86901
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Abstract
There are several findings on the action of magnesium ions supporting their possible therapeutic potential in affective disorders. Examinations of the sleep-electroencephalogram (EEG) and of endocrine systems point to the involvement of the limbic-hypothalamus-pituitary-adrenocortical axis as magnesium affects all elements of this system. Magnesium has the property to suppress hippocampal kindling, to reduce the release of adrenocorticotrophic hormone (ACTH) and to affect adrenocortical sensitivity to ACTH. The role of magnesium in the central nervous system could be mediated via the N-methyl-D-aspartate-antagonistic, gamma-aminobutyric acidA-agonistic or a angiotensin II-antagonistic property of this ion. A direct impact of magnesium on the function of the transport protein p-glycoprotein at the level of the blood-brain barrier has also been demonstrated, possibly influencing the access of corticosteroids to the brain. Furthermore, magnesium dampens the calciumion-proteinkinase C related neurotransmission and stimulates the Na-K-ATPase. All these systems have been reported to be involved in the pathophysiology of depression. Despite the antagonism of lithium to magnesium in some cell-based experimental systems, similarities exist on the functional level, i.e. with respect to kindling, sleep-EEG and endocrine effects. Controlled clinical trials examining the effect of Mg in affective disorder are warranted.
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86902
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Klein LC, Corwin EJ. Seeing the unexpected: how sex differences in stress responses may provide a new perspective on the manifestation of psychiatric disorders. Curr Psychiatry Rep 2002; 4:441-8. [PMID: 12441024 DOI: 10.1007/s11920-002-0072-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this report, the authors propose that underlying sex differences in the biobehavioral response to stress may contribute to the variance in prevalence of some psychiatric disorders based on sex. The authors begin with a discussion of stress physiology and review a new theory on sex differences in stress responses (ie, the "tend-and-befriend" response), which may provide a recent framework for considering sex differences in the manifestation of some psychiatric illnesses. The authors then move to a discussion of major depression and attention deficit hyperactivity disorder as examples of how sex differences in stress responses may influence the behavioral symptoms of psychiatric disorders that are more often diagnosed in one sex compared with another. The authors conclude with a brief discussion of the implications of this new perspective on treatment approaches and encourage further inquiry into the importance of sex-based differences in the behavioral manifestation of some psychiatric illnesses.
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Affiliation(s)
- Laura Cousino Klein
- Department of Biobehavioral Health, Pennsylvania State University, 315 East Health and Human Development Building, University Park, PA 16802, USA.
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86903
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Butterfield MI, Becker M, Marx CE. Post-traumatic stress disorder in women: current concepts and treatments. Curr Psychiatry Rep 2002; 4:474-86. [PMID: 12441028 DOI: 10.1007/s11920-002-0076-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the US, 13% of women develop post-traumatic stress disorder (PTSD) during their lifetime. An accurate diagnosis of PTSD requires screening for trauma and symptoms of PTSD. Current research in the neurobiologic and psychologic responses to traumatic stress supports the use of pharmacologic and psychosocial interventions. Selective serotonin reuptake inhibitors are the current first-line pharmacotherapy. Efficacious psychosocial interventions include exposure therapy and cognitive processing therapy.
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Affiliation(s)
- Marian I Butterfield
- Department of Psychiatry, Duke University and the Department of Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA.
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86904
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Hudson JL, Rapee RM. Parent-child interactions in clinically anxious children and their siblings. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2002; 31:548-55. [PMID: 12402573 DOI: 10.1207/s15374424jccp3104_13] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Observed 57 children (37 anxiety-disordered and 20 non-clinic-referred children) and their siblings interacting with their parents while completing a complex puzzle task. Consistent with previous findings, mothers were more involved and more intrusive during the task with their anxiety-disordered child than mothers of non-clinic-referred children. Mothers in the clinic-referred group were also significantly more involved and more intrusive during interactions with the anxious child's sibling than mothers of non-clinic-referred children. Although fathers were more involved during the task than mothers overall, no significant differences in overinvolvement were found between fathers of anxiety-disordered children and fathers of non-clinic-referred children. Both mothers and fathers were equally involved with the anxious child and the sibling of the anxious child. Although this study provides support for the association between maternal overinvolvement and the anxiety disorders, it suggests that overinvolvement does not occur exclusively in the context of relationships with the anxiety-disordered child.
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86905
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Abstract
Psychological depression is shown to be associated with several aspects of coronary artery disease (CAD), including arrhythmias, myocardial infarction, heart failure and sudden death. The physiological mechanisms accounting for this association are unclear. Hypothalamic-pituitary-adrenal dysregulation, diminished heart rate variability, altered blood platelet function and noncompliance with medial treatments have been proposed as mechanisms underlying depression and cardiovascular disease. Recent evidence also suggests that reduced baroreflex sensitivity, impaired immune function, chronic fatigue and the co-morbidity of depression and anxiety may be involved in the relationship between depression and cardiovascular dysregulation. An experimental strategy using animal models for investigating underlying physiological abnormalities in depression is presented. A key to understanding the bidirectional association between depression and heart disease is to determine whether there are common changes in brain systems that are associated with these conditions. Such approaches may hold promise for advancing our understanding of the interaction between this mood disorder and CAD.
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Affiliation(s)
- Angela J Grippo
- Department of Psychology, The University of Iowa, Iowa City 52242-1407, USA
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86906
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Linzmayer L, Arnold O, Saletu-Zyhlarz GM, Semlitsch HV, Boeck G, Anderer P, Saletu B. Daytime Noopsychic and Thymopsychic Dysfunctions in Nonorganic Insomnia Related to Different Mental Disorders. Noopsychische und thymopsychische Tagesfunktionsstorungen bei nichtorganischer Insomnie assoziiert mit verschiedenen psychischen Erkrankungen. SOMNOLOGIE 2002. [DOI: 10.1046/j.1439-054x.2002.02192.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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86907
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Sattar SP, Ucci B, Grant K, Bhatia SC, Petty F. Quetiapine therapy for posttraumatic stress disorder. Ann Pharmacother 2002; 36:1875-8. [PMID: 12452747 DOI: 10.1345/aph.1c040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report a case of improvement in posttraumatic stress disorder (PTSD) after adjunctive therapy with quetiapine. CASE SUMMARY A 49-year-old white man witnessed a traumatic event and experienced severe PTSD. He was started on paroxetine, with increases in dosage and no significant improvement. Quetiapine was added to his regimen, with increased doses resulting in improvement of PTSD symptoms, both clinically and as measured on the Hamilton-D rating scale for depression and the clinician-administered PTSD screen. DISCUSSION This is the first case published in the English language literature describing improvement in PTSD symptoms after treatment with quetiapine. There are several treatment options for PTSD, but some severe cases may require treatment with antipsychotic medications. Because of the lower risks of serious adverse effects, the newer atypical antipsychotics are much safer than the older antipsychotics. Although use of risperidone and olanzapine in the successful treatment of PTSD has been reported in the literature, there are no reports of quetiapine use in this clinical condition. CONCLUSIONS Quetiapine appeared to improve clinical signs and symptoms of PTSD in this patient. It may be a treatment option in other severe cases of PTSD.
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86908
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Huisman HW, van Rooyen JM, Malan NT, Eloff FC, Malan L, Laubscher PJ, Schutte AE. Prolactin, testosterone and cortisol as possible markers of changes in cardiovascular function associated with urbanization. J Hum Hypertens 2002; 16:829-35. [PMID: 12522463 DOI: 10.1038/sj.jhh.1001493] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2002] [Revised: 08/22/2002] [Accepted: 09/22/2002] [Indexed: 11/09/2022]
Abstract
People living in large informal settlements in South Africa showed a significant increase in cardio/cerebrovascular disease. This study was undertaken to compare the cardiovascular and endocrine parameters of urbanized and rural black female and males. The hormone levels such as prolactin, cortisol and testosterone may also change with urbanization and could make a contribution to the high rate of hypertension. For this study, 1202 black subjects were selected from 37 randomly selected rural and urbanized settlements. Resting blood pressure was recorded with a Finapres apparatus. Cardiac output, stroke volume, heart rate, total peripheral vascular resistance and compliance had been obtained with the Fast Modelflow software program. An acute laboratory stressor (hand dynamometer exercise) was applied to challenge the cardiovascular system and the measurements were repeated. Blood sampling was done and hormone levels were determined by biochemical analyses. For females, significant lower levels of cortisol were found in the urban strata in comparison with the rural strata. The testosterone levels were significantly lower and the prolactin levels significantly higher for females in the informal settlements compared with the rural strata. It is noticeable that most cardiovascular parameters showed the highest changes with the application of the stressor in the informal settlement strata and the lowest in people living on farms for both male and female. The prolactin levels in males are significantly higher in the informal settlement stratum. Subjects living in informal settlements showed a noticeable endocrine pattern of ongoing stress that can be associated with changes in the cardiovascular parameters with urbanization. This can partly explain the reported high rate of cardio/cerbrovascular disease in black South Africans living in informal settlements.
