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Background to the Celebration of Herbert D. Kleber (1904 -2018) by Thomas A
1 Background to the Celebration of Herbert D. Kleber (1904 -2018) by Thomas A. Ban By the mid-1990s the pioneering generation in neuropsychopharmacology was fading away. To preserve their legacy the late Oakley Ray (1931-2007), at the time Secretary of the American College of Neuropsychopharmacology (ACNP), generated funds from Solway Pharmaceuticals for the founding of the ACNP-Solway Archives in Neuropsychopharmacology. Ray also arranged for the videotaping of interviews (mainly by their peers) with the pioneers, mostly at annual meetings, to be stored in the archives. Herbert Kleber was interviewed by Andrea Tone, a medical historian at the Annual Meeting of the College held in San Juan, Puerto Rico, on December 7, 2003 (Ban 2011a; Kleber 2011a). The endeavor that was to become known as the “oral history project” is based on 235 videotaped interviews conducted by 66 interviewers with 213 interviewees which, on the basis of their content, were divided and edited into a 10-volume series produced by Thomas A. Ban, in collaboration with nine colleagues who were to become volume editors. One of them, Herbert Kleber, was responsible for the editing of Volume Six, dedicated to Addiction (Kleber 2011b). The series was published by the ACNP with the title “An Oral History of Neuropsychopharmacology Peer Interviews The First Fifty Years” and released at the 50th Anniversary Meeting of the College in 2011 (Ban 2011b). Herbert Daniel Kleber was born January 19, 1934, in Pittsburgh, Pennsylvania. His family’s father’s side was from Vilnius, Lithuania, and the Mother’s side was from Germany. Both families came to the United State during the first decade of the 20th century. -
Switching from Clonidine Immediate-Release to Guanfacine Extended-Release
/ DE L’ACADÉMIE CANADIENNE DE PSYCHIATRIE DE L’ENFANT ET DE L’ADOLESCENT PSYCHOPHARMACOLOGY Switching from Clonidine Immediate-Release to Guanfacine Extended-Release Dean Elbe PharmD, BCPP1,2,3 s a clinical pharmacy specialist in child and adolescent (Canada) Ltd, 2012b). Clonidine has been used off-label Amental health, I am frequently asked how to switch in children for many years for treatment of insomnia, patients from clonidine immediate-release (IR) to guanfa- ADHD, and disruptive behaviour disorders (Hunt, Capper cine extended-release (XR). This therapeutic switch may be & O’Connell, 1990; Rubinstein; Jaselskis, Cook, Fletcher required when poor adherence to a clonidine IR regimen & Leventhal, 1992; Silver & Licamele, 1994; Palumbo et (typically requiring 3–4 doses daily) is identified, when al., 2008; Efron, Lycett & Sciberras, 2014). A clonidine XR clonidine dose-optimization is limited by sedation, brady- formulation is not available in Canada, but is available in cardia or hypotension, or when coverage situations change. the United States for treatment of ADHD (Concordia Phar- The latter may occur if, for example, new eligibility for a maceuticals, Inc. 2015). government program or a third party-payer occurs. Weight-based dosing guidelines exist for clonidine IR Guanfacine XR, a selective alpha2A agonist, was first mar- (0.003–0.008 mg/kg/day) and guanfacine XR (0.05–0.08 keted in Canada in late 2013 for the treatment of attention mg/kg/day) (Shire Pharma Canada ULC, 2019; Elbe et deficit hyperactivity disorder (ADHD) in children and ado- al., 2018). Based on these guidelines and other literature, lescents (Shire Pharma Canada ULC, 2019). -
Advances in Opioid Antagonist Treatment for Opioid Addiction
Advances in Opioid Antagonist Treatment for Opioid Addiction a, a b Walter Ling, MD *, Larissa Mooney, MD , Li-Tzy Wu, ScD KEYWORDS • Addiction treatment • Depot naltrexone • Opioid dependence • Relapse KEY POINTS • The major problem with oral naltrexone is noncompliance. Administration of naltrexone as an intramuscular injection may be less onerous and improve compliance because it occurs only once a month (ie, extended-release depot naltrexone). • To initiate treatment with extended-release depot naltrexone, steps should be taken to ensure that the patient is sufficiently free from physical dependence on opioids (eg, detoxification). • Research on naltrexone in combination with other medications suggests many opportu- nities for studying