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January 1978, Vol 35, No. 1 >
Article | January 1978

Physostigmine in Mania

Kenneth L. Davis, MD; Philip A. Berger, MD; Leo E. Hollister, MD; Emanuel Defraites, MD
[+] Author Affiliations

Accepted for publication July 25, 1977.

Reprint requests to Veterans Administration Hospital, 3801 Miranda Ave, Palo Alto, CA 94304 (Dr Davis).


Arch Gen Psychiatry. 1978;35(1):119-122. doi:10.1001/archpsyc.1978.01770250121012
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• Seven men and one woman with primary affective disorder, mania, were given a slow intravenous infusion of physostigmine salicylate. In six patients, mood and thought content changed from mania toward depression as evaluated by either a visual analog mood scale or the Pettersen scale. Two other patients, who were the only predominantly irritable manics in the study, demonstrated little change in their hostility, although one became somewhat depressed. These findings are consistent with earlier reports of suppression of manic symptoms after physostigmine infusion in some but not all patients with mania. The pharmacologic mechanism of physostigmine reversal of manic symptoms may be the direct result of increased cholinergic activity or a result of the effect of increased cholinergic activity on other brain neurotransmitters.

REFERENCES

1 +
Gershon L, Shaw FH:  Psychiatric sequelae of chronic exposure to organophosphorous insecticides . Lancet 1:1371-1374, 1961;.
2 +
Bowers MB, Goodman E, Sim VM:  Some behavioral changes in man following anticholinesterase administration . J Nerv Ment Dis 138:383-389, 1964;.
3 +
Davis KL, Hollister LE, Overall J, et al:  Physostigmine: Effects on cognition and affect in normal subjects . Psychopharmacologia 51:23-27, 1976;.
4 +
Janowsky DS, El-Yousef MK, Davis JM:  Parasympathetic suppression of manic symptoms by physostigmine . Arch Gen Psychiatry 28:542-547, 1973;.
5 +
Carroll BJ, Frazer A, Schless A, et al:  Cholinergic reversal of manic symptoms . Lancet 1:427-428, 1973;.
6 +
Feighner JP, Robins R, Guze SB, et al:  Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 26:57-63, 1972;.
7 +
Pettersen U, Fyro B, Sedvall G:  A new scale for the longitudinal rating of manic states . Acta Psychiatr Scand 49:248-256, 1973;.
8 +
Rountree DW, Nevin S, Wilson A:  The effects of diisopropyl fluorophosphonate in schizophrenia and manic depressive psychosis . J Neurol Neurosurg Psychiatry 13:47-59, 1950;.
9 +
Westerink BHC, Korf J:  Influence of drugs on striatal and limbic homovanillic acid concentration in the rat brain . Eur J Pharmacol 33:31-40, 1975;.
10 +
Javoy F, Agid Y, Glowinski J:  Oxotremorine and atropine-induced changes of dopamine metabolism in the rat striatum . J Pharm Pharmacol 27:677-681, 1975;.
11 +
Bunney BS, Walters JR, Roth RH, et al:  Dopaminergic neurones: Effect of antipsychotic drugs and amphetamine on single cell activity . J Pharmacol Exp Ther 185:560-571, 1973;.
12 +
Nybaek H, Sedvall G:  Further studies on the accumulation and disappearance of catecholamines formed from 14C-tyrosine in mouse brain: Effect of some phenothiazine analogues . Eur J Pharmacol 10:193-205, 1970;.
13 +
Westfall TC:  Effect of muscarinic agonists on the release of 3Hnorepinephrine and 3H-dopamine by potassium and electrical stimulation from rat brain slices . Life Sci 14:1641-1652, 1974;.
14 +
Davis KL, Hollister LE, Berger PA, et al:  A cholinergic imbalance hypothesis of psychosis and movement disorders: A strategy for evaluation . Psychopharmacol Comm 1:533-544, 1975;.
15 +
Davis KL, Hollister LE, Barchas JD, et al:  Choline in tardive dyskinesia and Huntington's disease . Life Sci 19:1507-1516, 1976;.
16 +
Davis KL, Hollister LE, Tepper J:  Oxotremorine reversal of methylphenidate-induced stereotypy: Comparison to physostigmine . Psychopharmacology , to be published.

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1 +
Gershon L, Shaw FH:  Psychiatric sequelae of chronic exposure to organophosphorous insecticides . Lancet 1:1371-1374, 1961;.
2 +
Bowers MB, Goodman E, Sim VM:  Some behavioral changes in man following anticholinesterase administration . J Nerv Ment Dis 138:383-389, 1964;.
3 +
Davis KL, Hollister LE, Overall J, et al:  Physostigmine: Effects on cognition and affect in normal subjects . Psychopharmacologia 51:23-27, 1976;.
4 +
Janowsky DS, El-Yousef MK, Davis JM:  Parasympathetic suppression of manic symptoms by physostigmine . Arch Gen Psychiatry 28:542-547, 1973;.
5 +
Carroll BJ, Frazer A, Schless A, et al:  Cholinergic reversal of manic symptoms . Lancet 1:427-428, 1973;.
6 +
Feighner JP, Robins R, Guze SB, et al:  Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 26:57-63, 1972;.
7 +
Pettersen U, Fyro B, Sedvall G:  A new scale for the longitudinal rating of manic states . Acta Psychiatr Scand 49:248-256, 1973;.
8 +
Rountree DW, Nevin S, Wilson A:  The effects of diisopropyl fluorophosphonate in schizophrenia and manic depressive psychosis . J Neurol Neurosurg Psychiatry 13:47-59, 1950;.
9 +
Westerink BHC, Korf J:  Influence of drugs on striatal and limbic homovanillic acid concentration in the rat brain . Eur J Pharmacol 33:31-40, 1975;.
10 +
Javoy F, Agid Y, Glowinski J:  Oxotremorine and atropine-induced changes of dopamine metabolism in the rat striatum . J Pharm Pharmacol 27:677-681, 1975;.
11 +
Bunney BS, Walters JR, Roth RH, et al:  Dopaminergic neurones: Effect of antipsychotic drugs and amphetamine on single cell activity . J Pharmacol Exp Ther 185:560-571, 1973;.
12 +
Nybaek H, Sedvall G:  Further studies on the accumulation and disappearance of catecholamines formed from 14C-tyrosine in mouse brain: Effect of some phenothiazine analogues . Eur J Pharmacol 10:193-205, 1970;.
13 +
Westfall TC:  Effect of muscarinic agonists on the release of 3Hnorepinephrine and 3H-dopamine by potassium and electrical stimulation from rat brain slices . Life Sci 14:1641-1652, 1974;.
14 +
Davis KL, Hollister LE, Berger PA, et al:  A cholinergic imbalance hypothesis of psychosis and movement disorders: A strategy for evaluation . Psychopharmacol Comm 1:533-544, 1975;.
15 +
Davis KL, Hollister LE, Barchas JD, et al:  Choline in tardive dyskinesia and Huntington's disease . Life Sci 19:1507-1516, 1976;.
16 +
Davis KL, Hollister LE, Tepper J:  Oxotremorine reversal of methylphenidate-induced stereotypy: Comparison to physostigmine . Psychopharmacology , to be published.

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