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Affiliation(s)
- H W Huisman
- School for Physiology, Nutrition and Consumer Sciences, Potchefstroom University, Potchefstroom, South Africa.
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86909
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Klink R, Robichaud M, Debonnel G. Gender and gonadal status modulation of dorsal raphe nucleus serotonergic neurons. Part I: effects of gender and pregnancy. Neuropharmacology 2002; 43:1119-28. [PMID: 12504918 DOI: 10.1016/s0028-3908(02)00219-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Gender differences in susceptibility to affective disorders are well documented. The ovarian steroids, estrogen (E) and progesterone (P), may modulate the function of the serotonergic (5-HT) system, implicated in the etiology and treatment of affective disorders. We tested the hypothesis that ovarian steroid modulation of 5-HT function could result in a modification of the 5-HT neuronal firing activity. Extracellular unitary recordings of dorsal raphe nucleus 5-HT neurons were obtained in male rats and in female rats during natural E and P fluctuations. The average firing activity of 5-HT neurons was significantly higher in males (41%) than in freely cycling (CF) and in ovariectomized (OVX) females. During pregnancy, it increased gradually and by up to 136% on gestational day 17, then declined before parturition. In the postpartum period (PP), the firing rate decreased markedly compared to P17 but remained 63% higher than in CF. During pregnancy, the firing rate variations were closely correlated with P plasmatic levels. Finally no modification of the basal firing activity of locus coeruleus noradrenergic neurons was found in any group tested. Our results thus reveal a gender and pregnancy-dependent modulation of 5-HT firing rate that would impact 5-HT-mediated neurotransmission.
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Affiliation(s)
- R Klink
- McGill University, Department of Psychiatry, 1033 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1
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86910
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Abstract
Suicide and suicide attempts by children and adolescents continue to be a major public health problem in the United States. Major risk factors include a previous suicide attempt, a mood disorder, a family history of suicide, a parental psychiatric disorder, and a history of sexual abuse. Genetic vulnerability appears to be a factor as well. Efforts to prevent subsequent attempts at suicide have not generally been successful, and many children and adolescents are not receiving treatment for the mood disorders and other psychiatric conditions that are risk factors. Evaluation of suicide risk should be carried out through multiple informants, not simply the adolescent or the parents, although a thorough clinical interview of the adolescent is essential.
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Affiliation(s)
- Brett Koplin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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86911
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Perugi G, Toni C, Frare F, Ruffolo G, Moretti L, Torti C, Akiskal HS. Effectiveness of adjunctive gabapentin in resistant bipolar disorder: is it due to anxious-alcohol abuse comorbidity? J Clin Psychopharmacol 2002; 22:584-91. [PMID: 12454558 DOI: 10.1097/00004714-200212000-00008] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We evaluated effectiveness and predictors of response of gabapentin (GBP) as adjunctive treatment in a sample of 43 subjects with DSM-III-R bipolar disorder who were resistant to standard mood stabilizers. Diagnostic evaluation was performed by means of the Semistructured Interview for Mood Disorder. Clinical evaluation was performed at the beginning and end of the observation period by means of the Hamilton Rating Scale for Depression (HAM-D), the Young Mania Rating Scale, and the Clinical Global Impression Scale. GBP was administered as an adjunctive treatment for an 8-week period in combination with other mood stabilizers, benzodiazepines, antidepressants, and neuroleptics. Mean dosage +/- SD at week 8 was 1270 +/- 561.4 mg (range, 600-2400 mg). Adjunctive treatment with GBP was well tolerated by almost all the subjects; only three patients had to interrupt treatment before week 8, two because of inefficacy and one because of the appearance of side effects (ataxia and irritability); in other patients, the most frequent side effects were sedation, irritability, tremor, ataxia or motor instability, and nausea. Eighteen (41.9%) of 43 patients who began treatment were considered responders. Mean total HAM-D score showed a significant reduction during the 8 weeks of treatment. Analysis of the various HAM-D dimensions showed that the anxiety-somatization factor was the one with the greatest change. Seventeen of the 18 responder patients remained in remission for a period ranging from 4 to 12 months without clinically significant side effects or adverse events. One patient had to interrupt GBP treatment and be administered neuroleptics because of the reappearance of manic symptoms. Regarding response predictors, logistical regression analysis showed that the presence of panic disorder and alcohol abuse was associated with positive response. The results of the present study replicate prior studies indicating that GBP is an effective and well tolerated treatment in a large proportion of bipolar patients who are resistant to traditional mood stabilizers. More specifically, this drug appears to have antidepressant and anxiolytic properties. What is new in the present report is the suggestion that the utility of GBP in resistant bipolar disorder resides in its effectiveness against comorbid panic disorder and alcohol abuse.
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Affiliation(s)
- Giulio Perugi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, Psychiatry Section, University of Pisa, Pisa, Italy.
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86912
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Teplin LA, Abram KM, McClelland GM, Dulcan MK, Mericle AA. Psychiatric disorders in youth in juvenile detention. ARCHIVES OF GENERAL PSYCHIATRY 2002; 59:1133-43. [PMID: 12470130 PMCID: PMC2861992 DOI: 10.1001/archpsyc.59.12.1133] [Citation(s) in RCA: 679] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Given the growth of juvenile detainee populations, epidemiologic data on their psychiatric disorders are increasingly important. Yet, there are few empirical studies. Until we have better epidemiologic data, we cannot know how best to use the system's scarce mental health resources. METHODS Using the Diagnostic Interview Schedule for Children version 2.3, interviewers assessed a randomly selected, stratified sample of 1829 African American, non-Hispanic white, and Hispanic youth (1172 males, 657 females, ages 10-18 years) who were arrested and detained in Cook County, Illinois (which includes Chicago and surrounding suburbs). We present 6-month prevalence estimates by demographic subgroups (sex, race/ethnicity, and age) for the following disorders: affective disorders (major depressive episode, dysthymia, manic episode), anxiety (panic, separation anxiety, overanxious, generalized anxiety, and obsessive-compulsive disorders), psychosis, attention-deficit/hyperactivity disorder, disruptive behavior disorders (oppositional defiant disorder, conduct disorder), and substance use disorders (alcohol and other drugs). RESULTS Nearly two thirds of males and nearly three quarters of females met diagnostic criteria for one or more psychiatric disorders. Excluding conduct disorder (common among detained youth), nearly 60% of males and more than two thirds of females met diagnostic criteria and had diagnosis-specific impairment for one or more psychiatric disorders. Half of males and almost half of females had a substance use disorder, and more than 40% of males and females met criteria for disruptive behavior disorders. Affective disorders were also prevalent, especially among females; more than 20% of females met criteria for a major depressive episode. Rates of many disorders were higher among females, non-Hispanic whites, and older adolescents. CONCLUSIONS These results suggest substantial psychiatric morbidity among juvenile detainees. Youth with psychiatric disorders pose a challenge for the juvenile justice system and, after their release, for the larger mental health system.
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Affiliation(s)
- Linda A Teplin
- Psycho-Legal Studies Program, Department of Psychiatry and Behavioral Sciences, The Feinberg School of Medicine, Northwestern Univerity, 710 N Lake Shore Dr, Suite 900, Chicago, IL 60611, USA.
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86913
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Rojas-Corrales MO, Berrocoso E, Gibert-Rahola J, Micó JA. Antidepressant-like effects of tramadol and other central analgesics with activity on monoamines reuptake, in helpless rats. Life Sci 2002; 72:143-52. [PMID: 12417248 DOI: 10.1016/s0024-3205(02)02220-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Affective states are regulated mainly by serotonin and noradrenaline. However the opioid system has been also related to antidepressant-induced mood improvement, and the mu-opioid receptor has been involved in affective responses to a sustained painful stimulus. Similarly, antidepressant drugs induce an antinociceptive effect via both the monoaminergic and opioid systems, probably involving sensorial and affective dimensions of pain. The aim of this study was to test three opiate analgesics, which also inhibit monoamine reuptake, in the learned helplessness model of depression in rats. Helpless rats receiving (+/-)tramadol (10, 20 mg/Kg) or (-)methadone (2, 4 mg/Kg) showed a decreased number of failures to avoid or escape aversive stimulus (shock) in both the second and the third daily sessions, compared with controls. Rats receiving levorphanol (0.5, 1 mg/Kg) showed a decreased number of such failures in the third session. The number of crossings in the intertrial interval (ITI) was not significantly modified by (+/-)tramadol or (-)methadone. Levorphanol enhanced ITI crosses at 1 mg/Kg. These results, together with other clinical and experimental data, suggest that analgesics with monoaminergic properties improve mood and that this effect may account for their analgesic effect in regulating the affective dimension of pain. From this, it seems probable that the analgesic effect of opiates could be induced by adding together the attenuation produced of both the sensorial and the affective dimensions of pain.