mixed receptor activities in the treatment of opioid and other drug addictions. PERSPECTIVE ON OPIOID ANTAGONIST TREATMENT FOR ADDICTION Naltrexone, an opioid antagonist derived from the analgesic oxymorphone, was synthesized as EN-1639A by Blumberg and colleagues in 1967. Four years later, in 1971, naltrexone was selected for high-priority development as a treatment for opioid addiction by the Special Action Office for Drug Abuse Prevention, an office created by President Nixon and put under the leadership of Dr Jerome Jaffe. Extinction Model The rationale for the antagonist approach to treating opioid addiction had been advanced by Dr Abraham Wikler a decade earlier, based largely on the extinction model explored in animal behavioral studies. It was believed that by blocking the euphorogenic effects of opioids at the opioid receptors, opiate use would become Disclosures: Dr Ling has served as a consultant to Reckitt Benckiser Pharmaceuticals and to Alkermes, Inc. Dr Mooney and Dr Wu report no relationships with commercial companies with any interest in the article’s subject matters. -
Flashbacks and HPPD: a Clinical-Oriented Concise Review
Isr J Psychiatry Relat Sci - Vol. 51 - No 4 (2014) Flashbacks and HPPD: A Clinical-oriented Concise Review Arturo G. Lerner, MD,1-2 Dmitri Rudinski, MD,1 Oren Bor, MD,1 and Craig Goodman, PhD1 1 Lev Hasharon Mental Health Medical Center, Pardessya, Israel 2 Sackler School Of Medicine, Tel Aviv University, Ramat Aviv, Israel INTRODUCTION ABSTRACT Hallucinogens encompass a group of naturally occurring A unique characteristic of LSD, LSD-like and substances and synthetic substances (1) which may trigger a transient with hallucinogenic properties is the recurrence of some and generally reversible state of intoxication characterized or all the hallucinogenic symptoms which had appeared by perceptual disturbances primarily visual in nature, often during the intoxication after the immediate effects of the referred to as “trips” (2, 3). A unique characteristic of LSD substance had worn off. This recurring syndrome, mainly (lysergic acid diethylamide) and LSD-like substances is the visual, is not clearly understood. The terms Flashback total or partial recurrence of perceptual disturbances which and Hallucinogen Persisting Perception Disorder (HPPD) appeared during previous intoxication and reappeared in have been used interchangeably in the professional the absence of voluntarily or involuntarily recent use (1-3). literature. We have observed at least two different This syndrome is still poorly understood (2, 3). LSD is the recurrent syndromes, the first Flashback Type we refer prototype of synthetic hallucinogenic substances and it is to as HPPD I, a generally short-term, non-distressing, probably the most investigated hallucinogen associated benign and reversible state accompanied by a pleasant with the etiology of this condition. -
Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes–Beyond Benzodiazepines
Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes–Beyond Benzodiazepines José R. Maldonado, MD KEYWORDS Alcohol withdrawal Withdrawal prophylaxis Benzodiazepines Anticonvulsant agents Alpha-2 agonists Delirium tremens KEY POINTS Ethanol affects multiple cellular targets and neural networks; and abrupt cessation results in generalized brain hyper excitability, due to unchecked excitation and impaired inhibition. In medically ill, hospitalized subjects, most AWS cases (80%) are relatively mild and un- complicated, requiring only symptomatic management. The incidence of complicated AWS among patients admitted to medical or critical care units, severe enough to require pharmacologic treatment, is between 5% and 20%. Despite their proven usefulness in the management of complicated AWS, the use of BZDP is fraught with potential complications. A systematic literature review revealed that there are pharmacologic alternatives, which are safe and effective in the management of all phases of complicated AWS. BACKGROUND Alcohol use disorders (AUDs) are maladaptive patterns of alcohol consumption mani- fested by symptoms leading to clinically significant impairment or distress.1 Ethanol is the second most commonly abused psychoactive substance (second to caffeine) and AUD is the most serious drug abuse problem in the United States2 and worldwide.3 The lifetime prevalences of Diagnostic and Statistical Manual of Mental Disorders,4thedi- tion, alcohol abuse and dependence were 17.8% and 12.5%, respectively; the total life- time prevalence for any AUD was 30.3%.4 Alcohol consumption-related problems are the Psychosomatic Medicine Service, Emergency Psychiatry Service, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Suite 2317, Stan- ford, CA 94305-5718, USA E-mail address: [email protected] Crit Care Clin 33 (2017) 559–599 http://dx.doi.org/10.1016/j.ccc.2017.03.012 criticalcare.theclinics.com 0749-0704/17/ª 2017 Elsevier Inc. -
