bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregabalin GAD-treatment in Different Patient Populations Under Clinical Practice Conditions
Authors: Brasser M.
Published: March 2009

Background:

The safety and efficacy of pregabalin in Generalized Anxiety Disorder (GAD) has been confirmed based on the results of 7 large, placebo-controlled trials. We report data on different patient populations from an open-label non-interventional observational trial under naturalistic conditions.

Methods:

331 physicians (mainly psychiatrists) recruited 578 adult GAD patients and documented treatment with pregabalin over 4 weeks. GAD severity was rated by the patients using Hospital Anxiety and Depression Scale (HADS) and a 100mm daily Visual Analogue Scale (VAS-anxiety). Spontaneous Adverse Events (AEs) were collected.

Results:

Most patients received an initial dose of 150mg pregabalin per day, which was then increased to 300mg per day. Mean HADS-A Baseline Score (15.5 vs. 14.6) and Improvement (-5.9 vs. -6.1) was similar in younger (≤65 years, n=484) and older (>65 years, n=71) patients. Treatment naive patients had a lower HADS-A-Score (mean 14.2) than patients who got pregabalin add-on to their current medication (mean 15.8); both groups showed a similar improvement by 5.9 points over 4 weeks. A total of 26 AEs occured during this study, most of them rated mild to moderate in severity with no treatment related serious events. The pattern of events resembled the one known from clinical trials and post-marketing experience. 1.2% of subjects discontinued treatment due to adverse events.

Conclusion:

Data from this non-interventional study in GAD show that pregabalin demonstrates similar effectiveness in adults and older (≤65 years) patients, regardless of whether used as mono- or adjunctive therapy.
Anxiety Sensitivity Among Female Victims of Intimate Partner Violence
Authors: Dabkowska M. , Araszkiewicz A.
Published: March 2009

The study examine whether some aspects of anxiety is associated with domestic violence.

Subjects:

The examined group consisted of 59 women at the age between 17 and 64 years, the average age 35,9 years. Perpetrators used psychical violence (humiliating, menacing, deriding, setting financial limits, cheating victims out of money) or physical violence (beating and spanking, strangling, tieing together, sexual intercourse forcing, locking in a house).

Research method:

To assess the level and symptoms of anxiety Hamilton Anxiety Scale (HAS) was used. To assess the level of anxiety as state and as trait the State Trait Anxiety Inventory (STAI) self-evaluation questionnaire was used. To assess the level of social anxiety self-report Liebowitz Social Anxiety Scale (LSAS) was used.

Results:

The average level of intensity of anxiety according to HAS was 16, 5 points. In 28,8 % of women the medium intensity anxiety were found, in 8,4 % - hard intensity anxiety. In the studied group the low level of anxiety as a trait and as a state was noted. Social anxiety was reported among 57,1% of women who have experienced domestic violence. 38% was noted with a subtype of isolated social anxiety, whereas 19% had a generalized subtype of social phobia. Moderate intensity of social anxiety was presented by 9,5% of women, quite significant by 6,4% and severe and very severe by 9,4% of respondents.

Conclusions:

Traumatic events caused by home bullying can be a source of anxiety in victims. Victims of domestic violence are inherently at risk of social anxiety.
Spa Therapy in Anxiety Disorder in a 8 Week Comparative and Randomized Multicentre Study on 237 Patients
Authors: Dubois O.
Published: March 2009

We compared spa therapy-like balneotherapy treatment with Paroxetine by means of a multicentre, comparative, randomized 8-week study. At least 200 patients fitting the diagnosed criteria of generalized anxiety disorder (DSM IV) were to be recruited. They were carried out by an independent, fully-trained and specialized assessor.

The total score on the HAM-A scale (Hamilton Rating Scale for Anxiety) was the main measure for efficiency.

There were 237 patients altogether attending in ambulatory who were admitted into the 4 French centres and joined the protocol. 117 were divided up by drawing lots into the Spa Therapy group and 120 into the Paroxetine group.

All 207 patients were able to be assessed at W8. The HAM-A scores at W8 showed significant improvement in the Spa Therapy group compared to the Paroxetine group (t = 3.04 p≤ 0.0001). Remission and the rate of improvement (superior or equal to 50%) were markedly higher in the Spa Therapy group.

Other analyses stemming from this assessment enrich the results, with complemetary information on the importance of a spa treatment course prescribed in a psychiatric aim.

In conclusion, the Spa Therapy-based Balneotherapy treatment is one that has shown specific efficiency in generalized anxiety disorders. Its profile of being well-tolerated and well-accepted by the patients may enable to introduce it regularly in GAD, particularly for people who are resistent to, dependent on or have difficulty in tolerating pharmacology or psychotherapy treatments.
Comparison of Sleep Outcomes in Generalized Anxiety Disorder Following Treatment with Pregabalin or Venlafaxine-XR
Authors: Herman B. , Mychaskiw M. , Mandel F.
Published: March 2009

Objective:

To evaluate the differential effect of pregabalin and venlafaxine-XR versus placebo on sleep outcomes in non-depressed outpatients with generalized anxiety disorder (GAD).

Methods:

This secondary analysis was based on data from a double-blind trial in which adults who met DSM-IV criteria for GAD were randomized to 8-weeks of flexible-dose treatment with pregabalin (300-600 mg/d; N=121; baseline HAM-A=27.6), venlafaxine-XR (75-225 mg/d: N=125; HAM-A=27.4), or placebo (PBO; N=128; HAM-A=26.8). Sleep was evaluated at baseline, weeks 4, 8, and endpoint using the Medical Outcomes Study (MOS) Sleep Scale, including an overall sleep problems index (SPI), as well as subscale scores such as sleep disturbance.

