Psychoses treatment

In the treatment of manic depressive psychosis (treatment of mania). 

For second and subsequent episodes of psychosis, treatment may need to be indefinite... 

BKCa The diversity of BKCa channels can be attributed to the assembly of pore-forming a subunit together with four different auxiliary subunits ((31 -(34). BMS-204352 has been identified as a BKCa channel opener for the treatment of acute ischemic stroke although it has also been shown as an M-channel activator. Therapeutic applications for channel openers include epilepsy, bladder overactivity, asthma, hypertension, and psychosis. Other known BKCa channel openers include NS-8, NS-1619, NS-4, and certain aminoazaindole analogs. 

Cbnvulsions, steroid-induced catatonia, increased intracranial pressure with papilledema (usually after treatment is discontinued), vertigo, headache, neuritis or paresthesia, steroid psychosis, insomnia... 

McDougle CJ, Price LH, Palumbo JM, et al Dopaminergic responsivity during cocaine abstinence a pilot smdy. Psychiatry Res 43 77-85, 1992 McDougle CJ, Black JE, Malison RT, et al Noradrenergic dysregulation during discontinuation of cocaine use in addicts. Arch Gen Psychiatry 51 713-719,1994 Misra L, Kofoed L Risperidone treatment of methamphetamine psychosis (letter). Am J Psychiatry 154 1170, 1997... 

Somoza EC, Winhusen TM, Bridge TP, et al An open-label pilot study of methylpheni-date in the treatment of cocaine-dependent patients with adult attention deficit/ hyperactivity disorder. J Addict Dis 23 77—92, 2004 Sora 1, Wichems C, Takahashi N, et al Cocaine reward models conditioned place preference can be established in dopamine- and in serotonin-transporter knockout mice. Proc Natl Acad Sci U S A 95 7699-7704, 1998 Soral, Hall FS, Andrews AM, etal Molecular mechanisms of cocaine reward combined dopamine and serotonin transporter knockouts eliminate cocaine place preference. Proc Nad Acad Sci U S A 98 5300-5305, 2001 Spear J, Alderton D Psychosis associated with prescribed dexamphetamine use 0etter). 

The oldest anti-anxiety agent is undoubtedly alcohol and it is certain that this drug is still routinely self-administered for this purpose. Towards the end of the eighteenth century, bromide salts were used to relieve conditions akin to anxiety despite the risk of a characteristic toxic delirium, known as bromism . Alternative treatments, such as paraldehyde and chloral hydrate, were also widely used but these too had adverse effects the former can cause psychosis but the latter is still used as a sedative and anaesthetic agent. 

In addition, Pfizer has identified a number of related, fused bicyclic pyrazole analogues [286-292]. These compounds, of which structures (419 25) are specified examples, are claimed to be of use in the treatment of a number of diseases including alcoholism, psychosis, tobacco abuse, Parkinson s disease and obesity. 

Investigation of the differences in crystal packing between (431) and (426) from comparison of their respective X-ray structures, revealed that (431) was more tightly packed than (442), reflected in their respective melting points of 235 and 170 °C. It was postulated that the absence of in vivo activity for (431) may be explained by the resultant reduction in water solubility and dissolution rate compared with (426). The comparatively high calculated polar surface area of (431) (122.5A ) compared with (426) (89.3 A ) was also proposed as a factor influencing the marked difference in bioavailability between the two related compounds. Compound (426) (SLV-319) is currently being developed with Bristol-Myers Squibb for the potential treatment of obesity and other metabolic disorders. Phase I trials for obesity were started in April 2004. Earlier Phase I clinical trials for the treatment of schizophrenia and psychosis, which commenced in April 2002, appear to have been abandoned. 

Giannini, A.J. Eighan, M.S. Loiselle, R.H. and Giannini, M.C. Comparison of haloperidol and chiorpromazine in the treatment of phencyclidine psychosis. J. Clin Pharmacol 244 202-204, 1984. Grove, V.E. Painless self-injury after ingestion of "angel dust." TAMA 242 655, 1979. 

Psychoses, when they occur, appear to be due to drug effect interacting with a vulnerable personality organization (Luisada 1978). Our experience has been that some adolescents with borderline personality disorders, as well as adolescents at risk of schizophrenic decompensation, may have this vulnerability. Although we do not have hard data to support the hypothesis that patients with PCP psychoses that are most resistant to treatment have the poorest long-term prognosis (Erard et al. 1980), our observations have been that persistence of symptoms of psychosis after the first 2 to 3 weeks of treatment often correlates with extended periods of impai rment. 

Although it has not been proven that acidification of the urine to increase PCP excretion alters the duration of the symptoms of psychosis, it appears appropriate to facilitate excretion of PCP from the adipose tissue in which it is stored in any PCP user (Done 1980). Maintaining the urine pH at an acid level for several weeks, even though the mental status is normal, is advised. It is important to test the pH of the urine to ensure compliance with the acidification. We have found that PCP becomes detectable in acidified urine for a time, even after being undetectable in alkaline urine, in previously intoxicated individuals. We have not found a change in mental status to result from such acidification treatment and resultant enhanced PCP excretion. 

Luisada, P.V. The phencyclidine psychosis Phenomenology and treatment. In Peterson, R.C., and Stillman, R.C., eds. Phencvcli di ne Abuse An Apprai sal. National Institute on Drug Abuse Research Monograph 21. DHEW Pub. No. 78-728. Washington, D.C. Supt. of Docs., U.S. Govt. Print. Off., 1978. pp. 

Russ, C., and Wong, D. Diagnosis and treatment of the phencyclidine psychosis Clinical observations. J. Psvchedel i c Drugs... 

The atypical antipsychotics are the preferred agents for the treatment of psychosis (hallucinations, delusions, and suspiciousness) and the disruptive behaviors (agitation and... 

The treatment goals for acute intoxication of ethanol, cocaine/amphetamines, and opioids include (1) management of psychological manifestations of intoxication, such as aggression, hostility, or psychosis, and (2) management of medical manifestations of intoxication such as respiratory depression, hyperthermia, hypertension, cardiac arrhythmias, or stroke. 

Antipsychotics can be safe and effective for the treatment of psychosis in the elderly, if used at lower doses than those commonly used in younger adults. Older adults are particularly vulnerable to the side effects of FGAs. Parkinsonian symptoms... 

To date, clozapine remains the only drug with proven and superior efficacy in treatment-resistant patients, and it is currently the only drug approved for the treatment-resistant schizophrenic. Studies have shown a response of approximately 30% to 50% in these well-defined treatment-resistant patients. Clinical trials have consistently found clozapine to be superior to traditional antipsychotics for treatment-refractory patients, and it is efficacious even after nonresponse to other SGAs and in partially responsive patients. It is often rapidly effective even in those who have had a poor response to other medication for years. Recent studies have demonstrated that it has a beneficial effect for aggression and suicidality, which led to the Food and Drug Administration (FDA) approval for the treatment of suicidal behavior in people with psychosis.41... 

Optimize the dose of mood stabilizing medication(s) before adding on lithium, lamotrigine, or antidepressant (e.g., bupropion or an SSRI) if psychotic features are present, add on an antipsychotic ECT used for severe or treatment-resistant depressive episodes or for psychosis or catatonia... 

Fourth, if response is inadequate, consider ECT for mania with psychosis or catatonia 6 or add clozapine for treatment-refractory illness Fifth, if response is inadequate, consider adding adjunctive therapies8... 

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