Memory Deficits Associated with Clonidine
Letter to the Editor Letters to the Editor are invited for comment on a topic of current interest or on Table material published in GENERAL HOSPITAL PSYCHIATRY. Letters should be typed doubled spaced and are subject to editing according to space limitations. - Memory Deficits Associated with Attent KnO Clonidine WA Verbal WA Drugs used in the treatment of essential hyperten- Initiation of clonidine therapy (0.1 mg b.i.d.) in WA sion are among the most commonly prescribed. April 1984 resulted in well-controlled hypertension Tactilc Some of these agents have primary effects on neu- without immediately apparent adverse effects. Fulc rotransmitter systems and are centrally active. However, the coincidence of the onset of memory Verba Thus, drugs such as a-methyldopa, propranalol, complaints and the beginning of clonidine treat- 3% ment suggested that clonidine might be respon- List Ll and reserpine have well-established neuropsychia- Fulc tric complications, ranging from depression to cog- sible. si nitive impairments and psychosis [l].Since the use After consultation with the patient's internist, a R of these drugs is widespread and unavoidable, we switch was made to captopril, an angiotensin-con- T must be alert to the possibility that these drugs verting enzyme inhibitor. Before the change we T administered tests of attention, concentration, and contribute to psychologic complaints and symp- -R toms of our patients. verbal skills as well as the Fuld Object-Memory Evaluation, which includes a measure of verbal 'Age-a Clonidine, a presynaptic adrenergic a2agonist, bNonc has become well established as a useful and rela- fluency as well as a selective reminding list learning tively safe therapeutic agent. -
ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update
The ASAM NATIONAL The ASAM National Practice Guideline 2020 Focused Update Guideline 2020 Focused National Practice The ASAM PRACTICE GUIDELINE For the Treatment of Opioid Use Disorder 2020 Focused Update Adopted by the ASAM Board of Directors December 18, 2019. © Copyright 2020. American Society of Addiction Medicine, Inc. All rights reserved. Permission to make digital or hard copies of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for commercial, advertising or promotional purposes, and that copies bear this notice and the full citation on the fi rst page. Republication, systematic reproduction, posting in electronic form on servers, redistribution to lists, or other uses of this material, require prior specifi c written permission or license from the Society. American Society of Addiction Medicine 11400 Rockville Pike, Suite 200 Rockville, MD 20852 Phone: (301) 656-3920 Fax (301) 656-3815 E-mail: [email protected] www.asam.org CLINICAL PRACTICE GUIDELINE The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update 2020 Focused Update Guideline Committee members Kyle Kampman, MD, Chair (alpha order): Daniel Langleben, MD Chinazo Cunningham, MD, MS, FASAM Ben Nordstrom, MD, PhD Mark J. Edlund, MD, PhD David Oslin, MD Marc Fishman, MD, DFASAM George Woody, MD Adam J. Gordon, MD, MPH, FACP, DFASAM Tricia Wright, MD, MS Hendre´e E. Jones, PhD Stephen Wyatt, DO Kyle M. Kampman, MD, FASAM, Chair 2015 ASAM Quality Improvement Council (alpha order): Daniel Langleben, MD John Femino, MD, FASAM Marjorie Meyer, MD Margaret Jarvis, MD, FASAM, Chair Sandra Springer, MD, FASAM Margaret Kotz, DO, FASAM George Woody, MD Sandrine Pirard, MD, MPH, PhD Tricia E. -
Sleep & Dreams & Dsm-5