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Affiliation(s)
- M O Rojas-Corrales
- Unit of Neuropsychopharmacology, Department of Neuroscience, Faculty of Medicine, University of Cádiz. Plz Fragela 9, 11003, Cádiz, Spain
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86914
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Vermetten E, Bremner JD. Circuits and systems in stress. II. Applications to neurobiology and treatment in posttraumatic stress disorder. Depress Anxiety 2002; 16:14-38. [PMID: 12203669 DOI: 10.1002/da.10017] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This paper follows the preclinical work on the effects of stress on neurobiological and neuroendocrine systems and provides a comprehensive working model for understanding the pathophysiology of posttraumatic stress disorder (PTSD). Studies of the neurobiology of PTSD in clinical populations are reviewed. Specific brain areas that play an important role in a variety of types of memory are also preferentially affected by stress, including hippocampus, amygdala, medial prefrontal cortex, and cingulate. This review indicates the involvement of these brain systems in the stress response, and in learning and memory. Affected systems in the neural circuitry of PTSD are reviewed (hypothalamic-pituitary-adrenal axis (HPA-axis), catecholaminergic and serotonergic systems, endogenous benzodiazepines, neuropeptides, hypothalamic-pituitary-thyroid axis (HPT-axis), and neuro-immunological alterations) as well as changes found with structural and functional neuroimaging methods. Converging evidence has emphasized the role of early-life trauma in the development of PTSD and other trauma-related disorders. Current and new targets for systems that play a role in the neural circuitry of PTSD are discussed. This material provides a basis for understanding the psychopathology of stress-related disorders, in particular PTSD.
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Affiliation(s)
- Eric Vermetten
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia 30306, USA.
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86915
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Pranzatelli MR. Infantile spasms versus myoclonus: is there a connection? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2002; 49:285-314. [PMID: 12040898 DOI: 10.1016/s0074-7742(02)49018-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Infantile spasms (IS) is usually classified as a form of "myoclonic epilepsy," but the nosology of this whole group of disorders is unclear. Evidence suggests that the spasms are subcortically mediated, but can be modified by input from the cortex, which is believed to be abnormally excitable and disorganized. The latter features may give rise to hypsarrhythmia. The whole issue of myoclonus rests on the phenotype of IS and precise measurements of the length of electromyographic (EMG) bursts. Based on scant EMG data, it would appear that the bursts during flexor spasms are too long for epileptic myoclonus. The nature of tonic spasms of even longer duration is not myoclonic. However, the infrequent spontaneous myoclonic jerks, which can occur without spasms, and head nodding could represent positive and negative myoclonus, respectively. Data can be collected easily through techniques such as back-averaging to resolve the issue of classification and localization of motor phenomena.
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Affiliation(s)
- Michael R Pranzatelli
- Departments of Neurology and Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois 62702, USA
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86916
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Overall KL, Dunham AE. Clinical features and outcome in dogs and cats with obsessive-compulsive disorder: 126 cases (1989-2000). J Am Vet Med Assoc 2002; 221:1445-52. [PMID: 12458615 DOI: 10.2460/javma.2002.221.1445] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine clinical features and outcome in dogs and cats with obsessive-compulsive disorder (OCD). DESIGN Retrospective study. ANIMALS 103 dogs and 23 cats. PROCEDURES Records of patients with OCD were analyzed for clinical features, medication used, extent of behavior modification, and outcome. RESULTS Most dogs affected with OCD had been obtained from breeders. Male dogs significantly outnumbered females (2:1). Female cats outnumbered male cats by 2:1 in a small sample. Most affected dogs lived in households with 2 or more humans and other dogs or cats, and had some formal training. Client compliance with behavior modification was high. A combination of behavior modification and medication resulted in a large decrease in intensity and frequency of OCD in most animals. Clomipramine was significantly more efficacious for treatment in dogs than was amitriptyline. Only 1 dog and 1 cat were euthanatized because of OCD during the study. CONCLUSIONS AND CLINICAL RELEVANCE OCD in dogs does not appear to be associated with lack of training, lack of household stimulation, or social confinement. In cats, OCD may be associated with environmental and social stress. Obsessive-compulsive disorder appears at the time of social maturity and may have sporadic and heritable forms. With appropriate treatment (consistent behavior modification and treatment with clomipramine), frequency and intensity of clinical signs in most dogs and cats may decrease by > 50%. Success appears to depend on client understanding and compliance and the reasonable expectation that OCD cannot be cured, but can be well controlled.
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Affiliation(s)
- Karen L Overall
- Center for Neurobiology and Genetics-Psychiatry Department, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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86917
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Foa EB, Franklin ME, Moser J. Context in the clinic: how well do cognitive-behavioral therapies and medications work in combination? Biol Psychiatry 2002; 52:987-97. [PMID: 12437939 DOI: 10.1016/s0006-3223(02)01552-4] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cognitive-behavioral therapy (CBT) and pharmacotherapy demonstrate efficacy across the anxiety disorders, but recognition of their limitations has sparked interest in combining modalities to maximize benefit. This article reviews the empirical literature to examine whether combining treatments influences efficacy of either monotherapy. We conducted a comprehensive literature search of published randomized trials that compared combined treatment with pharmacologic or CBT monotherapies. Ten studies that met our inclusion criteria were reviewed in detail, and within-subjects effect sizes were calculated to compare treatment conditions within and across studies. At posttreatment and follow-up, effect size and percentage responder data failed to clearly demonstrate an advantage or disadvantage of combined treatment over CBT alone for obsessive-compulsive disorder, social phobia, and generalized anxiety disorder. Some advantage of combined treatment over pharmacotherapy alone emerged from the few studies that allowed for such a direct comparison. In contrast, combined treatment for panic disorder seems to provide an advantage over CBT alone at posttreatment, but is associated with greater relapse after treatment discontinuation. The advantage of combined treatment may vary across the anxiety disorders. The potential differences in usefulness of combined treatment are discussed, directions for future research are suggested, and implications for clinical practice are considered.
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Affiliation(s)
- Edna B Foa
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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86918
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Montañez S, Daws LC, Gould GG, Gerhardt GA, Frazer A. Differential in vivo clearance of serotonin in rat dorsal raphe nucleus and CA3 region. Brain Res 2002; 955:236-44. [PMID: 12419542 DOI: 10.1016/s0006-8993(02)03470-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In vivo chronoamperometric recordings were used to determine if the majority of serotonin transporters (SERTs) in the dorsal raphe nucleus (DRN) are functionally active. This was achieved by comparing the clearance of exogenously applied serotonin (5-HT) from the extracellular fluid (ECF) of the DRN to that in the CA3 region of the hippocampus, an area with lower SERT density. Serotonin was pressure ejected into these regions in anesthetized rats and reproducible electrochemical signals measured by carbon fiber microelectrodes were recorded. Consistent with SERT density as measured by [3H]cyanoimipramine binding in these brain regions (DRN>>CA3), clearance of 5-HT was significantly faster in DRN compared to that in the CA3 region. The selective serotonin reuptake inhibitor, fluvoxamine, prolonged 5-HT clearance in both CA3 and DRN. It is known that the norepinephrine transporter (NET) contributes to clearance of 5-HT in the dentate gyrus (DG) but not in CA3. Given that the DRN receives noradrenergic innervation, it was also determined if the NET contributes to 5-HT clearance in the DRN. Destruction of the NET with the neurotoxin 6-hydroxydopamine failed to alter 5-HT clearance parameters in the DRN. These data support the hypothesis that serotonin transporters are functionally active in the DRN, that serotonin clearance is mediated primarily by the SERT in the DRN and that the faster clearance of 5-HT from this region is related to its greater density of functional SERTs.
