A randomized, double-blind, placebo-controlled study of ziprasidone monotherapy in bipolar disorder with co-occurring lifetime panic or generalized anxiety disorder. Randomized, placebo-controlled trial of risperidone for acute treatment of bipolar anxiety. Aripiprazole as augmentation treatment of refractory generalized anxiety disorder and panic disorder. Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS) Lifetime prevalence of specific mental disorders among people born in Iceland in 1931 Efficacy of sertraline in severe generalized social anxiety disorder: results of a double-blind, placebo-controlled study. Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder Personality disorders in the community: a report from the Australian National Survey of Mental Health and Wellbeing The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey. Randomized, placebo-controlled trial of quetiapine XR and divalproex ER monotherapies in the treatment of the anxious bipolar patient. Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study. The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary. Therapeutic effect of adjunctive N-acetyl cysteine (NAC) on symptoms of chronic schizophrenia: A double-blind, randomized clinical trial Adding quetiapine to SRI in treatment-resistant obsessive–compulsive disorder: a randomized controlled treatment study A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis Placebo-controlled trial of atomoxetine for weight reduction in people with schizophrenia treated with clozapine or olanzapine. Effects of the Cannabinoid-1 Receptor Antagonist Rimonabant on Psychiatric Symptoms in Overweight People With Schizophrenia: A Randomized, Double-Blind, Pilot Study Cognitive-behavioral therapy as an adjunct to second-generation antipsychotics in the treatment of schizophrenia. Efficacy and Safety of Risperidone and Quetiapine in Adolescents With Bipolar II Disorder Comorbid With Conduct Disorder The Nottingham Study of Neurotic Disorder: predictors of 12-year outcome of dysthymic, panic and generalized anxiety disorder. L-theanine relieves positive, activation, and anxiety symptoms in patients with schizophrenia and schizoaffective disorder: an 8-week, randomized, double-blind, placebo-controlled, 2-center study. Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophrenia. Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS).
OBJECTIVE Bipolar disorder often co-occurs with anxiety disorders . Evidence suggests that second-generation antipsychotics ( SGAs ) may be useful in treating both conditions . This study examined the efficacy of ziprasidone in the treatment of these disorders . METHOD This 3-site , r and omized , double-blind , placebo-controlled , parallel group , 8-week trial of ziprasidone monotherapy examined 49 subjects with bipolar disorder and lifetime panic disorder ( with or without agoraphobia ) or generalized anxiety disorder ( GAD ) experiencing moderately severe anxiety symptoms at entrance into the study . Both bipolar disorder and anxiety diagnoses were based on DSM-IV-TR criteria . Patients were screened and r and omized from June 25 , 2010 , through August 23 , 2011 . Primary outcome measures were the Clinical Global Impressions-21 Anxiety Scale ( CGI-21 Anxiety ) and the Sheehan Disability Scale ( SDS ) , with secondary measures monitoring anxiety and mood symptoms . RESULTS Last-observation-carried-forward analyses demonstrated that patients in the ziprasidone group did not improve significantly more than those in the placebo group on the CGI-21 Anxiety ( F1 = 0.34 ; P = .564 ) or SDS ( F1 = 0.26 ; P = .611 ) . Secondary analysis using hierarchical linear modeling found similar results ( CGI-21 Anxiety : F1 = 1.82 ; P = .178 ; and SDS : F1 = 0.70 ; P = .408 ) . Regardless of group , time in the study was associated with significant decrease in anxiety ( F1 = 11.08 ; P = .001 ) and total disability ( F1 = 26.16 ; P < .001 ) . Patients in the ziprasidone group showed a greater increase in abnormal involuntary movement , and 81.8 % ( n = 9 ) of the subjects who withdrew from the study due to adverse events , serious adverse events , or side effects were in the ziprasidone group . CONCLUSIONS Results suggest that ziprasidone monotherapy was not associated with a clinical ly significant improvement in anxiety symptoms or improved function for patients with bipolar disorder , lifetime panic disorder or GAD , and concurrent moderately severe anxiety symptoms , and it was associated with a more negative side-effect profile relative to placebo . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01172652 BACKGROUND The treatment of bipolar disorder is often complicated by the presence of a co-occuring anxiety disorder . Although second generation antipsychotics are being used with increasing frequency in bipolar patients , their anxiolytic effects have not been well studied in this population . METHODS The anxiolytic effect of risperidone 0.5 - 4 mg/day was tested in an 8-week , double-blind , placebo-controlled , r and omized clinical trial in 111 patients with bipolar disorder and a co-occuring panic disorder or generalized anxiety disorder ( GAD ) . The primary outcome measure was the Clinician Global Improvement-21 Anxiety scale ( CGI-21 Anxiety ) . Secondary measures included the Hamilton Anxiety Scale ( HAM-A ) and the Sheehan Panic Disorder Scale . RESULTS On the last-observation-carried forward analysis of repeated measures analysis of variance ( ANOVA ) , risperidone was not more effective than placebo for the CGI-21 Anxiety score or the other anxiety outcome measures .  