piperidines and Catatonia

New publications on malignant hyperthermia (MH), with direct clinical importance, are reported. Since even in the recent past patients have died from MH in spite of therapy with dantrolene, the effectiveness of dantrolene is discussed in particular. Atypical clinical pictures of MH are presented. Special psychiatric syndromes (malignant neuroleptic syndrome and acute febrile catatonia), rhabdomyolysis with myoglobinuria following strenuous exercise or exposure to heat are mentioned, as these disorders appear to be related to MH, in that they are hypermetabolic syndromes implying a muscle membrane dysfunction. The role of slow calcium channel blockers and 5-hydroxytryptamine antagonists as prophylactic or therapeutic agents in MH is discussed. A schedule describing how to diagnose, treat and prevent MH, considering recent advances, is presented.

Topics: Anesthesia; Animals; Calcium Channel Blockers; Catatonia; Dantrolene; Diagnosis, Differential; Humans; Ketanserin; Malignant Hyperthermia; Neuroleptic Malignant Syndrome; Piperidines; Serotonin Antagonists; Swine

Five depot neuroleptics (fluphenazinedeconoate, fluspirilene, pipothiazinepalmitate, penfluridol and perphenazine-enanthate) were compared based on clinical trials in subacute and chronic schizophrenic patients. The psychopathological symptoms were documented by means of the AMP-system. Statistical analyses showed several differences between the effects of the five substances. The AMP-system proved a useful instrument to differentiate similar drugs.

Topics: Administration, Oral; Bipolar Disorder; Catatonia; Clinical Trials as Topic; Delayed-Action Preparations; Drug Evaluation; Female; Fluorobenzenes; Fluphenazine; Hallucinations; Hostility; Humans; Hydrocarbons, Halogenated; Hypochondriasis; Injections, Intramuscular; Methods; Paranoid Disorders; Perphenazine; Piperidines; Schizophrenia; Spiro Compounds; Sulfonamides; Time Factors; Tranquilizing Agents

Topics: Adolescent; Adult; Antipsychotic Agents; Catatonia; Chlorpromazine; Clinical Trials as Topic; Drug Evaluation; Female; Humans; Injections; Male; Methotrimeprazine; Middle Aged; Palmitic Acids; Pilot Projects; Piperidines; Schizophrenia; Schizophrenia, Disorganized; Schizophrenia, Paranoid; Sulfonamides; Time Factors; Tremor

Sequential therapeutic trials for catatonoid frontal signs in clinically-evident frontotemporal dementia (n = 2) revealed differential benefits for lorazepam, amantadine, memantine, pramipexole, aripiprazole, quetiapine, citalopram, and donepezil, although certain signs also worsened. Citalopram and donepezil were poorly tolerated. Ramelteon was without effect. While memantine appeared to improve cognition in case 1, this remains to be established by more reliable neuropsychological testing. Parkinsonism (case 2) responded to pramipexole, but not amantadine or levodopa. Possible relationships of catatonoid signs requiring future confirmation include insufficient GABA-A (multiple signs) and D2 (mutism) and excessive NMDA (immobility, rigidity), D2/D3 (mannerisms, verbal perseveration), and 5HT1a (staring) receptor stimulation. Low-dose lorazepam and quetiapine required close monitoring.

Topics: Aged; Amantadine; Antipsychotic Agents; Aripiprazole; Benzothiazoles; Catatonia; Citalopram; Clinical Trials as Topic; Dibenzothiazepines; Donepezil; Dopamine Agents; Excitatory Amino Acid Antagonists; Female; Frontotemporal Dementia; Humans; Hypnotics and Sedatives; Indans; Lorazepam; Memantine; Middle Aged; Nootropic Agents; Piperazines; Piperidines; Pramipexole; Quetiapine Fumarate; Quinolones; Selective Serotonin Reuptake Inhibitors

Topics: Aged; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Catatonia; Chlorpromazine; Cholinesterase Inhibitors; Cognition Disorders; Creatine Kinase; Dementia; Disease Progression; Donepezil; Female; Humans; Indans; Lorazepam; Muscle Rigidity; Neuroleptic Malignant Syndrome; Olanzapine; Piperidines; Recurrence; Risperidone

