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Abdolizadeh A, Hosseini Kupaei M, Kambari Y, Amaev A, Korann V, Torres-Carmona E, Song J, Ueno F, Koizumi MT, Nakajima S, Agarwal SM, Gerretsen P, Graff-Guerrero A. The effect of second-generation antipsychotics on anxiety/depression in patients with schizophrenia: A systematic review and meta-analysis. Schizophr Res 2024; 270:11-36. [PMID: 38843584 DOI: 10.1016/j.schres.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/06/2024] [Accepted: 05/26/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Despite the high prevalence of anxiety in schizophrenia, no established guideline exists for the management of these symptoms. We aimed to synthesize evidence on the effect of second-generation antipsychotics (SGAs) on anxiety in patients with schizophrenia. METHODS We systematically searched Medline, Embase, PsycInfo, Web of Science, PubMed, and Cochrane library to identify randomized controlled trials of SGAs that reporting anxiety measures in schizophrenia. The search was limited to English-language articles published before February 2024. Data were pooled using a random-effects model. RESULTS Among 48 eligible studies, 29 (n = 7712) were included in the meta-analyses comparing SGAs to placebo, haloperidol, or another SGAs for their effect on anxiety/depression. SGAs had a small effect on anxiety/depression versus placebo (SMD = -0.28 (95 % CI [-0.34, -0.21], p < .00001, I2 = 47 %, n = 5576)) associated with efficacy for positive (z = 5.679, p < .001) and negative symptoms (z = 4.490, p < .001). Furthermore, SGAs were superior to haloperidol (SMD = -0.44, 95 % CI [-0.75, -0.13], p = .005, n = 1068) with substantial study-level heterogeneity (I2 = 85 %). Excluding one study of quetiapine in first-episode patients (SMD = -3.05, n = 73), SGAs showed a small effect on anxiety/depression versus haloperidol without heterogeneity (SMD = -0.23, 95 % CI [-0.35, -0.12], p = 01; I2 = %0). Risperidone's effect on anxiety/depression was comparable to olanzapine (SMD = -0.02, 95 % CI [-0.24,0.20], p = .87, I2 = 45 %, n = 753) and amisulpride (SMD = 0.27, 95 % CI [-1.08,0.61], p = .13, I2 = 50 %, n = 315). CONCLUSION While SGAs showed a small effect on anxiety/depression, the findings are inconclusive due to scarcity of research on comorbid anxiety in schizophrenia, heterogeneity of anxiety symptoms, and the scales used to measure anxiety. Further studies employing specific anxiety scales are required to explore antipsychotics, considering their receptor affinity and augmentation with serotonin/norepinephrine reuptake inhibitors or benzodiazepines for managing anxiety in schizophrenia.
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Affiliation(s)
- Ali Abdolizadeh
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Yasaman Kambari
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aron Amaev
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vittal Korann
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Edgardo Torres-Carmona
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jianmeng Song
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fumihiko Ueno
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Michel-Teruki Koizumi
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Sri Mahavir Agarwal
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada.
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Antipsychotic- and Anxiolytic-like Properties of a Multimodal Compound JJGW08 in Rodents. Int J Mol Sci 2022; 23:ijms232415929. [PMID: 36555568 PMCID: PMC9781916 DOI: 10.3390/ijms232415929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Schizophrenia is a chronic mental illness, which remains difficult to treat. A high resistance to the available therapies, their insufficient efficacy, and numerous side effects are the reasons why there is an urgent need to develop new antipsychotics. This study aimed to assess the antipsychotic-like effects of JJGW08, a novel arylpiperazine alkyl derivative of salicylamide, in rodents. First, considering the JJGW08 receptor profile, we investigated the compound's intrinsic activity towards dopamine D2 and serotonin 5-HT1A, 5-HT2A, and 5-HT7 receptors using functional assays. Next, we assessed the effect of JJGW08 on MK-801- and amphetamine-induced hyperlocomotion, its risk of inducing catalepsy and impairing motor coordination, as well as the anxiolytic-like effects in the four-plate and marble burying tests in mice. Finally, we investigated the antipsychotic-like properties of JJGW08 in rats using MK-801-induced hyperlocomotion and prepulse inhibition tests. We found that JJGW08 showed antagonistic properties at dopamine D2 and serotonin 5-HT1A, 5-HT2A, and 5-HT7 receptors. However, the effect on the 5-HT2A and 5-HT7 receptors was very weak. Moreover, the tested compound showed an antipsychotic-like effect in MK-801- and amphetamine-induced hyperlocomotion but not in a prepulse inhibition test in rats. Notably, JJGW08 demonstrated anxiolytic-like properties in both behavioral tests. Importantly, the compound did not induce catalepsy or motor coordination impairment in mice at antipsychotic-like doses. Our study suggests it is worth searching for new potential antipsychotics among arylpiperazine alkyl derivatives of salicylamide.