Results:

At baseline, 64% of patients with GAD met MOS-Sleep scale criteria for insomnia. Treatment with pregabalin was associated with significant endpoint improvement in the MOS-SPI compared to both placebo (-18.1 vs. -10.5; P< 0.01) and venlafaxine-XR (-10.1: P< 0.01). Treatment with pregabalin was associated with significant endpoint improvement in the MOS-sleep disturbance score compared to both placebo (-22.2 vs. -12.0; P< 0.001) and venlafaxine-XR (-11.6: P< 0.001). While somnolence as a treatment-emergent adverse event occurred more frequently on pregabalin (9.1%) compared to venlafaxine-XR (4.8%) and placebo (2.3%), overall, patients treated with pregabalin reported greater reduction in daytime sleepiness compared to venlafaxine-XR on the MOS-daytime sleepiness sub-scale (-9.7 vs. -5.8).

Conclusions:

Treatment of moderate-to-severe GAD with pregabalin was associated with significantly better sleep outcomes compared to both placebo and venlafaxine-XR. Improvement in anxiety on pregabalin was associated with reduction in daytime sleepiness.
Is Speed of Onset of Anti-anxiety Efficacy with Pregabalin Influenced by Starting Dose?
Authors: Herman B. , Mandel F.
Published: March 2009

Objective:

There appears to be no dose-response effect for pregabalin at doses of 300-600 mg, and a modest dose-response effect in the range of 150-300 mg. The goal of the current investigation was to determine the effect of the starting dose on the speed of onset of anxiolytic efficacy.

Methods:

Data were analyzed from 7 trials of outpatients with DSM-IV GAD and a HAM-A total score ≥18. Starting doses of pregabalin ranged from 100 mg (N=301) or 150 mg (N=104), to 200 mg (N=167) and 300 mg (N=388). Assessment of early improvement included the HAM-A total score and CGI-Severity and Improvement scores.

Results:

The mean Week 1 HAM-A change score was similar for a starting dose of 200 mg/d with no titration (-8.24) when compared to patients who started on 200 mg/d and then titrated up to 400 mg/d on Day 4 (-8.64). The mean Week 1 HAM-A change score was somewhat higher for patients started on 300 mg/d, and then titrated to 450 mg/d on Day 4/5 (-8.84) when compared to patients started on a lower (100/150 mg/d) dose and titrated on Day 5 to 400/450 mg/d (-7.32). Starting on a dose of 300 mg/d with no titration resulted in an intermediate Week 1 change score (-7.87). The interaction of starting dose and titration schedule with baseline anxiety severity will be summarized in detail.

Conclusion:

The initial dose of pregabalin appears to have only a weak effect on the speed of onset of anxiolytic improvement.
Epidemiological Characteristics of Organ Somatization in Multimedical Network
Authors: Kim A.
Published: March 2009

Objectivities:

The frequency of organ somatization in multimedical network was the object of study.

Materials and methods:

Study of 2181 patients (average age-54 ± 0.8) are presented.inventory for clinical-anamnestic behavior sign of adaptation form of disease of patients with comorbid phenomenon and standard scales for value of anxiety and depressions were used.

Results:

The organ somatization have been often among patients with highly education, higher job-qualification and more favorable indexes of job-performance: scientific workers (5,6% over 2,6% in the general selection, p< 0,05), leading workers (9,3% over 3,8% in the general selection, p< 0,05), employers (14,5% over 9,9% in the general selection, p< 0,5). At the same time, the workers with lower qualificated job and manual labour (3,6% over 5,9% in general selection, p< 0,05) and also without working activity by any reason (6,0% over 42,8% in general selection, p< 0,0001).

Conclusion:

The analyze of receive clinical characteristics, that reflected the structure of comorbid organ somatization with psychic pathology disorders has been following regularities: The patients with functional disorders of intestinal organs have been the wide specter of psychopathological disorders, such as personality, anxiety-phobic, obsessive-compulsive and affective disorders, and also continuous sluggish schizophrenia. Pathology among all psychical diseases by patients with organ somatization for certain (p< 0,05) exceed analogical activities in general disorders.
Social Anxiety and Personality Traits
Authors: Martín-Santos R. , López-Solá C. , Binelli C. , Gelabert E. , Navinés R. , Crippa J.A. , Gutierrez F. , Subirà S.
Published: March 2009

The prevalence of social anxiety is estimated of 7-12% of the general population and 18% of university student. Social anxiety has a high prevalence of psychiatry and personality comorbidity. At age of 18-25 years old 80% of social anxiety cases have onset. To detect social anxiety at that age maybe important to avoid chronicity of the illness.

Aims:

To study personality traits associated with social anxiety in university students.

Methods:

We designed a cross-sectional study at the Autonomous University of Barcelona. Student were recruited by an advertisement. All student signed the informed consent. We collected: Socio-demographic data, personal and family psychiatry history, and the Liebowitz Anxiety Scale (LSAS) and the Temperament and Character Inventory of Cloninger. We defined as a social anxiety group a LSAS ≥50 total score.

Results:

Five hundred ninety-one students enter in the study. Final sample after excluded those who did not filled the rating scales was 574 participants: 75% were women, mean age (SD): 22.7 (5.3), 156 (124 women/32 men), 26% had social anxiety. Eighteen percent had family and 22% personal psychiatry history. The personality profile of the social anxiety group was: high harm avoidance (HA) (p< .001), low novelty seeking (NS) (p< .001), and low self-directedness (SD) (p< .001).