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Affiliation(s)
- Sylvia Montañez
- Department of Psychiatry, MS 7792, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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86919
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Abstract
Although the cathecholamine systems have long been the focus of drug therapy in anxiety and depression, the development of novel drugs specifically aimed at new targets within these traditional neurotransmitter systems and at targets outside of these systems is now propelling the field of drug development in anxiety. A greater understanding of regional brain networks implicated in stress, anxiety, and anxious behaviors has provided localized targets for anxiolytics. Within the serotonin and norepinephrine systems, increased understanding of postsynaptic receptor regulation with chronic treatment and cross-system effects of drug therapy have been critical in furthering our understanding of effective pharmacological interventions. Receptors within the glutamate, gamma-aminobutyric acid, and neuropeptide systems provide a rich diversity of drug targets, both in localization and function. While acknowledging significant clinical and biological differences between the various anxiety disorders, an important aspect of modern neurobiological research is to look for similarities among these disorders, given that they are highly comorbid with each other and often respond to the same spectrum of treatments. Here we review current views on both traditional and new molecular targets in the treatment of anxiety, realizing that the ultimate challenge in effective anxiolytic drug development may be achieving specificity in brain regions important in generating and sustaining anxiety.
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Affiliation(s)
- Justine M Kent
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
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86920
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Serretti A, Mandelli L, Lattuada E, Cusin C, Smeraldi E. Clinical and demographic features of mood disorder subtypes. Psychiatry Res 2002; 112:195-210. [PMID: 12450629 DOI: 10.1016/s0165-1781(02)00227-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study was to investigate demographic, clinical and symptomatologic features of the following mood disorder subtypes: bipolar disorder I (BP-I); bipolar disorder II (BP-II); major depressive disorder, recurrent (MDR); and major depressive episode, single episode (MDSE). A total of 1832 patients with mood disorders (BP-I=863, BP-II=141, MDR=708, and MDSE=120) were included in our study. The patients were assessed using structured diagnostic interviews and the operational criteria for psychotic illness checklist (n=885), the Hamilton depression rating scale (n=167), and the social adjustment scale (n=305). The BP-I patients were younger; had more hospital admissions; presented a more severe form of symptomatology in terms of psychotic symptoms, disorganization, and atypical features; and showed less insight into their disorder than patients in the other groups. Compared with the major depressive subgroups, BP-I patients were more likely to have an earlier age at onset, an earlier first lifetime psychiatric treatment, and a greater number of illness episodes. BP-II patients had a higher suicide risk than both BP-I and MDSE patients. MDSE patients presented less severe symptomatology, lower age at observation, and a higher number of males. The retrospective approach and the selection constraints due to the inclusion criteria are the main limitations of the study. Our data support the view that BP-I disorder is quite different from the remaining mood disorders from a demographic and clinical perspective, with BP-II disorder having an intermediate position to MDR and MDSE, that is, as a less severe disorder. This finding may help in the search for the biological basis of mood disorders.
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Affiliation(s)
- Alessandro Serretti
- Department of Psychiatry, Vita-Salute University, San Raffaele Institute, Via Luigi Prinetti 29, Milan, Italy.
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86921
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Payne JL, Quiroz JA, Zarate CA, Manji HK. Timing is everything: does the robust upregulation of noradrenergically regulated plasticity genes underlie the rapid antidepressant effects of sleep deprivation? Biol Psychiatry 2002; 52:921-6. [PMID: 12437933 DOI: 10.1016/s0006-3223(02)01676-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The mechanisms by which sleep deprivation brings about rapid antidepressant effects remain to be elucidated. Biological rhythms have the capacity to temporally dissociate biochemical processes, and imposing a temporal coincidence on normally dissociated events can have striking and unexpected effects. In this context, it is noteworthy that the locus coeruleus (LC) noradrenergic projection is quiescent only during rapid-eye-movement (REM) sleep, when the target tissues display their greatest sensitivity; indeed, the temporal dissociation between the firing of the LC noradrenergic neurons and the sensitivity of its postsynaptic targets in the cortex may have considerable relevance for the antidepressant effects of sleep deprivation. Sleep deprivation rapidly upregulates several plasticity-related genes, effects that are noradrenergically mediated; these are the very same genes that are upregulated by chronic antidepressants. Thus, activating the norepinephrine system during REM sleep (by infusing an alpha(2) antagonist) may allow an interaction with a primed, sensitized postsynaptic milieu, thereby rapidly increasing the expression of plasticity genes and consequently a rapid antidepressant response.
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Affiliation(s)
- Jennifer L Payne
- Laboratory of Molecular Pathophysiology, National Institute of Mental Health, Bethesda, Maryland 20892-1283, USA
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86922
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Scott LV, Dinan TG. Vasopressin as a target for antidepressant development: an assessment of the available evidence. J Affect Disord 2002; 72:113-24. [PMID: 12200202 DOI: 10.1016/s0165-0327(02)00026-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis is one of the key biological abnormalities described in major depressive disorder, occurring in 30-50% of depressed subjects. Corticotropin-releasing hormone (CRH) and vasopressin (AVP) are the main regulators of this stress system, with the two neuropeptides acting synergistically in bringing about adrenocorticotropin (ACTH) release from the anterior pituitary and cortisol from the adrenal gland. Based on the demonstration of elevated cerebrospinal fluid levels of CRH in depressives, and other evidence, it has been postulated that excess CRH and the resultant increased HPA forward drive form the basis of neuroendocrine dysregulation in depression. However, there is an accumulating body of evidence to support a significant role for AVP in the regulation of pituitary-adrenal activity in health and also in depressive disorder. This review, based on a Medline search from 1980 to 2001, focuses on the functional neuroanatomy, receptor pharmacology, VP synergism with CRH, and the data from clinical and pre-clinical studies that support an important role for AVP in the pathophysiology of major depression. We suggest that future antidepressants may target the vasopressinergic system.
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Affiliation(s)
- Lucinda V Scott
- Department of Psychiatry, Cork University Hospital, Cork, Ireland.
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86923
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Srinivasan K, Sucharita S, Vaz M. Effect of standing on short term heart rate variability across age. Clin Physiol Funct Imaging 2002; 22:404-8. [PMID: 12464145 DOI: 10.1046/j.1475-097x.2002.00450.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined the response of heart rate variability measures to standing in three age groups of male subjects: Children (6-11 years), young adults (20-30 years) and elderly (60-70 years). Supine and standing heart rate variability indices were measured in all the subjects using power spectral analysis. The effect of posture on heart rate variability was assessed using the change in heart rate variability measures over resting values during the first 2 min following active standing. There was an attenuated response in normalized low frequency (LF) and high frequency (HF) power to standing in the elderly as compared with young adults and children. Heart rate variability responses to standing were highest in the young adults, followed by the children and the elderly, although the differences between the young adults and children were not significant. More studies are needed to characterize HRV responses to posture in children.
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Affiliation(s)
- K Srinivasan
- Department of Psychiatry, St John's Medical College Hospital, Bangalore, India.
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86924
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Grassi L, Satriano J, Serra A, Biancosino B, Zotos S, Sighinolfi L, Ghinelli F. Emotional stress, psychosocial variables and coping associated with hepatitis C virus and human immunodeficiency virus infections in intravenous drug users. PSYCHOTHERAPY AND PSYCHOSOMATICS 2002; 71:342-9. [PMID: 12411769 DOI: 10.1159/000065993] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The increasing health problem of hepatitis C virus (HCV) infection has only recently attracted the attention of psychosocial research, especially among subjects at higher risk (e.g. intravenous drug users; IDUs). The aim of the present study was to compare emotional stress symptoms, psychosocial variables (i.e. social support, external locus of control and emotional repression) and coping strategies in HCV-seropositive, human immunodeficiency virus (HIV)-seropositive and HCV/HIV-noninfected IDUs. METHODS IDUs followed by the Infectious Diseases Outpatient clinic were enrolled in the study over a period of 1 year. HCV-positive (n = 62) and HIV-positive (n = 76) IDUs and HCV/HIV-seronegative IDUs (n = 152) completed the Brief Symptom Inventory, the Social Provision Scale, the Locus of Control scale and the affective inhibition scale of the Illness Behavior Questionnaire. Coping with illness among HCV-positive and HIV-positive subjects was assessed through a modified version of the Mental Adjustment to Cancer Scale. RESULTS No significant differences were found between the samples with respect to individual and interpersonal variables. HCV-positive subjects showed higher scores on several psychological stress dimensions (i.e. obsessive-compulsive, phobic anxiety, paranoid ideation, psychoticism) and lower scores on fighting spirit, hopelessness and anxious preoccupation towards illness than HIV-positive patients. HCV-positive and HCV/HIV-seronegative IDUs reported comparable scores on most of the psychological measures. CONCLUSIONS The findings indicate that routine assessment of psychosocial variables and coping mechanisms should be integrated into all HCV and HIV services, especially those dedicated to treatment of patients with substance abuse, as a vulnerable segment of the population at risk for life-threatening physical illness such as HCV and HIV infections.