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Kim HJ, Han DH, Choi KT, Hwang HC, Min KJ, Kim SM. Efficacy of aripiprazole as adjunctive therapy in major depressive disorder with somatic symptoms: A randomized, double-blind, placebo-controlled trial with clinical and electroencephalography evidence. J Psychopharmacol 2022; 37:289-302. [PMID: 36239033 DOI: 10.1177/02698811221127294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Somatic symptoms, which are common in major depressive disorder (MDD), are associated with a worse prognosis and increased health costs. AIMS This randomized, double-blind, placebo-controlled study evaluated the efficacy of aripiprazole augmentation in MDD patients with somatic symptoms. METHODS In all, 41 MDD patients with somatic symptoms completed the study. Participants who had been on a stable dose of antidepressants for at least 1 month were randomly assigned to receive an 8-week adjunctive treatment with either aripiprazole or placebo. The initiation dose of aripiprazole was 2 mg/day, which was later adjusted to 1-10 mg/day. The primary endpoint was the change in the Symptom Checklist-90-Revised-Somatization (SCL-90-R-SOM) score. We collected quantitative electroencephalogram data and performed spectral analyses to obtain the absolute power of frequency bands. RESULTS/OUTCOMES The aripiprazole group (n = 20; 2.98 ± 1.75 mg/day) showed a significant improvement in SCL-90-R-SOM scores compared to the placebo group (n = 21; F = 8.56, p = 0.006), without significant differences in changes in depression and anxiety symptoms. Compared to the control, the aripiprazole group showed a greater decrease in total alpha power (F = 7.03, p = 0.01). Changes in frontal alpha power were positively correlated with changes in SCL-90-R-SOM scores in the aripiprazole group (r = 0.53, p = 0.014). CONCLUSIONS/INTERPRETATION Aripiprazole adjunctive to antidepressants in patients with MDD and somatic symptoms improved somatic symptom severity without significant safety concerns, and this improvement correlated with a decrease in total and frontal alpha power.Trial Registration: https://cris.nih.go.kr; identifier: KCT0004607.
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Affiliation(s)
- Hee Jin Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Doug Hyun Han
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Kang Ta Choi
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hyun Chan Hwang
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Kyoung Joon Min
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Sun Mi Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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New 2,3-Benzodiazepine Derivative: Synthesis, Activity on Central Nervous System, and Toxicity Study in Mice. Pharmaceuticals (Basel) 2021; 14:ph14080814. [PMID: 34451911 PMCID: PMC8401732 DOI: 10.3390/ph14080814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
We report the design and synthesis of a new diazepine derivative, 4-(4-methoxyphenyl)-2,3,4,5-tetrahydro-2,3-benzodiazepin-1-one (VBZ102), and the evaluation of its anxiolytic-like profile, memory impairment effect, and toxicity in Swiss mice. VBZ102 was evaluated for central nervous system effects in an open field, light–dark box, and novel object recognition tests under oral administration for acute and sub-acute treatment. We tested the VBZ102 toxicity in mice through a determination of LD50 values and examination of the biochemical and histopathological parameters. The VBZ102 induced an anxiolytic effect at different doses both in the light–dark box and open field tests. Unlike other benzodiazepines (e.g., bromazepam), a sedative effect was noted only after administration of the VBZ102 at 10.0 mg/kg.
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Raza H, Abbasi MA, Rehman AU, Siddiqui SZ, Hassan M, Shah SAA, Shahid M, Hong H, Seo SY. Design, synthesis and computational studies of N-(substituted-phenyl)-4-(4-phenyl-1-piperazinyl)butanamides as potent anti-melanogenic and tyrosinase inhibitors. J Mol Struct 2020. [DOI: 10.1016/j.molstruc.2020.127969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Medishetti R, Rani R, Kavati S, Mahilkar A, Akella V, Saxena U, Kulkarni P, Sevilimedu A. A DNAzyme based knockdown model for Fragile-X syndrome in zebrafish reveals a critical window for therapeutic intervention. J Pharmacol Toxicol Methods 2019; 101:106656. [PMID: 31734279 DOI: 10.1016/j.vascn.2019.106656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 11/05/2019] [Accepted: 11/10/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION FXS is the leading cause of intellectual disabilities in males and a major monogenic cause of ASD (Autism spectrum disorders). It occurs due to the loss of FMRP, whose role in early development is not well understood. In this study, we have used a novel DNAzyme based approach to create a larval model of FXS in zebrafish with specific focus on the early developmental window. METHODS Fmr1specific DNAzymes were electroporated into embryos to create the knockdown. Changes in RNA and protein levels of FMRP and relevant biomarkers were measured in the 0-7dpf window. Behavioral tests to measure anxiety, cognitive impairments and irritability in the larvae were conducted at the 7dpf stage. Drug treatment was carried out at various time points in the 0-7dpf window to identify the critical window for pharmacological intervention. RESULTS The DNAzyme based knockdown approach led to a significant knockdown of FMRP in the zebrafish embryos, accompanied by increased anxiety, irritability and cognitive impairments at 7dpf, thus creating a robust larval model of FXS. Treatment with the Mavoglurant was able to rescue the behavioral phenotypes in the FXS larvae, and found to be more efficacious in the 0-3dpf window. DISCUSSION The results from this study have revealed that a) a DNAzyme based knockdown approach can be used to create robust larval zebrafish model of disease, in a high-throughput manner and b) optimal window for therapeutic intervention for FXS as well as other pediatric diseases with a monogenic cause can be identified using such a model.