Risperidone was well tolerated , with only two patients withdrawing because of adverse events . LIMITATIONS The  risperidone treated group had more patients with mixed states and lifetime panic disorder at r and omization than the placebo group . The study was limited to 8 weeks and to individuals with bipolar and comorbid panic disorder or GAD . The results may not be applicable to risperidone as an add-on treatment to mood stabilizers , or to bipolar disorder comorbid with anxiety disorders other than panic disorder or GAD . CONCLUSIONS Risperidone monotherapy was not an effective anxiolytic for bipolar patients with comorbid panic disorder or GAD in doses of 0.5 - 4 mg/day over 8 weeks of treatment . The efficacy of other second generation antipsychotics and mood stabilizers on anxiety in patients with bipolar disorder and a co-occuring anxiety disorder should be investigated in double-blind , placebo-controlled studies INTRODUCTION Individuals with anxiety disorders often remain symptomatic despite treatment with a first-line pharmacologic agent . More research examining pharmacotherapy augmentation strategies to improve outcomes is needed . METHODS In an 8-week , open-label , prospect i ve augmentation study , we examined the efficacy and tolerability of the novel antipsychotic agent aripiprazole for adult out patients with generalized anxiety disorder ( n=13 ) or panic disorder ( n=10 ) who remained symptomatic despite treatment for at least 8 weeks with an adequate ( or maximally tolerated ) dose of typical pharmacotherapy . RESULTS Aripiprazole augmentation was associated with a significant reduction in Clinical Global Impressions-Severity scores ( paired t=4.41 , df=22 , P<.001 ) in the intent-to-treat sample of 23 individuals . Three subjects ( 13 % ) discontinued due to sedation , chest discomfort , and restlessness , respectively . CONCLUSION These data provide preliminary evidence that aripiprazole may be a useful augmentation strategy for individuals with generalized anxiety disorder or panic disorder who show a limited response to initial pharmacotherapy Abstract This article reports the initial results of a prospect i ve study on the prevalence of  psychiatric disorders in the Dutch population aged 18–64 . The objectives and the design of the study are described elsewhere in this issue . A total of 7076 people were interviewed in person in 1996 . The presence of the following disorders was determined by means of the CIDI : mood disorders , anxiety disorders , eating disorders , schizophrenia and other non-affective psychoses , and substance use disorders . Psychiatric disorders were found to be quite common . Some 41.2 % of the adult population under 65 had experienced at least one DSM-III-R disorder in their lifetime , among them 23.3 % within the preceding year . No gender differences were found in overall morbidity . Depression , anxiety , and alcohol abuse and dependence were most prevalent , and there was a high degree of comorbidity between them . The prevalence rate encountered for schizophrenia was lower ( 0.4 % lifetime ) than generally presumed . A comparison with findings from other countries is made . Relevant determinants of psychiatric morbidity were analysed The lifetime prevalence rates are presented for mental disorders in a r and om sample of people born in Icel and in 1931 , interviewed at the age of 55–57 years . The diagnoses are made according to DSM‐III , on the basis of the National Institute of Mental Health 's diagnostic Interview Schedule ( NIMH‐DIS ) used by trained lay interviewers . The most common diagnoses were alcohol abuse and dependence , generalized anxiety disorder , phobic disorders , dysthymic disorder and major depressive episode . Disorders more common in men were antisocial personality , alcohol abuse and alcohol dependence . Disorders more common among women were major depressive episode and generalized anxiety disorder . Alcohol abuse was more prevalent among those living in rural areas , but dependence was more prevalent in the urban area , where panic disorder is also more frequent . Widowed , separated and divorced people had most of the highest prevalences : tobacco‐use disorder , alcohol abuse and dependence , dysthymia and generalized anxiety disorder . Except for a very high rate of alcohol abuse and dependence and a low rate of substance abuse disorders , the prevalence rates are similar to those obtained in North American studies using the NIMH‐DIS as a survey instrument . The DSM‐III criteria for alcohol abuse or dependence may be less applicable to Icel and than to North America , because of differences in what is culturally regarded as acceptable use of alcohol BACKGROUND Generalized social anxiety disorder is an early onset , highly chronic , frequently disabling disorder with a lifetime prevalence of approximately 13 % . The goal of the current study was to evaluate the efficacy and tolerability of sertraline for the treatment of severe generalized social anxiety disorder in adults . METHOD After a 1-week single-blind placebo lead-in period , patients with DSM-IV generalized social phobia were r and omly assigned to 12 weeks of double-blind treatment with flexible doses of sertraline ( 50 - 200 mg/day ) or placebo . Primary efficacy outcomes were the mean change in the Liebowitz Social Anxiety Scale ( LSAS ) total score and the responder rate for the Clinical Global Impressions-Improvement scale ( CGI-I ) , defined as a CGI-I score < /= 2 . Data were collected in 2000 and 2001 . RESULTS 211 patients were r and omly assigned to sertraline  ( intent-to-treat [ ITT ] sample , 205 ) , and 204 patients , to placebo  ( ITT sample , 196 ) . At week 12 , sertraline produced a significantly greater reduction in LSAS total score compared with placebo ( mean last-observation-carried-forward [ LOCF ] change from baseline : -31.0 vs. -21.7 ; p = .001 ) and a greater proportion of responders ( CGI-I score < /= 2 : 55.6 % vs. 29 % among week 12 completers and 46.8 % vs. 25.5 % in the ITT-LOCF sample ; p < .001 for both comparisons ) . Sertraline was well tolerated , with 7.6 % of patients discontinuing due to adverse events versus 2.9 % of placebo-treated