By logistic regression, after corrected by sex, age, personal and family psychiatry history, HA (OR=1.118; 95%CI=1.081-1.155), NS (OR=0.954;95%CI=0.927-0.982) and SD (OR=0.957;95%CI=0.930-0.985) predicted social anxiety. R2Nagelkerke=0.442. Hosmer-Lemeshow test (p>.05).

Conclusions:

A profile of high HA, low NS and SD personality dimensions may predict those university students with social anxiety.
The predictive Role of Anxiety Disorders on Depressive Phenomenology During Post-partum Period [P01-144]
Authors: Mauri M. , Rambelli C. , Montagnani M.S. , Camilleri V. , Cortopassi S. , Ramacciotti D. , Banti S. , Borri C. , Annalisa O. , Bettini A. , Ricciardulli S. , Giunti Y. , Ciaponi B. , Di Biase S.
Published: March 2009

Aims:

To investigate the predictive role of any specific (DSM-IV) Anxiety Disorders (AD) on depressive symptoms and Major or Minor Depressive Disorder (MDD, mDD) during early postpartum period.

Method:

Women (at the 12th-15th gestational week, N=1066) were recruited in the framework of the Program ‘Perinatal Depression - Research & Screening Unit (PND-ReScU)’. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS), and Axis-I disorders (AD, MDD, mDD) were diagnosed with the Structured Clinical Interview for Axis-I Disorders (SCID-I).

Results:

Any current AD at baseline (3rd month of pregnancy) was detected in 231 (21.7%). Having at least one current AD, was associated with a greater likelihood of having MDD or mDD during the early postpartum period, even after the adjustment for the confounding factor of having a lifetime history of MDD (RR=3.86 95%CI 1.58-9.42).

In particular, women affected by Obsessive Compulsive Disorder (N=17; 1.6%) or Panic Disorder (N=43; 4%) had at higher risk to develop depressive symptoms (EPDS≥13) during the postpartum period than women without these AD (RR=6.9 and 6.7 respectively). As for the risk of developing PPD, the strongest association was found for women with Panic Disorder (RR=7.6 95% CI 2.62-22.0).

Conclusions:

AD are associated with a greater likelihood to develop depressive symptoms and MDD or mDD during the early postpartum period. Women with current PD have the strongest risk to develop both MDD or mDD and depressive symptoms during early postpartum period compared to other anxiety disorders.
Comparison of Symptom-free Days in Generalized Anxiety Disorder Following Treatment with Pregabalin or Venlafaxine-XR
Authors: Hoffman D.L. , Mychaskiw M.A. , Dukes E.M. , Dodge W.E. , Joshi A.
Published: March 2009

Aims:

To estimate the clinical benefit of pregabalin and venlafaxine-XR for the short-term treatment of generalized anxiety disorder (GAD) using the metric of symptom-free days (SFDs).

Methods:

A post-hoc analysis of a clinical trial in which adults who met DSM-IV criteria for GAD, with a HAM-A total score ≥ 20, were randomized to 8-weeks of double-blind, flexible-dose treatment with pregabalin (300-600 mg/d), venlafaxine-XR (75-225 mg/d) or placebo. SFDs were estimated for each one-week period based on weekly HAM-A scores using a published algorithm. Differences were analyzed using pairwise comparisons from a GLM adjusting for baseline HAM-A and sites.

Results:

The sample consisted of 121 patients on pregabalin (female, 64%; mean age, 39.5 years; LS mean ± SE baseline HAM-A, 27.6 ± 0.5), 125 patients on venlafaxine-XR (female, 58%; mean age, 42.6 years; baseline HAM-A, 27.5 ± 0.5), and 128 patients on placebo (female, 61%; mean age, 40.2 years; baseline HAM-A, 26.8 ± 0.5). At endpoint, LS mean (± SE) number of SFDs was significantly higher for pregabalin (20.6 ± 1.4) compared with both venlafaxine-XR (16.5 ± 1.4; p=0.018) and placebo (15.5 ± 1.3; p=0.004). Values remained significant after adjusting for multiple comparisions (p=0.0447 and p=0.0107, respectively).

Conclusion:

Treatment with pregabalin resulted in more SFDs compared with venlafaxine-XR and placebo. The lack of difference in SFDs for groups treated with venlafaxine-XR compared to placebo contrasts with a previously reported study. Further studies are warranted to explore the application of the SFD metric.
Insomnia and Quality of Life in Generalized Anxiety Disorder: Impact on Clinical Presentation and Response to Pregabalin and Venlafaxine-XR
Authors: Mychaskiw M.A. , Alvir J.M. , Herman B.K. , Pallanti S. , Joshi A.
Published: March 2009

Aims:

To assess the impact of insomnia on quality of life (QoL) and functioning in patients with generalized anxiety disorder (GAD), and evaluate the efficacy of pregabalin and venlafaxine-XR in improving sleep and QoL.

Methods:

A double-blind trial in adults who met DSM-IV criteria for GAD, with a HAM-A total score ≥20,randomized to 8-weeks of flexible-dose treatment with pregabalin (300-600 mg/d, N=121), venlafaxine-XR (75-225 mg/d, N=125), or placebo (N=128).

