Faculty Bibliography

To evaluate anticholinergic effects on cognition and other functions, we studied 60 healthy volunteers in a double-blind crossover trial of two antiparkinsonian agents, benztropine and amantadine. Benztropine 4 mg/day, but not amantadine 200 mg/day, impaired free recall and perception of time, and subjects' perception of their own memory impairment was significantly greater with benztropine. Side effects in general were worse with benztropine, particularly such anticholinergic effects as dry mouth and blurred vision, and benztropine decreased measured salivary flow to a significantly greater degree than amantadine. Our findings support the hypothesis that drugs that decrease cholinergic transmission impair storage of new information into long-term memory, but have little effect on retrieval from memory or on tasks involving only immediate memory. Clinically, anticholinergic agents can levy a considerable burden on memory and time perception

Fourteen patients with bulimia were treated with group psychotherapy and with strategic use of antidepressants and individual psychotherapy as needed. The 12 who achieved sustained remission required an average of 21 months of treatment. Patients with both an axis I and an axis II diagnosis did less well and required longer treatment than those who met criteria for bulimia only. Bulimic symptoms varied substantially with time, so that a definition of remission requiring that a patient be symptom-free for 6 months was more accurate than acute outcome data. Patients with comorbid affective disorders, personality disorders, and bulimia had the poorest prognosis

Eleven consecutive severe cocaine abusers were treated openly with maprotiline. Nine completed a 7-week trial, and eight maintained abstinence for at least 1 month as outpatients. Treatment compliance and response appeared better than for a similar group of subjects treated without antidepressants

Rebound--the relative worsening of symptoms on discontinuation of treatment as compared to baseline symptoms--is distinguished from withdrawal. Case reports and a clinical study are presented to illustrate the management of patients with panic disorder who are taking short- and intermediate-acting benzodiazepines and are experiencing rebound anxiety. The authors present the results of switching over to clonazepam 48 patients with panic disorder who were experiencing rebound effects with alprazolam. Eighty-two percent (39) of the patients rated clonazepam as being 'better' than alprazolam due to decreased dosing frequency and lack of interdose anxiety. The authors conclude that clonazepam can be a useful alternative to alprazolam and other short-acting benzodiazepines in the treatment of anxiety disorders. Clonazepam offers the advantage of antipanic efficacy without the relative side effect problems seen with tricyclic antidepressants and monoamine oxidase inhibitors