patients . CONCLUSION The results of the current study confirm the efficacy of sertraline in the treatment of severe social anxiety disorder Tardive dyskinesia ( TD ) is a serious , often disabling , movement disorder that is caused by medications that block dopamine receptors ( i.e. , neuroleptics , anti-emetics ) . There is currently no st and ard treatment approach for physicians confronted with such patients . This may be the result of notions that TD is disappearing because of the switch to second-generation antipsychotic agents and that it is largely reversible . In this article we demonstrate that second-generation antipsychotics do , indeed , cause TD and , in fact , the frequency is likely higher than expected because of growing off-label uses and a tripling of prescriptions written in the last 10 years . In addition , studies demonstrate that TD actually remits in only a minority of patients when these drugs are withdrawn . Furthermore , neuroleptic agents are often utilized to treat TD , despite prolonged exposure being a risk factor for irreversibility . The outcome of these trends is a growing population afflicted with TD . We review non-neuroleptic agents that have shown positive results in small , early-phase , blinded trials , including tetrabenazine , amantadine , levetiracetam , piracetam , clonazepam , propranolol , vitamin B6 , and Ginkgo biloba . Other options , such as botulinum toxin and  deep brain stimulation  , will also be discussed , and a suggested treatment algorithm is provided . While these agents are reasonable treatment options at this time there is a need , with a concerted effort between neurology and psychiatry , for full-scale drug development , including multicenter , r and omized , blinded trials to confirm the effectiveness of the agents that were positive in phase 2 trials and the development of newer ones Background : The first set of aims of the present study was to determine the prevalence of personality disorders  ( PDs ) in a nation , and gender differences in the types and numbers of PDs endorsed . The second set of aims was to establish the relationship of PD to other , non-PD disorders , physical conditions , and disability . Method : Data were obtained from the Australian National Survey of Mental Health and Wellbeing , conducted between May and August 1997 . A stratified r and om sample of households was generated , from which all those aged 18 or over were considered potential interviewees . There were 10,641 respondents to the survey , and this represented a response rate of 78 % . Each interviewee was asked 59 questions indexing specific ICD-10 PD criteria . Results : Of the total survey sample , 704 persons had at least one PD . Using weighted replicate weights , it was estimated that approximately 6.5 % of the adult population of Australia have one or more PDs ( lifetime prevalence ) . Persons with PD were more likely to be younger , male , and not married , and to have an anxiety disorder , an affective disorder , a substance use disorder , or a physical condition . They were also more likely to have greater disability than those without PD . Conclusion : The study is the first nation-wide survey of mental disorders conducted within Australia . It provides an estimate of the prevalence of the various types of PD . The survey has considerable limitations , however , and these are discussed In order to estimate the prevalence of affective disorders in Hungary a sample of the Hungarian adult population ( 18 - 64 years ) selected at r and om was interviewed using the Diagnostic Interview Schedule ( DIS ) which generated DSM-III-R diagnoses . The lifetime rate for Major Depressive Disorder ( MDD ) was 15.1 % , and for Bipolar Disorders ( BD ) 5.1 % . The female-to-male ratio was 2.7 for MDD and nearly equal for BD . The 1-year and 1-month period prevalence rates were 7.1 % and 2.6 % for MDD and 0.9 % and 0.5 % for manic episodes . A higher rate of divorced or separated persons was found among individuals with a lifetime diagnosis of MDD . Besides these , the lifetime diagnosis of BD coexisted with higher rates of the never-married state . The highest hazard rate for the development of BD or MDD was in the range 15 - 19 years but in MDD another peak was also found in the range 45 - 50 years . The first peak was characteristic of the recurrent , and the other one of the single form of MDD . Insomnia , loss of energy , decreased interest , concentration problems were the most common symptoms during the depressive episode , independent of polarity . Higher rates of lifetime diagnosis of dysthymia and all kinds of anxiety disorder were revealed among persons with MDD . BD was associated with GAD ( Generalized Anxiety Disorder ) , and panic disorder more often than chance BACKGROUND Anxiety disorders complicate the treatment of bipolar disorder but are seldom the focus of bipolar treatment studies . METHODS The anxiolytic effect of quetiapine XR 50 - 300 mg/day compared to divalproex ER ( 500 - 3000 mg/day ) was tested in an 8-week , double-blind , placebo-controlled , r and omized clinical trial in 149 patients with bipolar disorder and a co-occurring panic disorder or GAD . The primary efficacy measure was the Clinician Global Improvement-21 Anxiety Scale ( CGI-21 ) . Secondary measures included the Hamilton Anxiety Scale ( HAM-A ) and Sheehan Panic Disorder Scale ( SPS ) . RESULTS Repeated measures last-observation-carried-forward ( LOCF ) analyses of variance demonstrated significant treatment-by-time interaction effects on 3 of the 4 anxiety measures .  