Results:

At baseline, 64% of all subjects had insomnia (according to the Medical Outcomes Study Sleep scale [MOS]-Sleep Problems Index [SPI] criteria).While HAM-A total scores (minus the insomnia item) were similar for patients with and without baseline insomnia (25.7 vs. 25.0) those with reported significantly more impairment on the Quality of Life, Enjoyment, and Satisfaction Questionnaire (Q-LES-Q; 45.4 vs. 53.6; p< 0.0001) and Sheehan Disability Scale (SDS; 17.5 vs.14.3; p< 0.0001) than those without. At endpoint, there was a significantly greater mean improvement in MOS-sleep disturbance factor and MOS-SPI with pregabalin (-29.0 and -21.1, respectively) than venlafaxine-XR (-14.7 and -11.0) or placebo (-15.2 and -12.5; all p< 0.05). In more pregabalin (64%) than venlafaxine-XR (51%) or placebo (52%) subjects, abnormal baseline sleep had normalized by endpoint. Endpoint change in MOS-SPI significantly correlated with improvement in both Q-LES-Q and SDS-total scores (Spearman r-values, -0.48 and 0.46, respectively; both p< 0.0001; all subjects).

Conclusion:

Significantly greater impairment in QoL and functioning was observed in patients with high (vs. low) levels of insomnia. Pregabalin produced significantly greater improvement in insomnia than venlafaxine-XR or placebo.
The Sources of Pubertal Information and their Impact on Stress and Anxiety Among Adolescents
Authors: Najafianpour B.
Published: March 2009

Adolescence is known as a period of major hormonal, physical, and psychological changes. Stress and anxiety during adolescence are associated with different factors. The aim of this study is to investigate and examine the associations between stress and anxiety and different sources of information received by adolescent students regarding puberty, as well as evaluating the intensity and degree of puberty's stress and anxiety. Using a cross-sectional method, two groups of students belonging to two different economic family levels were chosen randomly. Spillberger's test for anxiety and stress was applied utilizing a personal-familial data questionnaire. In this research, parents, teachers, friends, and media (books, TV, radio, magazines, internet, and so on) were considered as the major sources for information regarding puberty for the subjects in the groups under investigation. The obtained results have shown a meaningful impact of the pubertal information sources on the intensity and degree of stress and anxiety experienced by the individuals of each investigated group (p=< 0/001). Hence, characteristics and the types of sources used by adolescents to obtain pubertal information have a significant impact on controlling puberty's stress and anxiety in adolescents.
Different Pathways into Panic Disorder, Agoraphobia and Specific Phobia
Authors: Nocon A. , Brückl T. , Zimmermann P. , Pfister H. , Irving H. , Rehm J. , Lieb R. , Wittchen H.-U.
Published: March 2009

Background:

In light of the ongoing debate whether agoraphobia [AG] should be viewed as a severe phobic disorder similar to specific phobia [SPE] or as a complication of panic disorder [PD] we aim to study the vulnerability structure of PD, AG and SPE.

Methods:

3021 14-24 year-olds from the general population were followed-up over 10 years. DSM-IV syndromes were assessed via computerized M-CIDI interview and vulnerability factors via questionnaires. Associations were assessed with odds ratios from logistic regression. Latent class analysis (LCA) regressed on vulnerability factors was used to derive classes that underlie panic and phobic syndromes and to assess their associations with vulnerability factors.

Results:

1.

Vulnerability patterns were largely similar between PD, AG and SPE.

2.

The LCA resulted in a best fitting model with 4 classes: a healthy class, a class with moderate frequency of phobias without PD, a class characterized by PD and AG and moderate frequency of SPE (PDAG class) and one class characterized by high frequency of AG and SPE situational type and lower frequency of PD (AGSIT class).

3.

All classes showed different associations with multiple vulnerability measures. Subjects in the PDAG class reported less SPE in parents (OR=0.2; 95% CI=0.0-0.6) and older onset-age of any psychopathology (OR=2.0; 95% CI=1.07-3.6) than the AGSIT class.

Discussion:

We found indications for separate latent classes underlying PD and phobias that were characterized by different vulnerability factors. We interprete the different classes as different vulnerability clusters and evidence of multiple pathways leading to panic and phobias.
Cultural Adaptation into Spanish of the Generalized Anxiety Disorder Scale - 7 (GAD-7) Scale
Authors: García-Campayo J. , Zamorano E. , Ruíz M.A. , Pardo A. , Freire O. , Pérez-Páramo M. , López-Gómez V. , Rejas J.
Published: March 2009

Purpose:

To carry out cultural adaptation and validation into Spanish of the 7-items self-administered GAD-7 scale; a tool to identify probable patients with Generalized Anxiety Disorder (GAD).

Material and methods:

The adaptation, conducted by an eight-expert panel, was performed by means of a conceptual equivalence process, including forward and backward translations in duplicate to the original language. The content validity was assessed by inter-ratter-agreement (item-goal congruence index of Rovinelli-Hambleton). The adapted version was administered to patients with GAD according to DSM IV criteria and their respective controls, matched by age and sex, who were recruited at random in Mental Health and Primary Care centres to verify scale feasibility and potential understanding problems.

Results:

The inter-ratter reliability confirmed the correct inclusion of items in the corresponding dimension of GAD. The study sample consisted of 8 patients with GAD and 8 controls (62.5% male), mean age 50.38 years (SD=16.76). The average time to completion was 2’30”. No items of the scale were left blank. Floor and ceiling effects were negligible. No patients with GAD had to be assisted to fill in the questionnaire. All the items, except item 5 (p=0,105), showed statistically significant differences among groups (p< 0.05).