PAL Conference - Green River, WY - May 2015 SLEEP & DREAMS & DSM-5: ASSESSMENT AND TREATMENT OF PEDIATRIC INSOMNIA James Peacey, MD PAL Conference Green River, WY Disclosure Statement No relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity. I will reference off-label or investigational use of medications in this presentation. PAL Conference - Green River, WY - May 2015 Goals and Objectives Learn how to identify and categorize pediatric insomnia. Increase knowledge of common behavioral and pharmacologic sleep treatments. Increase understanding of sleep issues in particular patient populations (Autism, ADHD, depression and anxiety) and appropriate strategies to optimize treatment. PAL Conference - Green River, WY - May 2015 Sleep Stage Development PAL Conference - Green River, WY - May 2015 Homeostatic and Circadian Processes D. J. Dijk and D. M. Edgar, Regulation of Sleep and Wakefulness, 1999 PAL Conference - Green River, WY - May 2015 Homeostatic and Circadian Processes PAL Conference - Green River, WY - May 2015 Alerting Systems PAL Conference - Green River, WY - May 2015 Normal Sleep Requirements Babcock, Pediatr Clin N Am 58 (2011) 543–554PAL Conference - Green River, WY - May 2015 Percentiles for total sleep duration per 24 hours from infancy to adolescence. Iglowstein I et al. Pediatrics 2003;111:302-307 PAL Conference - Green River, WY - May 2015 ©2003 by American Academy of Pediatrics Insomnia “significant difficulty initiating -
Myrtle Beach, SC May 24, 2019 New Drug Update 2019* *Presentation
New Drug Update 2019* *Presentation by Daniel A. Hussar, Ph.D. Dean Emeritus and Remington Professor Emeritus Philadelphia College of Pharmacy University of the Sciences Objectives: After attending this program, the participant will be able to: 1. Identify the new therapeutic agents and explain their appropriate use. 2. Identify the indications and mechanisms of action of the new drugs. 3. Identify the most important adverse events and other risks of the new drugs. 4. State the route of administration for each new drug and the most important considerations regarding dosage and administration. 5. Compare the new therapeutic agents with older medications to which they are most similar in properties and/or use, and identify the most important advantages and disadvantages of the new drugs. New Drug Comparison Rating (NDCR) system 5 = important advance 4 = significant advantage(s) (e.g., with respect to use/effectiveness, safety, administration) 3 = no or minor advantage(s)/disadvantage(s) 2 = significant disadvantage(s) (e.g., with respect to use/effectiveness, safety, administration) 1 = important disadvantage(s) Additional information The Pharmacist Activist monthly newsletter: www.pharmacistactivist.com Myrtle Beach, SC May 24, 2019 Erenumab-aooe (Aimovig – Amgen; Novartis) Agent for Migraine 2018 New Drug Comparison Rating (NDCR) = Indication: Administered subcutaneously for the preventive treatment of migraine in adults Comparable drugs: Beta-adrenergic blocking agents (e.g., propranolol); (fremanezumab [Ajovy] and galcanezumab [Emgality] -
Pharmacological Approach to Sleep Disturbances in Autism Spectrum Disorders with Psychiatric Comorbidities: a Literature Review
medical sciences Review Pharmacological Approach to Sleep Disturbances in Autism Spectrum Disorders with Psychiatric Comorbidities: A Literature Review Sachin Relia 1,* and Vijayabharathi Ekambaram 2,* 1 Department of Psychiatry, University of Tennessee Health Sciences Center, 920, Madison Avenue, Suite 200, Memphis, TN 38105, USA 2 Department of Psychiatry, University of Oklahoma Health Sciences Center, 920, Stanton L Young Blvd, Oklahoma City, OK 73104, USA * Correspondence: [email protected] (S.R.); [email protected] (V.E.); Tel.: +1-901-448-4266 (S.R.); +1-405-271-5251 (V.E.); Fax: +1-901-297-6337 (S.R.); +1-405-271-3808 (V.E.) Received: 15 August 2018; Accepted: 17 October 2018; Published: 25 October 2018 Abstract: Autism is a developmental disability that can cause significant emotional, social and behavioral dysfunction. Sleep disorders co-occur in approximately half of the patients with autism spectrum disorder (ASD). Sleep problems in individuals with ASD have also been associated with poor social interaction, increased stereotypy, problems in communication, and overall autistic behavior. Behavioral interventions are considered a primary modality of treatment. There is limited evidence for psychopharmacological treatments in autism; however, these are frequently prescribed. Melatonin, antipsychotics, antidepressants, and α agonists have generally been used with melatonin, having a relatively large body of evidence. Further research and information are needed to guide and individualize treatment for this population group. Keywords: autism spectrum disorder; sleep disorders in ASD; medications for sleep disorders in ASD; comorbidities in ASD 1. Introduction Autism is a developmental disability that can cause significant emotional, social, and behavioral dysfunction. According to the Diagnostic and Statistical Manual (DSM-V) classification [1], autism spectrum disorder (ASD) is characterized by persistent deficits in domains of social communication, social interaction, restricted and repetitive patterns of behavior, interests, or activities. -
