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Cohen SE, Zantvoord JB, Storosum BWC, Mattila TK, Daams J, Wezenberg B, de Boer A, Denys DAJP. Influence of study characteristics, methodological rigour and publication bias on efficacy of pharmacotherapy in obsessive-compulsive disorder: a systematic review and meta-analysis of randomised, placebo-controlled trials. BMJ Ment Health 2024; 27:e300951. [PMID: 38350669 PMCID: PMC10862307 DOI: 10.1136/bmjment-2023-300951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
QUESTION We examined the effect of study characteristics, risk of bias and publication bias on the efficacy of pharmacotherapy in randomised controlled trials (RCTs) for obsessive-compulsive disorder (OCD). STUDY SELECTION AND ANALYSIS We conducted a systematic search of double-blinded, placebo-controlled, short-term RCTs with selective serotonergic reuptake inhibitors (SSRIs) or clomipramine. We performed a random-effect meta-analysis using change in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) as the primary outcome. We performed meta-regression for risk of bias, intervention, sponsor status, number of trial arms, use of placebo run-in, dosing, publication year, age, severity, illness duration and gender distribution. Furthermore, we analysed publication bias using a Bayesian selection model. FINDINGS We screened 3729 articles and included 21 studies, with 4102 participants. Meta-analysis showed an effect size of -0.59 (Hedges' G, 95% CI -0.73 to -0.46), equalling a 4.2-point reduction in the YBOCS compared with placebo. The most recent trial was performed in 2007 and most trials were at risk of bias. We found an indication for publication bias, and subsequent correction for this bias resulted in a depleted effect size. In our meta-regression, we found that high risk of bias was associated with a larger effect size. Clomipramine was more effective than SSRIs, even after correcting for risk of bias. After correction for multiple testing, other selected predictors were non-significant. CONCLUSIONS Our findings reveal superiority of clomipramine over SSRIs, even after adjusting for risk of bias. Effect sizes may be attenuated when considering publication bias and methodological rigour, emphasising the importance of robust studies to guide clinical utility of OCD pharmacotherapy. PROSPERO REGISTRATION NUMBER CRD42023394924.
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Affiliation(s)
- Sem E Cohen
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Jasper Brian Zantvoord
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Bram W C Storosum
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | | | - Joost Daams
- Medical Library, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Babet Wezenberg
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Anthonius de Boer
- Medicines Evaluation Board, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Damiaan A J P Denys
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
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Su W, Zhao D, Zhao H, Zheng W, Zhang W. A 28-Year-Old Man with Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, and Dissociative Identity Disorder Responding to Aripiprazole Augmentation of Clomipramine Combined with Psychoeducation and Exposure and Response Prevention. Am J Case Rep 2023; 24:e941534. [PMID: 38100391 PMCID: PMC10728879 DOI: 10.12659/ajcr.941534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/08/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND We report the case of a 28-year-old man with comorbidity of OCD, PTSD, and DID responding to aripiprazole augmentation of clomipramine combined with psychoeducation and exposure and response prevention (ERP). CASE REPORT A 28-year-old, well-educated man presented with depression, obsessive thoughts, behavioral impulsivity, and suicidal thoughts/behavior. He was known to be stubborn and sensitive to criticism since childhood. The obsessive thoughts and compulsive behaviors also started at an early age. He had 4 past psychiatric hospitalizations, mostly for dissociative episodes and bizarre behaviors, complicated with significant anxiety and distress from traumatic experiences during doctoral study. He had no-to-minimal responses to various psychotropics and traditional Chinese medicine. A thorough assessment showed he met the diagnostic criteria for OCD, PTSD, and DID. He was then treated with clomipramine in combination with aripiprazole, plus psychoeducation and exposure and response prevention (ERP). His anxiety and irritability significantly improved within 2 months and his obsessive thoughts faded away. At 6-month follow-up, the patient achieved clinical remission. One year later, he remained stable and reported having a normal life. CONCLUSIONS The case illustrates both how impairing the comorbidity of OCD, PTSD, and DID can be and how concurrent use of tricyclic antidepressant (TCA) clomipramine and partial dopamine agonist aripiprazole, together with psychoeducation and ERP, can improve outcomes when other treatment choices fail to be effective.
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Affiliation(s)
- Wei Su
- Department of Psychology, The Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, PR China
| | - Dan Zhao
- Department of Psychology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Hongmei Zhao
- Psychology Department Outpatient, Tianping Street Community Health Service Center, Taian, Shandong, PR China
| | - Wanhong Zheng
- Departmanr of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Wangxin Zhang
- Department of Psychology, The Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, PR China
- School of Clinical and Basic Medical Sciences, Shandong First Medical University& Shandong Academy of Medical Sciences, Jinan, Shandong, PR China
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Guaiana G, Meader N, Barbui C, Davies SJ, Furukawa TA, Imai H, Dias S, Caldwell DM, Koesters M, Tajika A, Bighelli I, Pompoli A, Cipriani A, Dawson S, Robertson L. Pharmacological treatments in panic disorder in adults: a network meta-analysis. Cochrane Database Syst Rev 2023; 11:CD012729. [PMID: 38014714 PMCID: PMC10683020 DOI: 10.1002/14651858.cd012729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND A panic attack is a discrete period of fear or anxiety that has a rapid onset and reaches a peak within 10 minutes. The main symptoms involve bodily systems, such as racing heart, chest pain, sweating, shaking, dizziness, flushing, churning stomach, faintness and breathlessness. Other recognised panic attack symptoms involve fearful cognitions, such as the fear of collapse, going mad or dying, and derealisation (the sensation that the world is unreal). Panic disorder is common in the general population with a prevalence of 1% to 4%. The treatment of panic disorder includes psychological and pharmacological interventions, including antidepressants and benzodiazepines. OBJECTIVES To compare, via network meta-analysis, individual drugs (antidepressants and benzodiazepines) or placebo in terms of efficacy and acceptability in the acute treatment of panic disorder, with or without agoraphobia. To rank individual active drugs for panic disorder (antidepressants, benzodiazepines and placebo) according to their effectiveness and acceptability. To rank drug classes for panic disorder (selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), mono-amine oxidase inhibitors (MAOIs) and benzodiazepines (BDZs) and placebo) according to their effectiveness and acceptability. To explore heterogeneity and inconsistency between direct and indirect evidence in a network meta-analysis. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, CENTRAL, CDSR, MEDLINE, Ovid Embase and PsycINFO to 26 May 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) of people aged 18 years or older of either sex and any ethnicity with clinically diagnosed panic disorder, with or without agoraphobia. We included trials that compared the effectiveness of antidepressants and benzodiazepines with each other or with a placebo. DATA COLLECTION AND ANALYSIS Two authors independently screened titles/abstracts and full texts, extracted data and assessed risk of bias. We analysed dichotomous data and continuous data as risk ratios (RRs), mean differences (MD) or standardised mean differences (SMD): response to treatment (i.e. substantial improvement from baseline as defined by the original investigators: dichotomous outcome), total number of dropouts due to any reason (as a proxy measure of treatment acceptability: dichotomous outcome), remission (i.e. satisfactory end state as defined by global judgement of the original investigators: dichotomous outcome), panic symptom scales and global judgement (continuous outcome), frequency of panic attacks (as recorded, for example, by a panic diary; continuous outcome), agoraphobia (dichotomous outcome). We assessed the certainty of evidence using threshold analyses. MAIN RESULTS Overall, we included 70 trials in this review. Sample sizes ranged between 5 and 445 participants in each arm, and the total sample size per study ranged from 10 to 1168. Thirty-five studies included sample sizes of over 100 participants. There is evidence from 48 RCTs (N = 10,118) that most medications are more effective in the response outcome than placebo. In particular, diazepam, alprazolam, clonazepam, paroxetine, venlafaxine, clomipramine, fluoxetine and adinazolam showed the strongest effect, with diazepam, alprazolam and clonazepam ranking as the most effective. We found heterogeneity in most of the comparisons, but our threshold analyses suggest that this is unlikely to impact the findings of the network meta-analysis. Results from 64 RCTs (N = 12,310) suggest that most medications are associated with either a reduced or similar risk of dropouts to placebo. Alprazolam and diazepam were associated with a lower dropout rate compared to placebo and were ranked as the most tolerated of all the medications examined. Thirty-two RCTs (N = 8569) were included in the remission outcome. Most medications were more effective than placebo, namely desipramine, fluoxetine, clonazepam, diazepam, fluvoxamine, imipramine, venlafaxine and paroxetine, and their effects were clinically meaningful. Amongst these medications, desipramine and alprazolam were ranked highest. Thirty-five RCTs (N = 8826) are included in the continuous outcome reduction in panic scale scores. Brofaromine, clonazepam and reboxetine had the strongest reductions in panic symptoms compared to placebo, but results were based on either one trial or very small trials. Forty-one RCTs (N = 7853) are included in the frequency of panic attack outcome. Only clonazepam and alprazolam showed a strong reduction in the frequency of panic attacks compared to placebo, and were ranked highest. Twenty-six RCTs (N = 7044) provided data for agoraphobia. The strongest reductions in agoraphobia symptoms were found for citalopram, reboxetine, escitalopram, clomipramine and diazepam, compared to placebo. For the pooled intervention classes, we examined the two primary outcomes (response and dropout). The classes of medication were: SSRIs, SNRIs, TCAs, MAOIs and BDZs. For the response outcome, all classes of medications examined were more effective than placebo. TCAs as a class ranked as the most effective, followed by BDZs and MAOIs. SSRIs as a class ranked fifth on average, while SNRIs were ranked lowest. When we compared classes of medication with each other for the response outcome, we found no difference between classes. Comparisons between MAOIs and TCAs and between BDZs and TCAs also suggested no differences between these medications, but the results were imprecise. For the dropout outcome, BDZs were the only class associated with a lower dropout compared to placebo and were ranked first in terms of tolerability. The other classes did not show any difference in dropouts compared to placebo. In terms of ranking, TCAs are on average second to BDZs, followed by SNRIs, then by SSRIs and lastly by MAOIs. BDZs were associated with lower dropout rates compared to SSRIs, SNRIs and TCAs. The quality of the studies comparing antidepressants with placebo was moderate, while the quality of the studies comparing BDZs with placebo and antidepressants was low. AUTHORS' CONCLUSIONS In terms of efficacy, SSRIs, SNRIs (venlafaxine), TCAs, MAOIs and BDZs may be effective, with little difference between classes. However, it is important to note that the reliability of these findings may be limited due to the overall low quality of the studies, with all having unclear or high risk of bias across multiple domains. Within classes, some differences emerged. For example, amongst the SSRIs paroxetine and fluoxetine seem to have stronger evidence of efficacy than sertraline. Benzodiazepines appear to have a small but significant advantage in terms of tolerability (incidence of dropouts) over other classes.