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Affiliation(s)
- Luigi Grassi
- Department of Medical Sciences of Communication and Behavior, Section of Psychiatry, University of Ferrara, Italy.
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86925
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Rollman BL, Hanusa BH, Belnap BH, Gardner W, Cooper LA, Schulberg HC. Race, quality of depression care, and recovery from major depression in a primary care setting. Gen Hosp Psychiatry 2002; 24:381-90. [PMID: 12490339 DOI: 10.1016/s0163-8343(02)00219-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Racial variations in the use of effective medical care and subsequent clinical outcomes have been identified for many medical conditions. Still, it is unclear whether racial variations in care and clinical outcomes exist for depressed primary care patients. Primary care patients presenting for routine treatment were screened for major depression as part of a study to disseminate a depression treatment guideline. Primary care physicians (PCPs) were informed of their patients' depression via an electronic medical record system and asked whether they agreed with the diagnosis. Treatment patterns and depressive symptoms over the following six-months were assessed by chart review and the Hamilton Rating Scale for Depression, respectively. Over a 20-month period, 8,944 African-American and Caucasian patients aged 18-64 were approached for screening. African-Americans were less likely to agree to undergo screening than Caucasians (83% vs. 88%; P<.0001), but those doing so were more likely to report mood symptoms (26% vs. 15%; P<.001). 204 patients, including 52 African-Americans (25%), met protocol-eligibility criteria and completed a baseline interview. Baseline sociodemographic and clinical characteristics, and PCPs' agreement rate with the depression diagnosis were similar. Although PCPs were less likely to counsel their African-American than Caucasian patients for depression (P=.03), this difference resolved after adjusting for education level, employment, and insurance status and we found no other variations in the depression care provided or in clinical outcomes by race. We found little racial variation in either process measures or clinical outcomes for depression in our sample of African-American and Caucasian primary care patients.
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Affiliation(s)
- Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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86926
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Martire LM, Hall M. Dementia caregiving: recent research on negative health effects and the efficacy of caregiver interventions. CNS Spectr 2002; 7:791-6. [PMID: 12947241 DOI: 10.1017/s1092852900024305] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Provision of care to an older adult with dementia is an important societal resource. This resource may also come at a high cost to informal caregivers, most of whom are family members. In this paper we provide an overview of recent research on dementia caregiving and caregiver interventions. First, we provide background information on the prevalence and costs of Alzheimer's disease and related disorders. Second, we describe the specific stressors and broader mental and physical health outcomes of dementia caregiving. Third, recent evidence of the efficacy of caregiver interventions for both caregiver and patient outcomes is reviewed. Throughout the paper, we describe promising new directions for future research in this area, including assessment and intervention with family caregivers of older patients with comorbid dementia and depression, and the focus on sleep disturbance as a critical health consequence of dementia caregiving.
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Affiliation(s)
- L M Martire
- Department of Psychiatry, Western Psychiatric Institute and Clinic at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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86927
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Agosti V, Quitkin FM, Stewart JW, McGrath PJ. Somatization as a predictor of medication discontinuation due to adverse events. Int Clin Psychopharmacol 2002; 17:311-4. [PMID: 12409685 DOI: 10.1097/00004850-200211000-00007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medication discontinuation due to intolerable side-effects remains a significant clinical problem in the treatment of depression. We were unable to locate studies which found predictors of medication cessation due to side-effects. We posited that an identifiable subgroup of medically healthy, depressed adults who discontinued medication because of adverse events would have higher pre-treatment somatic symptoms than patients who completed a course of treatment. The sample (n =940) was drawn from a series of double-blind, placebo-controlled studies of antidepressants (imipramine, phenelelzine, L-deprenyl, mianserin and desipramine). Within the medication group, side-effect dropouts had more somatic symptoms than study completers and those who discontinued treatment for miscellaneous reasons. Within the placebo-treated group, the small number of subject who discontinued treated because of side-effects precluded valid statistical analyses, but the findings were in the same direction as those in the medication group. Clearly, further research is required to determine whether these results, obtained from a series of university-based clinical trials with healthy subjects, are generalizable to patients with significant comorbid medical and/or psychiatric disorders, treated with newer antidepressants agents in a general clinical practice setting.
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Affiliation(s)
- V Agosti
- New York State Psychiatric Institute, New York 10032, USA.
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86928
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Moretti R, Torre P, Antonello RM, Cazzato G, Bava A. Depression and Alzheimer's disease: symptom or comorbidity? Am J Alzheimers Dis Other Demen 2002; 17:338-44. [PMID: 12501480 PMCID: PMC10833988 DOI: 10.1177/153331750201700607] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Alzheimer's disease is the most frequent form of dementia, where behavioral and cognitive disruption symptoms coexist. Depression, apathy, anxiety, and other conduct disorders are the complaints most often reported by caregivers. Fifty subjects were referred to our Institute with a diagnosis of probable Alzheimer's disease. Cognitive impairment was equally distributed among the subjects. Patients, aged 68 to 76 years old, were randomized to receive inhibitors of cholinesterase (Donepezil, 5 mg/day) alone, or inhibitors of cholinesterase plus selective serotonin reuptake inhibitors (SSRIs) (citalopram HBr, 20 mg/day). We followed up all the patients for one year, with particular concern for neuropsychological aspects associated with eventual behavioral changes. Results indicate that SSRI intake seems to be effective for depression, decreasing it and improving quality of life for both patients and caregivers. Side effects in both groups were few, and there were no study withdrawals. This paper discusses the relationship between dementia and depression, and presents our finding that depressive symptoms, if specifically treated, tend to reduce caregiver stress and improve well-being in patients with Alzheimer's disease.
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Affiliation(s)
- Rita Moretti
- Dipartimento di Fisiologia e Patologia, Università degli Studi di Trieste, Italia
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86929
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Nemeroff CB, Owens MJ. Treatment of mood disorders. Nat Neurosci 2002; 5 Suppl:1068-70. [PMID: 12403988 DOI: 10.1038/nn943] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Accepted: 09/04/2002] [Indexed: 11/09/2022]
Abstract
Depression is a leading cause of morbidity and mortality, and its treatment includes a high percentage of the medications prescribed by physicians. Available antidepressant drugs are safe and effective, but less than half of all patients attain complete remission after therapy with a single antidepressant. Others exhibit partial, refractory or intolerant responses to treatment, emphasizing the need to discover new antidepressants. The mechanisms of action of available medications are directing the field toward new research avenues. This review highlights those areas we believe will influence the field and soon lead to better treatment.
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Affiliation(s)
- Charles B Nemeroff
- Laboratory of Neuropsychopharmacology, Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, 1639 Pierce Drive, Suite 4000, Atlanta, Georgia 30322, USA.
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86930
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Zhang EY, Knipp GT, Ekins S, Swaan PW. Structural biology and function of solute transporters: implications for identifying and designing substrates. Drug Metab Rev 2002; 34:709-50. [PMID: 12487148 DOI: 10.1081/dmr-120015692] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Solute carrier (SLC) proteins have critical physiological roles in nutrient transport and may be utilized as a mechanism to increase drug absorption. However, we have little understanding of these proteins at the molecular level due to the absence of high-resolution crystal structures. Numerous efforts have been made in characterizing the peptide transporter (PepT1) and the apical sodium dependent bile acid transporter (ASBT) that are important for both their native transporter function as well as targets to increase absorption and act as therapeutic targets. In vitro and computational approaches have been applied to gain some insight into these transporters with some success. This represents an opportunity for optimizing molecules as substrates for the solute transporters and providing a further screening system for drug discovery. Clearly the future growth in knowledge of SLC function will be led by integrated in vitro and in silico approaches.
