Maurice W Dysken

A review of GHRH stimulation test in psychiatry

We critically reviewed controlled investigations of the growth hormone releasing hormone (GHRH) stimulation test in depression, anorexia nervosa, bulimia, panic disorder, schizophrenia, and Alzheimers disease. Comparisons of GH responsiveness between patients and controls within each diagnostic category were equivocal and in some cases contradictory. Factors that may contribute substantially to the inconsistent findings within diagnostic categories include (1) the variability of GHRH-simulated GH among control groups; (2) the lack of uniformity in test procedures and outcome measures; and (3) the age and gender of subjects. In addition, the individual reproducibility of the GHRH stimulation test has not been adequately investigated and until the tests stability within subjects can be determined, the validity of interpretations resulting from the GHRH simulation test are in question.

Intrasubject reproducibility of growth hormone-releasing hormone-stimulated growth hormone in older women, older men, and younger men

Intrasubject reproducibility of growth hormone (GH) response to growth hormone-releasing hormone (GHRH) was studied in healthy older women (n = 9), older men (n = 8), and younger men (n = 10). Subjects received IV injections of 0.1 ml/kg saline, 1 micrograms/kg GHRH, and 2 micrograms/kg GHRH, three times each, and blood was sampled at 0, 15, 30, 45, 60, and 120 min for GH concentration. There was no significant difference in peak GH response between the 1- and 2-micrograms/kg GHRH dosages. GH responsiveness, group variance of peak GH, and intrasubject variability were greatest for younger men, less for older men, and least for older women at both dosages of GHRH. Because of the large intrasubject variability observed in this study, it appears necessary to test subjects more than once to obtain a valid characterization of GH responsiveness.

Haloperidol Concentrations in Patients With Alzheimer's Dementia

To investigate the relationship between clinical response and haloperidol blood concentrations in Alzheimers dementia (AD) patients with behavior problems, 29 AD inpatients were assigned to a fixed oral dosage of haloperidol (0.5 mg, 1.0 mg, or 2.0 mg) every 12 hours for 3 weeks. BEHAVE-AD ratings and concentrations of plasma and RBC haloperidol and reduced haloperidol were obtained on Days 8, 15, and 22. Although no significant linear or curvilinear relationships were apparent between percent of change on BEHAVE-AD and plasma or RBC haloperidol concentrations, a good response (change ≥ 30%) was observed in 55% of the patients who entered the study.

Haloperidol and reduced haloperidol in saliva and blood

A total of 18 outpatients (17 male, 1 female) ranging in age from 36-66 years old were on a constant dosage of haloperidol in equally divided doses at 9:00 a.m. and 9:00 p.m. for at least 1 month. DSM-III-R diagnoses included schizophrenia (N = 9), schizoaffective disorder (N = 3), bipolar disorder (N = 4), organic mental disorder (N = 1), and delusional disorder (N = 1). Blood samples for steady-state concentrations of plasma and red blood cell haloperidol (H) and reduced haloperidol (RH) were drawn at 9:00 a.m. (12 hr trough). The haloperidol dosage was held at 9:00 a.m. until samples of whole saliva and parotid saliva could be collected for flow rates and concentrations of H and RH. Haloperidol dosages ranged from 1 mg/day to 60 mg/day (mean 11 +/- 15). Correlation coefficients were calculated for saliva concentrations versus blood levels and for saliva secretion rates versus blood levels. The correlations between whole saliva measures and blood concentrations were all higher than the correlations between parotid saliva measures and blood concentrations. In one case the higher correlation reached statistical significance. There was only one case in which substitution of saliva secretion rate improved the correlation between measures with saliva concentration. Our findings suggest that saliva measures of H and RH are useful alternatives to plasma concentrations in monitoring maintenance haloperidol treatment.