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Affiliation(s)
| | - Nicholas Meader
- Centre for Reviews and Dissemination, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Simon Jc Davies
- Geriatric Psychiatry Division, CAMH, University of Toronto, Toronto, Canada
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Markus Koesters
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Chemnitz, Germany
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Irene Bighelli
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, München, Germany
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Abstract
PURPOSE OF REVIEW This article describes the phenomenology and clinical presentation of obsessive-compulsive disorder (OCD), a common but underdiagnosed psychiatric disorder. Guidance for effectively identifying obsessive-compulsive symptoms is provided, and treatment options, including psychotherapy, pharmacologic management, and neuromodulation approaches for treatment-resistant OCD, are discussed. RECENT FINDINGS OCD affects 2% to 3% of adults worldwide and is associated with substantial individual disability and societal costs. Lack of recognition of common OCD symptom types, in addition to shame and fear of stigma on the part of patients, has created an average delay in diagnosis by almost 10 years and a delay in effective treatment (ie, a treatment gap) of nearly 2 years. Cognitive-behavioral therapy (CBT), specifically a form of CBT that includes a type of behavioral intervention called exposure and response prevention, remains the most effective form of treatment for OCD. If CBT is not effective or not available, pharmacologic treatment with selective serotonin reuptake inhibitors (SSRIs) or clomipramine, a nonselective serotonin reuptake inhibitor, can also be of benefit. Neuromodulation approaches such as deep brain stimulation and transcranial magnetic stimulation are rapidly emerging as effective treatments for OCD, particularly for patients who have not experienced an adequate response to psychotherapy or pharmacologic management. SUMMARY OCD affects more than one in every 50 adults in the United States but is recognized and adequately treated in fewer than half of those affected. Early intervention and appropriate treatment can substantially reduce OCD symptom severity, improve quality of life, and minimize the functional disability associated with this chronic and often debilitating illness.
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Velikić V, Wippel A, Freidl M. Relapse of obsessive-compulsive disorder after cerebral venous sinus thrombosis: a case report. Neuropsychiatr 2020; 34:27-29. [PMID: 31828741 PMCID: PMC7083798 DOI: 10.1007/s40211-019-00327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
Obsessive-compulsive disorder (OCD) is characterized by repetitive, persistent and unwanted thoughts and ritualistic, repetitive behaviors. The pathophysiology of OCD involves many distinct cortical and subcortical regions and it has been reported that OCD may occur as a consequence of traumatic brain injury, infections and tumors as well as cerebrovascular insult such as cerebral venous sinus thrombosis (CVST). We here describe the case of a 36-year-old woman who developed OCD at the age of 13 with almost complete remission of the symptoms after a 1 year-long treatment. Interestingly, after suffering CVST at the superior sagittal sinus at the age of 33, she experienced a relapse of OCD. The patient was successfully treated with Sertraline and Clomipramine. Previous studies revealed cases of OCD following different cerebrovascular accidents, i.e. predominantly arterial stroke. However, the present case is the first to describe OCD after venous thrombosis. Based on our clinical experience, the most effective treatment of OCD after CVST represents the combination of the selective serotonin reuptake inhibitor Sertraline and the tricyclic antidepressant Clomipramine.
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Affiliation(s)
- Vid Velikić
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Andreas Wippel
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Marion Freidl
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Hashikawa-Hobara N, Otsuka A, Ishikawa R, Hashikawa N. Roman chamomile inhalation combined with clomipramine treatment improves treatment-resistant depression-like behavior in mice. Biomed Pharmacother 2019; 118:109263. [PMID: 31369988 DOI: 10.1016/j.biopha.2019.109263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022] Open
Abstract
It is well known that chamomile is one of the oldest known medicinal herbs and has been used to treat various disorders, but it is mainly German chamomile. The effects of Roman chamomile on depression still unclear. In this study, we used chronically stressed mice to investigate whether inhalation of Roman chamomile essential oil affects depression-like behavior. We previously reported that restraint and water immersion stress produce depression-like behavior and a blunted response to the tricyclic antidepressant clomipramine. Each mouse was exposed to restraint and water immersion stress for 15 days, and resistance to the effect of clomipramine was induced in a behavioral despair paradigm. In the present study, we found that cotreatment with clomipramine and inhalation of Roman chamomile attenuated depression-like behavior in a forced swim test. Next, we examined the hippocampal mRNA levels of two cytokines, tumor necrosis factor (TNF) alpha and interleukin-6 (IL-6); a neurotrophic factor, brain derived-neurotrophic factor (BDNF); and nerve growth factor (NGF). TNF alpha, IL-6 and BDNF mRNA levels did not change in the hippocampus of stressed mice. However, the NGF mRNA level was significantly decreased, and this decrease was not attenuated by treatment with clomipramine or inhalation of Roman chamomile alone. We also examined whether Roman chamomile combined with clomipramine treatment affects hippocampal neurogenesis and serum corticosterone levels. Stressed mice had fewer doublecortin (DCX)-positive cells in the subgranular zone of the dentate gyrus, but this was significantly attenuated by Roman chamomile and clomipramine treatment. In addition, the serum corticosterone level was also significantly decreased by treatment with Roman chamomile and clomipramine. These results suggest that Roman chamomile inhalation may enhance the antidepressant effect of clomipramine by increasing hippocampal neurogenesis and modulating corticosterone levels in patients with treatment-resistant depression.
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Affiliation(s)
- Narumi Hashikawa-Hobara
- Department of Life Science, Okayama University of Science, 1-1 Ridai-cho, Kita-ku, Okayama, 700-0005, Japan.
| | - Ami Otsuka
- Department of Life Science, Okayama University of Science, 1-1 Ridai-cho, Kita-ku, Okayama, 700-0005, Japan.
| | - Risa Ishikawa
- Department of Life Science, Okayama University of Science, 1-1 Ridai-cho, Kita-ku, Okayama, 700-0005, Japan.
| | - Naoya Hashikawa
- Department of Life Science, Okayama University of Science, 1-1 Ridai-cho, Kita-ku, Okayama, 700-0005, Japan.
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Rad F, Buica AM, Anghel GC, Stancu M, Dobrescu I. Hormonal imbalance and pituitary adenoma during antipsychotic treatment in an adolescent with bipolar affective disorder. Riv Psichiatr 2019; 54:37-39. [PMID: 30760936 DOI: 10.1708/3104.30939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this paper we present the case of a female teenager patient who was diagnosed with bipolar affective disorder and during psychotropic treatment with risperidone, the prolactin levels ranged between 55 ng/mL and 85 ng/mL at monthly repeated dosing. During this period, the patient presented somatic alterations in her state of health. The patient benefited from brain imaging, which revealed that in sella turcica is distinguished a well-defined and relatively homogeneous formation, measuring approximately 11/8 mm, suggestive of a pituitary adenoma. After changing the antipsychotic treatment, the pituitary formation resolved to a subsequent imaging re-evaluation.
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Affiliation(s)
- Florina Rad
- Child and Adolescent Psychiatry Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Alexandra Mariana Buica
- Child and Adolescent Psychiatry Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Gianina Cristina Anghel
- Child and Adolescent Psychiatry Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Mihaela Stancu
- Child and Adolescent Psychiatry Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Iuliana Dobrescu
- Child and Adolescent Psychiatry Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
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Faye A, Kirpekar V, Tadke R, Gawande S, Bhave S. Obsession of pregnancy: Does it exist? Asian J Psychiatr 2017; 29:89-90. [PMID: 29061437 DOI: 10.1016/j.ajp.2017.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Abhijeet Faye
- Dept of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra 440019, India.
| | - Vivek Kirpekar
- Dept of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra 440019, India
| | - Rahul Tadke
- Dept of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra 440019, India
| | - Sushil Gawande
- Dept of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra 440019, India
| | - Sudhir Bhave
- Dept of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra 440019, India
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Abstract
We have previously observed impairing effects of social defeat stress (CSDS) on inhibitory avoidance (IA) in mice. Given the similarity between changes produced by social stress in animals and symptoms of certain human psychopathologies such as depression and anxiety, the effects of the antidepressant clomipramine on IA impairment produced by CSDS were evaluated in the present study. Male CD1 mice were randomly assigned to the groups: non-stressed+saline, non-stressed+clomipramine, stressed+saline and stressed+clomipramine. Stressed animals were subjected to daily agonistic encounters (10 min) in the home cage of the aggressor over a 20-day period. Just before each encounter, non-stressed and stressed mice were injected i.p. with saline or clomipramine (10 mg/kg) according to their experimental condition. 24 hours after the last CSDS session, all the mice were tested in a step-through IA task. In the IA training phase, animals were punished by a shock to the paw when they entered the dark compartment of the apparatus. In the IA test phase (one week later) the same procedure took place, but without shock. Complementary measures were obtained by evaluating all the animals in an elevated plus maze (locomotor activity and emotionality) and on a hot plate (analgesia). IA learning was confirmed in all groups except the stressed+saline group, which was the only one that exhibited higher anxiety levels. No variations were observed in either locomotor activity or analgesia. In conclusion, CSDS induces anxiety and impairs emotional memory in mice; the negative effects of CSDS on memory appear to be attenuated by clomipramine, and these detrimental effects do not seem to be secondary to the effects of CSDS on locomotor activity, emotionality or pain sensitivity.
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Affiliation(s)
- Aranzazu Duque
- Department of Psychobiology, University of Valencia, Valencia, Spain
| | | | - Santiago Monleón
- Department of Psychobiology, University of Valencia, Valencia, Spain.
