bluuebunny/crossref_metadata_2025 huggingface dataset:
An increase in bone stability in an aripiprazole add-on or switching study
Authors: Masand S. , Sherwood R. , Aitchison K.J.
Published: May 2011

Introduction

Schizophrenia is a mental health disorder associated with high rates of osteoporosis. Studies have suggested antipsychotics as a major cause of accelerated decrease in bone mineral density.

Oestrogen deficiency contributes to osteoporosis and causes increased osteoclast numbers/osteoclastic activity. Prolactin suppresses hypothalamo-pituitary-ovarian axis activity, leading to decreased oestrogen concentrations.

Aripiprazole, an ‘atypical’ antipsychotic, is a partial agonist at dopamine D2-receptors, while other atypical antipsychotics are antagonists at these receptors. Dopamine inhibits prolactin release via these receptors at the anterior pituitary. Aripiprazole has been found to decrease prolactin concentrations in chronic schizophrenics and may be protective against osteoporosis.

Quantitation of specific markers of osteoclastic (cross-linked N-telopeptide (NTX)) and osteoblastic activity (bone alkaline phosphatase (BAP)) can be correlated with bone resorption and bone formation, respectively.

Objectives

Exploring whether aripiprazole is effective in stabilising bone turnover.

Aims

Investigate changes in urinary markers of bone turnover.

Methods

We performed 52 week, open-label, intention-to-treat study, offering either a switch to aripiprazole or aripiprazole as add-on to initial antipsychotic medication.

Serial measurements of prolactin, testosterone, 17-β-oestradiol, serum BAP, albumin, urinary creatinine, and urinary NTX concentrations were taken between 0 and 52 weeks.

Results

At the end-point of study, versus the baseline, there were significant decreases in concentrations of urinary markers of bone resorption (P = 0.002 for NTX) and bone formation (P = .026 for BAP). Additionally, a significant decrease in prolactin (P = 0.004) and significant increase in 17-β-oestradiol concentrations (P = 0.015) were found.

Conclusions

Our results show decreased overall bone turnover; and increased long-term bone stability in patients who changed medication.
Glutamate theory of depression-new elements
Authors: Mititelu A.G.
Published: May 2011

Introduction

It is well known that actual mechanisms which explain depression are very exhaustive and at same time extremely limited. Among these ones, it had been given the priority, maybe too quick, to serotonin hypothesis. Even so, the actual SSRI and SRNI classes doesn’t do. really, a lot in alleviating the course of the disease. Recent randomised clinical trials and clinic -epidemiological studies support the idea that something more effective must be offered. On the other side addiction reveals more and more in depth correlations with all major psychiatric disorders.

Objectives

It is possible to develop in the close future new chemical products which could act in more effective way for the reduction or even cancelling of the symptoms determined by the alteration of major neurotransmitters-, GABA and glutamate.

Aims

Based on huge interconnection which exists between depression and drug dependence at various levels-especially through the effects exerted by particular anti depressant and some of anti craving medications, it is possible to evaluate the impact which some new pharmaceutical compounds -derivated from glutamate type of receptor NMDA-might exert upon various types of depression elicited by patients with associated drug dependence.

Methods

Had been realised a thematical reanalysis of the studies published on Medline, EMBASE and OVID about this subject.

Results

The conclusion of the studies reveals the huge potential represented by treatment with some types of NMDA antagonists-Ketamine. The putative site of action is prefrontal cortex and is had been proved highly efficient in MDD patients.
Sleep-memory-plasticity:A circuit closed by Gaba?
Authors: Mititelu A.
Published: May 2011

It is already widely known that benzodiazepines, the most prolific compound for pharma industry, are the most used psychotropic medication used at moment. It is striking that even now, after more than 50 yrs from first use of Diazepam, still exerts such a massive interest. Both mechanism, of dependence and withdrawn are not still unknown. Benzodiazepines by their structure and sites of action upon GABA receptors realise a huge effect in majority of neuronal circuits.

Objectives

The effect of BDZ in mood and affective disorders and also in major psychotic sdr-Schizophrenia realise an reduction of hyper GABA influence. acting on specific neuronal populations which posses particularly alpha 5 GABAa receptors they produce sedative but non anxiolytic effect. Also is still an “mistery” how only retrograde amnesia is produced and why plasticiticity occurs after a longtime use of BDZ facilitating the development of tolerance.

Aims

By a better intimate description of mechanisms by which GABAa receptors realise the sedative action and development of less side effects comparing with actual BDZ in use, even from different classes.

Methods

In this communication we had realised a thematical analysis of all studies (randomised clinical trials, clinical case study) but also various experimental research with this subjects-sleep, memory, plasticity. All had been indexed in PubMed, EMBASE, www.ionchannels.com and Science Direct.

Results

The conclusion of our tematical study and also, our previous research suggests antagonists of GABA a or agonists of beta carbolines could be proven solid point of start for more efficient therapeutic substances.
Collaborative study of compliance in psychotic patients with risperidone long-acting injection (RLAI) in the last 5 years
Authors: Molina Ramos R. , Arnillas H. , Playà J. , Sánchez de Muniain M. , LLiteras M. , Hernandez B.
Published: May 2011

Introduction

Compliance is essential to achieve the best results in serious mental illness like schizophrenia.