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Affiliation(s)
- Eric Y Zhang
- Division of Pharmaceutics, The Ohio State University, 500 West 12th Avenue, Columbus, OH 43210-1291, USA
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86931
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Bhanji NH, Margolese HC, Saint-Laurent M, Chouinard G. Dysphoric mania induced by high-dose mirtazapine: a case for 'norepinephrine syndrome'? Int Clin Psychopharmacol 2002; 17:319-22. [PMID: 12409687 DOI: 10.1097/00004850-200211000-00009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The antidepressant mirtazapine antagonizes central presynaptic alpha2-adrenergic auto- and heteroreceptors resulting in increased central norepinephrine and serotonin activity. Histamine H2 receptors are also antagonized, as are postsynaptic serotonin 5-HT2 and 5-HT3 receptors, leading to serotonergic activity primarily via 5-HT1A receptors. Based on the case report of a patient who developed mania with higher than recommended dosage of mirtazapine, we review the literature on the atypical nature of manic symptoms with mirtazapine. Eight subjects, including those in our study, were identified as having developed mirtazapine-induced mania with atypical features, consisting of dysphoria, irritability, insomnia, psychomotor agitation and abnormal gait. Predisposing features may have included the presence of underlying brain dysfunction and certain selective serotonin reuptake inhibitor-mirtazapine combinations. Dysphoric mania with atypical features may be induced by mirtazapine, providing support for a common hypothesis such as 'central norepinephrine hyperactivity' as the basis for development of mania with mirtazapine.
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Affiliation(s)
- N H Bhanji
- Clinical Psychopharmacology Unit, Allan Memorial Institute, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
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86932
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Yeragani VK, Tancer ME, Glitz D, Uhde T, Desai N. Significant difference in beat-to-beat QT interval variability among different leads. HEART DISEASE (HAGERSTOWN, MD.) 2002; 4:344-8. [PMID: 12441010 DOI: 10.1097/00132580-200211000-00002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
QT interval on the surface electrocardiogram (ECG) reflects the time for repolarization of myocardium, and QTc prolongation is strongly associated with sudden cardiac death. Findings of studies that have examined the dispersion of QT interval in 12-lead ECGs strongly suggest that an increased QT dispersion between different leads is associated with an increased risk of cardiac mortality. Recent studies using novel techniques on beat-to-beat QT interval variability have also shown that the interval is both influenced by the autonomic nervous system and a predictor of sudden cardiac death. However, in these studies the variability of QT was quantified in a single lead, and thus is different from QT dispersion. The present study examined whether there was a significant difference between QT variability (detrended QT variance [QTv]) and Qtvi (index of QT interval variability corrected for mean QT squared divided by heart rate variability corrected for mean heart rate squared) in 17 data sets of continuous ECGs recorded in three channels (leads V(5), V(1), and V(3)) during ambulatory monitoring of ECG digitized at 1,000 Hz. The results showed a highly significant difference between QT variability measures (QTv and QTvi) (P < 0.0001) in two of three lead configurations that were used (V(5) and V(1) versus V(3)). This finding underscores the importance of using the same lead while recording ECG for the calculation of QT variability, though further investigations are clearly warranted before any definitive conclusion can be made. These findings should be evaluated in relation to the issue of local versus global cardiac repolarization of ventricular myocardium.
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Affiliation(s)
- Vikram Kumar Yeragani
- Department of Psychiatry, Wayne State University School of Medicine, Detroit, Michigan, USA.
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86933
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Detke MJ, Lu Y, Goldstein DJ, McNamara RK, Demitrack MA. Duloxetine 60 mg once daily dosing versus placebo in the acute treatment of major depression. J Psychiatr Res 2002; 36:383-90. [PMID: 12393307 DOI: 10.1016/s0022-3956(02)00060-2] [Citation(s) in RCA: 219] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Existing therapies for major depressive disorder (MDD) have either limited efficacy and/or poor tolerability. The present study examined the effects of duloxetine, a potent and balanced dual reuptake inhibitor of serotonin (5-HT) and norepinephrine (NE), in patients with MDD. Adult patients (N = 267) with MDD were randomly assigned to receive duloxetine (60 mg/day) or placebo in this 9-week, multi-center, double-blind, parallel-group clinical trial. Efficacy was evaluated using the 17-item Hamilton Depression Rating Scale (HAMD(17)), Visual Analog Scales (VAS) for pain, Clinical Global Impression of Severity (CGI-S), Patient's Global Impression of Improvement (PGI-I), and Quality of Life in Depression Scale (QLDS). Safety was evaluated by assessing discontinuation rates, adverse event rates, vital signs, and laboratory tests. Duloxetine (60 mg QD) significantly reduced the HAMD(17) total score compared with placebo at the end of 9-week therapy. Estimated probabilities of response and remission were 65 and 43%, respectively, for duloxetine compared with 42 and 28% for placebo. Duloxetine also reduced overall pain, back pain, shoulder pain and time in pain while awake significantly more than placebo. Global measures of improvement, including PGI-I and QLDS, were significantly improved by duloxetine compared with placebo. Discontinuations due to adverse events were more frequent for duloxetine-treated patients (12.5%) than for placebo-treated patients (4.3%). Nausea, dry mouth, dizziness, and constipation were more frequent for duloxetine than placebo. There was no significant incidence of hypertension, nor any other safety issues. Duloxetine 60 mg administered once daily appears to be a safe and effective treatment for MDD.
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Affiliation(s)
- Michael J Detke
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA.
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86934
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Abstract
Depression in Parkinson's disease (PD) is a common complication, with a major impact on quality of life. Failure to recognize and treat depression can lead to premature and inappropriate discontinuation of antiparkinsonian therapies. Cited frequency for depression in PD varies between 2.7 and 70%. Methodological differences account for much of the disparity. The aetiology of depression in PD is complex, with 'tonic' (slowly changing and persistent) and 'phasic' (short-lived and fluctuating) components. Both depression and anxiety may predate the onset of the motor disorder by some years. Hedonistic homeostatic dysregulation is a cyclical mood disorder associated with excessive intake of dopaminergic therapies, inappropriate for the motor state. Negative affective symptoms occur on attempted reduction of medication, reinforcing the abnormal medication pattern. The Montgomery-Asberg Depression Rating Scale and the Hamilton Rating Scale for Depression have good diagnostic sensitivity and specificity for assessing depression in PD. There is a dearth of sizeable, placebo-controlled studies for evaluating drug treatment of depression in PD. Dopaminergic drugs have variable antidepressant properties. Selective serotonin reuptake inhibitors are currently the most commonly prescribed group of antidepressants in the depressed PD patient. Depression in the PD patient may be associated with a more rapid deterioration in cognitive and motor functions.
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Affiliation(s)
- D J Burn
- Regional Neurosciences Centre, Newcastle General Hospital, Newcastle upon Tyne, UK.
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86935
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DeBattista C, Rothschild AJ, Schatzberg AF. A Dynamic Algorithm for the Treatment of Psychotic Major Depression. Psychiatr Ann 2002. [DOI: 10.3928/0048-5713-20021101-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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86936
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Walker EA, Newman E, Dobie DJ, Ciechanowski P, Katon W. Validation of the PTSD checklist in an HMO sample of women. Gen Hosp Psychiatry 2002; 24:375-80. [PMID: 12490338 DOI: 10.1016/s0163-8343(02)00203-7] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although Post-traumatic Stress Disorder (PTSD) is common among patients seeking care at medical clinics, little is known about the performance of screening instruments for this disorder in these settings. Previous studies of acute trauma populations using the PTSD Checklist (PCL) have suggested that scores of 45-50 provide the best discrimination between cases and noncases. We gave the PCL to 1,225 randomly selected women enrolled in an HMO. After interviewing a sample of 261 of these women using a structured, clinician-administered PTSD interview, we compared the results of the PCL to the clinician interviews over a range of possible cut scores using Receiver Operating Characteristic analysis. The optimum balance of sensitivity and specificity for this population was a score of 30, yielding a sensitivity of.82 and specificity of.76. The positive and negative likelihood ratios for this cut score were 3.40 and 0.24, respectively. By comparison, the use of 45 as a cut score would result in very low sensitivity (.36) in this setting. The lower cut score found in this study may indicate that the use of previously published cut scores of 45-50 may not optimize the function of the PCL as a screening tool outside of acute trauma settings due to an unacceptably high number of false negative cases.
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Affiliation(s)
- Edward A Walker
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
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86937
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Nicholson SL, Brotchie JM. 5-hydroxytryptamine (5-HT, serotonin) and Parkinson's disease - opportunities for novel therapeutics to reduce the problems of levodopa therapy. Eur J Neurol 2002; 9 Suppl 3:1-6. [PMID: 12464115 DOI: 10.1046/j.1468-1331.9.s3.1.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While Parkinson's disease is undoubtedly a disorder with a primary pathology of dopamine neuronal loss, that loss of dopamine and subsequent dopamine replacement therapy leads to imbalances in many non-dopaminergic transmitter systems, including 5-hydroxytryptamine (5-HT). Recent advances in understanding the role of 5-HT in parkinsonism and the generation of side-effects of dopamine replacement therapy (e.g. wearing-off and levodopa-induced dyskinesia) have identified 5-HT1A, 5-HT1B and 5-HT2C receptors as potential therapeutic targets in Parkinson's disease.