Conclusion:

After the adaptation process, a Spanish version of the GAD-7 scale was obtained, confirming its content validity, pertinence and adequacy of items in the Spanish cultural context. The brief time to completion precluded a fast and easy self-administration in the routine medical practice to promptly detect probable cases of GAD.
Revisiting the Obsessive-compulsive Spectrum
Authors: Ramalho e Silva F. , Branco C. , Ribeiro A.E.
Published: March 2009

In the DSM IV-TR, Obsessive-Compulsive Disorder (OCD) is categorized as an anxiety disorder. A wide range of psychiatric and medical disorders, not included in this category, has been hypothesized to be related to OCD and to form a family of disorders known as obsessive compulsive spectrum disorders (OCSD). OCSD would include several clinically heterogeneous disorders such as Body Dysmorphic Disorder, Tourette's Syndrome or Pathological Gambling. This construct is based on disorders’ similarities with OCD in a variety of domains such as phenomenology, comorbidity, neurotransmitter or peptide systems, neurocircuitry, family history, genetic factors and treatment response. This presentation provides an overview of the existing literature regarding the concept of the OCD spectrum and the relationships between the disorders included in OCSD. Although there are data supporting the inclusion of some disorders in the OC spectrum, more research is needed to clarify the relationships and the boundaries between these disorders. Ultimately, a better understanding of OC spectrum may have significant implications for clinical practice.
Post-traumatic Stress Disorder Associated to Long-term Dissociative Fugue: A Case Report
Authors: Manteiga A. Tatay , Sopena L. Laguna , Diez-Canseco M. Lloret , Magán T. Merino , Díez S. Cepeda , Martínez V. Balanzá
Published: March 2009

Aims:

Since the end of 19th century, mental health professionals have noticed that individuals who have experienced traumatic situations often present dissociative symptoms, such as amnesia or fugue states. Dissociation is a defensive mechanism that allows an individual to separate from conscience the psychological distress produced by the trauma. Our aim was to remark the association between Post-traumatic Stress Disorder (PTSD) and long-term dissociative disorders through the study of a clinical case.

Method:

A clinical case was followed and reviewed to illustrate this relationship.

Results:

Ten years ago, a 49-year-old man was diagnosed of PTSD after having witnessed several colleagues burnt in a tragic accident at work and having helped the emergency fire brigade to rescue other victims. His symptoms required treatment with antidepressants and psychotherapy, and fully remitted after one year. Nevertheless, during the last year, he has presented two dissociative amnesia episodes lasting for three days each, which were examined by a neurology service. More recently, he has suffered a ten-day episode of dissociative fugue, which required psychiatric hospitalization. Although the patient has been asymptomatic during a decade, it is remarkable that he has presented three dissociative episodes in a short period of time. One of them, the fugue state, is interesting because of its long duration and its relatively low prevalence in the general population.

Conclusions:

This clinical case allows us to appreciate the long-term relationships between psychological trauma and dissociation, in addition to the well-known short-term effects.
Lamotrigine in Therapy of Patient with Posttraumatic Stress Disorder: Case Report
Authors: Kozumplik O. , Uzun S. , Jakovljevic M.
Published: March 2009

Patient N-V, with diagnose of PTSD according to DSM-IV-TR, was hospitalized in Vrapce Psychiatric Hospital, Zagreb, during 2008. At admission he reported tension, anxiety, irritability, need for isolation form other people, insomnia and nightmares. He said he was waking up almost every night because of nightmares.

In the beginning of hospital treatment lamotrigine was introduced in therapy, in daily dosage of 25 mg, along with diazepam 10 mg daily and zolpidem 10 mg in the evening. After three days the daily dosage of lamotrigine was elevated to 50 mg. No side effects of treatment were observed and the daily dosage of lamotrigine was elevated to 100 mg after six days and again on 200 mg after ten days of continuous therapy with lamotrigine. The patient reported improvement of sleep - he said he the nightmares were less frequent and he did not wake up as often as before. Also, during second week of treatment he became less tensed. After three weeks of treatment he became even more relaxed and less irritable. Also, he became more active and able to endure conversation. Initial insomnia was reduced, and he was waking up only occasionally during night. The patient was discharged from hospital after six weeks of treatment. Recommended therapy at discharge was lamotrigine in daily dosage of 200 mg, 10 mg of zolpidem in the evening, and diazepam 5 mg in case of tension.
Audit of Pattern of Benzodiazepine Prescribing in a Community Mental Health Team in England
Authors: Nodiyal A. Ghosh , Ahuja N.
Published: March 2009

Aims:

To audit benzodiazepine prescribing in a Community Mental Health team, with a view to identifying areas for improvement.

Methods:

All the 245 patient's case notes were audited, from October 2004 to October 2005, of those in the Outpatients Clinic's case load, in North Shields. A semi structured pro-forma was designed. On the basis of the guidelines from Committee on Safety of Medicines (CSM) (1988), DOH Document (1999), DOH Ireland report of benzodiazepine commission (2002), www.benzo.org.uk, Newcastle, North Tyneside and Northumbria NHS Trust Guidelines for hypnotic/anxiolytic use and Lanarkshire PCT guidelines, the standards were finalised. The audit tool looked at demographics, indications of benzodiazepine prescription, co-morbid medical conditions, substance misuse, psychotherapeutic intervention and follow up of patients prescribed benzodiazepines.

Results:

245 notes were audited. 24% of all patients were on benzodiazepines. Out of those, 56% were women. A third of these patients were between 41-50 year olds, while another third were older than 50years. Co-morbid substance and alcohol dependence was uncommon. The most common diagnoses in these patients were mood disorder (31%), schizophrenia (20%), and personality disorders (12%). Nearly two-third of patients suffered from co-morbid medical conditions. 25% patients had had psychological therapies. None of them were given advice about sleep hygiene and driving.