Objectives

It was expected that the use of second-generation oral antipsychotics with less extrapyramidal side effect profile would improve the compliance, but the results do not support these expectations except in the case of risperidone long-acting injection.

Aims

The aim of this study is to assess the degree of compliance in outpatients who were started treatment with RLAI while they were hospitalized for an acute psychotic episode in psychiatric unit.

Methods

A retrospective study was conducted by reviewing medical records of hospitalized patients for psychotic episodes over the past 5 years in three hospitals in Mallorca (Balearic Islands, Spain) -Hospital de Manacor, Hospital son Llatzer and Hospital de Inca). Due to computerization of medical records, we knew the degree of compliance with treatment and outcome in outpatient clinics. We designed a case report data (CRD) to assess specific variables in our study that was completed for each patient.

Results

The mean duration of treatment in patients who continue with RLAI was 38.8 months. Overall. 69.5% continued with the treatment after 5 years. The patients who continued treatment were rehospitalazed 20% less than the ones who discontinued.

Conclusions

The compliance with RLAI in outpatients was high even in patients with substances abuse. The patients who remain on treatment from hospital discharge have less readmissions. The most common dosis of RLAI is 50 mg. Lack of insight was the most frequent cause of discontinuation.
Managing strategies for antidepressant-related sexual dysfunction. results from a multicentric, pragmatic study with 2000 patients in spain: the SALSEX-I study
Authors: Montejo A.L. , Majadas S. , Calama J. , Hernandez A.I. ,   SALSEX-I Project Working Group
Published: May 2011

Introduction

Antidepressant-related sexual dysfunction (ADr-SD) is the most frequent and long-lasting adverse event, often underestimated and rarely spontaneously communicated. Strategies to manage it haven’t been explored to date.

Study aim

To explore ADr-SD clinical management in regular practice.

Objectives

1.

To stablish the prevalence of SD in patients following antidepressant treatment.

2.

To describe the therapeutic interventions used when SD is detected.

Methods

Cross-sectional, multicentric and naturalistic study. Patients taking antidepressant for at least two months without previous SD were included. SD was evaluated with the specific questionnaire PR-Sex-DQ (SALSEX, Montejo et al 2001).

Results

1988 out of 2000 patients recruited resulted eligible for the analysis. According to PRSexDQ scores SD was present in 87.5% ot the sample. Only 44.2% communicated it spontaneusly. 66.2% reported regular to poor tolerance of SD and 19.6% had thought about discontinuing treatment due to it. Regarding the therapeutic interventions used for managing ADr-SD, waiting for its spontaneus remission was the most frequent strategy reported (36.8%), followed by changing the antidepressant (32.5%) and reducing the dosage (18.5%); 5% chosed “weekend holidays”, 4% discontinued the antidepressant, 2.5% associated another antidepressant and 1.3% added a 5-phosphodiesterase inhibitor. Bupropion and mirtazapine were the antidepressants most frequently selected for the switching and association strategies.

Conclusions

These results study highlight the high rates of SD related to antidepressants and its potential association with non-adherence to treatment. Despite this unfortunatelly clinicians do prefer to wait rather than performing any active strategy to manage this adverse event.
Antipsychotic polytherapy versus antipsychotic monotherapy in patients with schizophrenia and other psychoses
Authors: Morales Alcaide N.
Published: May 2011

Introduction

Antipsychotic therapy is the cornerstone of the treatment of psychotic disorders. Although clinical guidelines recommend the use of antipsychotics in monotherapy, the combination of two or more antipsychotics is a common habit in clinical practice, especially in cases resistant to treatment with one antipsychotic, although there are few controlled trials that support this treatment modality.

Objectives

To analyze the characteristics of antipsychotic therapy in patients admitted to hospitalization with diagnoses of schizophrenia and other psychoses, to determine if there are differences between diagnostic groups.

Material

We analyzed a sample of 241 patients admitted during 2009, 97 women and 144 men, with schizophrenia and other psychoses.

Methods

We designed a protocol of collecting data based on clinical histories of patients, reflecting the gender, age, diagnosis and treatment regimen (monotherapy or combination therapy), and performed a statistical analysis using SPSS.

Results

Of the sample, 40.2% were females and 59.8% were males. The mean age was 39.7 years old.

The diagnosis of schizophrenia was obtained in 60.2% of patients, while the remaining 39.8% were diagnosed with other psychoses (schizoaffective disorder, chronic delusional disorder, schizophreniform disorder, brief psychotic disorder, psychotic disorder not otherwise specified and other.)

The combination therapy was used in 62.2% of patients, while the remaining 37.8% were treated with monotherapy.

Conclusions

Combination therapy is used more often in male patients and in patients diagnosed with schizophrenia, while monotherapy is used more in women and patients with other psychoses.
Comparative efficacy, effectiveness and harms of second-generation antidepressants in the pharmacologic treatment of adult depression
Authors: Morgan L. , Gartlehner G.
Published: May 2011

Introduction

Second-generation antidepressants dominate the medical management of major depressive disorder (MDD). Two published comparative effectiveness reviews (CER) provide conflicting evidence about the comparative efficacy and safety of second-generation antidepressants for treating MDD.

Objectives

To compare the benefits and harms of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine for the treatment of MDD in adults.

