Treatments Disorders

The treatment of such order-disorder phenomena was initiated by Gorsky (1928) and generalized by Bragg and Williams (1934) [5], For simplicity we restrict the discussion to the synnnetrical situation where there are equal amounts of each component (x = 1/2). The lattice is divided into two superlattices a and p, like those in the figure, and a degree of order s is defined such that the mole fraction of component B on superlattice p is (1 +. s)/4 while that on superlattice a is (1 -. s)/4. Conservation conditions then yield the mole fraction of A on the two superlattices... 

Figure A2.5.21. The heat eapaeity of an order-disorder alloy like p-brass ealeulated from various analytie treatments. Bragg-Williams (mean-field or zeroth approximation) Bethe-1 (first approximation also Guggenheim) Bethe-2 (seeond approximation) Kirkwood. Eaeh approximation makes the heat eapaeity sharper and higher, but still finite. Reprodueed from [6] Nix F C and Shoekley W 1938 Rev. Mod. Phy.s. 10 14, figure 13. Copyright (1938) by the Ameriean Physieal Soeiety.

The standard analytic treatment of the Ising model is due to Landau (1937). Here we follow the presentation by Landau and Lifschitz [H], which casts the problem in temis of the order-disorder solid, but this is substantially the same as the magnetic problem if the vectors are replaced by scalars (as the Ising model assumes). The themiodynamic... 

Several of the naturally occurring indoles also have clinical importance. The dimeric vinca alkaloid vincristine and closely related compounds were among the first of the anti-mitotic class of chemotherapeutic agents for cancer[14]. The mitomycins[15] and derivatives of ellipticine[16] are other examples of compounds having anti-tumour activity. Reserpine, while not now a major drug, was one of the first compounds to show beneficial effects in treatment of mental disorders[17]... 

Since the introduction of cortisone (1) (1948) and hydrocortisone (2) (1951), adrenal-cortical hormones have remained an important and unreplaced dmg class. Though not without adverse effects, these compounds have continued to be the dmg of choice in the treatment of afflictions ranging from the moderate skin rash to severe acute inflammatory disorders, and are included in many other therapeutic regimes. 

The path from squalene (114) to the corresponding oxide and thence to lanosterol [79-63-0] (126), C qH qO, cholesterol [57-88-5] (127), and cycloartenol [469-38-5] (128) (Fig. 6) has been demonstrated in nonphotosynthetic organisms. It has not yet been demonstrated that there is an obligatory path paralleling the one known for generation of plant sterols despite the obvious stmctural relationships of, for example, cycloartenol (128), C qH qO, to cyclobuxine-D (129), C25H42N2O. The latter, obtained from the leaves of Buxus sempervirens E., has apparentiy found use medicinally for many disorders, from skin and venereal diseases to treatment of malaria and tuberculosis. In addition to cyclobuxine-D [2241-90-9] (129) from the Buxaceae, steroidal alkaloids are also found in the Solanaceae, Apocynaceae, and LiUaceae. 

Progesterone. Progesterone (1) is not orally active. Although seldom used clinically, it can be adrninistered as an intramuscular injection, pessaries, or suppositories in the treatment of menstmal disorders and habitual abortion (121). Progesterone can be recrystaUized from dilute alcohol and exists in two crystalline forms (122). It is soluble in chloroform and ethanol sparingly soluble in acetone, dioxane, ether, and fixed oils and practically insoluble in water (121). Two syntheses of progesterone (1) are described in Figure 3. 

Melatonin [73-31-4] C 2H N202 (31) has marked effects on circadian rhythm (11). Novel ligands for melatonin receptors such as (32) (12), C2yH2gN202, have affinities in the range of 10 Af, and have potential use as therapeutic agents in the treatment of the sleep disorders associated with jet lag. Such agents may also be usehil in the treatment of seasonal affective disorder (SAD), the depression associated with the winter months. Histamine (see Histamine and histamine antagonists), adenosine (see Nucleic acids), and neuropeptides such as corticotropin-like intermediate lobe peptide (CLIP) and vasoactive intestinal polypeptide (VIP) have also been reported to have sedative—hypnotic activities (7). 

The molten carbonate fuel ceU uses eutectic blends of Hthium and potassium carbonates as the electrolyte. A special grade of Hthium carbonate is used in treatment of affective mental (mood) disorders, including clinical depression and bipolar disorders. Lithium has also been evaluated in treatment of schizophrenia, schizoaffective disorders, alcoholism, and periodic aggressive behavior (56). 

Lithium ion is commonly ingested at dosages of 0.5 g/d of lithium carbonate for treatment of bipolar disorders. However, ingestion of higher concentrations (5 g/d of LiCl) can be fatal. As of this writing, lithium ion has not been related to industrial disease. However, lithium hydroxide, either dHectly or formed by hydrolysis of other salts, can cause caustic bums, and skin contact with lithium haHdes can result in skin dehydration. Organolithium compounds are often pyrophoric and requHe special handling (53). 

Uses and Economic Aspects. Magnesium bromide is used in medicine as a sedative in treatment of nervous disorders, in electrolyte paste for magnesium dry cells, and as a reagent in organic synthesis reactions. The price of magnesium bromide hexahydrate in January 1995 was 5.51/kg (33). 