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Affiliation(s)
- Raghavender Medishetti
- Center for Innovation in Molecular and Pharmaceutical Sciences (CIMPS), Dr. Reddy's Institute of Life Sciences, University of Hyderabad Campus, Gachibowli, Hyderabad, Telangana, 500046, India
| | - Rita Rani
- Center for Innovation in Molecular and Pharmaceutical Sciences (CIMPS), Dr. Reddy's Institute of Life Sciences, University of Hyderabad Campus, Gachibowli, Hyderabad, Telangana, 500046, India
| | - Srinivas Kavati
- Center for Innovation in Molecular and Pharmaceutical Sciences (CIMPS), Dr. Reddy's Institute of Life Sciences, University of Hyderabad Campus, Gachibowli, Hyderabad, Telangana, 500046, India
| | - Anjali Mahilkar
- Center for Innovation in Molecular and Pharmaceutical Sciences (CIMPS), Dr. Reddy's Institute of Life Sciences, University of Hyderabad Campus, Gachibowli, Hyderabad, Telangana, 500046, India
| | - Venkateswarlu Akella
- Center for Innovation in Molecular and Pharmaceutical Sciences (CIMPS), Dr. Reddy's Institute of Life Sciences, University of Hyderabad Campus, Gachibowli, Hyderabad, Telangana, 500046, India
| | - Uday Saxena
- Center for Innovation in Molecular and Pharmaceutical Sciences (CIMPS), Dr. Reddy's Institute of Life Sciences, University of Hyderabad Campus, Gachibowli, Hyderabad, Telangana, 500046, India
| | - Pushkar Kulkarni
- Center for Innovation in Molecular and Pharmaceutical Sciences (CIMPS), Dr. Reddy's Institute of Life Sciences, University of Hyderabad Campus, Gachibowli, Hyderabad, Telangana, 500046, India.
| | - Aarti Sevilimedu
- Center for Innovation in Molecular and Pharmaceutical Sciences (CIMPS), Dr. Reddy's Institute of Life Sciences, University of Hyderabad Campus, Gachibowli, Hyderabad, Telangana, 500046, India.
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D'Agati E, Curatolo P, Mazzone L. Comorbidity between ADHD and anxiety disorders across the lifespan. Int J Psychiatry Clin Pract 2019; 23:238-244. [PMID: 31232613 DOI: 10.1080/13651501.2019.1628277] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: Attention deficit/hyperactivity disorder (ADHD) and anxiety disorders are among the most common psychiatric disorders with a 25% comorbidity rate with each other. In this study, we overview the comorbidity between ADHD and anxiety disorders in a longitudinal perspective across the lifespan and we discuss possible therapeutic strategies.Methods: A literature search was performed using PubMed to identify clinical studies assessing comorbidity between ADHD and anxiety disorders from childhood to adulthood.Results: Anxiety disorders may substantially change the presentation, the prognosis, and the treatment of ADHD itself. In childhood, the presence of generalised anxiety disorder, could prevent the typical inhibitory dysfunction present in ADHD, in adolescence may increase the deficit of working memory, and in adulthood may enhance the presence of sleep problems. Individuals with comorbid ADHD and anxiety disorders would benefit from adjunctive psychosocial or adjunctive pharmacotherapy interventions to cognitive behavioural treatment.Conclusions: The management of individuals with comorbid ADHD and anxiety disorders could be challenging for clinicians, and assessing the developmental course is crucial in order to shed light on individualised treatment.KeypointsThe comorbidity between ADHD and anxiety disorders changes the clinical presentation, the prognosis and treatment of patients with ADHD across lifespan.ADHD and anxiety disorders shared common neurobiological dysfunctions but have also different neurobiological abnormalities suggesting that they are different diagnoses.These patients are less likely to benefit from cognitive behavioural treatment strategies alone and often need adjunctive pharmacological treatments.Studies that evaluated the response to MPH reported conflicting results. These patients could respond less well and get more unpleasant arousal side-effects, but these findings need to be confirmed.For his unique mechanism of action, low dose aripiprazole treatment in adolescents and adults with this comorbid condition could be an intriguing avenue of exploration.