Methods

We updated a CER published in 2007 by the Agency for Healthcare Research and Quality searching MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts up to May 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias. If data were sufficient, we conducted meta-analyses of head-to-head trials of the relative benefit of response to treatment. In addition, we conducted mixed treatment comparisons to derive indirect estimates of the comparative efficacy among all second-generation antidepressants.

Results

Overall, no substantial differences in efficacy could be detected among second-generation antidepressants. Statistically significant differences in response rates between some compared drugs are small and likely not clinically relevant. Differences exist in the incidence of specific adverse events and the onset of action. Venlafaxine leads to higher rates of nausea and vomiting, sertraline to higher rates of diarrhea, and mirtazapine to higher rates of weight gain than comparator drugs. Bupropion caused lower rates of sexual dysfunction than other antidepressants.

Conclusions

Our findings indicate that the existing evidence does not warrant the choice of one second-generation antidepressant over another based on greater efficacy and effectiveness.
Effects of antipsychotics on cognitive functions: an ERP study in healthy controls
Authors: Mucci A. , Galderisi S. , Vignapiano A. , Russo D. , Romano P. , Plescia G. , Maj M.
Published: May 2011

Introduction

Clinical studies on cognitive effects of second generation antipsychotics produced disappointing findings probably due to the heterogeneity of the clinical populations under investigation, as well as to poor sensitivity of neurocognitive indices. Event-Related Potentials (ERPs) provide a functional measure of electrical brain activity time-locked to discrete stages of information processing. They have been widely used as putative biological markers of cognitive abnormalities in schizophrenia and represent useful indices in the investigation of the cognitive effects of psychotropic drugs.

Objectives

The present study investigated the effect of risperidone, haloperidol and placebo on N1 and P3 in male healthy subjects.

Methods

ERPs were recorded during a three-tone oddball task in which target, standard and rare-nontarget tones were randomly presented. Subjects had to press a button when hearing a target tone. Amplitude and topography of the ERP component maps at peak latencies were compared across conditions. If a significant drug effect was obtained, changes in the cortical sources of the corresponding ERP component were analyzed using Low-Resolution Electromagnetic Tomography (LORETA).

Results

The amplitude of N1 for attended stimuli and of P3 for rare-nontargets (P3a) was significantly increased only by risperidone. No significant change was observed in overall topographic features and in LORETA cortical sources of the same components. No significant drug effect was demonstrated for the latency of all the investigated components and for P3b amplitude.

Conclusions

Our findings suggest that risperidone has a favorable effect on early attention processes and automatic attention allocation.
Does prescribing depot medication really improve medication adherence?
Authors: Nendick J. , Tacchi M.-J. , Scott J.
Published: May 2011

Introduction

Clinicians often prescribe depot medication assuming that it will improve medication adherence. Few studies have systematically explored patterns of non-adherence with depots or whether the beliefs and attitudes that influence adherence are similar to those that affect acceptability and adherence of oral medication.

Objectives

To investigate adherence with and attitudes towards depot medication.

Aims

(1)

To explore non-adherence with depot medication.

(2)

To examine key determinants of acceptability of depot versus oral treatment.

Methods

Patients with a severe mental disorder receiving depot medication completed a face to face interview incorporating several ratings, including the Beliefs about Medication Questionnaire (BMQ). Frequency of depot injections and adherence rates were recorded over two years. Data were compared with that from similar patients receiving oral medication.

Results

Full adherence with depots was only slightly higher than with oral medication (77% v 71%). Although side effect ratings were correlated with the BMQ-Concerns sub-scale (r.29) the most robust single predictor of adherence was a high score on the BMQ Necessity scale (r .46). In both oral and depot medication groups the combination of Low Necessity and High Concerns predicted poor adherence (Odds Ratio 4.21).

Conclusions

Depot medication is a necessary but not sufficient treatment for many non-adherent patients. Our findings suggest that barriers to acceptance of depots vary little from those that impair adherence with oral antipsychotics and that interventions to modify these beliefs are as important as the mode of delivery of treatment.
Pleural effusion as a complication of clozapine treatment
Authors: Hospers A. , Arends J. , Timmerman L. , Oven W.V.
Published: May 2011

Introduction

Clozapine treatment has been recognized as a superior treatment in schizophrenia. Clozapine treatment has also be accompanied with several rare but severe adverse events, like neutropenia, agranulocytosis, myocarditis, pericarditis and polyperositis. We report a patient that suffers from hyperleucocytemia, eosinophilia and pleuritis, due to clozapine treatment, the adverse events disappeared after a switch to aripiprazole.

Objectives

To review the literature on reports on pleuritis and polyserositis in order searching for guidance in these clinical situation, like the need tot interrupt the medication, the prognosis and if rechallenges are reported. Another objective was to discover if something is known about the underlying mechanism.

Methods

To review the literature, we used the following terms: clozapine, treatment, immunological reaction, neutropenia, leucopenia, epicarditis, polyserositis, pleuritis, pleural effusion, underlying mechanisms, risk factors.

A literature search was performed in Pubmed® and Embase Psychiatry® in the period longing from 1972 till October 2010

Results

Risk factors as well as the underlying mechanisms offer no guidance for dealing with the clinical critical situations.

There are only a few reports on pleural effusion, there are some reports on pleural effusion in combination with epicarditis, there are some reports on polyserositis including pleural effusion.