Data Sheet SURMONTIL Trimipramine (As Maleate) 25 Mg Tablets and 50 Mg Capsules
Data Sheet SURMONTIL trimipramine (as maleate) 25 mg tablets and 50 mg capsules Presentation SURMONTIL tablets are compression coated, white or cream, circular, biconvex, containing the equivalent of 25mg trimipramine (as maleate) with a diameter of about 8.0mm. The face is indented with the name and strength, reverse plain. SURMONTIL capsules are opaque white with opaque green cap, printed SU50, each containing the equivalent of 50mg trimipramine (as maleate). Uses Actions SURMONTIL has a potent anti-depressant action similar to that of other tricyclic anti-depressants. The mechanism of action is not fully understood but it is thought to be via inhibition of neuronal re- uptake of noradrenalin, thereby increasing availability. SURMONTIL also possesses a pronounced sedative action. Pharmacokinetics SURMONTIL is readily absorbed after oral administration, reaching a mean peak plasma level after 3 hours. High first pass hepatic clearance results in a mean bioavailability of about 41% of the oral dose, and trimipramine is extensively protein bound in plasma. Elimination half-life is 24 hours. Metabolism is in the liver to its major metabolite, desmethyltrimipramine, which is excreted mainly in the urine. Indications SURMONTIL is indicated in the treatment of depressive illness, especially where sleep disturbance, anxiety or agitation is a presenting symptom. Sleep disturbance is controlled within 24 hours and true anti-depressant action follows within 7-10 days. Dosage and Administration Adults Mild/Moderate Depression in General Practice: The recommended dosage is 50-75 mg orally given two hours before bedtime, the larger dose (75 mg) being preferable for those patients with more marked sleep disturbance. -
Effects of Sympathetic Inhibition on Receptive, Proceptive, and Rejection Behaviors in the Female Rat
Physiology & Behavior, Vol. 59, No. 3, pp. 537-542, 1996 Copyright © 1996 Elsevier Science Inc. Printed in the USA. All rights reserved 0031-9384/96 $15.00 + .00 ELSEVIER 0031-9384(95)02102-2 Effects of Sympathetic Inhibition on Receptive, Proceptive, and Rejection Behaviors in the Female Rat CINDY M. MESTON, 1 INGRID V. MOE AND BORIS B. GORZALKA Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4 Received 27 September 1994 MESTON, C. M., I. V. MOE AND B. B. GORZALKA. Effects of sympathetic inhibition on receptive, proceptive, and rejection behaviors in the female rat. PHYSIOL BEHAV 59(3) 537-542, 1996.--The present investigation was designed to examine the effects of sympathetic nervous system (SNS) inhibition on sexual behavior in ovariec- tomized, steroid-treated female rats. Clonidine, an alpha2-adrenergic agonist, guanethidine, a postganglionic noradren- ergic blocker, and naphazoline, an alpha2-adrenoreceptor agonist were used to inhibit SNS activity. Intraperitoneal injections of eit:aer 33/zg/ml or 66/xg/ml clonidine significantly decreased receptive (lordosis) and proceptive (ear wiggles) behaviors and significantly increased rejection behaviors (vocalization, kicking, boxing). Either 25 mg/ml or 50 mg/ml guanethidine significantly decreased receptive and proceptive behavior and had no significant effect on rejection behav!iors. Naphazoline significantly inhibited lordosis behavior at either 5 mg/ml or 10 mg/ml doses, significantly inhibited proceptive behavior at 5 mg/ml, and had no significant effect on rejection behaviors. These findings supporc the hypothesis that SNS inhibition decreases sexual activity in the female rat. Lordosis Proceptive behavior Rejection behavior Clonidine Guanethidine Naphazoline Alpha-adrenergic INTRODUCTION as 2 /xg/animal also inhibits lordosis behavior (1).