Quetiapine XR at a mean endpoint dose of 186 mg/day produced rapid sustained improvements relative to baseline , divalproex ER and placebo on anxiety . Mean baseline-to-endpoint improvement was significantly greater for quetiapine XR compared to divalproex ER and placebo on the HAM-A and SPS . Both active medications were well tolerated , but weight gain was higher on quetiapine XR . LIMITATIONS The study was limited to 8 weeks and to patients with bipolar disorder and comorbid panic disorder or GAD . The results may not be applicable to quetiapine XR as an add-on treatment to mood stabilizers or to bipolar disorder comorbid with other anxiety disorders . CONCLUSIONS Quetiapine XR in a dose range of 50 - 300 mg/day appears to reduce anxiety in bipolar patients with comorbid panic disorder or GAD treated for 8 weeks . The efficacy of other second-generation antipsychotics and mood stabilizers in patients with bipolar disorder and a co-occurring anxiety disorder should be investigated in double-blind , placebo-controlled studies OBJECTIVE Atypical ( second-generation ) antipsychotics are considered st and ard treatment for children and adolescents with early-onset schizophrenia and schizoaffective disorder . However , the superiority of second-generation antipsychotics over first-generation antipsychotics has not been demonstrated . This study compared the efficacy and safety of two second-generation antipsychotics ( olanzapine and risperidone ) with a first-generation antipsychotic ( molindone ) in the treatment of early-onset schizophrenia and schizoaffective disorder . METHOD This double-blind multisite trial r and omly assigned pediatric patients with early-onset schizophrenia and schizoaffective disorder to treatment with either olanzapine ( 2.5 - 20 mg/day ) , risperidone ( 0.5 - 6 mg/day ) , or molindone ( 10 - 140 mg/day , plus 1 mg/day of benztropine ) for 8 weeks . The primary outcome was response to treatment , defined as a Clinical Global Impression ( CGI ) improvement score of 1 or 2 and > or=20 % reduction in Positive and Negative Syndrome Scale ( PANSS ) total score after 8 weeks of treatment . RESULTS In total , 119 youth were r and omly assigned to treatment . Of these subjects , 116 received at least one dose of treatment and thus were available for analysis . No significant differences were found among treatment groups in response rates  ( molindone : 50 % ; olanzapine : 34 % ; risperidone : 46 % ) or magnitude of symptom reduction . Olanzapine and risperidone were associated with significantly greater weight gain . Olanzapine showed the greatest risk of weight gain and significant increases in fasting cholesterol , low density lipoprotein , insulin , and liver transaminase levels . Molindone led to more self-reports of akathisia . CONCLUSIONS Risperidone and olanzapine did not demonstrate superior efficacy over molindone for treating early-onset schizophrenia and schizoaffective disorder . Adverse effects were frequent but differed among medications . The results question the nearly exclusive use of second-generation antipsychotics to treat early-onset schizophrenia and schizoaffective disorder . The safety findings related to weight gain and metabolic problems raise important public health concerns , given the widespread use of second-generation antipsychotics in youth for nonpsychotic disorders OBJECTIVES A growing number of atypical antipsychotics are available for clinicians to choose from in the treatment of psychotic disorders . However , a number of important questions concerning medication selection , dosing and dose equivalence , and the management of inadequate response , compliance problems , and relapse have not been adequately addressed by clinical trials . To aid clinical decision-making , a consensus survey of expert opinion on the pharmacologic treatment of psychotic disorders was undertaken to address questions not definitively answered in the research literature . METHOD Based on a literature review , a written survey was developed with 60 questions and 994 options . Approximately half of the options were scored using a modified version of the R AND 9-point scale for rating the appropriateness of medical decisions . For the other options , the experts were asked to write in answers ( e.g. , average doses ) or check a box to indicate their preferred answer . The survey was sent to 50 national experts on the pharmacologic treatment of psychotic disorders , 47 ( 94 % ) of whom completed it . In analyzing the responses to items rated on the 9-point scale , consensus on each option was defined as a non r and om distribution of scores by chi-square " goodness-of-fit"test . We assigned a categorical rank ( first line/preferred choice , second line/alternate choice , third line/usually inappropriate ) to each option based on the 95 % confidence interval around the mean rating . Guideline tables indicating preferred treatment strategies were then developed for key clinical situations . RESULTS The expert panel reached consensus on 88 % of the options rated on the 9-point scale . The experts overwhelmingly endorsed the atypical antipsychotics for the treatment of psychotic disorders . Risperidone was the top choice for first-episode and multi-episode patients , with the other newer atypicals rated first line or high second line depending on the clinical situation . Clozapine and a long-acting injectable atypical ( when available)were other high second line options for multi-episode patients . The expert 's dosing recommendations agreed closely with the package inserts for the drugs , and their estimates of dose equivalence among the antipsychotics followed a linear pattern . The experts considered 3 - 6 weeks an adequate antipsychotic trial , but would wait a little longer ( 4 - 10 weeks ) before making a major change in treatment regimen if there is a partial response . The experts recommended trying to improve response by increasing the dose of atypical and depot antipsychotics before switching to a different agent ; there was less agreement about increasing the dose of conventional antipsychotics before switching , probably because of concern about side effects at higher doses . If it is decided to switch