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Varigonda AL, Jakubovski E, Bloch MH. Systematic Review and Meta-Analysis: Early Treatment Responses of Selective Serotonin Reuptake Inhibitors and Clomipramine in Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2016; 55:851-859.e2. [PMID: 27663940 PMCID: PMC6944467 DOI: 10.1016/j.jaac.2016.07.768] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/30/2016] [Accepted: 07/28/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We conducted a meta-analysis to examine the following: the time course of response to selective serotonin reuptake inhibitors (SSRIs) and clomipramine in pediatric obsessive-compulsive disorder (OCD); whether higher doses of SSRIs are associated with an improved response in pediatric OCD; differences in efficacy among SSRI agents; differences in efficacy between SSRIs and clomipramine; and whether the time course and magnitude of response to SSRIs are different in pediatric and adult patients with OCD. METHOD We searched PubMed and CENTRAL for randomized controlled trials comparing SSRIs (or clomipramine) to placebo for the treatment of pediatric OCD and using the Children's Yale-Brown Obsessive-Compulsive Scale as an outcome. We extracted weekly symptom data from trials to characterize the trajectory of pharmacological response to SSRIs. Pooled estimates of treatment effect were calculated based on weighted mean differences between the treatment and placebo groups. RESULTS Nine trials involving 801 children with OCD were included in this meta-analysis. A logarithmic model indicating that the greatest benefits occurred early in treatment best fit the longitudinal data for both clomipramine and SSRIs. Clomipramine was associated with a greater measured benefit compared to placebo than SSRIs. There was no evidence for a relationship between SSRI dosing and treatment effect, although data were limited. Adults and children with OCD demonstrated a similar degree and time course of response to SSRIs in OCD. CONCLUSION These results suggest that the greatest incremental treatment gains in pediatric OCD occur early in SSRI treatment (similar to adults with OCD and children and adults with major depression).
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Feng B, Zhang ZJ, Zhu RM, Yuan GZ, Luo LY, McAlonan GM, Xu FZ, Chen J, Liu LY, Lv YY, Wong HK, Zhang Y, Zhu LX. Transcutaneous electrical acupoint stimulation as an adjunct therapy for obsessive-compulsive disorder: A randomized controlled study. J Psychiatr Res 2016; 80:30-37. [PMID: 27281260 DOI: 10.1016/j.jpsychires.2016.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/25/2016] [Accepted: 05/27/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transcutaneous electrical acupoint stimulation (TEAS) is thought to have potential to treat obsessive-compulsive disorder (OCD). OBJECTIVE The purpose of this study was to determine whether adding TEAS to cognitive behavioral therapy (CBT) and clomipramine would improve the efficacy of these conventional treatments in OCD. METHODS In this randomized controlled trial, 360 OCD patients were assigned to receive TEAS combined with CBT plus clomipramine (Group A, n = 120), TEAS combined with CBT plus placebo (Group B, n = 120), and simulated (placebo) TEAS combined with CBT plus clomipramine (Group C, n = 120) for 12 weeks. The primary outcome was measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). RESULTS OCD symptoms in all patients reduced over time, however Groups A and B had a significantly greater reduction in Y-BOCS total score and the subscale for obsession and compulsion between week 2 and week 12 compared to Group C. Groups A and B had similar scores on these measures. Both groups had significantly higher rates of clinical response than Group C (88.3% and 81.7% vs. 67.5%, respectively, p < 0.001); and higher rates of remission (30.0% and 22.5% vs. 9.2%, respectively, p < 0.001). Group B experienced fewer adverse events than the other two groups. CONCLUSIONS TEAS enhances the efficacy of conventional OCD interventions and avoids the adverse effects associated with conventional pharmacological treatment. It can be considered as an effective adjunct intervention for OCD.
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Affiliation(s)
- Bin Feng
- Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhang-Jin Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Rui-Ming Zhu
- Department of Psychiatry, Yiwu Hospital of Traditional Chinese Medicine, Yiwu, Zhejiang, China
| | - Guo-Zhen Yuan
- Department of Psychiatry, Wuxi Mental Health Center, Wuxi, Jiangsu, China
| | - Li-Yuan Luo
- The Second Clinical Medical College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Grainne M McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Fang-Zhong Xu
- Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jiong Chen
- Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Lan-Ying Liu
- Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yang-Yang Lv
- The Second Clinical Medical College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Hei Kiu Wong
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ying Zhang
- Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Li-Xia Zhu
- Department of Psychiatry, Yiwu Hospital of Traditional Chinese Medicine, Yiwu, Zhejiang, China
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Leth-Møller KB, Hansen AH, Torstensson M, Andersen SE, Ødum L, Gislasson G, Torp-Pedersen C, Holm EA. Antidepressants and the risk of hyponatremia: a Danish register-based population study. BMJ Open 2016; 6:e011200. [PMID: 27194321 PMCID: PMC4874104 DOI: 10.1136/bmjopen-2016-011200] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine the association between classes of antidepressants and hyponatremia, and between specific antidepressants and hyponatremia. DESIGN Retrospective register-based cohort study using nationwide registers from 1998 to 2012. SETTING The North Denmark Region. PARTICIPANTS In total, 638 352 individuals were included. PRIMARY AND SECONDARY OUTCOME MEASURES Plasma sodium was obtained from the LABKA database. The primary outcome was hyponatremia defined as plasma sodium (p-sodium) below 135 mmol/L and secondary outcome was severe hyponatremia defined as p-sodium below 130 mmol/L. The association between use of specific antidepressants and hyponatremia was analysed using multivariable Poisson regression models. RESULTS An event of hyponatremia occurred in 72 509 individuals and 11.36% (n=6476) of these events happened during treatment with antidepressants. Incidence rate ratios and CIs for the association with hyponatremia in the first p-sodium measured after initiation of treatment were for citalopram 7.8 (CI 7.42 to 8.20); clomipramine 4.93 (CI 2.72 to 8.94); duloxetine 2.05 (CI 1.44 to 292); venlafaxine 2.90 (CI 2.43 to 3.46); mirtazapine 2.95 (CI 2.71 to 3.21); and mianserin 0.90 (CI 0.71 to 1.14). CONCLUSIONS All antidepressants except mianserin are associated with hyponatremia. The association is strongest with citalopram and lowest with duloxetine, venlafaxine and mirtazapine.
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Affiliation(s)
| | | | - Maia Torstensson
- Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | | | - Lars Ødum
- Department of Biochemistry, University Hospital Zealand, Roskilde, Denmark
| | | | | | - Ellen Astrid Holm
- Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
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Landuyt G, Dierckx B, de Nijs PFA, Dieleman GC. [Treatment options for paediatric trichotillomania]. Tijdschr Psychiatr 2016; 58:463-470. [PMID: 27320510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Trichotillomania (TTM) is a psychiatric condition that first manifests itself in infancy and adolescence. If untreated, the condition can become chronic. TTM places a considerable burden on the individual patient. The condition is often linked to social isolation and the emergence of somatic and psychiatric comorbidity. Nevertheless, investment in research, particularly in the pharmacotherapeutical area, has been rather limited. AIM To provide an overview of the phenomenology of TTM, the associated comorbidity and the therapies available for treating this underexposed child psychiatric disorder. METHOD We searched PubMed using the the MeSH term 'trichotillomania/therapy' and located 49 relevant articles. RESULTS We found 49 usable articles. Selective serotonine reuptake inhibitors (SSRIs) are the most frequently prescribed drugs for the treatment of pediatric TTM, although their efficacy is not yet proven. The results of a meta-analysis of several SSRIs did not differ significantly from the results obtained with patients who had been prescribed only placebos. The efficacy of SSRIs in youths has not been studied yet. A meta-analysis of clomipramine with adult TTM patients did show a statistical difference with the control group. The efficacy of clomipramine in youths has not yet been studied. In a randomised controlled trial (RCT), treatment of adult TTM patients with olanzapine proved to be more effective than placebos. Despite this RCT and the positive results of open-label studies with pimozide and haloperidol in adults, there is no research available concerning the efficacy of antipsychotics in children and youths. In an RCT with 7-8 year-olds, cognitive behavioural therapy was found to decrease the symptoms in 75% of the participants. CONCLUSION For now there's only evidence for HRT as effective intervention in children and youths with TTM.
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Cecconi A, Franco E, de Agustín JA, Vilchez JP, Palacios-Rubio J, Sánchez-Enrique C, Fernández-Ortiz A, Macaya C, Fernández-Jiménez R. Hyponatremia-induced stress cardiomyopathy due to psychogenic polydipsia. Int J Cardiol 2016; 202:618-20. [PMID: 26447674 DOI: 10.1016/j.ijcard.2015.09.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/29/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Alberto Cecconi
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Eduardo Franco
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Jean Paul Vilchez
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | - Antonio Fernández-Ortiz
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Carlos Macaya
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Martin KM. Animal Behavior Case of the Month. Compulsive disorder. J Am Vet Med Assoc 2015; 247:156-8. [PMID: 26133213 DOI: 10.2460/javma.247.2.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Roos BE. Tryptophan, 5-hydroxytryptophan and tricyclic antidepressants in the treatment of depression. Monogr Neural Sci 2015; 3:23-5. [PMID: 790168 DOI: 10.1159/000399330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
BACKGROUND Antidepressants are widely used to treat chronic neuropathic pain (pain due to nerve damage), usually in doses below those at which they exert antidepressant effects. An earlier review that included all antidepressants for neuropathic pain is being replaced by new reviews of individual drugs examining individual neuropathic pain conditions.Nortriptyline is a tricyclic antidepressant that is occasionally used for treating neuropathic pain, and is recommended in European, UK, and USA guidelines. OBJECTIVES To assess the analgesic efficacy and associated adverse events of nortriptyline for chronic neuropathic pain in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE from inception to 7 January 2015, and the reference lists of retrieved papers and other reviews. We also searched two clinical trials databases for ongoing or unpublished studies. SELECTION CRITERIA We included randomised, double-blind studies of at least two weeks' duration comparing nortriptyline with placebo or another active treatment in chronic neuropathic pain. Participants were adults aged 18 years and over. We included only full journal publication articles and clinical trial summaries. DATA COLLECTION AND ANALYSIS Two review authors independently extracted efficacy and adverse event data, and examined issues of study quality. We considered the evidence using three tiers. First tier evidence derived from data meeting current best standards and subject to minimal risk of bias (outcome equivalent to substantial pain intensity reduction, intention-to-treat analysis without imputation for dropouts; at least 200 participants in the comparison, 8 to 12 weeks' duration, parallel design); second tier evidence from data that failed to meet one or more of these criteria and were considered at some risk of bias but with adequate numbers in the comparison; and third tier evidence from data involving small numbers of participants that was considered very likely to be biased or used outcomes of limited clinical utility, or both.We planned to calculate risk ratio (RR) and numbers needed to treat for an additional beneficial outcome (NNT) and harmful outcome (NNH) using standard methods expected by The Cochrane Collaboration. MAIN RESULTS We included six studies treating 310 participants (mean or median age 49 to 64 years) with various neuropathic pain conditions. Five studies used a cross-over design, and one used a parallel-group design; 272 participants were randomised to treatment with nortriptyline, 145 to placebo, 94 to gabapentin, 56 to gabapentin plus nortriptyline, 55 to morphine, 55 to morphine plus nortriptyline, 39 to chlorimipramine, and 33 to amitriptyline. Treatment periods lasted from three to eight weeks. All studies had one or more sources of potential major bias.No study provided first or second tier evidence for any outcome. Only one study reported our primary outcome of people with at least 50% reduction in pain. There was no indication that either nortriptyline or gabapentin was more effective in postherpetic neuralgia (very low quality evidence). Two studies reported the number of people with at least moderate pain relief, and one reported the number who were satisfied with their pain relief and had tolerable adverse effects. We considered these outcomes to be equivalent to our other primary outcome of Patient Global Impression of Change (PGIC) much or very much improved.We could not pool data, but third tier evidence in individual studies indicated similar efficacy to other active interventions (gabapentin, morphine, chlorimipramine, and amitriptyline), and to placebo in the conditions studied (very low quality evidence). Adverse event reporting was inconsistent and fragmented. More participants reported adverse events with nortriptyline than with placebo, similar numbers with nortriptyline and other antidepressants (amitriptyline and chlorimipramine) and gabapentin, and slightly more with morphine (very low quality evidence). No study reported any serious adverse events or deaths. AUTHORS' CONCLUSIONS We found little evidence to support the use of nortriptyline to treat the neuropathic pain conditions included in this review. There were no studies in the treatment of trigeminal neuralgia. The studies were methodologically flawed, largely due to small size, and potentially subject to major bias. The results of this review do not support the use of nortriptyline as a first line treatment. Effective medicines with much greater supportive evidence are available, such as duloxetine and pregabalin.