We report a 75-year-old Japanese woman with probable dementia with Lewy bodies (DLB). At the age of 64, she showed left hand resting tremor, and gradually developed bradykinesia, and rigidity. She was diagnosed as having parkinsonism and took medication. At the age of 70, she showed hallucination and dementia. As she had developing cognitive dysfunction and hallucination and parkinsonism, she was diagnosed to have probable DLB. At the age of 75, after administration of donepezil, she showed severe psychosis and worsened parkinsonism, and was admitted to hospital. On neurological examination, she showed severe rigidity and akinesia, and behavioral immobility like "waxy flexibility" or motiveless resistance to maintenance of rigid posture against attempts to be moved. The phenomena, she presented as motor abnormalities, were thought to be catatonia. In consideration of clinical course, her catatonia and worsened parkinsonism was thought to be induced by donepezil and she was stopped the administration of donepezil. After treatment with trihexiphenizil, she had improvement of motor abnormalities and worsened parkinsonism. It is important to recognize that donepezil may induce catatonia on the patients of parkinsonism with severe dementia.

Topics: Aged; Catatonia; Donepezil; Female; Hallucinations; Humans; Indans; Lewy Body Disease; Nootropic Agents; Parkinsonian Disorders; Piperidines

1. The authors describe a case report of catatonia syndrome after administration of depot neuroleptics. 2. Differential diagnosis was made between neuroleptic malignant syndrome or catatonic syndrome complicated by infection. The signs and symptoms observed throughout the patient's course are detailed. 3. A critical review is made of bibliography on the topic, with emphasis on the lack of clear clinical description and poor conceptual definition.

Topics: Adult; Antipsychotic Agents; Biperiden; Catatonia; Delayed-Action Preparations; Diagnosis, Differential; Humans; Male; Neuroleptic Malignant Syndrome; Phenothiazines; Piperidines; Schizoid Personality Disorder; Syndrome; Thiazines

The effects of different subcutaneous doses of fentanyl (0.02, 0.04, 0.08, and 0.16 mg/kg), piritramide (0.63, 2.50, 10.0 and 40.0 mg/kg), and morphine (2.50, 5.00, 10.0 and 20.0 mg/kg) on self-stimulation in rats were studied. Different stimulus parameter combinations (SPC) inducing low, high or intermediate control response rates (CRR) were applied during the same experimental sessions. The three narcotic analgesics induced response depression (RD) and response stimulation (RS). RS was mostly observed at low dose levels; RD was dose-related. SPC's inducing low CRR were more sensitive than those inducing high CRR. Fentanyl was more potent than piritramide and than morphine. The RD is related to motor incapacitation, as the doses needed to effectively reduce self-stimulation also induced obvious catatonia. The RS probably is a more specific effect reflecting sensitization of structures involved in reinforcement of behavior.

Topics: Analgesics, Opioid; Animals; Catatonia; Fentanyl; Humans; Hypothalamus; Isonipecotic Acids; Male; Morphine; Piperidines; Rats; Reinforcement, Psychology; Self Stimulation

Topics: 1-Propanol; Adolescent; Adult; Antiparkinson Agents; Basal Ganglia Diseases; Biperiden; Catatonia; Delayed-Action Preparations; Extrapyramidal Tracts; Humans; Male; Middle Aged; Paranoid Disorders; Piperidines; Psychotic Disorders; Schizophrenia; Schizophrenia, Disorganized; Tranquilizing Agents; Tremor

Topics: Adult; Alanine Transaminase; Aspartate Aminotransferases; Autistic Disorder; Autonomic Nervous System; Catatonia; Female; Hallucinations; Humans; Hypnotics and Sedatives; Liver Function Tests; Male; Mental Disorders; Nausea; Neurotic Disorders; Paranoid Disorders; Personality Disorders; Phenothiazines; Piperidines; Schizophrenia; Sleep Wake Disorders; Stimulation, Chemical; Sweating; Tremor; Vascular Diseases; Vomiting

Topics: Antidepressive Agents; Butyrophenones; Catatonia; Female; Fluorine; Humans; Male; Paranoid Disorders; Piperidines; Schizophrenia; Trifluperidol

Topics: Adolescent; Catatonia; Child; Chlorpromazine; Convulsive Therapy; Electroconvulsive Therapy; Humans; Insulin; Methotrimeprazine; Perphenazine; Piperidines; Reserpine; Schizophrenia; Toxicology