No rechallenges are reported of clozapine on pleural effusion.

There is no information in the literature on the risk that a pleuritis will extend to other organs, like the heart and the liver, when continuing the clozapine treatment.

Conclusion

Hypotheses about the underlying mechanism will be presented. A program of additional diagnostics will be described
Physical health monitoring of patients on antipsychotic medication in community - findings of an audit
Authors: Paul M. , Philip D. , Garcia J.
Published: May 2011

Introduction

Patients with severe mental illness are at increased risk of cardiovascular disease because of lifestyle, co-morbidity and medication effects.

Aim/objectives

The aim of this audit is to ascertain the regularity of blood tests (u&e's, fasting blood glucose, lipid profile)among patients on Antipsychotic medication under North Durham Psychosis team.

Method

According to audit standards (based on NICE guidelines-Schizophrenia and Maudsley guidelines), All patients on antipsychotic medication should have Urea & Electorates, Fasting blood glucose and Fasting Lipid profile done at least once a year. All 67 patients in North Durham Psychosis Team were included. We searched for these readings between 1st September 2008 to 30th August 2009 in patient records. Of the 67 patients, notes were retrieved for 50. Of the 50, 46 were on antipsychotic medications.

Results

Of 46 patients, 58% had urea & electorates, 58% had Fasting blood glucose and 46%had fasting lipid profile recorded.

Conclusion

Because of lifestyle, co-morbidity and medication effects, patients with severe mental illness are at increased risk of cardiovascular disease. Our audit identified a need for systemic assessment of physical health with appropriate blood investigations and follow up with appropriate management plan (lifestyle education, lipid modification therapy) which are critical to minimising risks and preventing long term adverse health consequences. This results may also reflect a lack of communication between primary care and secondary care as the physical health for these clients are primarily managed by General Practitioners. It may be that these investigations are conducted but not communicated to secondary care.
Use of atypical antipsychotics and movement disorders: a case of aripiprazole induced chorea
Authors: Pomponi M. , Soleti F. , Raja M. , Bentivoglio A.R.
Published: May 2011

We describe a 66-year-old woman with a 33-year history of treatment with antipsychotic drugs (she was reportedly affected by psychiatric symptoms, dominated by “depression”), who presented with severe, generalized chorea, which started after shifting from haloperidol to aripiprazole.

Since 1974, she had been treated with several antipsychotics (including haloperidol and risperidone) and antidepressants, in different combinations; moreover she underwent electroconvulsive therapy. In 2003, after shifting from haloperidol to aripiprazole, she presented facial dyskinesias, which progressively diffused to all the body regions and, after a few months. In 2006, aripiprazole was discontinued and olanzapine was introduced, with a dramatic increase of choreic dyskinesias. The picture was so severe that the patient could barely stand, walk, talk and eat.

MRI of the brain revealed minimal signs of diffuse atrophy and chronic leucoencefalopathy. Genetic testing for HD and the screening for Wilson's disease were negative; so the diagnosis was a severe tardive syndrome (orolingual dyskinesias, pelvic dyskinesias and generalized chorea).

Olanzapine (10 mg/die) was discontinued, and a low dose of clozapine (12,5 mg/die) was introduced, without any exacerbation of the psychiatric disorder, and without modification of chorea. After a few days, tetrabenazine was introduced and gradually titrated up to 75 mg/die in two weeks. After two weeks, a dramatic improvement of dyskinesias was evident (video).

To explain the case of our patient, we hypothesize that chronic administration of neuroleptics would lead to dopamine D2-receptor hypersensitivity in the nigrostriatal pathway and favor the agonist profile of aripiprazole to promote the activation of dopamine D2-receptors.
Screening of metabolic side effects of antipsychotics in patients with mental disorder
Authors: Reddy H.T. , Edwards R.
Published: May 2011

This audit was undertaken to evaluate what screening is undertaken for metabolic side effects of antipsychotic drugs in patients under the care of Ceredigion Community Mental Health.

Raise awareness with Local health Board regarding metabolic screening Raise awareness regarding four aspects of metabolic syndrome.

Audit tool based on POMH (Prescribing Observatory for Mental Health) Topic 2B Audit Data was collected from medical notes, abstracted and inputted into Microsoft Excel. The sample consisted of 15 service users; 11(73%) male and 4(27%) female.

Most individuals where of white British/Irish ethnicity, (14, 93%).

Most (14, 93%) patients primary clinical psychiatric diagnosis based on the ICD10 category was F20–F29.

Six (40%) individuals in the sample smoked, of which two (33%) were offered help with smoking cessation. There was evidence of diabetes in three case notes. In one (33%) case note it was Mental Health services that uncovered the diabetes. One service users file had evidence of a known diagnosis of Hypertension. This was not discovered by Mental Health services. Three service users had evidence of a disturbed lipid profile. In two (66%) of these notes it was Mental Health services that discovered the disturbed lipid profile.

Lifestyle management pack: guidance and resources for staff and service users around diet, exercise, smoking cessation and other health lifestyle issues. Physical health check reminder cards: A patient-held card to record the results of physical health checks and due dates for new appointments.
Review of high dose anti psychotic prescription and monitoring at north end house, durham
Authors: Reddy J.
Published: May 2011

Introduction

A single or more than two Antipsychotics above the recommended dose is known as High Dose prescription. Regular review of these patients is necessary due to the potential side effects.