because of inadequate response , risperidone was the expert 's first choice to switch to , no matter what drug was initially tried . Although there was some disparity in the expert 's recommendations concerning how many agents to try before switching to clozapine , the expert 's responses suggest that switching to clozapine should be Clozapine was also the antipsychotic of choice for patients with suicidal behavior . When switching oral antipsychotics , the experts considered cross-titration the preferred strategy . When switching to an injectable antipsychotic , the experts stressed the importance of continuing the oral antipsychotic until therapeutic levels of the injectable agent are achieved . The experts considered psychosocial interventions the first choice strategy for partially compliant patients , with pharmacologic interventions the first choice for patients with clear evidence of noncompliance . However , because it can be difficult to distinguish partially compliant from noncompliant patients , the editors recommended combining psychosocial and pharmacologic interventions to improve compliance whenever possible . When patients relapse because of compliance problems or if there is any doubt about compliance , the experts recommended the use of a long-acting injectable antipsychotic and would select an injectable atypical when this option becomes available . The experts would also consider using an injectable atypical antipsychotic ( when available ) in many clinical situations that do not involve compliance problems . The experts stressed the importance of monitoring for health problems-especially obesity , diabetes , cardiovascular problems , HIV risk behaviors , medical complications of substance abuse , heavy smoking and its effects , hypertension , and amenorrhea-in patients being treated with antipsychotics . Although many patients are prescribed adjunctive treatments , multiple antipsychotics , and combinations of different classes of drugs ( e.g. , antipsychotics plus mood stabilizers or antidepressants ) in an effort to enhance response , the experts gave little support to any of these strategies , with the exception of antidepressants for patients with  dysphoria/depression  , antidepressants or ECT for patients with suicidal behavior , and mood stabilizers for patients with aggression/violence . When asked about indicators of remission and recovery , the experts considered acute improvement in psychotic symptoms the most important indicator of remission , whereas they considered more sustained improvement in multiple outcome domains ( e.g. , occupational/educational functioning , peer relationships , independent living ) important in assessing recovery . CONCLUSIONS The experts reached a high level of consensus on many of the key treatment questions in the survey . Within the limits of expert opinion and with the expectation that future research data will take precedence , these guidelines provide direction for addressing common clinical dilemmas that arise in the pharmacologic treatment of psychotic disorders . They can be used to inform clinicians and educate patients regarding the relative merits of a variety of interventions . Clinicians should keep in mind that no guidelines can address the complexities involved in the care of each individual patient and that sound clinical judgment based on clinical experience should be used in applying these recommendations Background : Schizophrenia is one of the most disabling psychiatric syndromes with the prevalence of 1 % in the general population . Despite availability of various antipsychotics , negative symptoms and cognitive impairment are difficult to treat . In addition antipsychotic monotherapy is not effective in most of these patients . Current evidence indicates the roles of glutamatergic system in this disorder . N‐acetyl cysteine ( NAC ) also increases extracellular glutamate . This study was conducted to evaluate the clinical effects of oral NAC as an add‐on to maintenance medication for the treatment of chronic schizophrenia . Material s and methods : This 12‐week , double‐blind , r and omized , placebo‐controlled , clinical trial was performed to determine the effectiveness of 1200 mg N‐acetyl cysteine as an adjunctive treatment with conventional antipsychotic medications in 84 patients with chronic schizophrenia . The subjects were evaluated with the Positive and Negative Syndrome Scale ( PANSS ) , Mini‐Mental State Examination ( MMSE ) , and a st and ard neuropsychological screening test . Data were analyzed with SPSS‐16 software . Results : NAC‐treated patients showed significantly improvement in the positive ( F = 5.47 , P = 0.02 ) and negative ( F = 0.20 , df = 1 ) PANSS subscale . Also the general and total PANSS score  of NAC group declined over times whilst it was increased for placebo group . Regarding cognitive functions , improvement was observed in some explored areas , such as attention , short‐term and working memory , executive functioning and speed of processing . There was no significant difference between the 2 groups in the frequency of adverse effects . Conclusion : The present study detected improvement in positive , negative , general and total psychopathology symptoms as well as cognitive performance with NAC treatment . It is also well‐tolerated , safe and easy‐to‐use agent as an effective therapeutic strategy to improve outcome in schizophrenia treatment . Highlights Evidence indicates roles for glutamatergic systems in schizophrenia . This study has evaluated the effects of NAC in chronic schizophrenia . We detected improvement in psychotic and cognitive symptom  with NAC treatment This study aim ed to determine the efficacy and tolerability of adding quetiapine to a serotonin reuptake inhibitor in treatment-resistant obsessive – compulsive disorder ( OCD ) . Twenty-one adult treatment-resistant OCD patients were r