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Affiliation(s)
- Elisa D'Agati
- Department of Systems Medicine, Unit of Child Neurology and Psychiatry, 'Tor Vergata' University of Rome, Rome, Italy
| | - Paolo Curatolo
- Department of Systems Medicine, Unit of Child Neurology and Psychiatry, 'Tor Vergata' University of Rome, Rome, Italy
| | - Luigi Mazzone
- Department of Systems Medicine, Unit of Child Neurology and Psychiatry, 'Tor Vergata' University of Rome, Rome, Italy
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Bushnell GA, Compton SN, Dusetzina SB, Gaynes BN, Brookhart MA, Walkup JT, Rynn MA, Stürmer T. Treating Pediatric Anxiety: Initial Use of SSRIs and Other Antianxiety Prescription Medications. J Clin Psychiatry 2018; 79:16m11415. [PMID: 29099547 PMCID: PMC6468981 DOI: 10.4088/jcp.16m11415] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/15/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Multiple pharmacotherapies for treating anxiety disorders exist, including selective serotonin reuptake inhibitors (SSRIs), the recommended first-line pharmacotherapy for pediatric anxiety. We sought to describe initial antianxiety medication use in children and estimate how long antianxiety medications were continued. METHODS In a large commercial claims database, we identified children (3-17 years) initiating prescription antianxiety medication from 2004 to 2014 with a recent anxiety diagnosis (ICD-9-CM = 293.84, 300.0x, 300.2x, 300.3x, 309.21, 309.81, 313.23). We estimated the proportion of children initiating each medication class across the study period and used multivariable regression to evaluate factors associated with initiation with an SSRI. We evaluated treatment length for each initial medication class. RESULTS Of 84,500 children initiating antianxiety medication, 70% initiated with an SSRI (63% [95% CI, 62%-63%] SSRI alone, 7% [95% CI, 7%-7%] SSRI + another antianxiety medication). Non-SSRI medications initiated included benzodiazepines (8%), non-SSRI antidepressants (7%), hydroxyzine (4%), and atypical antipsychotics (3%). Anxiety disorder, age, provider type, and comorbid diagnoses were associated with initial medication class. The proportion of children refilling their initial medication ranged from 19% (95% CI, 18%-20%) of hydroxyzine initiators and 25% (95% CI, 24%-26%) of benzodiazepine initiators to 81% (95% CI, 80%-81%) of SSRI initiators. Over half (55%, 95% CI, 55%-56%) of SSRI initiators continued SSRI treatment for 6 months. CONCLUSIONS SSRIs are the most commonly used first-line medication for pediatric anxiety disorders, with about half of SSRI initiators continuing treatment for 6 months. Still, a third began therapy on a non-SSRI medication, for which there is limited evidence of effectiveness for pediatric anxiety, and a notable proportion of children initiated with 2 antianxiety medication classes.
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Affiliation(s)
- Greta A. Bushnell
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Scott N. Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Stacie B. Dusetzina
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy and the Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Bradley N. Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - M. Alan Brookhart
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - John T. Walkup
- Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, New York
| | - Moira A. Rynn
- Division of Child and Adolescent Psychiatry, Department of Psychiatry at Columbia University/New York State Psychiatric Institute, New York, New York
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
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Thom PRP, Hall W, Maneta E, Luber MJ, Coffey BJ. Treatment of Hallucinations in the Context of Anxiety: When Less Is More. J Child Adolesc Psychopharmacol 2017; 27:389-392. [PMID: 28489429 DOI: 10.1089/cap.2017.29133.bjc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - William Hall
- 1 Department of Psychiatry, Boston Children's Hospital , Boston, Massachusetts
| | - Eleni Maneta
- 1 Department of Psychiatry, Boston Children's Hospital , Boston, Massachusetts
| | - Maxwell J Luber
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Barbara J Coffey
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
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Gerasch S, Kanaan AS, Jakubovski E, Müller-Vahl KR. Aripiprazole Improves Associated Comorbid Conditions in Addition to Tics in Adult Patients with Gilles de la Tourette Syndrome. Front Neurosci 2016; 10:416. [PMID: 27672358 PMCID: PMC5018494 DOI: 10.3389/fnins.2016.00416] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022] Open
Abstract
Gilles de la Tourette Syndrome (GTS) is characterized by motor and vocal tics, as well as associated comorbid conditions including obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), depression, and anxiety which are present in a substantial number of patients. Although randomized controlled trials including a large number of patients are still missing, aripiprazole is currently considered as a first choice drug for the treatment of tics. The aim of this study was to further investigate efficacy and safety of aripiprazole in a group of drug-free, adult patients. Specifically, we investigated the influence of aripiprazole on tic severity, comorbidities, premonitory urge (PU), and quality of life (QoL). Moreover, we were interested in the factors that influence a patient's decision in electing for-or against- pharmacological treatment. In this prospective uncontrolled open-label study, we included 44 patients and used a number of rating scales to assess tic severity, PU, comorbidities, and QoL at baseline and during treatment with aripiprazole. Eighteen out of fortyfour patients decided for undergoing treatment for their tics with aripiprazole and completed follow-up assessments after 4–6 weeks. Our major findings were (1) aripiprazole resulted in significant reduction of tics, but did not affect PU; (2) aripiprazole significantly improved OCD and showed a trend toward improvement of other comorbidities including depression, anxiety, and ADHD; (3) neither severity of tics, nor PU or QoL influenced patients' decisions for or against treatment of tics with aripiprazole; instead patients with comorbid OCD tended to decide in favor of, while patients with comorbid ADHD tended to decide against tic treatment; (4) most frequently reported adverse effects were sleeping problems; (5) patients' QoL was mostly impaired by comorbid depression. Our results suggest that aripiprazole may improve associated comorbid conditions in addition to tics in patients with GTS. It can be hypothesized that these beneficial effects are related to aripiprazole's adaptive pharmacological profile, which exhibits an influence on the dopaminergic as well as a number of other neurotransmitter systems. For the first time, our data provide evidence that patients' decision making process for or against medical treatment is influenced by other factors than tic severity and QoL.