Objective

Reviewing of the HDAT prescription and monitoring process between June and July 2010.

Standard - TEWV NHS Trust guidelines suggest that patients on High Dose Antipsychotics should have

1)

Documentation of Medical history and Physical examination at the Well Being Clinic

2)

Medication Alert on PARIS (Trust intranet)

3)

Documentation on Visual display Board

4)

Regular Blood tests and ECG

Methodology

Referring Case notes, PARIS entries and Visual Display board.

Results

Of the 8 patients at Well Being Clinic, Male −4, Female −4.

Details of medical history & physical examination were recorded for all patients.

Medication alerts were documented on PARIS.

Visual display board was up to date with dates for bloods & ECG. Bloods tests - FBC,U&E, LFT, Lipids, Blood glucose & Prolactin. The tests were done at baseline, repeated on 1,2,3,6,9,12 months & at dose increment. All the blood tests & ECGs were up to date. 2 male patients were discharged following dose review. Once the patients were discharged, the alert on PARIS was removed.

1 male patient was referred to GP for physical examination as the patient was quite obese. Prolactin levels of 2 patients were high. They were followed up with further blood investigations.

Conclusion

•

Side effect monitoring scales like “LUNSERS” to be used

•

Arrange educational meetings to the Support workers.
How to treat patients with adult attention-deficit/hyperactivity disorder (ADHD) comorbid with psychosis? a case report
Authors: Holler M. , Foff C. , Rittmannsberger H.
Published: May 2011

Introduction

It is not uncommon that patients suffering from psychosis reveal a comorbidity of attention-deficit/hyperactivity disorder (ADHD). There is lack of evidence how to treat these patients as amphetamines are considered contraindicated for patients with psychosis.

Objective/aims/methods

To provide the case history of such a comorbid patient.

Results

A 21 year old male patient is committed to the psychiatric clinic displaying massive assaultive behavior. He has been consuming cannabis heavily over the last few years; for a couple of days now he has been displaying psychotic features. Occasional aggressive outbursts have been known to occur since childhood. The patient’s own accounts and those of his relatives also make an ADHD highly probable. During inpatient stay there are massive, dangerous aggressive assaults without detectable reasons along with complete disorganized behavior and massive thought disorders on three different occasions. Medication with very high doses of antipsychotics, benzodiazepines as well as mood stabilizers could not prevent the patient from his aggressive outbursts. The lack of efficacy of conventional treatment led us to propose to the patient a trial dose of methylphenidate, which calmed the patient instantly. Psychotic symptom, aggression and symptoms of ADHD improved during further treatment with methylphenidate, which was replaced by atomoxetine later. The patient was dismissed on a regimen of atomoxetine, Risperidone and Valproate and was well at a follow-up investigation 2 months later.

Conclusions

The use of methylphenidate in patients with adult ADHD comorbid with psychosis seems to be possible and helpful on some occasions.
Adherence to antidepressant treatment in depressive patients with comorbid psychiatric disorders
Authors: Roca M. , Armengol S. , García-García M. , Salva J. , Monzón S. , Bauzá N. , Gili M.
Published: May 2011

Background

Depression is associated with high rates of comorbidity with other psychiatric disorders. Adherence to antidepressant medication regimens has been associated to different factors. Few studies have analyzed the influence of comorbid psychiatric disorders and adjunctive pharmacological treatments on antidepressant adherence.

Aim

The study evaluates the association of comorbid psychiatric disorder and pharmacological treatments with adherence rates to antidepressants in a large sample of depressive outpatients.

Method

3606 depressive patients were included in a cross-sectional epidemiological study, involving a stratified sample of 750 psychiatrists selected to participate. Patients were included if they met DSM-IV criteria for current single or recurrent non-psychotic major depressive disorder. Simplified Medication Adherence Questionnaire (SMAQ) and Hamilton Depression Rating Scale (HDRS) were used to assess adherence and depression severity.

Results

Adherence rates are lower in depressive patients with psychiatric comorbidity (62.8%) than in patients without comorbidity (69.1%) (Chi-square = 15.9, p < 0.001, OR = 1.6, 1.2–1.8). There are no significant differences in adherence rates between those patients taking or not benzodiacepines.

Conclusions

Psychiatric comorbidity plays a negative role in adherence to antidepressant treatment. Benzodiazepine use has no influence on adherence rates. Special attention should be paid to the symptom overlapping between anxiety and depression and to the benzodiazepine prescription in comorbid depressive patients.
Involvement of the lateral septal nucleus and GABAa receptors in the antidepressant-like effects of allopregnanolone in wistar rats
Authors: Rodríguez-Landa J.F. , Contreras C.M. , Bernal-Morales B. , Gutiérrez-García A.G. , García-Ríos R.I.
Published: May 2011

Introduction

Pharmacological and non-pharmacological antidepressant therapies increase the firing rate of lateral septal nucleus neurons (a brain structure involved in mood state regulation) and reduce immobility in the forced swim test (FST), whereas the neurosteroid allopregnanolone appears to produce antidepressant-like effects through actions at GABAA receptors.

Objective

To explore the participation of the lateral septal nucleus and GABAA receptors in the antidepressant-like effects of allopregnanolone in Wistar rats.