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Irimajiri M. The author responds. J Am Vet Med Assoc 2015; 246:49. [PMID: 25654819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Gama-Marques J, Jesus G, Brissos S. [Olfactory reference syndrome and hyperhidrosis: comorbidity in one patient]. Rev Neurol 2014; 59:575. [PMID: 25501459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
BACKGROUND Antidepressants are widely used to treat chronic neuropathic pain (pain due to nerve damage), usually in doses below those at which they exert antidepressant effects. An earlier review that included all antidepressants for neuropathic pain is being replaced by new reviews of individual drugs examining individual neuropathic pain conditions.Desipramine is a tricyclic antidepressant that is occasionally used for treating neuropathic pain. OBJECTIVES To assess the analgesic efficacy of desipramine for chronic neuropathic pain in adults, and to assess the associated adverse events. SEARCH METHODS We searched CENTRAL, MEDLINE, and EMBASE from inception to 29 April 2014, and the reference lists of retrieved papers and other reviews. We also used our own hand searched database to identify older studies, and two clinical trials databases for ongoing or unpublished studies. SELECTION CRITERIA We included randomised, double-blind studies of at least two weeks duration comparing desipramine with placebo or another active treatment in chronic neuropathic pain. Participants were adults aged 18 years and over. We included only full journal publication articles. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the efficacy and adverse event data, and examined issues of study quality. We performed analysis using three tiers of evidence. First tier evidence was derived from data meeting current best standards and subject to minimal risk of bias (outcome equivalent to substantial pain intensity reduction, intention-to-treat analysis without imputation for dropouts, at least 200 participants in the comparison, 8 to 12 weeks duration, parallel design); second tier from data that failed to meet one or more of these criteria and were considered at some risk of bias but with adequate numbers in the comparison; and third tier from data involving small numbers of participants and considered very likely to be biased or that used outcomes of limited clinical utility, or both. MAIN RESULTS Five studies treated 177 participants with painful diabetic neuropathy (104) or postherpetic neuralgia (73). The mean or median ages in the studies were 55 to 72 years. Four studies used a cross-over, and one a parallel group design; 145 participants were randomised to receive desipramine 12.5 mg to 250 mg daily, with most taking 100 mg to 150 mg daily following titration. Comparators were placebo in three studies (an 'active placebo' in two studies), fluoxetine, clomipramine (one study each), and amitriptyline (two studies), and treatment was for two to six weeks. All studies had one or more sources of potential major bias.No study provided first or second tier evidence for any outcome. No data were available on the proportion of people with at least 50% or 30% reduction in pain, but data were available from three studies for our other primary outcome of Patient Global Impression of Change, reported as patient evaluation of pain relief that was 'complete' or 'a lot'. No pooling of data was possible, but third tier evidence in individual studies indicated some improvement in pain relief with desipramine compared with placebo, although this was very low quality evidence, derived mainly from group mean data and completer analyses in small, short duration studies where major bias was possible. There were too few participants in comparisons of desipramine with another active treatment to draw any conclusions.All studies reported some information about adverse events, but reporting was inconsistent and fragmented. Participants taking desipramine experienced more adverse events, and a higher rate of withdrawal due to adverse events, than did participants taking placebo (very low quality evidence). AUTHORS' CONCLUSIONS This review found little evidence to support the use of desipramine to treat neuropathic pain. There was very low quality evidence of benefit and harm, but this came from studies that were methodologically flawed and potentially subject to major bias. Effective medicines with much greater supportive evidence are available. There may be a role for desipramine in patients who have not obtained pain relief from other treatments.
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Affiliation(s)
- Leslie Hearn
- Churchill HospitalCochrane Pain, Palliative and Supportive Care Group, Pain Research UnitOxfordUKOX3 7LE
| | | | | | | | - Tudor Phillips
- University of OxfordPain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics)Churchill HospitalOxfordUKOX3 7LJ
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Mumoli N, Cocciolo M, Vitale J, Mantellassi M, Sabatini S, Gambaccini L, Cei M. Diabetes mellitus associated with clomipramine treatment: a retrospective analysis. Acta Diabetol 2014; 51:167-8. [PMID: 23824324 DOI: 10.1007/s00592-013-0500-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022]
Abstract
In this retrospective analysis, we analyzed all clinical record data in our Medical Division between January 2005 and December 2006 to evaluate an association between clomipramine treatment and glucose intolerance. Of 1997 patients, 154 (7.7%) had diabetes and 525 (26.3%) had depression. Diabetes prevalence was significantly higher in patients treated with clomipramine than in patients not treated [odds ratio 3.9, (2.2-7.0), p < 0.00001], independently by age and BMI. A possible causal role needs to be investigated in a prospective way.
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Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, Ospedale Civile Livorno, viale Alfieri 36, 57100, Leghorn, Italy,
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Abstract
BACKGROUND Trigeminal neuralgia was defined by the International Association for the Study of Pain as a sudden, usually unilateral, severe, brief, stabbing recurrent pain in the distribution of one or more branches of the fifth cranial nerve. Standard treatment is with anti-epileptic drugs. Non-antiepileptic drugs have been used in the management of trigeminal neuralgia since the 1970s. This is an update of a review first published in 2006 and previously updated in 2011. OBJECTIVES To systematically review the efficacy and tolerability of non-antiepileptic drugs for trigeminal neuralgia. SEARCH METHODS On 20 May 2013, for this updated review, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL (2013, Issue 4), MEDLINE (January 1966 to May 2013), EMBASE (January 1980 to May 2013), LILACS (January 1982 to May 2013) and the Chinese Biomedical Retrieval System (1978 to May 2013). We searched clinical trials registries for ongoing trials. SELECTION CRITERIA We included double-blind, randomised controlled trials in which the active drug was used either alone or in combination with other non-antiepileptic drugs for at least two weeks. DATA COLLECTION AND ANALYSIS Two authors decided which trials fitted the inclusion criteria and independently graded risk of bias. We assessed the quality of the evidence according to the GRADE criteria for this update. MAIN RESULTS In this 2013 update, we updated the searches, but identified only two new ongoing studies. The review includes four trials involving 139 participants. The primary outcome measure in each was pain relief. Three trials compared one of the oral non-antiepileptic drugs tizanidine, tocainide or pimozide with carbamazepine. The quality of evidence for all outcomes for which data were available was low. In a trial of tizanidine involving 12 participants (one dropped out due to unrelated disease), one of five participants treated with tizanidine and four of six treated with carbamazepine improved (risk ratio (RR) 0.30, 95% confidence interval (CI) 0.05 to 1.89). Few side effects were noted with tizanidine. For pimozide, there was evidence of greater efficacy than carbamazepine at six weeks. Up to 83% of participants reported adverse effects but these did not lead to withdrawal; the report did not provide comparable data for carbamazepine. Limited data meant that we could not assess the effects of tocainide; however, data from non-randomised studies (not included in this review) indicate that serious haematological adverse events can occur. A trial involving 47 participants compared 0.5% proparacaine hydrochloride eyedrops with placebo but did not show any significant benefits, again according to low-quality evidence. The report did not mention adverse events. The proparacaine trial was at low risk of bias; the other trials were at unclear risk of bias overall. AUTHORS' CONCLUSIONS There is low-quality evidence that the effect of tizanidine is not significantly different than that of carbamazepine in treating trigeminal neuralgia. Pimozide is more effective than carbamazepine, although the evidence is of low quality and the data did not allow comparison of adverse event rates. There is also low-quality evidence that 0.5% proparacaine hydrochloride eye drops have no benefit over placebo. Limitations in the data for tocainide prevent any conclusions being drawn. There is insufficient evidence from randomised controlled trials to show significant benefit from non-antiepileptic drugs in trigeminal neuralgia. More research is needed.
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Affiliation(s)
- Jingjing Zhang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Xiang 37#, Chengdu, Sichuan, China, 610041
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da Costa CZG, de Morais RMCB, Zanetta DMT, Turkiewicz G, Neto FL, Morikawa M, Rodrigues CL, Labbadia EM, Asbahr FR. Comparison among clomipramine, fluoxetine, and placebo for the treatment of anxiety disorders in children and adolescents. J Child Adolesc Psychopharmacol 2013; 23:687-92. [PMID: 24350814 PMCID: PMC3870579 DOI: 10.1089/cap.2012.0110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to test the efficacy of clomipramine and fluoxetine, controlled by placebo, and compare their action in children and adolescents with anxiety disorders. METHOD Thirty subjects (ages 7-17 years), who were diagnosed with generalized anxiety disorder and/or separation anxiety disorder and/or social phobia, were submitted to a 12 week double-blind, randomized, placebo-controlled trial of clomipramine and fluoxetine. The instruments included: the Schedule for Affective Disorders and Schizophrenia, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, the Clinical Global Impressions, and the Children's Global Assessment Scale. RESULTS All groups (clomipramine [n=9], fluoxetine [n=10], placebo [n=11]) showed a significant improvement after 12 weeks of treatment. There were significant differences between the fluoxetine and placebo groups in some ratings of anxiety severity and impairment. No significant differences were observed between clomipramine and placebo groups or between fluoxetine and clomipramine groups. CONCLUSIONS Treatment with placebo showed an unusual high response rate. Clomipramine showed similar efficacy compared with fluoxetine, although it was not superior to placebo.
