Louis A. Pagliaro

Critical compilation of terminal half-lives, percent excreted unchanged, and changes of half-life in renal and hepatic dysfunction for studies in humans with references

Terminal half-lives, percent excreted unchanged, and reported changes in half-life associated with decreased renal and hepatic functions are tabulated for 186 drugs studied in humans. References from 332 original articles are keyed to each pharmacokinetic value. When given in the original article, range of values found and number of subjects studied are listed with each value. All references were critically evaluated by the authors before values were included in the tabulation.

A standard approach to compiling clinical pharmacokinetic data

A standard format for a Clinical Pharmacokinetic Summary is proposed. It consists of a heading, table, notes, and references for each drug reviewed. The table presents a unified and logical set of clinically useful population pharmacokinetic parameters. They concern four major areas: absorption, distribution, elimination, and the relationship of concentration to effect. Within each major group, parameters dealing with extents and rates of processes are given. Each such parameter is really two: a population mean value (for example, average volume of distribution) and the standard deviation of individual values about this mean. The first value allows individual predictions of dosage or drug level to be made; the second allows computation of the likely proximity of subsequently observed quantities to those predictions. The table presents single consensus values for each population parameter, rather than a list of values. A procedure for computing these consensus values, and for revising them in the light of new data, or reinterpreted old data, is given. Examples of Summaries are given. The method appears applicable to a variety of drugs. We suggest our approach as a standard one for preparing Clinical Pharmacokinetic Summaries, and urge our colleagues to consider it for that purpose.

Adolescent Depression and Suicide: A Review and Analysis of the Current Literature:

Adolescent suicide is a major worldwide problem. Reported rates for suicide ideation, attempts, and completion are particularly high in developed countries. For Canada, the suicide rate for adolescents consistently has been among the highest of those rates reported. Despite significant gouvernment attempts at intervention and public atigst when confronted with specific tragic examples of adolescent suicide, the rate does not appear to be significantly decreasing. This article reviews the nature and extent of suicide among Canadian adolescents. It also provides a brief overview of current assessment and treatment perspectives. With this information, school teachers, counsellors, and psychologists may be better informed regarding the significant problem of adolescent suicide in Canada and hence better prepared to recognize adolescents at high risk of suicide and to appropriately intervene.

Abuse Potential of Antidepressants

SummaryA review of the published literature over the past 30 years provides evidence that antidepressants are rarely associated with substance abuse and substance dependence as described by DSM-IV criteria.Reported data do not support the designation of antidepressants as substances of abuse or their general regulation by control acts or schedules. However, the data do support the recommendation that they be used with caution among people who have concurrent substance use disorders or personality disorders (e.g. antisocial personality disorder), who have a high proclivity toward substance abuse or dependence.As with other drugs, all people who use antidepressants require appropriate information regarding the associated risks and benefits of their drug therapy, and instruction regarding correct therapeutic use. They should also be monitored to ensure optimal therapeutic benefit with minimal adverse drug effects.

A psychoeducational model of counseling

This paper reviews the salient features of the Mega Interactive Model of Instruction (MIMI) MIMI has been proposed as the basis for a conceptual framework with which to study and interpret instructional/counseling interactions. The relevance of this model for instructional and counseling research are discussed.

The Phenomenon of Abusable Psychotropic Use Among North American Youth

Abusable psychotropic use can, and does, affect all North American youth, either directly or indirectly, regardless of age, gender, culture, ethnic background, education, race, or socioeconomic status. Over the last decade, the morbidity and mortality associated with abusable psychotropic use among youth have become staggering. A current overview of the phenomenon of abusable psychotropic use among youth in North America, including the use of alcohol, cannabis, cocaine, LSD, nicotine, and polyabusable psychotropic use, is presented with attention to the expanding role of clinical pharmacologists in relation to both prevention and treatment. The Mega Interactive Model of Abusable Psychotropic Use Among Youth is presented as a heuristic device to assist clinical pharmacologists, and other health care providers, in addressing the multifactorial interactive aspects of this complex phenomenon as observed in the pediatric age group. In this regard, attention is given to the interaction of the Abusable Psychotropic Dimension, including the Abusable Psychotropic Variables (e.g., pharmacokinetics, abuse potential) and Pattern of Use Variables (e.g., social use, abuse, compulsive use), with the Young Person, Societal, and Time Dimensions.

The Phenomenon of Substance Abuse among the Elderly: Part I

Because substance abuse, already a major problem among elderly people, is expected to worsen significantly during the 1990s, healthcare providers must be better prepared to identify and deal effectively with this important area of geriatric care. We present an overview of the phenomenon of substance abuse among the elderly with particular attention to the abuse of alcohol and benzodiazepines, the two substances most commonly abused by elderly people. Traditionally, substance abuse among the elderly has gone largely unrecognized because of a low level of suspicion, misdiagnosis, and concealment. It is axiomatic that problems cannot be solved unless they are first identified and appropriately characterized. To respond to the increasing problem of substance abuse among the elderly, healthcare providers must recognize that elderly people are at particular risk for substance abuse, and because of their heterogeneity, they require individualized and diverse prevention and treatment approaches. Once the abuse is identified and properly characterized, specific prevention and treatment strategies can be developed and implemented.

The Phenomenon of Substance Abuse among the Elderly: Part II: The Mega-Interactive Model

Substance abuse, a major problem a m o n g elderly people , is expec ted to significantly w o r s e n dur ing the 1990s . Thus , hea l thcare prov iders m u s t be better p r e p a r e d to identify and effectively deal with this important area of geriatric care . A n o v e r v i e w of the p h e n o m e n o n of substance abuse a m o n g the elderly w a s presented in Par t I o f this article, wi th a part icular focus on the abuse of alcohol and benzodiazepines , the t w o substances m o s t c o m m o n l y abused b y elderly people . P a r t II presents the Mega-Interact ive Model of Substance A b u s e A m o n g the Elderly ( M I M S A E ) as a f r a m e w o r k for heal thcare prov iders in an effort to assist them to better identify, unders tand, a n d effectively respond to the c o m p l e x a n d g r o w i n g prob lem of substance abuse a m o n g elderly people. By focusing attention on the four interrelated dimensions of this mode l (i.e., e lderly person dimension, substance of abuse d imens ion, societal d imension, a n d t ime dimension) , M I M S A E prov ides heal thcare prov iders wi th a unique and c o m p r e h e n s i v e f r a m e w o r k for effectively deal ing wi th the p h e n o m e n o n of substance abuse in their clinical pract ice and research.