Methods

First, the minimally effective dose of allopregnanolone that produces antidepressant-like effects in the FST was determined. Second, the effect of this minimally effective dose in the FST was evaluated on the firing rate of lateral septal neurons. Third, the antidepressant-like effects of microinjection of allopregnanolone (1.0 μg/rat) into the lateral septal nucleus was evaluated in the FST. Fourth, we explored whether the effects of allopregnanolone on the lateral septal neuron firing rate and FST are blocked by picrotoxin or bicuculline, two GABAA receptor antagonists.

Results

The minimally effective dose of allopregnanolone with antidepressant-like effects in the FST was 1.0 mg/kg (i.p.) and significantly increased the firing rate of lateral septal neurons. Microinjection of allopregnanolone into the lateral septal nucleus produced antidepressant-like effects in the FST. Pretreatment with picrotoxin and bicuculline blocked the increase in lateral septal neuron firing rate and the antidepressant-like effects of allopregnanolone in the FST.

Conclusion

The lateral septal nucleus participates in the antidepressant-like effects of allopregnanolone through actions on GABAA receptors in Wistar rats.
Does antipsychotic medication affect white matter in schizophrenia and bipolar disorder? a review of diffusion tensor imaging literature
Authors: Kyriakopoulos M. , Samartzis L. , Dima D. , Hayes D. , Corrigall R. , Barker G. , Correll C.U. , Frangou S.
Published: May 2011

Introduction

White matter (WM) abnormalities are considered integral to the pathophysiology of Schizophrenia (SZ) and Bipolar Disorder (BD), but there is ongoing uncertainty about the contribution of medication to these findings.

Objectives

Diffusion Tensor Imaging (DTI) is a neuroimaging technique that provides quantitative indices of the structural and orientational characteristics of WM. These indices include mean diffusivity (MD), which is a directionally averaged measure of the apparent diffusion coefficient, and fractional anisotropy (FA), which summarizes the orientational dependence of diffusivity. We wanted to determine if these indices are affected by antipsychotic medication.

Aims

Our aim was to examine the available literature in order to differentiate antipsychotic effects from disorder-specific WM abnormalities on DTI measures.

Methods

We conducted a systematic qualitative review of the DTI literature in Bipolar Disorder (BD) and Schizophrenia (SZ), between 1998 and 2010 and included only studies where the relationship between DTI measures and antipsychotic medication was explicitly examined and reported.

Results

We identified 40 studies in SZ and 8 in BD. All studies were cross-sectional and involved relatively small patient samples. 32 studies (80%) did not find any relationship between antipsychotic medication (dose, cumulative exposure) and FA or MD.

Conclusions

Current evidence does not indicate a major impact of antipsychotic treatment on DTI indices of WM integrity. However, the lack of longitudinal, within-subject designs is a major gap in the current literature.
Adherence and satisfaction survey in outpatients on treatment with antipsychotics
Authors: de Muniain M. Sanchez , Ramos R. Molina , Hernandez B. , Lliteras M. , Chada C. , Millan M. , Giner D. , Castillo C.
Published: May 2011

Introduction

One of the problems of many studies and clinical trials is that don’t reflect the patient's opinion about the medication that they receive and their satisfaction.

Objetive and aims

The aim of this study was to assess the degree of outpatients satisfaction with antipsychotic treatment in four outpatients clinics in Mallorca. The adherence rates was estimated from information provided by the patients and their psychiatrists.

Methods

A cross.-sectional and descriptive study was conducted during one month, from May to June 2010, by administering several questionnaires to outpatients with psychotic disorders. It was designed a case report data which recorded the following variables: age, gender, diagnosis (schizophreniform, schizophrenia, schizoaffective disorder, delusional, psychotic disorder not otherwise specified), time since diagnosis, substance use, number of antipsychotic drugs, type of antipsychotic (oral and / or im), number of doses per day and number of tablets, via of administration (buttocks or deltoid). The psychometric instruments used were: the Morisky-Green test, Haynes-Sacket test, the MSQ (Medication Satisfaction Questionnaire) and CGI (Clinical Global Impression).

Results

The sample was of 92 patients with a mean age of 42.1 years (SD 12.2): 57.6% male and the most frequent diagnosis was schizophrenia in 65.2%. The duration of treatment from diagnosis was more than 5 years in 66.3%.

Conclusions

The patients on maintenance monotherapy with RLAI showed better adherence rates and more insight, evaluated by their psychiatrits.

78% of patients receiving antipsychotic medication injections were satisfied with the treatment.

Patients with RLAI administrating in deltoid were satisfied in 65.7%.
Liver failure under valproic acid
Authors: Schönfeldt-Lecuona C. , Connemann B.J. , Freudenmann R.W. , Hiemke C. , Schmid M.M.
Published: May 2011