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MESH Headings
- Animals
- Antiparkinson Agents/adverse effects
- Antiparkinson Agents/therapeutic use
- Basal Ganglia/metabolism
- Basal Ganglia/physiology
- Drug Delivery Systems
- Drug Tolerance
- Dyskinesia, Drug-Induced/etiology
- Dyskinesia, Drug-Induced/prevention & control
- Humans
- Levodopa/adverse effects
- Levodopa/therapeutic use
- Neural Pathways
- Parkinson Disease/drug therapy
- Parkinson Disease/metabolism
- Receptor, Serotonin, 5-HT1B
- Receptor, Serotonin, 5-HT2C
- Receptors, Serotonin/drug effects
- Receptors, Serotonin/physiology
- Receptors, Serotonin, 5-HT1
- Serotonin/metabolism
- Serotonin Agents/therapeutic use
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Affiliation(s)
- S L Nicholson
- University of Manchester, School of Biological Sciences, UK
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86938
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86939
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Dirks A, Groenink L, Bouwknecht JA, Hijzen TH, Van Der Gugten J, Ronken E, Verbeek JS, Veening JG, Dederen PJWC, Korosi A, Schoolderman LF, Roubos EW, Olivier B. Overexpression of corticotropin-releasing hormone in transgenic mice and chronic stress-like autonomic and physiological alterations. Eur J Neurosci 2002; 16:1751-60. [PMID: 12431228 DOI: 10.1046/j.1460-9568.2002.02245.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To gain a greater insight into the relationship between hyperactivity of the corticotropin-releasing hormone (CRH) system and autonomic and physiological changes associated with chronic stress, we developed a transgenic mouse model of central CRH overproduction. The extent of central and peripheral CRH overexpression, and the amount of bioactive CRH in the hypothalamus were determined in two lines of CRH-overexpressing (CRH-OE) mice. Furthermore, 24 h patterns of body temperature, heart rate, and activity were assessed using radiotelemetry, as well as cumulative water and food consumption and body weight gain over a 7-day period. CRH-OE mice showed increased amounts of CRH peptide and mRNA only in the central nervous system. Despite the presence of the same CRH transgene in their genome, only in one of the two established lines of CRH-OE mice (line 2122, but not 2123) was overexpression of CRH associated with increased levels of bioactive CRH in the hypothalamus, increased body temperature and heart rate (predominantly during the light (inactive) phase of the diurnal cycle), decreased heart rate variability during the dark (active) phase, and increased food and water consumption, when compared with littermate wildtype mice. Because line 2122 of the CRH transgenic mice showed chronic stress-like neuroendocrine and autonomic changes, these mice appear to represent a valid animal model for chronic stress and might be valuable in the research on the consequences of CRH excess in situations of chronic stress.
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Affiliation(s)
- Anneloes Dirks
- Department of Psychopharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
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86940
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Baumgartner JL, Emslie GJ, Crismon ML. Citalopram in children and adolescents with depression or anxiety. Ann Pharmacother 2002; 36:1692-7. [PMID: 12398561 DOI: 10.1345/aph.1c078] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and tolerability of citalopram in children and adolescents. METHOD Retrospective chart review of 17 outpatients treated with citalopram at a tertiary care center. Subjects were diagnosed with a depressive or anxiety disorder with or without comorbidities and may have received concurrent medications. The primary outcome measure was the Clinical Global Impression Improvement Scale (CGI-I). Secondary outcome measures were the Children's Depression Rating Scale-Revised (CDRS-R), Inventory of Depressive Symptomatology, and Screen for Child Anxiety-Related Emotional Disorders (SCARED). Adverse effects were assessed via chart documentation. RESULTS Patients were treated with a mean citalopram dose of 22.4 +/- 7.3 mg for 12 weeks. Thirteen patients (76%) had CGI-I scores </=2: 8 of 12 patients with depression and 5 of 5 patients with an anxiety disorder. The mean time to response was 7.6 +/- 3.6 weeks. Additionally, 6 of 8 patients had >/=50% reduction from baseline CDRS-R score, with 3 patients (38%) meeting criteria for remission. Three of 4 patients had a >50% reduction for baseline SCARED-parent score. Overall, adverse effects appeared minor and transient. One patient discontinued citalopram due to intolerable adverse effects, and 1 patient required dose reduction. CONCLUSIONS Citalopram appears to be effective and well tolerated in this group of children and adolescents with depressive or anxiety disorders and a high degree of comorbidity. Controlled studies in this patient population are indicated.
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Affiliation(s)
- Jennifer L Baumgartner
- College of Pharmacy, University of Texas, Texas Department of Mental Health and Mental Retardation, Austin, USA
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86941
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86942
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Dobie DJ, Kivlahan DR, Maynard C, Bush KR, McFall M, Epler AJ, Bradley KA. Screening for post-traumatic stress disorder in female Veteran's Affairs patients: validation of the PTSD checklist. Gen Hosp Psychiatry 2002; 24:367-74. [PMID: 12490337 DOI: 10.1016/s0163-8343(02)00207-4] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We evaluated the screening validity of a self-report measure for post traumatic stress disorder (PTSD), the PTSD Checklist (PCL), in female Veterans Affairs (VA) patients. All women seen for care at the VA Puget Sound Health Care system from October 1996-January 1999 (n=2,545) were invited to participate in a research interview. Participants (n=282) completed the 17-item PCL, followed by a gold standard diagnostic interview for PTSD, the Clinician Administered PTSD Scale (CAPS). Thirty-six percent of the participants (n=100) met CAPS diagnostic criteria for current PTSD. Receiver Operating Characteristic (ROC) analysis was used to evaluate the screening performance of the PCL. The area under the ROC curve was 0.86 (95% CI 0.82-0.90). A PCL score of 38 optimized the performance of the PCL as a screening test (sensitivity 0.79, specificity 0.79). The PCL performed well as a screening measure for the detection of PTSD in female VA patients.
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Affiliation(s)
- Dorcas J Dobie
- Mental Illness Research Education and Clinical Center, VA Puget Sound Health Care System and Department of Medicine, University of Washington, Seattle, WA 98195, USA.
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86943
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Abstract
BACKGROUND The aim of this study was to assess the outcome of the comorbid conditions of panic disorder after 1 year of treatment, emphasizing the detection of residual symptoms and their relationship to other clinical variables. METHODS Subjects (N = 64) were assessed by the Structured Clinical Interview for DSM-III-R and the Eysenck Personality Questionnaire. Comorbidity with other disorders, scores on Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale were assessed at baseline and after 12 months. Criteria for residual anxiety/somatic symptoms were defined. RESULTS Reduction in generalized anxiety disorder rates accounted for a significant decrease in comorbidity at 1-year follow-up, with regard to baseline assessment. When the more severe symptoms of the disorder had remitted, a third of the patients referred physical symptoms with some concern over a fluctuating state of anxiety. The said symptoms were neither a recurrence of panic disorder nor did they account for other anxiety or somatoform disorders. Lower scores on extraversion predict higher risk of residual symptoms. DISCUSSION The persistence of residual anxiety/somatic symptoms in a third of the patients who apparently achieved a good response to treatment of panic disorder might characterize a minor form of chronic persistence of this condition. CONCLUSIONS The subgroup of patients with residual symptoms would not be detectable by follow-up studies, which focus on the assessment of relapse of panic disorder by means of strictly defined diagnostic criteria.
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Affiliation(s)
- Antoni Corominas
- Department of Psychiatry, Hospital de Mollet, Cristòfol Colom, 1, 08100 Mollet, Barcelona, Spain.
