., 1970). The incidence of these failures, which may include anything from missing occasional doses to taking no medication at all, has been reported to range from 25–59 Per cent. In addition, it has not been possible to identify those patients who will have the highest failure rates (Blackwell, 1972). While most of the studies have involved medical patients, it is probably legitimate to assume that schizophrenic patients are at least as unreliable in taking medication as the medical patients. Thus, in one study of 125 psychiatric patients, Willcox et al. (1965) found that 48 per cent took no medication at all.