Valproic acid (VPA, 2-propylvaleric acid) is originally an antiepileptic drug, which has been in use for more than 30 years in over 100 countries. The clinical application of VPA has expanded in the last years. Approval has been granted by the FDA for treatment of migraine and cluster headache in 1996, and for treatment of mania and long-term prophylaxis of bipolar affective disorder in 1995. In ongoing studies, VPA has been reported to inhibit growth of several types of cancer cells; in addition, effects on neurodegeneration, and on virus replication in HIV infection have been demonstrated potentially expanding the application of VPA in the future. Despite a good tolerability of the drug, reports of hepatotoxicty even in patients without risk factors become more frequent. We analysed all cases of VPA induced severe hepatic side effects reported to the german Federal Institute for Pharmaceuticals & Medical Products (BfArM) between 1993 and 2009. A special intention was to detect correlations with present co-medication as a crucial factor in the break-down of hepatic function. As frequent co-medications in VPA-induced hepatic side effects benzodiazepines, and antiepileptics, especially carbamazepine, lamotrigine and topiramate were found. In addition, propofol as a co-medication was found in 4 lethal cases. Different pathomechanisms of VPA hepatotoxicity and a therapeutic approach with carnitine are discussed. Current international guidelines for prevention of VPA-induced liver failure are contrasted. Weekly control of liver enzymes in the first treatment weeks might help to detect VPA-induced hepatic side effects earlier.
Antiepileptic effects of quinine in the pentylenetetrazole model of seizure
Authors: Torabinejad B. , Nassiri-Asl M. , Zamansoltani F.
Published: May 2011

Introduction

Quinine, is an anti-malarial drug that specifically blocks connexin 36 at gap junction channels.

Objective

Quinine has suppressed ictal epileptiform activity in vitro without decreasing neuronal excitability.

Aim

We considered the possible anticonvulsant effects of quinine in the pentylenetetrazole (PTZ) model of seizure.

Methods

In five groups, the mice were given quinine at the doses of 20, 30, 40, 50, or 60 mg/kg 30 min before the administration of PTZ (90 mg/kg). Two groups were injected with diazepam, the positive control (0.5, 1 mg/kg) and one group, the control group, was injected with saline + Tween 80 before the administration of PTZ. The onset of a general clonus was used as the endpoint. The general clonus was characterized by forelimb clonus followed by full clonus of the body.

Results

In the PTZ model, quinine at the dose of 60 mg/kg increased the latency of seizure. However, quinine at 40-60 mg/kg decreased the duration of seizure, dose dependently.

Conclusion

The present study provides evidence for anticonvulsant activity of quinine in the generalized clonic seizure of PTZ model. As a result of these finding, we suggest that gap junctions represent an appropriate target for the development of drugs aimed at decreasing epileptiform synchronization and preventing epileptogenesis.
Treatment of patient with depressive disorder - therapy with duloxetine
Authors: Uzun S. , Kozumplik O. , Jakovljevic M.
Published: May 2011

Aim

To present a case of a patient with depression who recovered during treatment with duloxetine.

Case report

Patient, 68 years old, was treated for the past 20 years because of depression. The patients described that worsening in mental condition usually started with depressed mood, followed by prostration and loss of motivation. So far, she was treated with different antidepressants, with partial therapeutic response. On the control examination, depressed mood, anxiety, fatigue, prostration, insomnia and loss in motivation were noticed. The patient reported spending most of the time in bed, with lack of interest for daily activities. Also, she reported indistinct pain in the back. She was afraid that there was no adequate cure for her condition. Treatment with duloxetine was initiated, in daily dosage of 60 mg. The patient was advised to take the medication along with the richest meal, so she started taking duloxetine after lunch. Also, the patient started taking zolpidem 10 mg in the evening because of insomnia. On the next control examination, ten days later, improvement in her mental condition was observed, and she said that she felt better. Her mood improved, as well as motivation, and anxiety was reduced. The patient continued taking duloxetine in daily dosage of 60 mg and on the following control examinations her condition remained stable, pain in the back was reduced, and she reported that she was able to function socially and was satisfied with her condition.
Immediate-release and extended-release formulations of second-generation antidepressants for the treatment of major depressive disorder in adults
Authors: Van Noord M. , Gartlehner G. , Hansen R. , Morgan L. , Thaler K. , Lux L. , Mager U. , Gaynes B. , Thieda P. , Strobelberger M. , Lloyd S. , Reichenpfader U. , Lohr K.
Published: May 2011

Introduction

Extended-release formulations of antidepressants have been marketed as a strategy to increase patient adherence. Changes in the formulation of drugs, however, could be related to changes in efficacy and tolerability. Among second-generation antidepressants, bupropion, fluoxetine, mirtazapine, paroxetine, and venlafaxine are available in immediate- and extended-release formulations.

Objectives

To compare the efficacy, tolerability, and adherence of immediate- versus extended-release formulations of second-generation antidepressants for the treatment of major depressive disorder (MDD) in adults.

Aim

To provide an evidence base for clinicians when choosing immediate- or extended-release formulations of antidepressants for the treatment of MDD.

Methods

We conducted a comparative effectiveness review for the U.S. Agency for Healthcare Research and Quality searching PubMed, EMBASE, The Cochrane Library, and the International Pharmaceutical Abstracts up to May 2010. Two people independently reviewed the literature, abstracted data, and rated the risk of bias.

Results

Six RCTs and one observational study provided evidence about the comparative efficacy, tolerability, and adherence of bupropion SR (sustained release) versus bupropion XL (extended release), fluoxetine daily vs. fluoxetine weekly, paroxetine IR (immediate release) versus paroxetine CR (continuous release), and venlafaxine IR versus venlafaxine XR (extended release). Overall, no substantial differences in efficacy and safety could be detected. Open-label and observational evidence indicated better adherence for bupropion XL and fluoxetine weekly than for immediate-release medications. No differences in adherence could be detected between paroxetine IR and paroxetine CR.