and omized to 16 weeks of augmentation with either quetiapine ( n=11 ) or placebo ( n=10 ) . Patients with significant comorbidities , including tic-spectrum disorders , were not included . The treatment was well tolerated , with only one premature dropout in each treatment-group . The primary analysis showed that individuals in the quetiapine-treated group showed a 14 % mean improvement in baseline Yale – Brown Obsessive – Compulsive Scale scores at study endpoint compared with a 6 % improvement in those treated with placebo , but this difference did not reach statistical significance ( F<1 ) . Three patients treated with quetiapine met criteria for clinical response , compared to one patient who was treated with placebo . Larger studies are needed to explore the efficacy of second generation antipsychotics , such as quetiapine , when used as adjunct treatment in resistant OCD BACKGROUND There has been increasing interest in early detection during the prodromal phase of a psychotic disorder . To date a few treatment studies have been published with some promising results for both pharmacological treatments , using second generation antipsychotics , and psychological interventions , mainly cognitive behavioral therapy . The purpose of this study was to determine first if cognitive behavioral therapy ( CBT ) was more effective in reducing the rates of conversion compared to a supportive therapy and secondly whether those who received CBT had improved symptoms compared to those who received supportive therapy . METHOD Fifty-one individuals at clinical high risk of developing psychosis were r and omized to CBT or a supportive therapy for up to 6 months . The sample was assessed at 6 , 12 and 18 months post baseline on attenuated positive symptoms , negative symptoms , depression , anxiety and social functioning . RESULTS Conversions to psychosis only occurred in the group who received supportive therapy although the difference was not significant . Both groups improved in attenuated positive symptoms , depression and anxiety and neither improved in social functioning and negative symptoms . There were no differences between the two treatment groups . However , the improvement in attenuated positive symptoms was more rapid for the CBT group . CONCLUSIONS There are limitations of this trial and potential explanations for the lack of differences . However , both the results of this study and the possible explanations have significant implication s for early detection and intervention in the pre-psychotic phase and for design ing future treatments BACKGROUND In recent years , several pharmacological and psychosocial interventions have examined ways to prevent or treat weight gain in people receiving second-generation antipsychotics .  While there has been some success , in general , results have not been compelling . Atomoxetine is a selective norepinepherine reuptake inhibitor found to be associated with appetite suppression . Therefore , we examined whether atomoxetine may be of benefit for those who have gained weight on either clozapine or  olanzapine . METHODS The study was a double-blind , placebo-controlled trial . All participants received the same psychosocial platform : a structured support and exercise group .  People with schizophrenia or schizoaffective disorder , on olanzapine or clozapine , who had gained at least 7 % of their pre-clozapine or pre-olanzapine weight were eligible for a 24-week , r and omized , parallel group , double-blind comparison of adjunctive atomoxetine or placebo . RESULTS Thirty-seven participants ( 20 atomoxetine , 17 placebo ) were r and omized and 26 participants ( 14 atomoxetine , 12 placebo ; 70.2 % ) completed the study . There were no significant group differences in baseline BMI  ( atomoxetine : 34.5±4.9  ; placebo : 35.7±7.0 ) or weight  ( atomoxetine :  102.2±15.7 kg  ; placebo : 104.3±17.5 kg ) . Both treatment groups showed modest , not significant , trends in weight loss , averaging about 2 kg . Gender or baseline antipsychotic treatment did not modify treatment effects on weight . Secondary outcomes included neuropsychological assessment s , symptom assessment s ( BPRS , SANS ) and safety assessment s. Of these , only the group difference in Gordon distractibility test scores was statistically significant and favored treatment with atomoxetine . CONCLUSIONS Atomoxetine is not effective for weight loss in this population , but both olanzapine and clozapine  participants can lose weight with structured group support and exercise Weight gain is a major adverse effect of several second-generation antipsychotic medications . Rimonabant is a cannabinoid-1 receptor antagonist that promotes weight loss in the general population . We conducted a 16-week , double-blind , placebo-controlled study of rimonabant ( 20 mg/d ) in people with schizophrenia or schizoaffective disorder , based on the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria , who were clinical ly stable on second-generation antipsychotics . Participants had a body mass index of 27 kg/m2 or higher with hyperlipidemia or body mass index of 30 kg/m2 or higher , and no current substance abuse/dependence ( except nicotine ) , more than weekly cannabis use , or recent depressive symptoms/suicidality . An exercise and dietary counseling group was offered weekly . Target enrollment was 60 ; the trial was terminated early because of withdrawal of rimonabant from the European market . Fifteen participants were r and omized ( 7 rimonabant  , 8 placebo ) ; 5 completed in each group . Rimonabant was associated with a greater reduction in Brief Psychiatric Rating Scale total score  versus placebo ( mean ± SE difference , −1.9 ± 0.8 , P = 0.02 ) , driven by differences in the Brief Psychiatric Rating Scale anxiety/depression ( −1.4 ± 0.35 , P = 0.0004 ) and hostility ( −0.7 ± 0.3 , P = 0.02 ) factors . Group differences were not