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86944
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Bauer LO, Hesselbrock VM. Lateral Asymmetries in the Frontal Brain: Effects of Depression and a Family History of Alcoholism in Female Adolescents. Alcohol Clin Exp Res 2002. [DOI: 10.1111/j.1530-0277.2002.tb02468.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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86945
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Tucker GJ, Stuart RB. Behavioral Treatments. Curr Treat Options Neurol 2002; 4:499-504. [PMID: 12354376 DOI: 10.1007/s11940-002-0017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The central nervous system is the source of all behaviors and emotions; it also mediates the individual's relationship with the environment. Consequently, when the central nervous system is disrupted by neurologic disease, there are frequently many concomitant emotional and behavioral disturbances, as well as conflicts with the environment and the people surrounding the patient. Patients are often unaware that these maladaptive interactions often determine the nature and quality of care that they receive from their caregivers. The aggressive or wandering brain-damaged patient often ends up in a secure facility, and the apathetic patient often becomes forgotten. Although psychopharmacologic agents can moderate some of the behavioral and emotional symptoms of brain damage, these medications have side effects such as sedation and falls, among others, and they often interfere with the metabolism of medications that patients are already taking. Behavior therapy is an excellent supplement to, if not alternative for, medications to control symptomatic behaviors associated with brain damage for the following reasons: 1) behavioral treatment is nonpharmacologic, and, therefore, there are no drug interactions or side effects in patients with neurologic illnesses; 2) behavioral treatments can be designed to treat specific symptoms, and, by mitigating them, improve the quality of life of the patient and the caregivers; 3) the success of behavioral treatments can usually be quantified as the target behaviors are pinpointed and measured before, during, and after the behavioral interventions; 4) behavioral treatments are usually cost effective, because they can be devised by psychologists, but administered by direct daily caregivers and family members; and 5) behavioral treatments administered by caregivers give the caregivers a sense of participation and control of the treatment. Reports of the effectiveness of behavioral treatments support their inclusion as an important complementary component in the care of individuals with neurologic disorders as well as the milieu of institutions that care for the brain damaged.
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Affiliation(s)
- Gary J. Tucker
- Department of Psychiatry, University of Washington, 9429 45th Avenue, NE, Seattle, WA 98195, USA.
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86946
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Montgomery SA. Late-life depression: rationalizing pharmacological treatment options. Gerontology 2002; 48:392-400. [PMID: 12393956 DOI: 10.1159/000065502] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Depressive symptoms in late life are a major concern as they increase disability and aggravate existing medical conditions. Depression is underrecognised and undertreated in the elderly, be it due to somatic symptoms, comorbid physical illness or anxiety, or because it is accepted as a normal feature of ageing. There is little doubt that effective and well-tolerated antidepressant therapy is required. OBJECTIVE This paper reviews the antidepressant treatment options for late-life depression (selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, mixed noradrenergic and serotonergic agents), in terms of their efficacy, safety and pharmacokinetics in elderly patients. RESULTS In addition to proven efficacy, selection of an antidepressant agent for late-life depression must be based on an understanding of safety and pharmacokinetic issues associated with each agent. Comorbid conditions and lifestyle characteristics of the elderly that are different to those encountered in the younger adult population should also be considered. CONCLUSIONS To date, published clinical evidence in the elderly suggests that the first-choice agents for treating late-life depression are the SSRIs.
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86947
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Daradkeh TK, Ghubash R, Abou-Saleh MT. Al Ain community survey of psychiatric morbidity II. Sex differences in the prevalence of depressive disorders. J Affect Disord 2002; 72:167-76. [PMID: 12200207 DOI: 10.1016/s0165-0327(01)00452-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To examine sex differences in the prevalence of depressive disorders in an Arab community. METHODS One thousand three hundred and ninety-four subjects (n=1394) were systematically sampled from the general population in Al-Ain city, United Arab Emirates. All subjects were interviewed and assessed with the modified version of the Composite International Diagnostic Interview (CIDI) and a specially designed socio-demographic questionnaire. The lifetime male and female prevalence rates were estimated. Multivariate logistic regression of various socio-demographic variables was carried out to assess independent risk factors for depression. Statistical significance of sex differences in rates of depression by various socio-demographic groups were also assessed. RESULTS The lifetime rates in males and females were 2.8 and 10.3%, respectively. F:M ratio found in this study is highest reported ratio in the literature. Sex, life events, chronic difficulties and to a certain extent age were found to be risk factors for depression in the studied community. The prevalence rates of depression were higher in females in all above categories but such differences reached statistical significance in age category before 55, regardless of marital status, when the number of children is four or more and among those exposed to recent life events and chronic difficulties. Females were found to to be more exposed to chronic life difficulties but only depressed females were significantly more subjected to recent life events. CONCLUSION Sex differences in depression is a robust finding but more studies are needed to explain the high F:M ratio found in this survey.
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Affiliation(s)
- Tewfik K Daradkeh
- Department of Psychiatry and Behavioural Sciences, Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al-Ain, United Arab Emirates
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86948
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Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder that is heterogeneous in its nature, and often presents with other psychiatric comorbidities. As a result, empirical research on effective pharmacotherapy for PTSD has produced complex findings. This article reviews the existing research literature on pharmacological treatments for PTSD, identifies the most effective treatments, and where possible examines their mechanism of action with respect to the neurobiology of PTSD. METHODS We examined reports of clinical trials of psychotropic agents carried out with PTSD patients and published in peer-reviewed journals, as well as reports from presentations at scientific meetings between 1966 and 2001. RESULTS Numerous medications are effective in treating PTSD. These include tricyclic antidepressants, monoamine oxidase inhibitors, and serotonin reuptake inhibitors. Considering reported overall efficacy and side effects profiles, selective serotonin reuptake inhibitors emerge as the preferred first line treatment for PTSD. Mood stabilizers, atypical neuroleptics, adrenergic agents, and newer antidepressants also show promise, but require further controlled trials to clarify their place in the pharmacopoeia for PTSD. DISCUSSION There is clear evidence for effective pharmacotherapy of PTSD. Future improvements in the treatment of this disorder await further clinical trials and neurobiological research.
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Affiliation(s)
- Ronald C Albucher
- Department of Psychiatry/PCT 116C, Veterans Administration Medical Center, University of Michigan, 2215 Fuller Road, Ann Arbor, MI 481105, USA
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86949
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Pearlstein T. Selective serotonin reuptake inhibitors for premenstrual dysphoric disorder: the emerging gold standard? Drugs 2002; 62:1869-85. [PMID: 12215058 DOI: 10.2165/00003495-200262130-00004] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
There have been a large number of studies conducted investigating the use of selective serotonin reuptake inhibitors (SSRIs) in the treatment of patients with premenstrual dysphoric disorder (PMDD). The 12 randomised, controlled trials with continuous dose administration of SSRIs and the eight randomised, controlled trials with luteal phase dose administration (from ovulation to menses) are reviewed. All the treatment studies on fluoxetine, sertraline, paroxetine and citalopram have reported positive efficacy. Fluoxetine and sertraline have the largest literature, with a smaller number of studies endorsing paroxetine and citalopram. Mixed efficacy results have been reported with fluvoxamine. In general, adverse effects from the use of SSRIs in women with PMDD are the usual mild and transient adverse effects from SSRIs including anxiety, dizziness, insomnia, sedation, nausea and headache. Sexual dysfunction and weight gain can be problematic long-term adverse effects of SSRIs, but these effects have not been systematically evaluated with long-term SSRI use in women with PMDD. Serotonergic antidepressants have differential superiority over nonserotonergic antidepressants in the treatment of PMDD. Treatments that enhance serotonergic action improve premenstrual irritability and dysphoria with a rapid onset of action, suggesting a different mechanism of action than in the treatment of depression. It is possible that neurosteroids, such as progesterone metabolites, are involved in the rapid action of serotonergic antidepressants in PMDD. Future research needs to address less frequent dose administration regimens, such as 'symptom-onset' dose administration, and the recommended length of treatment.
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Affiliation(s)
- Teri Pearlstein
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA.
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86950
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Yeragani VK, Pohl R, Balon R, Jampala VC, Jayaraman A. Twenty-four-hour QT interval variability: increased QT variability during sleep in patients with panic disorder. Neuropsychobiology 2002; 46:1-6. [PMID: 12207139 DOI: 10.1159/000063568] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recent studies on beat-to-beat QT interval variability (QTV) have shown that it can be used as a noninvasive measure of cardiac repolarization lability. It is also a predictor of sudden cardiac death and is higher in patients with anxiety and depression. This study examined the diurnal measures in QTV in 32 normal adults and 22 patients using 24-hour electrocardiogram records. We obtained 8 5-min segments of ECG sampled at 1,000 Hz from the 24-hour records. Our results show that QTV measures at nighttime are significantly higher in patients with panic disorder compared with controls. These findings demonstrate blunted diurnal changes in ventricular repolarization lability in patients resulting in a higher QT variability index during sleep. We speculate that these effects may relate to a relative increase in cardiac sympathetic activity in patients with panic disorder, and may contribute to the increased risk for cardiac mortality in patients with anxiety.
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Affiliation(s)
- Vikram Kumar Yeragani
- Department of Psychiatry, Wayne State University School of Medicine, Detroit, Mich, USA.
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