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Affiliation(s)
- Sarah Gerasch
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Ahmad Seif Kanaan
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical SchoolHannover, Germany; Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
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Coplan JD, Aaronson CJ, Panthangi V, Kim Y. Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches. World J Psychiatry 2015; 5:366-378. [PMID: 26740928 PMCID: PMC4694550 DOI: 10.5498/wjp.v5.i4.366] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/02/2014] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
Comorbid anxiety with depression predicts poor outcomes with a higher percentage of treatment resistance than either disorder occurring alone. Overlap of anxiety and depression complicates diagnosis and renders treatment challenging. A vital step in treatment of such comorbidity is careful and comprehensive diagnostic assessment. We attempt to explain various psychosocial and pharmacological approaches for treatment of comorbid anxiety and depression. For the psychosocial component, we focus only on generalized anxiety disorder based on the following theoretical models: (1) “the avoidance model”; (2) “the intolerance of uncertainty model”; (3) “the meta-cognitive model”; (4) “the emotion dysregulation model”; and (5) “the acceptance based model”. For depression, the following theoretical models are explicated: (1) “the cognitive model”; (2) “the behavioral activation model”; and (3) “the interpersonal model”. Integration of these approaches is suggested. The treatment of comorbid anxiety and depression necessitates specific psychopharmacological adjustments as compared to treating either condition alone. Serotonin reuptake inhibitors are considered first-line treatment in uncomplicated depression comorbid with a spectrum of anxiety disorders. Short-acting benzodiazepines (BZDs) are an important “bridging strategy” to address an acute anxiety component. In patients with comorbid substance abuse, avoidance of BZDs is recommended and we advise using an atypical antipsychotic in lieu of BZDs. For mixed anxiety and depression comorbid with bipolar disorder, we recommend augmentation of an antidepressant with either lamotrigine or an atypical agent. Combination and augmentation therapies in the treatment of comorbid conditions vis-à-vis monotherapy may be necessary for positive outcomes. Combination therapy with tricyclic antidepressants, gabapentin and selective serotonin/norepinephrine reuptake inhibitors (e.g., duloxetine) are specifically useful for comorbid chronic pain syndromes. Aripiprazole, quetiapine, risperidone and other novel atypical agents may be effective as augmentations. For treatment-resistant patients, we recommend a “stacking approach” not dissimilar from treatment of hypertension In conclusion, we delineate a comprehensive approach comprising integration of various psychosocial approaches and incremental pharmacological interventions entailing bridging strategies, augmentation therapies and ultimately stacking approaches towards effectively treating comorbid anxiety and depression.
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[Psychopharmacology of anxiety and depression: Historical aspects, current treatments and perspectives]. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 74:93-118. [PMID: 26472602 DOI: 10.1016/j.pharma.2015.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/25/2015] [Accepted: 09/02/2015] [Indexed: 01/08/2023]
Abstract
Pharmacological treatment of acute anxiety still relies on benzodiazepines, while chronic anxiety disorders and depression are treated with different antidepressants, according to specific indications. The monoaminergic axis is represented by two families which are being developed: (i) serotonin-norepinephrine-dopamine reuptake inhibitors (SNDRI), also called triple reuptake inhibitors (TRI), for the treatment of depression (amitifadine), (ii) multimodal antidepressants for depression and anxiety disorders (generalized anxiety disorder mainly) (tedatioxetine, vortioxetine and vilazodone). Third-generation antipsychotics (aripiprazole, lurasidone, brexpiprazole, cariprazine) appear relevant in the treatment of resistant depression and some anxiety disorders. Among the modulators of the glutamatergic axis, promising compounds include: (i) ionotropic regulators of NMDA receptors: esketamine, AVP-923 and AVP-786, CERC-301, rapastinel (Glyx-13), NRX-1074 developed for depression, rapastinel and bitopertine developed for obsessive compulsive disorder, (ii) metabotropic glutamate receptors modulators: decoglurant and basimglurant developed for depression and mavoglurant developed for obsessive compulsive disorder.