Conclusions:

Older women with mood disorders are more likely to be prescribed benzodiazepines longer than recommended. Advice about driving, sleep hygiene, information about side effects and risks was not offered to most patients. Recommendations have been made, with a view to re-auditing and improving services.
Psychopharmacotherapy in a Multy-type Hospital
Authors: Pyrkov P.
Published: March 2009

Introduction:

The increasing number of patients with comorbide mental disorders, who were staying in multy-type hospitals, necessitates the organization of psychiatric service, which includes psychopharmacotherapy.

Results:

Observations were performed during 25 years in a multy-type emergency hospital.

Indications for psychopharmacotherapy were:

1.

Organic (somatogenic) mental disorders (F06) - 61%, among them are: organic delirium ((F05, 8) - 25%, organic hallucinosis (F06.0) - 10%, organic amnesic syndrome (F04) - 27%, organic anxiety phobic disorder with agitation (F06.4) - 9%.

2.

Mental and behavioral disorders due to psychoactive substance use (F10 - 19%, F10.03 -12%, F10.31 - 6%, F11.21 - 1%.

3.

Neurotic depression with suicidal behaviour (accomplished parasuicide) (F43, 24) - 1%.

4.

Anorexia nervosa (F50.0) - 3%.

5.

Dementia (F00-F02) - 16%.

The examination showed that short-time (up to 10-15 days) psychotic disorders could be reduced with parenteral introduction of the Diazepam 2ml 2-3 times/day.

The use of Nootropics (Pyracetam 20% 10-20ml, Cerebryl 250ml iv) and B vitamins stimulated reduction of psychosis.

Any of patients wasn't moved to the residential psychiatric facility.

We didn't use neuroleptics cause their iatrogenic activity by organic psychosis and incompatibility with some somatotropic medicaments, employing by multiplex somatic disorder.

Conclusion:

Optimization of the psychopharmacotherapy in general hospital requires a regular psychiatrist on its staff. The treatment of the patient in the general hospital seems to be economic and moral effective.
Lorazepam-induced Heightened Sexual Desire
Authors: Simões S. , Amorim J. , Machado Á.
Published: March 2009

Introduction:

Drug-induced increased libido has been reported mainly with dopaminergic agents. Although benzodiazepines may cause behavioural dishinibition, they were rarely related to sexual undesired urges.

Case:

A 62-year-old woman was seen for breast mucinous carcinoma. Besides mild hypertension and initial insomnia she was otherwise previously healthy. She was chronically medicated with ramipril and diazepam 5mg id. Tumour ressection was carried out and chemotherapy with FEC-T was began. One week after, in a follow-up visit, she complained having difficulties on sleep onset. Lorazepam 1mg at the bedtime was prescribed. After the first dose she felt an overwhelming sexual desire, the urge making her to repeatedly open and close her legs, feeling even the physical intercourse. This sensation fade gradually over the next few hours. On the following day she decided to take another lorazepam pill to be sure it was the cause of that strange feelings. The symptoms of the previous night were completely reproduced. She has now completed the chemotherapy and proposed to adjuvant radiotherapy. She never felt those symptoms again and did not take another lorazepam.

Conclusion:

It is believed that dopaminomimetic drugs can heighten sexual desire by increasing dopamine concentration on the mesolimbic pathway. In this way, benzodiazepines, as GABA enhancers, would inhibit dopamine release leading to reduced libido. On the other hand, GABA also inhibits serotoninergic-mediated vigilance and impulse control, leading to dishinibition and impulsivity. In our patient, lorazepam has caused a “virtual intercourse” as previously found in electric and mechanic stimulation of septal region and amygdala.
Cognitive and Affective Endophenotypes Related to Major Depression are Associated with P2RX7
Authors: Sarosi A. , Szekely A. , Balogh G. , Gonda X. , Halmai Z. , Rihmer Z. , Faludi G. , Sasvari-Szekely M.
Published: March 2009

Background:

The P2RX7 gene encoding for purinergic receptor P2X has earlier been associated with a susceptibility to anxiety and affective disorders. The aim of our present study was to investigate the association of this polymorphism with different aspects and symptom clusters of major depression.

Method:

192 inpatients diagnosed with DSM-IV major depression and bipolar I and bipolar II depression aged 21-69 years (mean=48.2±11.05) participated in our study. All participants were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS). All patients were genotyped for the P2RX7 Gln460Arg SNP (rs2230912) using PCR. Association between genotype and MADRS scores was analysed with ANOVA controlling for age and gender.

Results:

rs2230912 genotype showed a significant association with depression indicated by the total MADRS score. We also found a significant genotype effect in case of the Affective and Cognitive clusters, but not on the Somatic and Psychomotor clusters of MADRS.

Discussion:

We managed to confirm earlier results concerning the association of the P2RX7 rs2230912 with major depressive disorder and bipolar depression. Furthermore, we found that this association is carried by the affective and cognitive symptoms associated with depression. Our results bring us closer to decomposing depression to endophenotypes more suitable for research and also for understanding the nature of affective disorders.

This work was supported by EU-Hungarian fund, GVOP AKF 311 2004 050324/3.0, the Hungarian National fund, OTKA T048576 and Janos Bolyai Research Fellowship of the Hungarian Academy of Science.
Is MAO-B Activity in Platelets Associated with the Occurrence of Suicidality and Behavioural Personality Traits in Depressed Patients?
Authors: Lewitzka U. , Müller-Oerlinghausen B. , Felber W. , Lauterbach E. , Ising M. , Bronisch T.
Published: March 2009

Objective:

Low platelet MAO-B activity has been associated with various forms of impulsive behaviour and suicidality. The present study investigated the relationship between MAO-B activity in platelets and aspects of suicidality in depressed patients and controls.