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Affiliation(s)
- Carolina Zadrozny Gouvêa da Costa
- Anxiety Disorders in Children and Adolescent Program, Department and Institute of Psychiatry - University of São Paulo, São Paulo, Brazil
| | | | | | - Gizela Turkiewicz
- Childhood and Adolescence Eating Disorder Teaching and Research Project (PROTAD), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Francisco Lotufo Neto
- Anxiety Disorders in Children and Adolescent Program, Department and Institute of Psychiatry - University of São Paulo, São Paulo, Brazil
| | - Márcia Morikawa
- Anxiety Disorders in Children and Adolescent Program, Department and Institute of Psychiatry - University of São Paulo, São Paulo, Brazil
| | - Camila Luisi Rodrigues
- Anxiety Disorders in Children and Adolescent Program, Department and Institute of Psychiatry - University of São Paulo, São Paulo, Brazil
| | - Eunice Monteiro Labbadia
- Anxiety Disorders in Children and Adolescent Program, Department and Institute of Psychiatry - University of São Paulo, São Paulo, Brazil
| | - Fernando Ramos Asbahr
- Anxiety Disorders in Children and Adolescent Program, Department and Institute of Psychiatry - University of São Paulo, São Paulo, Brazil
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Abstract
BACKGROUND Trichotillomania (TTM) (hair-pulling disorder) is a prevalent and disabling disorder characterised by recurrent hair-pulling. The effect of medication on trichotillomania has not been systematically evaluated. OBJECTIVES To assess the effects of medication for trichotillomania in adults compared with placebo or other active agents. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register (to 31 July 2013), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years); EMBASE (1974 to date); MEDLINE (1950 to date) and PsycINFO (1967 to date). Two review authors identified relevant trials by assessing the abstracts of all possible studies. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of a medication versus placebo or active agent for TTM in adults. DATA COLLECTION AND ANALYSIS Two review authors independently performed the data extraction and 'Risk of bias' assessments, and disagreements were resolved through discussion with a third review author. Primary outcomes included the mean difference (MD) in reduction of trichotillomania symptoms on a continuous measure of trichotillomania symptom severity, and the risk ratio (RR) of the clinical response based on a dichotomous measure, with 95% confidence intervals (CIs). MAIN RESULTS We identified eight studies with a total of 204 participants and a mean sample size of 25. All trials were single-centre trials, and participants seen on an outpatient basis. Seven studies compared medication and placebo (n = 184); one study compared medication and another active agent (n = 13). Duration of the studies was six to twelve weeks. Meta-analysis was not undertaken because of the methodological heterogeneity of the trials. The studies did not employ intention-to-treat analyses and were at a high risk of attrition bias. Adverse events were not well-documented in the studies.None of the three studies of selective serotonin reuptake inhibitors (SSRIs) demonstrated strong evidence of a treatment effect on any of the outcomes of interest. The unpublished naltrexone study did not provide strong evidence of a treatment effect. Two studies, an olanzapine study and a N-acetylcysteine (NAC) study, reported statistically significant treatment effects. One study of clomipramine demonstrated a treatment effect on two out of three measures of response to treatment. AUTHORS' CONCLUSIONS No particular medication class definitively demonstrates efficacy in the treatment of trichotillomania. Preliminary evidence suggests treatment effects of clomipramine, NAC and olanzapine based on three individual trials, albeit with very small sample sizes.
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Affiliation(s)
- Rachel Rothbart
- Department of Psychiatry, University of British Columbia, 2775 Laurel St, Vancouver, British Columbia, Canada, V5Z 1M9
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Weidt S, Rufer M, Brühl A, Baumann-Vogel H, Delsignore A. [Obsessive compulsive disorder--intrusive thoughts, impulses and repetitive behaviours as an expression of a significant disease]. Praxis (Bern 1994) 2013; 102:857-864. [PMID: 23823684 DOI: 10.1024/1661-8157/a001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Obsessive-compulsive disorder (OCD) is common and associated with marked impairment and reduced quality of life. In the general practitioner's office as well as in the specialist's consultation, patients with OCD usually present intrusive thoughts (obsessions) and repetitive behaviours (compulsions). OCD sufferers generally recognize their obsessions and compulsions as irrational. Without treatment, OCD often takes a chronic course. Some basic aspects can help to identify patients suffering from OCD earlier and to initiate sufficient therapy. With evidence-based treatment with cognitive-behavioral therapy and adequate psychopharmacotherapy, many patients can achieve complete symptom remission. Initial treatment can be initiated in the general practitioner's office.
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Affiliation(s)
- Steffi Weidt
- Klinik für Psychiatrie und Psychotherapie, Universitätsspital Zürich, Zürich, Switzerland.
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Abstract
BACKGROUND Self-injurious behaviour among people with intellectual disability is relatively common and often persistent. Self-injurious behaviour continues to present a challenge to clinicians. It remains poorly understood and difficult to ameliorate despite advances in neurobiology and psychological therapies. There is a strong need for a better evidence base in prescribing and monitoring of drugs in this population, especially since none of the drugs are actually licensed for self-injurious behaviour. OBJECTIVES To determine clinical effectiveness of pharmacological interventions in management of self-injurious behaviour in adults with intellectual disability. SEARCH METHODS We searched the following databases on 19 February 2012: CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, Science Citation Index, Social Science Citation Index, Conference Proceedings Citation Index - Science, Conference Proceedings Citation Index - Social Science and Humanities, ZETOC and WorldCat. We also searched ClinicalTrials.gov, ICTRP and the reference lists of included trials. SELECTION CRITERIA We included randomised controlled trials that examined drug interventions versus placebo for self-injurious behaviour (SIB) in adults with intellectual disability. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias for each trial using a data extraction form. We present a narrative summary of the results is presented. We did not consider meta-analysis was appropriate due to differences in study designs, differences between interventions and heterogeneous outcome measures. MAIN RESULTS We found five double-blind placebo-controlled trials that met our inclusion criteria. These trials assessed effectiveness and safety of drugs in a total of 50 people with intellectual disability demonstrating SIB. Four trials compared the effects of naltrexone versus placebo and one trial compared clomipramine versus placebo.One of the naltrexone versus placebo trials reported that naltrexone had clinically significant effects (≥ 33% reduction) on the daily rates of three of the four participants' most severe form of SIB and modest to substantial reductions in SIB for all participants; however, this study did not report on statistical significance. Another trial reported that naltrexone attenuated SIB in all four participants, with 25 mg and 50 mg doses producing a statistically significant decrease in SIB (P value < 0.05). Another trial (eight people) indicated that naltrexone administration was associated with significantly fewer days of high frequency self injury and significantly more days with low frequency self injury. Naltrexone had different effects depending on the form and location of self injury. Another trial with only 26 participants found that neither single-dose (100 mg) nor long-term (50 and 150 mg) naltrexone treatment had any therapeutic effect on SIB.Comparison of clomipramine versus placebo found no statistically significant benefit for any outcome measure, which included SIB rate and intensity, stereotypy and adverse events. However, it showed clinically significant improvement in the rate and intensity of SIB and stereotypy.There were very few noteworthy adverse events to report in any of the four trials in which these were reported.All trials were at high risk of bias, apart from one trial (Lewis 1996), which was probably at low risk of bias. The short period of follow-up was a significant drawback in the design of all five trials, as it did not allow long-term assessment of behaviour over time.We were unable to examine the efficacy of antidepressants other than clomipramine, antipsychotics, mood stabilisers or beta-blockers as we did not identify any relevant placebo-controlled trials. AUTHORS' CONCLUSIONS There was weak evidence in included trials that any active drug was more effective than placebo for people with intellectual disability demonstrating SIB. Due to sparse data, an absence of power and statistical significance, and high risk of bias for four of the included trials, we are unable to reach any definite conclusions about the relative benefits of naltrexone or clomipramine compared to placebo.
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Affiliation(s)
- Fareez Rana
- Psychiatry of Intellectual Disability, Southern Health NHS Foundation Trust, Oxford, UK.
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Li B, Yang CJ, Yue N, Liu Y, Yu J, Wang YQ, Liu Q, Wu GC. Clomipramine reverses hypoalgesia/hypoesthesia and improved depressive-like behaviors induced by inescapable shock in rats. Neurosci Lett 2013; 541:227-32. [PMID: 23416897 DOI: 10.1016/j.neulet.2013.01.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/28/2013] [Accepted: 01/30/2013] [Indexed: 11/18/2022]
Abstract
An increased vulnerability to pain complaints, along with a simultaneous increase in experimental pain thresholds, shows the paradoxical phenomenon of pain perception in depressive patients. Clomipramine, a tricyclic antidepressant, could also ameliorate syndromes in chronic pain patients. However, few studies have focused on the effect of antidepressants on experimental pain thresholds. By using a rat model, the learned helplessness paradigm, the present study explored the effect of clomipramine on behavioral deficits and experimental pain thresholds to different stimuli in "helpless" rats. Helpless rats were administered clomipramine (10mg/kg, i.p, b.i.d.) for 5 consecutive days. The depressive-like and anxiety-like behaviors were detected by shuttle box, open field and elevated plus maze test before and after inescapable shock and after medication. The sensitivity to the thermal and mechanical stimuli was also measured by the von Frey hair and Hargreaves test at the indicated time points. Helpless rats displayed shorter total travel distance and fewer rearing times in the open field test and decreased percentage of time spent in the open arms in the elevated plus maze test. In addition, they exhibited significant hypoalgesia/hypoesthesia to mechanical and thermal stimuli. Clomipramine alleviate depressive-like and anxiety-like behaviors and increased the sensitivity to von Frey filament stimuli with no effect on the sensitivity to radiant heat stimuli in helpless rats. These suggested that clomipramine could reverse mechanical but not thermal hypoalgesia/hypoesthesia and simultaneously improved behavioral deficits.