significant for the Calgary Depression Scale total score ( P = 0.24 ) , Scale for the Assessment of Negative Symptoms total score ( P = 0.13 ) , weight , blood pressure , or fasting lipids or glucose . Rimonabant was well tolerated with no significant adverse events . No significant weight loss , metabolic effects , or adverse psychiatric effects were associated with the cannabinoid-1 receptor antagonist rimonabant in this small sample of people with schizophrenia . The endocannabinoid system remains a promising target for pharmacotherapy of schizophrenia and obesity OBJECTIVE This study determined whether adding cognitive-behavioral therapy to treatment for out patients with schizophrenia  would be more effective than the use of second-generation antipsychotics alone . Thirty-three patients were r and omly assigned to receive either  second-generation antipsychotics alone  ( N=18 ) or  second-generation antipsychotics plus cognitive-behavioral therapy  ( N=15 ) . METHODS All patients received pharmacotherapy from a single provider and in a predetermined st and ard manner . Psychopathology ratings were done at baseline , at the end of treatment ( 12 weeks ) and three months after completion of treatment ( 24 weeks ) . RESULTS Twenty-five ( 76 % ) patients completed baseline and 12-week evaluations , and 17 ( 68 % ) patients who finished treatment also completed evaluations at 24 weeks . At the end of treatment persons in the second-generation antipsychotics plus cognitive-behavioral therapy group were rated as having less severe delusions than patients in the group receiving second-generation antipsychotics only , and this difference was maintained three months after treatment ended . CONCLUSIONS Adding cognitive-behavioral therapy may help with reducing the severity of delusions among patients with schizophrenia Abstract Although a frequent co-occurrence between bipolar disorder ( BD ) and conduct disorder ( CD ) in youth has been frequently reported , data about pharmacological management are scarce and focused on BD type I. Second generation antipsychotics are frequently used in clinical practice , but no comparative studies are available . The aim of this exploratory study was to compare efficacy and safety of risperidone and quetiapine in a sample of adolescents presenting a BD type II comorbid with CD . Twenty-two patients diagnosed with a structured interview according to Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , ( male/female ratio , 12/10 ; mean ( SD ) age 15.0 ( 1.4 ) years ) were r and omized in 2 treatment groups  ( quetiapine [ n = 12 ] vs risperidone [ n = 10 ] ) , treated with flexible doses , and followed up for 12 weeks . Efficacy measures assessed manic symptoms , aggression , anxiety , depression , global clinical severity , and impairment . Safety measures included body mass index , serum prolactin , extrapyramidal adverse effects , and electrocardiogram . At the end of the study , all patients improved in all efficacy measures . Both treatments showed similar efficacy in reducing manic symptoms and aggression . Quetiapine was more effective in improving anxiety and depressive symptoms . A change in body mass index was found , and in a post hoc analysis , it was significant only in the risperidone group . Prolactin significantly increased only in the risperidone group . In BD type II , CD comorbidity , quetiapine , or risperidone monotherapy may be effective and relatively safe , although the small sample size , the limited duration of the study , and the design ( lack of a blind assessment s and of a placebo group ) make it difficult to draw definitive conclusions BACKGROUND Controlled prospect i ve studies of the simultaneous long-term outcome of several mental disorders are rare . This study sought to determine if there were important differences between the outcome of anxiety and depressive disorders after 12 years and to examine their main predictors . METHOD A cohort of 210 people seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder ( 71 ) , panic disorder ( 74 ) , or dysthymic disorder ( 65 ) , including combined anxiety-depressive disorder ( cothymia ) ( 67 ) was followed up after 12 years . Interview assessment s of symptoms , social functioning and outcome were made , the latter using a new scale , the Neurotic Disorder Outcome Scale . Seventeen baseline predictors were also examined . RESULTS Data were obtained from 201 ( 96 % ) patients , 17 of whom had died . Only 73 ( 36 % ) had no DSM diagnosis at the time of follow-up . Using univariate and stepwise multiple linear regression those with cothymia , personality disorder , recurrent episodes and greater baseline self-rated anxiety and depression ratings had a worse outcome than others ; initial diagnosis did not contribute significantly to outcome and instability of diagnosis over time was much more common than consistency . CONCLUSION Only two out of five people with the common neurotic disorders have a good outcome despite alleged advances in treatment . Those with greater mood symptoms and pre-morbid personality disorder have the least favourable outcome . It is suggested that greater attention be paid to the concurrent treatment of personality disorder and environmental factors rather than symptoms as these may be the real cause of apparent treatment resistance OBJECTIVE L-theanine is a unique amino acid present almost exclusively in the tea plant . It possesses neuroprotective , mood-enhancing , and relaxation properties . This is a first study design ed to evaluate the efficacy and tolerability of L-theanine augmentation of antipsychotic treatment of patients with chronic schizophrenia and schizoaffective disorder . METHOD 60 patients with DSM-IV schizophrenia or schizoaffective disorder participated in an 8-week , double-blind , r and omized , placebo-controlled study . 