Method:

In 87 patients with affective spectrum disorders (58% suffering from a Major Depressive Episode - MDE) the potential association between platelet MAO-B activity and suicidality was examined. 59 of the patients had committed suicide attempt recently (SA - “suicide attempters”), 28 patients were acutely depressed without having shown suicidal thoughts or suicidal behaviour in the past (NA - “non suicide attempters”).

Results:

SA and NA were comparable as to their diagnoses and general demographic and psychopathological parameters. MAO-B activity did not differ between SA and NA. No systematic correlations existed between MAO-B activity and any dimensions of suicidal behaviour or psychopathology. As a single finding only a weak positive association of higher MAO-B activity in SA with a fatal intention of the suicide attempt was observed.

Conclusion:

Our findings do not support a consistent association of platelet MAO-B activity and suicidal behaviour in general, but specific facts of suicidality might be associated.
The Serotonin System, Stressful Life Events, and Risk of Suicidal Behaviour
Authors: Saiz P.
Published: March 2009

There is robust evidence that stressful life events (SLE) are associated with an increase in risk of developing depression. However, humans display wide variation in response to adversity. Recently, Caspi et al (2003) reported that a functional length polymorphism (5-HTTLPR) in the promoter of the serotonin transporter gene moderated the influence of SLE on depressive symptoms, major depression, and suicidality, suggesting evidences of a gene-by-environment interaction.

Neuroimage data from healthy, non-depressed, s allele carriers of the 5-HTTLPR show an exaggerated amygdale response to threatening visual stimuli as well as reduced gray matter volume in limbic regions critical for processing of negative emotion compared with individuals with the LL genotype. These data suggest a potent modulatory effect of the 5-HTTLPR on amygdala reactivity to environmental threat.

In recent years, a growing number of molecular genetic studies have focused on the serotonin system, suggesting that this system may be involved in the pathogenesis of suicidal behaviour. Meta-analytic evidences support a link between the s allele of the 5-HTTLPR and the risk of suicidal behaviour. However, several case-control association studies show an association between the short allele and the violence, the number, and the medical lethality of the attempts.

In this presentation we discuss data regarding the complex relationship between the serotonin functionality, stress, and suicidal behaviour.
Risk of Postpartum Depression in Association with Serum Leptin Levels: A Nested Case-control Study within the Uppsat Cohort
Authors: Skalkidou A. , Sundström-Poromaa I. , Sylven S. , Olovsson M. , Larsson A. , Papadopoulos F.
Published: March 2009

Although postpartum depression (PPD) is a common condition, it often goes undiagnosed and untreated, with devastating consequences for the woman's ability to perform daily activities, to bond with her infant and to relate to the infant's father. Leptin, a protein synthesised in the adipose tissue and involved in regulation of food intake and energy expenditure has been related to depressive disorders, but studies report conflicting results. The aim of this study was to evaluate the association between serum leptin levels at the time of delivery and the subsequent development of postpartum depression in women, using data from a population-based cohort of delivering women in Uppsala, Sweden. Three hundred and sixty five women from which serum was obtained at the time of delivery filled out at least one of three pre-coded questionnaires containing the Edinbourgh Scale for Postnatal Depression (EPDS) five days, six weeks and six months after delivery. Crude mean leptin levels did not significantly differ between cases of PPD and controls. Using linear regression analysis and adjusting for maternal age, body-mass index, smoking, interleukin-6 levels, duration of gestation, gender and birth weight of the newborn, the EPDS scores at five days, six weeks and six months after delivery were negatively correlated with leptin levels at delivery (p< 0.05). Serum leptin levels at delivery were found to be negatively correlated with self reported depression during the first six months after delivery.
Bipolar Affective Disorders: Diagnostic and Treatment Situation in Lithuania
Authors: Adomaitiene V. , Kunigeliene A. , Dambrauskiene K. , Danileviciute V.
Published: March 2009

Introduction:

Bipolar disorder is one of the most important psychiatric diseases. This is a lifelong illness which increases disability, bad social, employment, and functional outcomes. Bipolar disorder causes dramatic mood swings - from overly “high” and irritable to sad and hopeless, often with periods of normal mood between. Bipolar I disorder is characterized by a history of at least one manic episode, with or without depressive symptoms. Bipolar II disorder is characterized by the presence of both depressive symptoms and a less severe form of mania.

Objective:

To review diagnostic and treatment situation of bipolar affective disorders in Lithuania.

Method:

A review of bipolar affective disorders in Lithuania: the prevalence of bipolar disorders, the differences between genders, the clinical features between genders.

Results:

Studies have suggested, that the prevalence of bipolar disorder in Lithuania is 1 % of population. The rates of bipolar disorder: in 2003 was 1131 cases, in 2004 - 1133 cases, in 2005 - 1147 cases, in 2006 - 1255 cases, in 2007 - 1257 cases. Distribution of bipolar disorders between males and females: males - 35,88 %, females - 64,12 %.

Conclusion:

The rates of Bipolar I disorder are equal between female and male population, but bipolar II disorder is more frequent in female population (bipolar depression, mixed manic disorder). Bipolar disorder with alcohol and drug abuse are very common among male population. Bipolar disorders are very common with somatic disease (thyroid disease, migraine, obesity of medication), anxiety disorders are more frequent in female population.
Suicidal Attempts Among Bipolar Patients: Correlation with Affective Temperaments and Life Events
Authors: Amara G. , Ben Salah N. , Ben Nasr S. , Ben Hadj Ali B.
Published: March 2009

Aims:

In this study, we focused on the correlations between life events, affective temperaments and suicidal attempts among patients with bipolar disorder.