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13
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Habib MMW, Abdelfattah MAO, Abadi AH. Design and Synthesis of Novel Phenylpiperazine Derivatives as Potential Anticonvulsant Agents. Arch Pharm (Weinheim) 2015; 348:868-74. [DOI: 10.1002/ardp.201500272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/22/2015] [Accepted: 09/28/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Monica M. W. Habib
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Biotechnology; German University in Cairo; Cairo Egypt
| | - Mohamed A. O. Abdelfattah
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Biotechnology; German University in Cairo; Cairo Egypt
- American University of The Middle East; Egaila Kuwait
| | - Ashraf H. Abadi
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Biotechnology; German University in Cairo; Cairo Egypt
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Silva DPB, Florentino IF, Oliveira LP, Lino RC, Galdino PM, Menegatti R, Costa EA. Anti-nociceptive and anti-inflammatory activities of 4-[(1-phenyl-1H-pyrazol-4-yl) methyl] 1-piperazine carboxylic acid ethyl ester: A new piperazine derivative. Pharmacol Biochem Behav 2015; 137:86-92. [PMID: 26276732 DOI: 10.1016/j.pbb.2015.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 08/05/2015] [Accepted: 08/07/2015] [Indexed: 11/18/2022]
Abstract
Piperazine compounds possess anti-infective, anti-carcinogenic, anxiolytic, hypotensive, anti-hypertensive and vasorelaxant properties and are attractive candidates for the development of new analgesic and anti-inflammatory drugs. This study investigates the anti-nociceptive and anti-inflammatory effects of piperazine derivative 4-[(1-phenyl-1H-pyrazol-4-yl) methyl]1-piperazine carboxylic acid ethyl ester (LQFM-008) and the involvement of the serotonergic pathway. In the formalin test, treatments with LQFM-008 (15 and 30mg/kg p.o.) reduced the licking time in both neurogenic and inflammatory phases of this test. In the tail flick and hot plate tests, LQFM008 treatment (15 and 30mg/kg p.o.) increased latency to thermal stimulus, suggesting the involvement of central mechanisms in the anti-nociceptive effect of LQFM-008. In the carrageenan-induced paw edema test, LQFM-008 (p.o.) at the doses of 15 and 30mg/kg reduced the edema at all tested time points, while the dose of 7.5mg/kg reduced the edema only for the first hour. LQFM-008 (30mg/kg p.o.) reduced both cell migration and protein exudation in the carrageenan-induced pleurisy test. Furthermore, pre-treatment with NAN-190 (0.6mg/kgi.p.) and PCPA (100mg/kgi.p.) antagonized the anti-nociceptive effect of LQFM-008 in both phases of the formalin test. Our data suggest that LQFM-008 possesses anti-inflammatory and anti-nociceptive effects mediated through the serotonergic pathway.
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Affiliation(s)
- Daiany P B Silva
- Institute of Biological Sciences, Department of Pharmacology, Federal University of Goiás, Campus Samambaia, Goiânia, GO, Brazil.
| | - Iziara F Florentino
- Institute of Biological Sciences, Department of Pharmacology, Federal University of Goiás, Campus Samambaia, Goiânia, GO, Brazil
| | - Lanussy P Oliveira
- Institute of Biological Sciences, Department of Pharmacology, Federal University of Goiás, Campus Samambaia, Goiânia, GO, Brazil
| | - Roberta C Lino
- Institute of Biological Sciences, Department of Pharmacology, Federal University of Goiás, Campus Samambaia, Goiânia, GO, Brazil
| | - Pablinny M Galdino
- Institute of Biological Sciences, Department of Pharmacology, Federal University of Goiás, Campus Samambaia, Goiânia, GO, Brazil
| | - Ricardo Menegatti
- Faculty of Pharmacy, Laboratory of Medicinal Pharmaceutical Chemistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Elson A Costa
- Institute of Biological Sciences, Department of Pharmacology, Federal University of Goiás, Campus Samambaia, Goiânia, GO, Brazil
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Misri S, Abizadeh J, Sanders S, Swift E. Perinatal Generalized Anxiety Disorder: Assessment and Treatment. J Womens Health (Larchmt) 2015; 24:762-70. [PMID: 26125602 DOI: 10.1089/jwh.2014.5150] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.
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Affiliation(s)
- Shaila Misri
- 1 Reproductive Mental Health Program, British Columbia Children's & Women's Hospital , Vancouver, British Columbia, Canada .,2 Department of Obstetrics and Gynecology, University of British Columbia , Vancouver, British Columbia, Canada .,3 Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada .,4 British Columbia Mental Health and Addiction Services, Provincial Health Services Authority , Vancouver, British Columbia, Canada
| | - Jasmin Abizadeh
- 1 Reproductive Mental Health Program, British Columbia Children's & Women's Hospital , Vancouver, British Columbia, Canada .,3 Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada
| | - Shawn Sanders
- 1 Reproductive Mental Health Program, British Columbia Children's & Women's Hospital , Vancouver, British Columbia, Canada .,3 Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada
| | - Elena Swift
- 1 Reproductive Mental Health Program, British Columbia Children's & Women's Hospital , Vancouver, British Columbia, Canada .,3 Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada
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Garay RP, Samalin L, Hameg A, Llorca PM. Investigational drugs for anxiety in patients with schizophrenia. Expert Opin Investig Drugs 2014; 24:507-17. [DOI: 10.1517/13543784.2014.987339] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ricardo P Garay
- 1Université Paris-Sud et Hôpital Marie Lannelongue, INSERM U999, Le Plessis-Robinson, France
- 2Craven, Villemoisson-sur-Orge, France ;
| | - Ludovic Samalin
- 3Clermont-Ferrand University, CHU Clermont-Ferrand, EA 7280, Clermont-Ferrand, France
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Partyka A, Jarosz J, Wasik A, Jastrzębska-Więsek M, Zagórska A, Pawłowski M, Wesołowska A. Novel tricyclic[2,1-f]theophylline derivatives of LCAP with activity in mouse models of affective disorders. J Pharm Pharmacol 2014; 66:1755-62. [DOI: 10.1111/jphp.12305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/04/2014] [Indexed: 12/22/2022]
Abstract
Abstract
Objectives
The purpose of this study was to investigate the central activity of the two new imidazo[2,1-f]purine-2,4-dione derivatives behaved as presynaptic 5HT1A receptor agonists and postsynaptic 5HT1A, 5HT2A and D2 receptors antagonists. The compounds were examined using animal tests towards antipsychotic, antidepressant- and anxiolytic-like properties and then compared with effects evoked by an atypical antipsychotic drug ziprasidone.
