Fluvoxamine/pimozide treatment of concurrent Tourette's and obsessive-compulsive disorder

Article Abstract:

Almost half of all patients diagnosed with chronic multiple tics or Tourette's syndrome (TS), also have obsessive compulsive disorder (OCD). Because neuroleptic (antipsychotic) drugs such as pimozide (which blocks the effects of dopamine) work well to reduce tics in patients with TS, it is assumed that TS is related to a dysfunction of brain dopamine systems. The case report of a 25-year-old man with a history of simple phonic (e.g., coughing, grunting and barking), simple motor (e.g., blinking), and complex motor (e.g., hitting face) tics is presented. He began having increasingly severe obsessions, and agreed to participate in a double-blind experiment comparing two treatments for OCD. After eight weeks of medication, both his OCD and TS became worse, and he began to exhibit coprolalia (babbling in foul language). His participation in the study ended, and it was determined that he had been receiving fluvoxamine (which inhibits the reuptake of serotonin at the post-synaptic level, keeping higher levels of serotonin active). Fluvoxamine was continued, but with the addition of pimozide. Over the next month, both OCD and TS diminished dramatically. Following this, a double-blind sequential discontinuation of fluvoxamine, then pimozide was carried out. During fluvoxamine discontinuation, OCD symptoms increased, but TS tics did not worsen. When both drugs were discontinued, both the tics and OCD became worse. Although pimozide alone reduced tics, a combination of both drugs was necessary for the improvement of both tics and OCD. Therefore, TS may reflect a subtype of OCD in which symptoms are mediated by an abnormality in both the dopamine and serotonin systems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Physiological aspects, Tourette's syndrome, Tourette syndrome, Obsessive-compulsive disorder, Obsessive compulsive disorder, Monoamine oxidase

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Improving treatment outcome in pregnant opiate-dependent women

Article Abstract:

The outcomes of six pregnant opiate-dependent women enrolled in enhanced methadone maintenance was compared with that of six pregnant women receiving conventional methadone treatment. The enhanced methadone maintenance program was composed of weekly prenatal care, relapse prevention groups, thrice weekly urine screening, positive contingency awards for abstinence and therapeutic child care with conventional teatment, which includes daily methadone, group counseling and random urine toxicology screening. Those with enhanced treatment had heavier infants, more prenatal visits and fewer positive urine toxicology samples.

Research, Methadone maintenance, Drug abuse in pregnancy

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Baclofen-assisted detoxification from opiates

Article Abstract:

The clinical use of racemic baclofen in opiate detoxification is tested on five opiate-dependent patients. The chemical agonist is used as a substitute to methadone and alleviates withdrawal symptoms by acting on the dorsal horn of the spinal cord. Results fail to prove the efficacy or use of baclofen because withdrawal symptoms persisted among the patients despite its administration. Future tests should investigate L-baclofen which may be a more effective agonist than the racemic type of the drug. The suppression of noradrenergic activation by baclofen also warrants further study.

Testing, Substance abuse, Baclofen, Drug withdrawal symptoms, Substance withdrawal syndrome

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