The following data were obtained from 36 male chronic schizophrenics (ICD 295.6) of 47 +/- 11 years of age, treated with neuroleptics for the last 16 +/- 6 years: Age, age at first manifestation of disease, duration and dosage scheme of neuroleptic therapy and number of electroconvulsive shock treatments. Blood samples were drawn both under neuroleptic treatment and after a 12-day withdrawal of neuroleptics, for determining cortisol, prolactin, beta-endorphin and noradrenaline. Psychopathology was assessed by standard criteria via BPRS. In 27 patients CT determination was carried out to determine the breadth of the third ventricle and the ventricular brain ratio. Withdrawal of neuroleptics resulted in a marked improvement, whereas 11 patients showed pronounced deterioration of their psychotic symptoms. In respect of the entire group there was a significant improvement of anergy, while disturbances of thinking were significantly enhanced. Serum levels of beta-endorphin and cortisol increased after neuroleptic withdrawal, whereas the levels of prolactin and of noradrenaline dropped. A considerable proportion of the patients showed a distinct extension of the ventricular system, but the CT variables correlated only slight with psychopathological parameters or their changes after neuroleptic withdrawal. The other variables, too, were without clinically relevant prognostic importance compared with the psychopathological changes after neuroleptic withdrawal. These variables were e.g. demography, psychopathology, therapy and neuroendocrinology.
A double-blind cross-over study on the neuroendocrine and behavioural effects of naloxone, 10 mg/day, was performed in 12 male, acute and chronic schizophrenic patients, currently treated with neuroleptic drugs. The opiate antagonist was ineffective on prolactin, but increased P-endorphin and cortisol serum levels. Treatment over 5 days did not change psychotic behaviour in any of the patients.
Ein Fortschritt in der Therapie des sekundären Hyperpara thyreoidismus -von der "MetooListe" konterkariert Im Fokus Mit Paricalcitol steht zur Therapie des sekundären Hyperparathyreoi dismus (sHPT) erstmals ein selektiver VitaminDRezeptorAktivator (se lektiver VDRA) zur Verfügung, der ei ne Parathormon (PTH)Senkung oh ne klinisch relevante Beeinflussung der Kalzium und PhosphatSpiegel ermöglicht. Allerdings wird nun Pati enten diese therapeutische Verbesse rung durch die Verbannung von Pa ricalcitol in die sog. MetooListe [1] der Kassenärztlichen Vereinigung (KV) Nordrhein verwehrt. Begründet wird dies mit der Einstufung von Pa ricalcitol als teures Analogpräparat zu Calcitriol im Arzneiverordnungsre port (AVR) 2006. Doch ist die dort vor genommenen Einstufung weder auf der verfügbaren medizinischen Evi denz begründet noch entspricht sie den Erfahrungen in der Dialysepraxis.
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