Methods
D-amphetamine-induced hyperactivity test was used to determine antipsychotic-like activity of compounds 7 and 9. The forced swim test (FST) and the four-plate test were conducted to investigate antidepressant- and antianxiety-like activity, respectively, of studied agents. The investigated compounds 7, 9 and ziprasidone were administered intraperitoneally 60 min before the tests. Diazepam and imipramine were used as standard anxiolytic and antidepressant drugs, respectively.
Key findings
The obtained results demonstrate that new synthesized compound 9 evokes antipsychotic-like activity alike ziprasidone and, in contrary to the antipsychotic drug, shows antidepressant- and anxiolytic-like properties in behavioural tests in mice.
Conclusions
The present preclinical results indicate that one of the two investigated imidazo[2,1-f]purine-2,4-dione derivatives, compound 9, with methyl group at 7 position of imidazo[2,1-f]purine-2,4-dione fragment and the ortho-OCH3 substituent in the aryl moiety, acts as an antipsychotic drug with additional antidepressant and anxiolytic properties.
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Affiliation(s)
- Anna Partyka
- Department of Clinical Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Jarosz
- Department of Clinical Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Wasik
- Department of Clinical Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Agnieszka Zagórska
- Department of Pharmaceutical Chemistry, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Pawłowski
- Department of Pharmaceutical Chemistry, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Wesołowska
- Department of Clinical Pharmacy, Jagiellonian University Medical College, Kraków, Poland
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Muneer A. Aripiprazole in the treatment of refractory mood disorders: a case series. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2014; 12:157-9. [PMID: 25191507 PMCID: PMC4153863 DOI: 10.9758/cpn.2014.12.2.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/03/2014] [Accepted: 01/06/2014] [Indexed: 12/26/2022]
Abstract
Major depressive disorder and bipolar disorders are among the commonest neuropsychiatric conditions, affecting persons of both sexes which belong to all age groups. Comorbidity is the rule rather than the exception; anxiety spectrum disorders, somatoform disorders, eating disorders and substance use disorders frequently co-exist with mood disorders. Catatonia is a serious complication of the latter and every patient with a severe affective exacerbation should be assessed for the presence of catatonic signs and symptoms. In a significant minority of patients, symptoms show treatment resistance; many patients experience severe hopelessness and suicidal ideation, causing high rates of morbidity and mortality in afflicted individuals. Pharmacological management is challenging and currently available psychotropic agents often fall short of inducing remission. Second generation antipsychotics have been shown in a number of studies as having an antidepressant and mood stabilizing effect. Aripiprazole is a novel antipsychotic which is being increasingly used in difficult to treat mood disorders patients. Several controlled and uncontrolled studies have shown the efficacy and safety of this medication in subjects of all ages. Here a case series of three patients is presented who suffered from refractory mood disorders but responded to aripiprazole with complete remission of affective symptoms.
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Affiliation(s)
- Ather Muneer
- Department of Psychiatry, Islamic International Medical College, Pakistan Railway Teaching Hospital, Rawalpindi, Pakistan
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Vázquez GH, Baldessarini RJ, Tondo L. Co-occurrence of anxiety and bipolar disorders: clinical and therapeutic overview. Depress Anxiety 2014; 31:196-206. [PMID: 24610817 DOI: 10.1002/da.22248] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/12/2014] [Accepted: 01/18/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Anxiety commonly co-occurs with bipolar disorders (BDs), but the significance of such "co-morbidity" remains to be clarified and its optimal treatment adequately defined. METHODS We reviewed epidemiological, clinical, and treatment studies of the co-occurrence of BD and anxiety disorder through electronic searching of Pubmed/MEDLINE and EMBASE databases. RESULTS Nearly half of BD patients meet diagnostic criteria for an anxiety disorder at some time, and anxiety is associated with poor treatment responses, substance abuse, and disability. Reported rates of specific anxiety disorders with BD rank: panic ≥ phobias ≥ generalized anxiety ≥ posttraumatic stress ≥ obsessive-compulsive disorders. Their prevalence appears to be greater among women than men, but similar in types I and II BD. Anxiety may be more likely in depressive phases of BD, but relationships of anxiety phenomena to particular phases of BD, and their temporal distributions require clarification. Adequate treatment trials for anxiety syndromes in BD patients remain rare, and the impact on anxiety of treatments aimed at mood stabilization is not clear. Benzodiazepines are sometimes given empirically; antidepressants are employed cautiously to limit risks of mood switching and emotional destabilization; lamotrigine, valproate, and second-generation antipsychotics may be useful and relatively safe. CONCLUSIONS Anxiety symptoms and syndromes co-occur commonly in patients with BD, but "co-morbid" phenomena may be part of the BD phenotype rather than separate illnesses.