Conclusions

Our findings indicate similar efficacy and tolerability between immediate- and extended-release formulations. Whether extended-release formulations lead to better adherence remains unclear.
Valproate and cognitive therapy combined treatment efficacy in pathological gambling
Authors: Vasile D. , Vasiliu O. , Vasile B. , Tudor C. , Grigorescu G. , Mangalagiu A.G. , Ojog D.G.
Published: May 2011

Introduction

Valproate is used in psychiatry as a mood-stabilizer and has efficacy in controlling impulsivity, therefore it seems to be a useful pharmacologic agent in pathologic gambling.

Objective

To assess the efficacy of valproate in the treatment of pathologic gambling.

Methods

A group of 13 patients, 9 male and 4 female, mean age 32.6, diagnosed with pathologic gambling, according to the DSM-IV-TR criteria, received treatment with flexible dose of valproate (600–1400 mg/day, mean dose 850 mg/day) and 2 times/week cognitive therapy sessions. Patients with other axis I and II conditions were excluded. Also, none of these patients received valproate or structured cognitive therapy prior to this trial. Patients were monitored for 3 months using monthly administered Gambling Symptoms Assessment Scale (G-SAS), Clinical Global Impressions (CGI) and 10 points self-evaluated Visual Analogue Scale (VAS).

Results

Valproate was associated with a mean decrease of 10.5 points on G-SAS at week 12, compared to baseline (p < 0.05), while the CGI decreased with only 1.3 points (p = 0.122) and the VAS improved with 2.3 points (p < 0.05). The combined treatment was associated with good tolerability profile, since no drop-out was recorded in the study group due to side events and only 7 reports of mild and medium adverse events were recorded.

Conclusion

Valproate treatment associated with cognitive therapy could be a useful strategy in the management of pathologic gambling. Valproate's tolerability profile is good and the cognitive therapy offer an opportunity to ventilate the negative automatic thoughts, emotional distress and low impulse control strategies.
Therapeutic efficacy of duloxetine versus selective serotonin reuptake inhibitors in irritable bowel syndrome
Authors: Vasile D. , Vasiliu O. , Tudor C. , Bogdan V. , Mangalagiu A.G. , Vasile M.L. , Terpan M.
Published: May 2011

Introduction

Selective serotonin reuptake inhibitors (SSRIs) are frequently used for irritable bowel syndrome, while duloxetine was evaluated in other similar psycho-somatic syndromes.

Objective

This prospective, single-blind trial intends to compare the efficacy of SSRIs and duloxetine in the treatment of irritable bowel syndrome.

Methods

A group of 22 patients, 15 female and 7 male, mean age 50.2, diagnosed with irritable bowel syndrome according to the Rome II Diagnostic Criteria (1992) were treated with either an SSRI (escitalopram 20 mg/day, n = 6 or fluoxetine 40 mg/day, n = 6) or duloxetine (90 mg/day, n = 10). Patients were evaluated initially and every 4 weeks, for 6 months, using Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale 17 items version (HAMD), Clinical Global Impressions -Severity/Improvement (CGI-I/S) and a 7-points Likert scale (LS) for self-evaluated severity.

Results

Duloxetine improved anxiety and depressive symptoms, as reflected by the significant decrease of HAMA (−17.6 points, p < 0.05) and HAMD scores (−18.2 points, p < 0.05) at week 12. SSRIs also reduced the affective symptoms, significantly to baseline (p < 0.05), but less than duloxetine (−14.3, −15.2) at week 12, with no significant difference at week 24 (p = 0.120). The CGI-I results paralleled the decrease of HAMD and HAMA, while the LS evaluation of gastrointestinal symptoms improved similarly in both groups, with no significant difference (p = 0.09).

Conclusion

Duloxetine is an efficient agent in the treatment of irritable bowel syndrome, because it decreases the mood symptoms more rapidly than SSRIs. The overall efficacy of SSRIs and duloxetine at 6 months is nevertheless similar.
Neuro-psychopharmacology of aggression
Authors: Wallner B.
Published: May 2011

Aggression is a topic well investigated in neuro-psychopharmacology and behavioral research. Despite of the large number of publications dealing with this subject, many aspects are still not understood. The presentation centers on both the bio-social and the physiological regulation of aggression and its valid models. Recent studies have provided new endocrine and neurophysiologic insights into the underlying mechanisms. In the past, the steroid hormone testosterone (T) was believed to be the main endocrine activator of aggressive behavior and its expression rate. However, the importance of T seems to lie in its neuromodulatory function, especially in the regulation of overall dominance and competitive aggression. In turn, unrestrained aggression, impulsivity, and risk-taking behavior are associated with low central serotonergic activity. Other centrally active molecules, such as vasopressin or dopamine are also key players in mediating aggressiveness. In a social context, aggression is mostly applied in competitive processes to get access to limited resources such as food and mating partners, or for the defense of resources. Intriguingly, diverse forms of aggression are probably triggered by environmental factors such as the availability and quality of food. This presentation focuses both, availability and quality of food, with regard to their influence on anti-social behaviors in a variety of species and tries to work out their potential function as neurophysiologic modulators. Furthermore, unresolved methodological issues concerning the central activity of nutritional factors will be discussed.