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Affiliation(s)
- Bing Li
- Department of Integrative Medicine and Neurobiology, State Key Lab of Medical Neurobiology, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Kovács Z, Czurkó A, Kékesi KA, Juhász G. Neonatal tricyclic antidepressant clomipramine treatment reduces the spike-wave discharge activity of the adult WAG/Rij rat. Brain Res Bull 2012; 89:102-7. [PMID: 22884691 DOI: 10.1016/j.brainresbull.2012.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/19/2012] [Accepted: 07/29/2012] [Indexed: 11/15/2022]
Abstract
Recently it was revealed that the absence-like epileptic activity of the WAG/Rij (Wistar Albino Glaxo/Rijswijk) rat is associated with depression-like behavioural symptoms. Whether these depressive-like symptoms are accompanying epileptic activity (manifested in spike-wave discharges, SWDs, in the EEG) or whether they are causative for each other are open questions. Neonatally administered tricyclic antidepressant clomipramine is a well characterized animal model of major depression. It evokes behavioural symptoms of depression and changes sleep pattern in normal adult rats. We investigated whether in the WAG/Rij rat the neonatally administered clomipramine would aggravate the depression-like behavioural symptoms and the SWD activity. Male WAG/Rij pups from postnatal day 8 (PD8) to PD21 were treated with clomipramine (20mg/kg) or saline (control animals) twice daily intraperitoneally (i.p.). In the 8 months old rats, sleep parameters and sucrose solution intake (as hedonic index) as well as the SWD activity were measured. While the neonatal clomipramine treatment significantly increased the rapid eye movement sleep (REM) amount and decreased the sucrose preference score, it surprisingly attenuated the adult (8 months old) SWD activity. We concluded that neonatal clomipramine treatment produced aggravation of depression-like symptoms while decreased the SWD activity in the adult (8 months old) WAG/Rij rat.
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Affiliation(s)
- Zsolt Kovács
- Department of Zoology, University of West Hungary, Savaria Campus, Károlyi Gáspár tér 4, Szombathely 9700, Hungary.
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Santamaria-Cano J. [Diagnostic and therapeutic update in narcolepsy]. Rev Neurol 2012; 54 Suppl 3:S25-S30. [PMID: 22605629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Narcolepsy is an emblematic, unique disease within sleep disorders that is characterised by excessive daytime sleepiness, cataplexy and other abnormal manifestations of REM sleep. In the last 14 years truly spectacular progress has been made in our knowledge of this disease, since the discovery of its cause, i.e. a loss of the hypothalamic neurons that synthesise hypocretin, a previously unknown neurotransmitter, and its probable aetiopathogenic mechanisms, i.e. an autoimmune process in a patient with very precise immunological characteristics - a specific type of HLA and a specific type of T-cell receptor. The cause of this autoimmune process remains unknown. The definitive treatment - the administration of hypocretin, which is the substance missing in the organism - is still unavailable, but there are powerful drugs for treating its main symptoms, the sleepiness and the cataplexy. Some of these are classic compounds (methylphenidate, clomipramine), while others are more recent (modafinil, venlafaxine, sodium oxybate), but together they allow many patients to experience significant improvements. Lack of knowledge about the disease, both on the part of patients and their relatives as well as physicians, is the reason for the great delay in its diagnosis, with even more dramatic consequences when the disease begins in infancy.
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Affiliation(s)
- Joan Santamaria-Cano
- Servicio de Neurología, Unidad Multidisciplinar de Trastornos del Sueño, Hospital Clinic de Barcelona, Villaroel 170, Barcelona, Spain.
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Abstract
BACKGROUND Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental disorders, ranging in severity and characterised by early onset of delay and deviance in the development of social interaction, and verbal and nonverbal communication. ASD is associated with restricted and/or stereotyped interests or behaviours. Tricyclic antidepressants (TCAs) block noradrenaline and serotonin reuptake, increasing the availability of these neurotransmitters in the central nervous system. Via their impact on serotonin, TCAs have been used in the treatment of autistic symptoms and comorbidities in individuals with ASD. OBJECTIVES To determine if treatment with tricyclic antidepressants:1) improves the core features of autism, including restricted social interaction, restricted communication, and stereotypical and repetitive behaviours; 2) improves non-core features such as challenging behaviours; 3) improves comorbid states, such as depression and anxiety; 4) causes adverse effects. SEARCH METHODS We ran the latest searches for this review on 23 May 2011. We searched: Cochrane Central Register of Controlled Trials (CENTRAL), 2011 Issue 2, MEDLINE (1948 to May Week 2, 2011), EMBASE (1980 to 2011 Week 2), PsycINFO (1887 to current), CINAHL (1937 to current). We also searched Dissertation Abstracts International via Dissertation Express, and the metaRegister of Controlled Trials. SELECTION CRITERIA Randomised controlled trials of any dose, duration and frequency of oral TCAs compared with placebo, in children and adolescents with a diagnosis of ASD, where at least one standardised outcome measure had been used. DATA COLLECTION AND ANALYSIS Two review authors independently selected and appraised the studies for inclusion and risk of bias. All data were continuous. MAIN RESULTS Three studies met the inclusion criteria for this review. Two studies used clomipramine and one used tianeptine. All three trials were small, with between 12 and 32 participants. One of the clomipramine trials involved children and young adults, while the other two trials enrolled only children. Due to heterogeneity in study participant characteristics, the TCA medications investigated and the outcome measures used, we were not able to perform any meta-analysis.In only one of the three studies was there any indication that giving children tianeptine could be effective in the short term. In this study, parents and teachers reported that it reduced irritability, hyperactivity, inadequate eye contact and inappropriate speech, but clinician ratings found no significant impact on these symptoms. There were also significant adverse effects, including increased drowsiness and reduced activity levels in these individuals while being treated with tianeptine. The evidence of the impact of clomipramine in the two studies is contradictory. There was evidence of improvement in autistic symptoms, irritability and obsessive-compulsive disorder type symptoms, but conflicting evidence in relation to hyperactivity across the two studies, and no significant changes found with inappropriate speech. There were also adverse effects reported with the use of clomipramine. Although side effect ratings were not significantly different to placebo, there were significant dropout rates in the clomipramine arm of one study. AUTHORS' CONCLUSIONS Clinicians considering the use of TCAs need to be aware of the limited and conflicting evidence of effect and the side effect profile when discussing this treatment option with people who have ASD and their carers. Further research is required before TCAs can be recommended for treatment of individuals with ASD.
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Affiliation(s)
- Romy Hurwitz
- Department of Community Paediatrics, Sydney South West Local Health District, Liverpool Hospital, Liverpool BC,
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Targoński A, Prajsner A. [Treatment of premature ejaculation]. Wiad Lek 2012; 65:44-47. [PMID: 22827115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Premature ejaculation is the most common sexual dysfunction in men. Its prevalence rate in Europe and in United States is estimated to be between 20% and 30%. The diagnosis of premature ejaculation is based on three main criteria: increased intravaginal ejaculatory latency time (IELT), lack of control over ejaculation and interpersonal psychological disturbances. Premature ejaculation is classified as lifelong (primary) or acquired (secondary) and might be facilitated by chronic prostatitis, diabetes mellitus, hyperthyroidism, obesity. The exact etiology of the disease remains unclear, although 5-HT (5-hydroxytryptamine) receptors are known to have a significant role. The use of SSRIs (selective serotonine reuptake inhibitors) is old and efficient form of therapy for premature ejaculation. Other drugs like tramadol, clomipramine, local anaesthetics and PDE-5 (phosphodiesterase 5) inhibitors also have some efficacy in the treatment of premature ejaculation. To minimize adverse effects the "on demand" therapy is preferred to the daily treatment. Simple questionnaires for patients are used to assess treatment effects.
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Abstract
BACKGROUND Non-antiepileptic drugs have been used in the management of trigeminal neuralgia since the 1970s. OBJECTIVES The objective was to systematically review the efficacy and tolerability of non-antiepileptic drugs for trigeminal neuralgia. SEARCH STRATEGY For this updated review we searched the Cochrane Neuromuscular Disease Group Specialized Register (30 April 2010). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE (January 1966 to April 2010), EMBASE (January 1980 to April 2010), LILACS (January 1982 to April 2010) and the Chinese Biomedical Retrieval System (1978 to April 2010). We handsearched 10 Chinese journals. SELECTION CRITERIA We searched for double-blind randomized or quasi-randomized controlled trials in which the active drug was used for at least two weeks. DATA COLLECTION AND ANALYSIS Two authors decided which trials fitted the inclusion criteria and independently graded risk of bias. MAIN RESULTS Four trials involving 139 participants were included. The primary outcome measure in each was pain relief. Three trials with an unclear risk of bias compared one of the non-antiepileptic drugs tizanidine, tocainide or pimozide with carbamazepine. In a trial of tizanidine involving 12 participants (one dropped out due to unrelated disease) one of five treated with tizanidine and four of six treated with carbamazepine improved, risk ratio 0.30 (95% CI 0.05 to 1.89). Few side effects were noted with tizanidine. In a study involving 12 participants there was an improvement in mean pain scores with tocainide similar to that with carbamazepine, but significant side effects limited its use. In the pimozide study more participants improved on pimozide (48/48) than with carbamazepine (27/48) (risk ratio 1.76, 95% CI 1.37 to 2.26). Up to 83% of participants reported adverse effects but these did not lead to withdrawal from the study. A trial with low risk of bias involving 47 participants compared 0.5% proparacaine hydrochloride eyedrops with placebo but did not show any significant benefits or side effects. AUTHORS' CONCLUSIONS Of the four studies identified, one had low and three an unclear risk of bias. There is insufficient evidence from randomized controlled trials to show significant benefit from non-antiepileptic drugs in trigeminal neuralgia. More research is needed.
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Affiliation(s)
- Mi Yang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China, 610041
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Alvarez P, Brun A, Labertrandie A, Lopez J, Correa A, Constandil L, Hernández A, Pelissier T. Antihyperalgesic effects of clomipramine and tramadol in a model of posttraumatic trigeminal neuropathic pain in mice. J Orofac Pain 2011; 25:354-363. [PMID: 22247931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIMS To develop a behavioral model in mice that is capable of mimicking some distinctive symptoms of human posttraumatic trigeminal neuropathic pain such as spontaneous pain, cold allodynia, and chemical÷inflammatory hyperalgesia, and to use this model to investigate the antinociceptive effects of clomipramine and tramadol, two drugs used for the treatment of neuropathic pain. METHODS A partial tight ligature of the right infraorbital nerve by an intraoral access or a sham procedure was performed. Fourteen days later, mice were subcutaneously injected with saline or drugs and the spontaneous nociceptive behavior, as well as the responses to topical acetone and to formalin or capsaicin injected into the ipsilateral vibrissal pad, were assessed. Data were analyzed by ANOVA. RESULTS Neuropathic mice exhibited an increased spontaneous rubbing÷scratching of the ipsilateral vibrissal pad, together with enhanced responses to cooling (acetone) and the chemical irritants (formalin, capsaicin). Clomipramine and tramadol produced an antihyperalgesic effect on most of these nociceptive responses, but tramadol was ineffective on capsaicin-induced hyperalgesia. CONCLUSION Nociceptive responses in this neuropathic pain model in mice exhibited a pattern consistent with the pain described by posttraumatic trigeminal neuropathic patients. The selective antihyperalgesic effect obtained with two commonly used drugs for treating neuropathic pain confirms the validity of this preclinical model.
