Randolph B. Schiffer

Cleveland Clinic

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Roger C. Sider

Pine Rest Christian Mental Health Services

Robert F. Klein

Oregon Health & Science University

Dhelia Williamson

Centers for Disease Control and Prevention

Robert M. Herndon

University of Mississippi Medical Center

Laurie Wagner

McKing Consulting (United States)

Judy P. Henry

Austin Health & Human Services Department

Andrew Goodman

University of Rochester

Douglas M. Stocco

Texas Tech University Health Sciences Center

Richard A. Rudick

University Hospital of Basel

A. Petrosian

Texas Tech University

Cooperative Institutions

University of Rochester

Texas Tech University

Technical University of Munich

Johannes Gutenberg University Mainz

Texas Tech University Health Sciences Center

Harvard University

University of Rochester Medical Center

Charité - Universitätsmedizin Berlin

Medizinische Hochschule Hannover

Ludwig-Maximilians-Universität München

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Dextromethorphan Plus Ultra Low‐Dose Quinidine Reduces Pseudobulbar Affect

Annals of Neurology (2010)

Erik P. Pioro Benjamin Rix Brooks Jeffrey L. Cummings Randolph B. Schiffer Ronald A. Thisted

Abstract Objective To evaluate dextromethorphan combined with ultra low‐dose quinidine (DMq) for treating pseudobulbar affect (PBA) in patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). Methods In a 12‐week randomized, double‐blind trial, ALS and MS patients with clinically significant PBA (a baseline score ≥13 on the Center for Neurologic Studies–Lability Scale [CNS‐LS]) were maintained, twice daily, on placebo, DMq at 30/10mg (DMq‐30), or DMq at 20/10mg (DMq‐20). Results In 326 randomized patients (of whom 283, or 86.8%, completed the study), the PBA‐episode daily rate was 46.9% ( p < 0.0001) lower for DMq‐30 than for placebo and 49.0% ( p < 0.0001) lower for DMq‐20 than for placebo by longitudinal negative binomial regression, the prespecified primary analysis. Mean CNS‐LS scores decreased by 8.2 points for DMq‐30 and 8.2 for DMq‐20, vs 5.7 for placebo ( p = 0.0002 and p = 0.0113, respectively). Other endpoints showing statistically significant DMq benefit included, for both dosage levels, the likelihood of PBA remission during the final 14 days and, for the higher dosage, improvement on measures of social functioning and mental health. Both dosages were safe and well tolerated. Interpretation DMq markedly reduced PBA frequency and severity, decreasing the condition's detrimental impact on a patient's life, with satisfactory safety and high tolerability. The findings expand the clinical evidence that DMq may be an important treatment for patients suffering from the socially debilitating symptoms of PBA. Ann Neurol 2010

Tolerability

Crossover study

Dose

Affect

10.1002/ana.22093

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Citations (355)

The Dementias: Neuropsychiatric Syndromes of the 21st Century

Randolph B. Schiffer

In the new century, the dementias will probably become 1 of the 2 or 3 dominant behavioral health problems in the United States. This article provides an overview of the major clinical features of these cognitive loss syndromes and emphasizes the perspective of the practicing psychiatrist.

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The Mind and the Body in Clinical Medicine

Contemporary Psychology (1982)

Randolph B. Schiffer

Mind–body problem

10.1037/020761

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Pictorial Manual of Neurologic Tests, 2nd ed.; Alper's and Mancall's Essentials of the Neurological Examination, 2nd ed.; Pathways in Neurological Diagnosis

American Journal of Psychiatry (1982)

Randolph B. Schiffer

Download

Neurological examination

10.1176/ajp.139.4.533

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No association between alpha-2-macroglobulin and Alzheimer disease in Texans

Genetic Epidemiology (2000)

Eugene Drigalenko Shirley E. Poduslo Yangxuan Xin Randolph B. Schiffer

alpha-2-Macroglobulin

Association (psychology)

Alpha (finance)

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Sympathoadrenomedullary hyperactivity in the neuroleptic malignant syndrome: a case report

American Journal of Psychiatry (1981)

John H. Feibel Randolph B. Schiffer

The authors describe a patient with the neuroleptic malignant syndrome whose excessive catecholamine excretion indicates hyperactivity of the sympathoadrenomedullary component of the autonomic nervous system. Their finding provides a physiological basis for using catecholamine blocking agents to treat some patients with this syndrome.

Neuroleptic Malignant Syndrome

10.1176/ajp.138.8.1115

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A Review of Lewy Body Disease, an Emerging Concept of Cortical Dementia

Journal of Neuropsychiatry (1998)

Michelle Papka Ana Rubio Randolph B. Schiffer

Dementia associated with cortical Lewy bodies on neuropathologic examination may comprise the second largest category of age-related cognitive impairment, after Alzheimer's disease. Despite its prevalence, a consensus has not yet been reached regarding the terminology, neuropathologic criteria, or clinical symptomatology of this postulated nosologic entity. Lewy body disease (LBD) is beginning to be diagnosed clinically in neuropsychiatric clinics, but universally accepted diagnostic criteria for LBD remain to be validated. In this article the authors review the literature on LBD, including both neuropathologic and clinical findings.

Lewy body

Lewy body disease

10.1176/jnp.10.3.267

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Citations (69)

Psychiatry and Physical Assessment

Springer eBooks (1988)

Randolph B. Schiffer Robert F. Klein Roger C. Sider

Assessment center

10.1007/978-1-4899-0783-7_2

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Sympathoadrenomedullary hyperactivity in the neuroleptic malignant syndrome: a case report

Journal of Clinical Psychopharmacology (1982)

John H. Feibel Randolph B. Schiffer

Neuroleptic Malignant Syndrome

10.1097/00004714-198202000-00017

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Review of Pseudobulbar Affect Including a Novel and Potential Therapy

Journal of Neuropsychiatry (2005)

Randolph B. Schiffer

Pseudobulbar affect (PBA) is an affective disinhibition syndrome associated with various neuropathologies, which is characterized by involuntary and inappropriate outbursts of laughter and/or crying. The PBA syndrome can be socially and occupationally disabling, and it is largely unrecognized in clinical settings. Validated instruments to distinguish PBA from other disorders of affective regulation exist and could be used to improve recognition of the disorder. There is no pharmacological therapy with a Food and Drug Administration indication for PBA, although antidepressants and dopaminergic agents have been reported to show varying levels of treatment success. Recent evidence suggests that treatment with a fixed combination of dextromethorphan and the cytochrome P450 2D6 enzyme inhibitor, quinidine, can improve PBA. This review describes the clinical and neuropathological features of PBA, and presents an overview of current and future treatment approaches.

Affect

Disinhibition

Pseudobulbar palsy

10.1176/appi.neuropsych.17.4.447

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Citations (39)