Methods:

Patients with DSM IV diagnosis of bipolar I or bipolar II disorders were recruited from psychiatric consultation of the Farhat Hached Hospital in Sousse. All bipolar patients were in remission for at least four weeks. Suicidal attempts were checked by interrogating patients and consulting medical observations. Affective temperament dimensions were determined by using the Arabic version of TEMPS-A. The assessment of life events was based on the Paykel scale.

Results:

A total of 57 patients (47 with bipolar I disorder and 10 with bipolar II disorder) have participated in the study, with a mean age of 41,8 ± 11,3 years and a gender ratio of 2,29. Suicidal attempt number was positively correlated with depressive (p=0,021) and anxious (p=0,015) temperament, early orphanage (p=0,008) and the total number of life events (p=0,011). It was also correlated with the global negative impact of these events (p=0,036).

Conclusion:

According to our findings, life events and their negative impact, early parental loss and anxious and depressive temperaments predispose to suicidal attempts among patients with bipolar disorder. Further prospective studies are required to confirm these results.
Phenotypic and Genotypic Analysis in a Large Turkish Bipolar Family
Authors: Arisoy O. , Akarsu A.N. , Oral T.
Published: March 2009

Objective:

To document the phenotypic and genotypic characteristics of a three generational large family loaded with affective disorders.

Method:

Linkage analysis is done in a large three generational Turkish family loaded with affective disorders. 8 patients and 17 relatives are examined with SCID-I and the clinical characteristics of the patients are documented. Blood is drawn from all family members to isolate DNA but only the patients DNA are included in the molecular analysis and these patients are screened for five susceptibility regions implicated for both schizophrenia and bipolar disorder (10p12, 13q32, 18p11.2, 22q11 ve 20 p12-q12).

Results:

Clinical assesment of the patients revealed that, the depressive episodes of the patients are likely to be melancoholic and suicidal in nature and the manic episodes are usually associated with mood-congruent psychotic symptoms. No linkage could be detected for the screened regions in molecular analysis. Only a loss of heterozygosity could be detected in 18p11.2 region.

Conclusion:

The allelic loss from the maternal allele in this region did not seem to segregate with the disorder and this maternal allele loss could not be explained by an imprinting mechanism, since there was no parental transmission of the disorder in this pedigree. This region must be screened with multiple markers and sitogenetic analysis should be done in order to be able to understand whether there is a real loss of in this part of the chromosome.
Meta-analysis of Magnetic Resonance Imaging Studies in Bipolar Disorder and Schizophrenia [P01-175]
Authors: Arnone D. , Cavanagh J. , Gerber D. , Lawrie S.M. , Ebmeier K.P. , Mcintosh A.M.
Published: March 2009

Introduction:

Several MRI studies have identified structural abnormalities in association with bipolar disorder. The literature is however heterogeneous and there is remaining uncertainty about the brain areas pivotal to the pathogenesis of the condition. The aim of this study was to identify, appraise and summarise volumetric MRI studies of brain regions comparing bipolar disorder with an unrelated control group and/or patients with schizophrenia.

Methods:

A systematic review and random-effects meta-analysis was carried out to identify key areas of structural abnormality in bipolar disorder and whether the pattern of affected areas separated bipolar disorder from schizophrenia. Excessive variability was explored using meta-regression analyses.

Results:

Seventy two reports met inclusion criteria. Subjects with bipolar disorder showed significant whole brain and prefrontal lobe volume reductions, and also increases in the volume of the globus pallidus. Enlargement of the lateral ventricles in bipolar disorder was confirmed, although the magnitude of enlargement was smaller than in schizophrenia. Subjects with schizophrenia, but not bipolar disorder, showed significant reductions in right amygdala volumes. Heterogeneity was statistically significant for many of the analyses and could amongst others be explained by age, duration of illness and year of publication.

Conclusion:

There appear to be robust changes in brain volume in bipolar disorder compared with healthy volunteers. Age and duration of illness appear to be key issues in determining the magnitude of observed effect sizes.
Severely Mood-disordered Youth Respond Less Well to Treatment in a Community Clinic than Youth with Bipolar Disorder
Authors: Bastiaens L. , Bastiaens J.
Published: March 2009

Introduction:

Bipolar disorder diagnoses in youth have significantly increased in the past decade. To help establish proper diagnostic practices, four different phenotypes have been proposed, ranging from meeting full DSM-IV criteria to “severely mood disordered” conditions (Leibenluft et al, 2003). So far, not much is known about these phenotypes and their response to treatment in the community.

Objective:

To identify youth diagnosed with bipolar disorder versus mood disorder NOS and evaluate their response to treatment in a community clinic.

Methods:

A retrospective chart review identified 19 children with bipolar disorder and 22 with mood disorder NOS and “followed back” these patients for eight months. Pre- and post-treatment Global Assessment of Functioning (GAF) and Clinical Global Improvement (CGI) scales were collected.

Results:

There were no differences between the two groups in terms of gender, number of diagnoses, family history of bipolar disorder, initial GAF, level of care needed, or number of medications needed. Youth with bipolar disorder were older, had more risk factors for suicidality, more past medication trials, and more hospitalizations. Severely mood disordered patients had more ADHD.

After eight months, bipolar disorder youth improved significantly more than severely mood disordered patients: Change in GAF (+10.4 vs +5.3), endpoint GAF (56.9 vs 50.3), and CGI (2.6 vs 3.1).

Conclusion:

Even though bipolar disorder youth look more like adults with bipolar disorder (older age, more suicidality, more hospitalizations), severely mood disordered youth respond much less to treatment in a community clinic.