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Affiliation(s)
- Gustavo H Vázquez
- International Consortium for Bipolar and Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts; Department of Neuroscience, Palermo University, Buenos Aires, Argentina
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Abstract
BACKGROUND Marfan syndrome (MFS) is an autosomal dominant disorder of fibrillin-1 gene mutations, with the involvement of cardiovascular, skeletal, and ocular systems. In addition to physical abnormalities, MFS patients are also found to be susceptible to schizophrenia and other psychiatric conditions. OBJECTIVES Awareness of the association between MFS and psychiatric conditions would improve the clinical management of MFS patients to reduce the risk or even to prevent the development of psychiatric complications in MFS patients. METHODS Here, we describe a male MFS patient who manifested incoherent speech and impaired cognitive and social function at the age of 40 years. Results and conclusion His mental dysfunction could be attributed to his bilateral cerebral infarction, which is a neurovascular complication associated with MFS.
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Aripiprazole: a dopamine modulator that mimics methylphenidate in producing faster antidepressant effects. Med Hypotheses 2013; 81:183-5. [PMID: 23751312 DOI: 10.1016/j.mehy.2013.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/15/2013] [Indexed: 11/20/2022]
Abstract
Up to 60% of depressed patients do not respond to two months of pharmacotherapy, and late treatment responses are often correlated with poor outcomes and may be characterized as treatment-resistant depression (TRD). Previous studies have noted that the addition of a psychostimulant such as methylphenidate to the therapeutic regimen of patients with TRD or those depressed patients with comorbid fatigue, advanced age, or a major medical illness showed significant improvement within two weeks. One explanation for the benefit of methylphenidate in treating TRD is that it enhances the level of dopamine in the brain. Adjunctive low dose aripiprazole in patients with TRD has also become a common intervention. Several studies have focused on aripiprazole's pharmacodynamic and pharmacokinetic profiles, but no definitive comments on its antidepressant effects. We hypothesize that a low dose of aripiprazole might play a role as a dopamine agonist similar to that of methylphenidate due to its partial dopamine D2 agonist and 30% intrinsic dopaminergic activity. In addition to its use in patients with TRD, adjunctive aripiprazole might work like methylphenidate in those depressed patients with fatigue, advanced age, or major illnesses. A new drug invention which combined an antidepressant with an adequate dose of aripiprazole should be considered. The neurobiological basis for this combination in treating TRD awaits further study.
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Central pharmacological activity of a new piperazine derivative: 4-(1-Phenyl-1h-pyrazol-4-ylmethyl)-piperazine-1-carboxylic acid ethyl ester. Life Sci 2012; 90:910-6. [DOI: 10.1016/j.lfs.2012.04.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 03/23/2012] [Accepted: 04/16/2012] [Indexed: 11/20/2022]
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Chanachev A, Ansermot N, Crettol Wavre S, Nowotka U, Stamatopoulou ME, Conus P, Eap CB. Addition of aripiprazole to the clozapine may be useful in reducing anxiety in treatment-resistant schizophrenia. Case Rep Psychiatry 2011; 2011:846489. [PMID: 22937411 PMCID: PMC3420713 DOI: 10.1155/2011/846489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 07/11/2011] [Indexed: 11/19/2022] Open
Abstract
There exist many case reports and studies on the antipsychotic augmentation by aripirazole in partial responders to clozapine, the most seem to be finding a slight difference in the PANSS and CGI scores after the aripirazole addition. The results of our report are compatible with those of other studies but, we have found a considerable antianxiety action in both of the cases. The 5HT1A agonism of aripirazole could be hypothesized as mechanism contributing to this effect.
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Affiliation(s)
- Aleksandar Chanachev
- Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, Section Eugene Minkowski, Site de Cery, 1008 Prilly, Switzerland
| | - Nicolas Ansermot
- Unité de Biochimie et Psychopharmacologie Clinique, Centre de Neurosciences Psychiatriques, Site de Cery, 1008 Prilly, Switzerland
| | - Séverine Crettol Wavre
- Unité de Biochimie et Psychopharmacologie Clinique, Centre de Neurosciences Psychiatriques, Site de Cery, 1008 Prilly, Switzerland
| | - Ute Nowotka
- Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, Section Eugene Minkowski, Site de Cery, 1008 Prilly, Switzerland
| | - Maria-Eleni Stamatopoulou
- Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, Psychiatrie de Liason-Urgences et Crise, 1011 Lausanne, Switzerland
| | - Philippe Conus
- Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, Section Eugene Minkowski, Site de Cery, 1008 Prilly, Switzerland
| | - Chin B. Eap
- Unité de Biochimie et Psychopharmacologie Clinique, Centre de Neurosciences Psychiatriques, Site de Cery, 1008 Prilly, Switzerland
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