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Affiliation(s)
- Pedro Alvarez
- Programa de Farmacología Molecular y Clínica, Universidad de Chile, Santiago, Chile
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Nakamae T. [Diversity of obsessive-compulsive disorder and pharmacotherapy associated with obsessive-compulsive spectrum disorders]. Seishin Shinkeigaku Zasshi 2011; 113:1016-1025. [PMID: 22187889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Serotonin reuptake inhibitors (SRI) are effective in the treatment of obsessive-compulsive disorder (OCD). The response rate for SRI is approximately 50% and refractory OCD may exist. The effect of antipsychotics augmentation therapy has been established for this kind of patients. However, OCD is clinically and biologically heterogeneous neuropsychiatric disease and it will affect the response of pharmacotherapy. Several subtypes of OCD have been identified. Early onset OCD and hoarding symptoms dominant patients with OCD tend to resist SRI treatment. Antipsychotics augmentation with SRI is much effective for OCD with tic disorders. On the other hand, psychiatric disorders in obsessive-compulsive spectrum disorders (OCSD) have similar clinical symptoms, comorbidities, genetic factors, and neurobiological etiology. SRI is effective for patients with body dysmorphic disorder (BDD) in preoccupation with body appearance or sensation subgroup. The response of SRI in BDD is similar to OCD while that of eating disorders was different. Impulse control disorders will respond to opiate antagonist but not to SRI. This subgroup might have a characteristic of behavioral addiction. Antipsychotic agents are effective for neurological disorders including tic disorders, Tourette syndrome, and autistic spectrum disorders. Therefore, the dopaminergic pathophysiology might underlie in this subgroup. The main goal of DSM-V is to make diagnosis based on biological validity, and the treatment response is an important factor. Further studies are necessary for understanding the pathophysiology of OCSD.
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Okada T. [The mental disorder and obsessive-compulsive spectrum disorders in childhood ]. Seishin Shinkeigaku Zasshi 2011; 113:992-998. [PMID: 22292193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
AIM We report the case of two young subjects who developed an obsessive-compulsive disorder (OCD) during a heavy use of ecstasy. After several months of discontinuation of the drug, major depression with psychotic features developed in one subject and a psychotic disorder in the other individual. No mental disorder preceded the use of ecstasy in any subject. FINDINGS A familial and personality vulnerability for mental disorder was revealed in one subject, but not in the other, and all physical, laboratory and cerebral NMR evaluations showed normal results in both patients. Remission of OCD and depressive episode or psychotic disorder was achieved after treatment with a serotoninergic medication associated with an antipsychotic. CONCLUSIONS The heavy long-term use of ecstasy may induce an alteration in the brain balance between serotonin and dopamine, which might constitute a pathophysiological mechanism underlying the onset of obsessive-compulsive, depressive and psychotic symptoms. The heavy use of ecstasy probably interacted with a vulnerability to psychiatric disorder in one subject, whereas we cannot exclude that an "ecstasy disorder" ex novo affected the other individual.
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MESH Headings
- Adolescent
- Amphetamine-Related Disorders/diagnosis
- Amphetamine-Related Disorders/psychology
- Antidepressive Agents, Tricyclic/therapeutic use
- Antipsychotic Agents/therapeutic use
- Benzodiazepines/therapeutic use
- Borderline Personality Disorder/diagnosis
- Borderline Personality Disorder/psychology
- Brain/drug effects
- Clomipramine/therapeutic use
- Comorbidity
- Depressive Disorder, Major/chemically induced
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/drug therapy
- Depressive Disorder, Major/genetics
- Depressive Disorder, Major/psychology
- Dopamine/metabolism
- Female
- Genetic Predisposition to Disease/genetics
- Hallucinogens/toxicity
- Humans
- Male
- N-Methyl-3,4-methylenedioxyamphetamine/toxicity
- Obsessive-Compulsive Disorder/chemically induced
- Obsessive-Compulsive Disorder/diagnosis
- Obsessive-Compulsive Disorder/drug therapy
- Obsessive-Compulsive Disorder/genetics
- Obsessive-Compulsive Disorder/psychology
- Olanzapine
- Psychoses, Substance-Induced/diagnosis
- Psychoses, Substance-Induced/drug therapy
- Psychoses, Substance-Induced/genetics
- Psychoses, Substance-Induced/psychology
- Risk Factors
- Risperidone/therapeutic use
- Serotonin/metabolism
- Substance Withdrawal Syndrome/diagnosis
- Substance Withdrawal Syndrome/drug therapy
- Substance Withdrawal Syndrome/psychology
- Young Adult
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Affiliation(s)
- Carlo Marchesi
- Department of Neuroscience, Psychiatric Division, University of Parma, Italy.
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Cailhol L, Rodgers R, Burnand Y, Brunet A, Damsa C, Andreoli A. Therapeutic alliance in short-term supportive and psychodynamic psychotherapies: a necessary but not sufficient condition for outcome? Psychiatry Res 2009; 170:229-33. [PMID: 19906442 DOI: 10.1016/j.psychres.2008.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Revised: 08/29/2008] [Accepted: 09/30/2008] [Indexed: 11/18/2022]
Abstract
The therapeutic alliance is considered as one of the active relational factors to improve the outcome of patients engaged in a psychotherapeutic process. Our objective was to examine the role played by the therapeutic alliance in psychodynamic versus supportive psychotherapy. We examined data from a previously published randomized controlled study. Outpatients suffering from depression (n=74) received the same antidepressant (clomipramine) and were randomized into two groups, receiving either psychodynamic or supportive psychotherapy. Subjects were assessed at inclusion (Structured Clinical Interview for DSM-IV Disorders, SCID), during treatment and at discharge (Global Assessment Scale, Hamilton Depression Rating Scale, Helping Alliance questionnaire). Over time, the therapeutic alliance improved regardless of condition, and the relationship between alliance and outcome strengthened. This relationship was significant only among patients assigned to the supportive therapy condition. These data suggest that although the therapeutic alliance is an important factor in psychodynamic treatment, additional ingredients may be involved in its superiority compared to supportive therapy.
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Minelli A, Bortolomasi M, Scassellati C, Salvoro B, Avesani M, Manganotti P. Effects of intravenous antidepressant drugs on the excitability of human motor cortex: a study with paired magnetic stimulation on depressed patients. Brain Stimul 2009; 3:15-21. [PMID: 20633426 DOI: 10.1016/j.brs.2009.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 02/24/2009] [Accepted: 04/21/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effect of various drugs was investigated by using transcranial magnetic stimulation (TMS) both in healthy subjects and patients, and the results indicated an influence of antidepressant drugs (ADs) on motor excitability. OBJECTIVE The aim of our study was to analyze the effects of two ADs, the tricyclic (TCA) clomipramine and the serotoninergic antidepressant (SSRI) citalopram on the motor cortex excitability in major depressed patients with TMS. METHODS Thirty affected subjects were placed into three groups: two received an intravenous dose of 25 mg clomipramine or 40 mg citalopram, and one received an injection of a placebo. Motor cortex excitability was studied by single and paired TMS before and after 3.5, 8, and 24 hours from administration of the drugs and placebo. Motor cortical excitability was measured using different TMS parameters: resting motor threshold (RMT), motor-evoked potential (MEP) amplitude, intracortical inhibition (ICI), and intracortical facilitation (ICF). RESULTS The results indicated a temporary but significant increase of RMT and ICI and a decrease of ICF after the administration of both drugs, with a longer inhibition for the clomipramine rather than the citalopram. MEP amplitude was not significantly affected by the antidepressant injections. CONCLUSIONS Our findings highlight that a single intravenous dose of clomipramine or citalopram exerts a significant but transitory suppression of motor cortex excitability in depressed patients. TMS represents a useful research tool in assessing the effects of motor cortical excitability of drugs used in the treatment of mental disorders.
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Affiliation(s)
- Alessandra Minelli
- Genetics Unit, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Via Piastroni 4, Brescia, Italy.
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Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a prevalent and disabling preoccupation with a slight or imagined defect in appearance. Trials have investigated the use of serotonin reuptake inhibitors (SRIs) and cognitive behaviour therapy (CBT) for BDD. OBJECTIVES To assess the efficacy of pharmacotherapy, psychotherapy or a combination of both treatment modalities for body dysmorphic disorder. SEARCH STRATEGY We searched the Cochrane Depression, Anxiety and Neurosis Trial Register (December 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007), MEDLINE (January 1966 to December 2007), and PsycINFO (1967 to December 2007). Ongoing and unpublished trials were located through searching the metaRegister of Controlled Trials, the CRISP and WHO ICTRP search portals (databases searched in December 2007), and through contacting key researchers and pharmaceutical companies. Additional studies were located through study reference lists. SELECTION CRITERIA Randomised controlled trials (RCTs) of patients meeting DSM or ICD diagnostic criteria for BDD, in which the trials compare pharmacotherapy, psychotherapy or multi-modal treatment groups with active or non-active control groups. Short or long-term trials were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary effect sizes for dichotomous and continuous outcomes were calculated using a random effects model and heterogeneity was assessed. MAIN RESULTS Two pharmacotherapy and three psychotherapy trials were eligible for inclusion in the review, with data from four short-term RCTs (169 participants) available for analysis. Response data from a single placebo-controlled trial of fluoxetine suggested overall superiority of medication relative to placebo (relative risk (RR) 3.07, 95% CI 1.4 to 6.72, n = 67). Symptom severity was also significantly reduced in the RCTs of fluoxetine and clomipramine (relative to desipramine), as well as in the two CBT trials (WMD -44.96, 95% CI -54.43 to -35.49, n = 73). A low relapse rate (4/22) was demonstrated in one trial of CBT. AUTHORS' CONCLUSIONS Results from the small number of available RCTs suggest that SRIs and CBT may be useful in treating patients with BDD. The findings of these studies need to be replicated. In addition, future controlled studies in other samples, such as adolescents, and using other selective SRIs, as well as a range of psychological therapy approaches and modalities (alone and in combination), are essential in supplementing the sparse data currently available.