400 mg/d of L-theanine was added to ongoing antipsychotic treatment from February 2006 until October 2008 . The outcome measures were the Positive and Negative Syndrome Scale ( PANSS ) , the Hamilton Anxiety Rating Scale ( HARS ) , the Cambridge Neuropsychological Test Automated Battery ( CANTAB ) for neurocognitive functioning , and additional measures of general functioning , side effects , and quality of life . RESULTS 40 patients completed the study protocol . Compared with placebo , L-theanine augmentation was associated with reduction of anxiety ( P = .015 ; measured by the HARS scale ) and positive ( P = .009 ) and general psychopathology ( P < .001 ) scores ( measured by the PANSS 3-dimensional model ) . According to the 5-dimension model of psychopathology , L-theanine produced significant reductions on PANSS positive ( P = .004 ) and activation factor ( P = .006 ) scores compared to placebo . The effect sizes ( Cohen d ) for these differences ranged from modest to moderate ( 0.09 - 0.39 ) . PANSS negative and CANTAB task scores , general functioning , side effect , and quality of life measures were not affected by L-theanine augmentation . L-theanine was found to be a safe and well-tolerated medication . CONCLUSIONS L-theanine augmentation of antipsychotic therapy can ameliorate positive , activation , and anxiety symptoms in schizophrenia and schizoaffective disorder patients . Further long-term studies of L-theanine are needed to substantiate the clinical ly significant benefits of L-theanine augmentation There is good evidence that clozapine is more efficacious than first-generation antipsychotic drugs in resistant schizophrenia .  It is less clear if clozapine is more effective than the other second-generation antipsychotic ( SGA ) drugs . A noncommercially funded , pragmatic , open , multisite , r and omized controlled trial was conducted in the United Kingdom National Health Service ( NHS ) . Participants were 136 people aged 18 - 65 with DSM-IV schizophrenia and related disorders whose medication was being changed because of poor clinical response to 2 or more previous antipsychotic drugs . Participants were r and omly allocated to clozapine or to one of the class of other SGA drugs ( risperidone , olanzapine , quetiapine , amisulpride ) as selected by the managing clinician . Outcomes were assessed blind to treatment allocation . One-year assessment s were carried out in 87 % of the sample . The intent to treat comparison showed no statistically significant advantage for commencing clozapine in Quality of Life score ( 3.63 points ; CI : 0.46 - 7.71 ; p = .08 ) but did show an advantage in Positive and Negative Syndrome Scale ( PANSS ) total score that was statistically significant ( -4.93 points ; CI : -8.82 to -1.05 ; p = .013 ) during follow-up . Clozapine showed a trend toward having fewer total extrapyramidal side effects . At 12 weeks participants who were receiving clozapine reported that their mental health was significantly better compared with those receiving other SGA drugs . In conclusion , in people with schizophrenia with poor treatment response to 2 or more antipsychotic drugs , there is an advantage to commencing clozapine rather than other SGA drugs in terms of symptom improvement over 1 year BACKGROUND The German National Health Interview and Examination Survey ( GHS ) is the first government m and ated nationwide study to investigate jointly the prevalence of somatic and mental disorders within one study in the general adult population in Germany . This paper reports results from its Mental Health Supplement ( GHS-MHS ) on 4-week 12-month , and selected lifetime prevalence of a broad range of DSM-IV mental disorders , their co-morbidity and correlates in the community . METHODS The sample of the GHS-MHS ( n=4181 ; multistage stratified r and om sample drawn from population registries ; conditional response rate : 87.6 % ) can be regarded as representative for the German population aged 18 - 65 . Diagnoses are based on fully structured computer assisted clinical interviews ( M-CIDI ) , conducted by clinical ly trained interviewers . RESULTS 12-month prevalence for any DSM-IV study disorder is 31 % ( lifetime : 43 % ; 4-week : 20 % ) with anxiety disorders , mood disorders and somatoform syndromes being the most frequent diagnoses . Retrospective age of onset information reveals that most disorders begin early in life . Co-morbidity rates among mental disorders range from 44 % to 94 % . Correlates of increased rates of mental disorders and co-morbidity were : female gender ( except for substance disorders ) , not being married , low social class , and poor somatic health status . Health care utilization for mental disorders depended on co-morbidity ( 30 % in ' pure ' , 76 % in highly co-morbid cases ) and varied from 33 % for substance use disorders to 75 % for panic disorder . CONCLUSIONS Results confirm and extend results from other national studies using the same assessment instruments with regard to prevalence , co-morbidity and sociodemographic correlates , covering a broader range of DSM-IV disorders [ i.e. somatoform disorders , all anxiety disorders ( except PTSD ) , mental disorders due to substance or general medical factor , eating disorders ] . Intervention rates were higher than in previous studies , yet still low overall
Monotherapy with quetiapine seems to be efficacious in reducing symptoms of generalised anxiety disorder and this effect may be similar to that of antidepressants .
BACKGROUND Anxiety disorders are common and disabling conditions , with a lifetime prevalence of 17 % in the general population .
Due to high rates of treatment resistance , there is interest in new pharmacological treatment options such as second-generation antipsychotics .
OBJECTIVES To evaluate the efficacy and tolerability of second-generation antipsychotics as monotherapy or adjunctive treatment for people with anxiety disorders .