Aniracetam (6), launched in 1993 in both Japan and Italy for the treatment of cognition disorders, is in Phase II trials in the United States as of this writing. In clinical studies it has been shown to cause some improvement in elderly patients with mild to moderate mental deterioration (63), and in geriatric patients with cerebral insufficiency (64). In a multicenter double-blind placebo-controUed trial involving 109 patients with probable AD, positive effects were observed in 36% of patients after six months of treatment (65), a result repeated in a separate study of 115 patients (66). A review of the biological and pharmacokinetic properties, and clinical results of aniracetam treatment in cognitively impaired individuals is available (49). 

Inositols, ie, hexaliydrobenzenehexols, are sugars that have received increasing study and are useful in the treatment of a wide variety of human disorders, including vascular disease, cancer, cirrhosis of the Hver, frostbite, and muscular dystrophy (269). Myoinositol esters prepared by reaction with lower fatty acid anhydrides are useful as Hver medicines and nonionic surfactants the aluminum and ammonium salts of inositol hexasulfate are useful anticancer agents (270). Tetraarjloxybenzoquinones are intermediates in the preparation of dioxazine dyes (266,271). The synthesis of hexakis(aryloxy)benzenes has also beenpubUshed (272). 

Tretinoin, the - -trans isomer of retinoic acid [302-79-4] was shown in the 1960s to be useful for the treatment of disorders associated with abnormal epithehal differentiation. 

Artificial Hearts. Congestive heart failure (CHF) is a common cause of disabiHty and death. It is estimated that three to four million Americans suffer from this condition. Medical therapy in the form of inotropic agents, diuretics (qv), and vasofilators is commonly used to treat this disorder (see Cardiovascularagents). Cardiac transplantation has become the treatment of choice for medically intractable CHF. Although the results of heart transplantation are impressive, the number of patients who might benefit far exceeds the number of potential donors. Long-term circulatory support systems may become an alternative to transplantation (5). 

Pharmacological Profiles of Anxiolytics and Sedative—Hypnotics. Historically, chemotherapy of anxiety and sleep disorders rehed on a wide variety of natural products such as opiates, alcohol, cannabis, and kawa pyrones. Use of various bromides and chloral derivatives ia these medical iadications enjoyed considerable popularity early ia the twentieth century. Upon the discovery of barbiturates, numerous synthetic compounds rapidly became available for the treatment of anxiety and insomnia. As of this writing barbiturates are ia use primarily as iajectable general anesthetics (qv) and as antiepileptics. These agents have been largely replaced as treatment for anxiety and sleep disorders. 

Beginning in the 1960s, ben2odia2epiae anxiolytics and hypnotics rapidly became the standard prescription dmg treatment. In the 1980s, buspkone [36505-84-7] (3), which acts as a partial agonist at the serotonin [50-67-9] (5-hydroxytryptamine, 5-HT) type lA receptor, was approved as treatment for generali2ed anxiety. More recently, selective serotonin reuptake inhibitors (SSRIs) have been approved for therapy of panic disorder and obsessive—compulsive behavior. 

Benzodiazepines, ie, the hiU BZR agonists, are prescribed for anxiety, insomnia, sedation, myorelaxation, and as anticonvulsants (97). Those benzodiazepines most commonly prescribed for the treatment of anxiety disorders are lorazepam (19), alprazolam (20), diazepam (21), bromazepam (22), chlorazepate (23), and oxazepam (24). These dmgs together represent about 70% of total... 

SSRIs are well tolerated. Adverse effects for compounds in this class include nervousness, tremor, dizziness, headache, insomnia, sexual dysfunction, nausea, and diarrhea. In addition, the tricycHc antidepressant clomipramine (33), which is a potent nonselective serotonin reuptake inhibitor, is approved for treatment of obsessive—compulsive disorder. 

Treatment of Major Depression. Dmgs commonly used for the treatment of depressive disorders can be classified heuristicaHy iato two main categories first-generation antidepressants with the tricycHc antidepressants (TCAs) and the irreversible, nonselective monoamine—oxidase (MAO) inhibitors, and second-generation antidepressants with the atypical antidepressants, the reversible inhibitors of monoamine—oxidase A (RIMAs), and the selective serotonin reuptake inhibitors (SSRIs). Table 4 fists the available antidepressants. 

SSRIs are widely used for treatment of depression, as well as, for example, panic disorders and obsessive—compulsive disorder. These dmgs are well recognized as clinically effective antidepressants having an improved side-effect profile as compared to the TCAs and irreversible MAO inhibitors. Indeed, these dmgs lack the anticholinergic, cardiovascular, and sedative effects characteristic of TCAs. Their main adverse effects include nervousness /anxiety, nausea, diarrhea or constipation, insomnia, tremor, dizziness, headache, and sexual dysfunction. The most commonly prescribed SSRIs for depression are fluoxetine (31), fluvoxamine (32), sertraline (52), citalopram (53), and paroxetine (54). SSRIs together represent about one-fifth of total worldwide antidepressant unit sales. 

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