Ziprasidone: a novel psychotropic with unique properties

Ziprasidone (Geodon) is a relatively new atypical antipsychotic medication with a unique pharmacological profile. It is indicated for the treatment of schizophrenia, but has also often been used off-label for other uses. This review summarizes its important properties, specifically the pharmacodynamic parameters, receptor-binding profile and relevance to clinical outcomes, side effects, and potential for drug-drug interactions and established clinical indications. Novel therapeutic applications and relevant clinical trials or reports are also examined. The authors review the current market and speculate on likely changes in 5 years.

Obesity as a defense mechanism

INTRODUCTION

As the rate of obesity and bariatric surgery rise, various psychosocial etiologies contributing to obesity are being explored, and it is not uncommon to discover that a patient has been a victim of past abuse.

PRESENTATION OF CASE

A 37-year-old female was hospitalized for intractable nausea and vomiting following a laparoscopic Roux-en-Y gastric bypass performed a month and a half prior. After ruling out all medical etiologies, psychiatry was consulted due to a history of panic attacks, and to evaluate for a psychosomatic etiology.

DISCUSSION

During the initial consultation, it was elicited that the patient had been the victim of a date rape as a teen, which resulted in dramatic weight gain and obesity. Following a comprehensive medical workup, brief psychodynamic psychotherapy, and the initiation of pharmacotherapy, the patient had a resolution of her symptoms, and at a 2 month follow-up, remained asymptomatic.

CONCLUSION

Prior to surgery, patients should be questioned about any history of abuse by utilizing a structured diagnostic questionnaire, such as the Weight and Lifestyle Inventory (WALI). To prevent minimization, individuals with a history of abuse should be screened more thoroughly, and psychiatric involvement should be an intrinsic component of the follow-up care as abused patients may also be more sensitive to complaints as they lose weight. Psychiatric involvement can be a useful adjunctive treatment while medical etiologies are being ruled out, rather than after they have been ruled out.

Long-term tolerability and effectiveness of duloxetine in the treatment of major depressive disorder

To examine the long-term safety, tolerability, and effectiveness of duloxetine in the treatment of major depressive disorder in a naturalistic study design meant to mimic clinical practice. Data were from the long-term, open-label, extension phase that followed a 12-week acute-treatment, multicenter study of adult outpatients with major depressive disorder. After the first week of the acute phase, all patients were treated with at least 60 mg daily duloxetine, which could be titrated to a maximum dose of 120 mg daily. Outcome measures were collected at monthly visits and included spontaneously reported adverse events, weight, vital signs, and the 17-item Hamilton Depression Rating scale. Seventy-two of the 177 (40.7%) patients who entered the extension phase of this study completed the study. The mean duration of participation in the extension was 305 days, with total exposure ranging from 68 to 707 days. Of the 177 patients who entered the extension, only 12 or 13 (7.0%) showed clinically significant worsening of depression that led to study discontinuation. The mean 17-item Hamilton Depression Rating scale score remained below 7 throughout the extension. A total of 21/177 patients (11.9%) discontinued due to adverse events during extension treatment. The adverse events causing discontinuation during the extension, with the exception of weight gain, were generally not unique to the extension phase, with 11/21 patients (52.0%) discontinuing due to adverse events that were first reported during acute treatment. Weight gain was reported as a reason for discontinuation during extension treatment in 4/177 (2.3%) patients. In this open-label study, efficacy was maintained for most patients. The adverse events causing discontinuation during the extension phase were generally not unique to the extension phase. Few patients experienced significant weight gain.

Ziprasidone-associated mania: a case series and review of the mechanism

Atypical antipsychotics are now commonly used in the treatment of bipolar disorder, as they have been shown to have effects on mania as well as psychosis. Shortly after the introduction of atypical antipsychotics, several cases of associated hypomania and mania were reported. Ziprasidone is an atypical antipsychotic recently approved by the Food and Drug Administration for the treatment of psychosis. Although ziprasidone has also been shown to be effective in treating mania, it may be associated with the induction of mania or hypomania. We report four cases of mania associated with initiation of ziprasidone, which, to our knowledge, are the first reported for this drug in bipolar patients. As ziprasidone has substantial serotonergic and noradrenergic action, we hypothesize, it may more likely induce mania than other atypical antipsychotics. We advocate future studies to evaluate ziprasidone's efficacy in treating bipolar disorder and caution clinicians that induction of mania or hypomania may be possible with this agent.