The neurobiology of schizophrenia

The hypothesis that altered dopamine function is a major factor in the etiology of schizophrenia has persisted for some time, and changes in other neurochemical systems are strongly implicated as well. These findings are supported by the recent development of new, effective antipsychotic agents, such as clozapine and risperidone, whose actions are attributed to their combined serotonin and dopamine antagonism. In addition to their clinical efficacy, these agents are associated with substantially fewer extrapyramidal adverse effects. Continued research to identify the neurochemical alterations of psychotic diseases will undoubtedly have a favorable impact on the development of improved therapeutic regimens.

Clozapine therapy and clinical outcomes in Kentucky psychiatric hospitals

We reviewed the protocol for determining patient eligibility to receive clozapine in Kentucky state psychiatric facilities. Results of a retrospective review of the clinical outcomes of the initial 42 patients who received clozapine under this protocol are reported. Patients receiving clozapine were severely ill patients with a mean duration of illness and mean length of current hospitalization of 11 years and 2 years, respectively. Symptomatic response was dramatic with a reduction in total Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) ratings of 48.4% and 36.3%, respectively. The time patients spent in restraints decreased significantly following clozapine initiation. Clozapine was well tolerated, with sedation being the most common adverse effect reported. One patient experienced a seizure and another developed leukopenia. Following 12 weeks of clozapine treatment, the patient discharge rate was 42.9%.

Carisoprodol (Soma): a new and cautious perspective on an old agent

Carisoprodol (Soma, others) is a commonly prescribed, noncontrolled, skeletal muscle relaxant whose active metabolite is meprobamate. Patients for whom carisoprodol is prescribed are at risk for meprobamate dependence; several such cases have been reported. Toxicity and withdrawal associated with the use of meprobamate is high and has led to abandonment of this agent in clinical practice. Because carisoprodol possesses the same risks it should be avoided when possible, and it should be given schedule IV controlled substance status.

Patient-controlled analgesia: a review of effectiveness of therapy and an evaluation of currently available devices

Patient-controlled analgesia (PCA) is a major advance in the management of pain in postoperative and cancer patients. The success of PCA has resulted in a proliferation of marketed devices to administer small bolus doses of parenteral pain-control drugs at fixed intervals controlled by the patient with the push of a button. Because patients demonstrate marked individual variation in pain medication requirements, PCA devices should be able to accommodate rapidly changing requirements for drugs with a minimum amount of effort on behalf of health care personnel. Crude electronic devices were developed in the late 1960s and the early 1970s and usually consisted of a syringe pump connected to some sort of timing device. Most modern PCA devices marketed in the past five years are much more sophisticated devices that are microprocessor based and some newer devices even generate hard copy for a permanent record of drug administration. Although many such devices are available (including a totally disposable PCA device), few have undergone extensive clinical evaluation. A review of the literature shows many devices are available for use without a single publication to document the safety and utility of the device in the routine patient care situation. Use of the PCA method of pain control will grow, and all hospital-based health care personnel should become familiar with their use and limitations.