A multicenter controlled trial in phobic-obsessive psychoneurosis. The effect of chlorimipramine and of its combinations with haloperidol and diazepam

Contrast-enhanced transrectal ultrasonography for detection and localization of prostate index tumor: correlation with radical prostatectomy findings

OBJECTIVE

To evaluate the ability of contrast-enhanced transrectal ultrasonography (CETRUS) to detect and localize prostate index tumor.

METHODS

Eighty-three patients with biopsy-proven prostate cancer (PCa), who were scheduled to undergo radical prostatectomy, were enrolled in this prospective study. Each patient underwent baseline grayscale and CETRUS imaging of the prostate according to a standardized protocol before the operation. Ultrasonography findings (CETRUS and grayscale imaging) were correlated with step-section histopathology.

RESULTS

Overall, 53 and 68 tumor foci were detected by grayscale imaging and CETRUS, respectively. The combination of grayscale imaging and CETRUS allowed identification of 89 of the 232 cancer foci (38.4%). The sensitivity of combined imaging was significantly superior to that of grayscale imaging (P<.01) and CETRUS (P<.05). Additionally, the prostate index tumor detection rate by the use of grayscale imaging, CETRUS, and their combination was 42 of 83 (50.6%), 53 of 83 (63.9%), and 67 of 83 (80.7%), respectively. The combined approach performed significantly better than grayscale and CETRUS imaging (P<.001 and P<.05, respectively). The index tumor detection rate of CETRUS was higher than that of grayscale imaging, but no significant difference was found (P>.05).

CONCLUSION

Our study has demonstrated significantly improved detection of both PCa and index tumor with a combined approach of CETRUS and grayscale imaging compared with baseline grayscale technique only, and this technique may be applicable to focal therapy of PCa.

Efficacy of drug treatment in obsessive-compulsive disorder. A meta-analytic review

BACKGROUND

A review of the efficacy of antidepressant drug treatment in patients with obsessive-compulsive disorder (OCD), using a meta-analytic approach.

METHOD

Randomised double-blind clinical trials of antidepressant drugs, carried out among patients with OCD and published in peer-reviewed journals between 1975 and May 1994, were selected together with three studies currently in press. Forty-seven trials were located by searching the Medline and Excerpta Medica-Psychiatry data bases, scanning psychiatric and psychopharmacological journals, consulting recent published reviews and bibliographies, contacting pharmaceutical companies and through cross-references. Hedges' g was computed in pooled data at the conclusion of treatment under double-blind conditions or at the latest reported point of time during this treatment period. For each trial, effect sizes were computed for all available outcome measures of the following dependent variables: obsessive-compulsive symptoms considered together; obsessions; compulsions; depression; anxiety; global clinical improvement; psychosocial adjustment; and physical symptoms.

RESULTS

Clomipramine was superior to placebo in reducing both obsessive-compulsive symptoms considered together (g = 1.31; 95% CI = 1.15 to 1.47) as well as obsessions (g = 0.89, 95% CI = 0.36 to 1.42) and compulsions (g = 0.79; 95% CI = 0.34 to 1.24) taken separately. Also, selective serotonin re-uptake inhibitors (SSRIs) as a class were superior to placebo, weighted mean g being respectively 0.47 (95% CI = 0.33 to 0.61), 0.54 (95% CI = 0.34 to 0.74) and 0.52 (95% CI = 0.34 to 0.70) for obsessive-compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y-BOCS the increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties.

CONCLUSION

Antidepressant drugs are effective in the short-term treatment of patients suffering from OCD; although the increase in improvement rate over placebo was greater for clomipramine than for SSRIs, direct comparison between these drugs showed that they had similar therapeutic efficacy on obsessive-compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serotonergic properties; concomitant high levels of depression at the outset did not seem necessary for clomipramine and for SSRIs to improve obsessive-compulsive symptoms.

Clomipramine: an antiobsessive drug

In the past decade, various investigators have attempted to find new pharmacological agents for the treatment of obsessive disorders. Of these, the drug which has attracted attention and has been most promising is clomipramine. This paper attempts to review the usefulness of clomipramine in the treatment of obsessive disorder. Accidentally, it was discovered that clomipramine was effective in alleviating obsessive symptoms in depressed patients by a Spanish psychiatrist, Lopez-Ibor. Initial studies carried out mainly on patients with major depression reported that obsessive symptomatology benefited with clomipramine therapy. A number of uncontrolled and controlled studies confirmed the efficacy of this drug in obsessive neurosis. The drug improves the obsessive symptoms. Discontinuation of the drug is followed by a relapse. The efficacy, dosage, duration and side effects of treatment with clomipramine are discussed in this paper.