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Affiliation(s)
- Jonathan C Ipser
- MRC Research Unit for Anxiety and Stress Disorders, University of Stellenbosch, PO Box 19063, Tygerberg, Western Cape, South Africa, 7505.
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41
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Abstract
Onychophagia can be explained as a kind of a compulsion that may cause destruction of the nails. Habitual nail biting is a common behaviour among children and young adults. By the age of 18 years the frequency of this behaviour decreases, but it may persist in some adults. Nail biting is an under-recognized problem, which may occur on a continuum ranging from mild to severe. Nail biting has received little attention in the psychiatric and dermatological literature. Its position in widely accepted classifications of psychiatric disorders (ICD-10 and DSM-IV) remains unclear. This disorder seems to be related to obsessive-compulsive spectrum disorder. Here, we present three case reports of onychophagia and co-occurring psychopathological symptoms and discuss the close relationship of onychophagia to obsessive- compulsive spectrum disorder and possible treatment modalities. Psychiatric evaluation of co-occurring psycho pathological symptoms in patients with onychophagia, especially those with chronic, severe or complicated nail biting, may be helpful in making a choice of individual therapy. Serotonin re-uptake inhibitors seem to be the treatment of choice in severe onychophagia.
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Kim YM, Choi YJ, Kim SH, Abd El-Aty AM, Kim BJ, Hwang SH, Lee SM. Response to a combined treatment program with clomipramine, behavioral, and environmental management of compulsive tail chasing in a German Shepherd. Berl Munch Tierarztl Wochenschr 2008; 121:329-333. [PMID: 18822603 DOI: 10.2376/0005-9366-121-329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
A 15-month-old female German Shepherd dog showing compulsive tail chasing was treated with a treatment protocol of pharmacological therapy (using clomipramine) in conjunction with behavioral and environmental management. The responses to the treatment protocol were assessed once a week for 7 weeks in respects to behavioral conditions and the frequency of bouts and its duration. The behavior history including mother, father, and her littermates were also evaluated for the apparent diagnosis. The compulsive tail chasing of the patient dog was improved on the aspect of behavioral condition and gradually decreased in the frequency and duration of bouts. However, in the mid of treatment, the animal showed an aggressive behavior as a concurrent sign associated with compulsive tail chasing.
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Affiliation(s)
- Young-Mee Kim
- Department of Veterinary Physiology, College of Veterinary Medicine, Konkuk University, Seoul, Republic of Korea.
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43
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Abstract
A double-blind, placebo-controlled clinical trial was conducted to determine the efficacy of clomipramine hydrochloride in cats with psychogenic alopecia. Twenty-five cats were randomly assigned to receive clomipramine hydrochloride (0.5 mg/kg orally q 24 hours) or placebo for 56 days. Eleven cats in each group completed the trial. The results of this study showed that clomipramine hydrochloride failed to demonstrate significant changes in the number of grooming bouts, hair regrowth, and the area of alopecia in cats with psychogenic alopecia when compared to a placebo. It was uncertain whether these results reflected a lack of drug efficacy, insufficient treatment duration, or an insufficient number of cases enrolled.
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Affiliation(s)
- Petra A Mertens
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota 55108, USA
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44
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Simpson HB, Petkova E, Cheng J, Huppert J, Foa E, Liebowitz MR. Statistical choices can affect inferences about treatment efficacy: a case study from obsessive-compulsive disorder research. J Psychiatr Res 2008; 42:631-8. [PMID: 17892885 PMCID: PMC3905985 DOI: 10.1016/j.jpsychires.2007.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 07/20/2007] [Indexed: 11/21/2022]
Abstract
Longitudinal clinical trials in psychiatry have used various statistical methods to examine treatment effects. The validity of the inferences depends upon the different method's assumptions and whether a given study violates those assumptions. The objective of this paper was to elucidate these complex issues by comparing various methods for handling missing data (e.g., last observation carried forward [LOCF], completer analysis, propensity-adjusted multiple imputation) and for analyzing outcome (e.g., end-point analysis, repeated-measures analysis of variance [RM-ANOVA], mixed-effects models [MEMs]) using data from a multi-site randomized controlled trial in obsessive-compulsive disorder (OCD). The trial compared the effects of 12 weeks of exposure and ritual prevention (EX/RP), clomipramine (CMI), their combination (EX/RP&CMI) or pill placebo in 122 adults with OCD. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale. For most comparisons, inferences about the relative efficacy of the different treatments were impervious to different methods for handling missing data and analyzing outcome. However, when EX/RP was compared to CMI and when CMI was compared to placebo, traditional methods (e.g., LOCF, RM-ANOVA) led to different inferences than currently recommended alternatives (e.g., multiple imputation based on estimation-maximization algorithm, MEMs). Thus, inferences about treatment efficacy can be affected by statistical choices. This is most likely when there are small but potentially clinically meaningful treatment differences and when sample sizes are modest. The use of appropriate statistical methods in psychiatric trials can advance public health by ensuring that valid inferences are made about treatment efficacy.
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45
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Kopecek M, Tislerova B, Sos P, Bares M, Novak T, Krajca V, Brunovsky M. QEEG changes during switch from depression to hypomania/mania: a case report. Neuro Endocrinol Lett 2008; 29:295-302. [PMID: 18580843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Accepted: 05/22/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND QEEG cordance and low-resolution electromagnetic tomography (LORETA) are relatively new applications of QEEG. Four small-scale studies have shown that decreases of QEEG prefrontal theta cordance after the first week on new antidepressants predict clinical response to treatment in patients with unipolar depression. METHODS We calculated prefrontal theta cordance and changes in 3D distribution of brain electrical activity using LORETA in the case of a 54-year old man experiencing his third depressive episode. RESULTS We did not detect a decrease of prefrontal theta cordance after one week of new treatment and the patient did not respond to this therapy after four weeks. However, we observed a decrease of prefrontal theta cordance after the first week of clomipramine therapy. Manic symptoms emerged after two weeks of clomipramine treatment. A decrease of prefrontal theta cordance preceded the clomipramine induced switch to hypomania during the next episode of depression also. LORETA before and during clomipramine therapies detected a significant increase of theta in the right postcentralis gyrus in the parietal lobe, and a borderline increase of alfa2 in the right middle frontal gyrus. DISCUSSION In a patient with bipolar spectrum disorder we found that a treefold change in theta prefrontal cordance preceded mood changes in a similar way as in patients with unipolar depression. We speculate that the changes detected by LORETA can attributed to the anticholinergic activity of clomipramine and the specific effects of a mood switch. Our data suggest that the new applications of QEEG can be sensitive to mood changes and have potential in bipolar disorder research.
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Affiliation(s)
- Miloslav Kopecek
- Prague Psychiatric Centre; 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
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46
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Micale V, Scapagnini G, Colombrita C, Mazzola C, Alkon DL, Drago F. Behavioral effects of dietary cholesterol in rats tested in experimental models of mild stress and cognition tasks. Eur Neuropsychopharmacol 2008; 18:462-71. [PMID: 18222653 DOI: 10.1016/j.euroneuro.2007.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2007] [Revised: 09/03/2007] [Accepted: 11/21/2007] [Indexed: 11/17/2022]
Abstract
Abnormalities in serum cholesterol levels of patients with mood disorders have been identified in epidemiological studies. However, evidence for an influence of dietary cholesterol on behavioral models is poor. Here, we investigated the behavioral changes of Wistar male rats fed a 2% cholesterol-enriched diet for 2 months in experimental models of depression and anxiety, such as the forced swim test (FST) paradigm and the novelty-induced grooming sampling test (NGT). The correlation between behavioral depression and impaired cognitive capacity was also examined testing rats in the Morris water maze (MWM) task one day after the FST. Different groups of rats fed various dietary regimens, were subjected to acute or repeated treatment (14 days) with clomipramine hydrochloride (50 or 25 mg/kg), diazepam (1 mg/kg) or with the peripheral benzodiazepine receptors (PBRs) antagonist, isoquinoline PK11195 (1 mg/kg) injected intraperitoneally (i.p.). Rats fed the cholesterol-enriched diet showed a significant decrease of grooming score in the NGT and of immobility time in the FST in comparison to animals fed a standard diet. Furthermore, the anxiolytic and antidepressant effects of diazepam and clomipramine were not affected by the different diets. Only after repeated treatment, PK11195 impaired the performance of animals fed a standard diet in the FST, and exhibited an anxiolytic-like profile in animals fed either the cholesterol-enriched or the standard diet. The improved performance in the FST was followed by a better learning performance in the acquisition phase of the MWM. These results suggest that effects of cholesterol-enriched diet on the behavioral reaction of rats in experimental models of mild stress may involve PBRs. They deserve attention in order to clarify the clinical correlation between plasma cholesterol levels and mood disorders in humans.
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MESH Headings
- Analysis of Variance
- Animals
- Antidepressive Agents, Tricyclic/therapeutic use
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Behavior, Animal/drug effects
- Cholesterol, Dietary/pharmacology
- Cholesterol, Dietary/therapeutic use
- Clomipramine/therapeutic use
- Cognition/drug effects
- Cognition/physiology
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Grooming/drug effects
- Grooming/physiology
- Immobility Response, Tonic/drug effects
- Immobility Response, Tonic/physiology
- Isoquinolines/pharmacology
- Isoquinolines/therapeutic use
- Male
- Maze Learning/drug effects
- Maze Learning/physiology
- Rats
- Rats, Wistar
- Stress, Psychological/diet therapy
- Stress, Psychological/drug therapy
- Swimming
- Time Factors
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Affiliation(s)
- Vincenzo Micale
- Department of Experimental and Clinical Pharmacology, University of Catania, Catania, Italy
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47
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Andrés S, Lázaro L, Salamero M, Boget T, Penadés R, Castro-Fornieles J. Changes in cognitive dysfunction in children and adolescents with obsessive-compulsive disorder after treatment. J Psychiatr Res 2008; 42:507-14. [PMID: 17599358 DOI: 10.1016/j.jpsychires.2007.04.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 03/18/2007] [Accepted: 04/18/2007] [Indexed: 10/23/2022]
Abstract
The majority of follow-up studies show stability of deficits after treatment in adults with obsessive-compulsive disorder (OCD), regardless of improvement in symptomatology, and this suggests a possibly chronic dysfunction of the dorsolateral-striatal circuit. To our knowledge, this is the first study to explore the evolution of cognitive dysfunction in children and adolescents with OCD after treatment. A neuropsychological battery designed for this study was administered to 29 OCD patients aged between 7 and 18 years before and after 6 months of naturalistic treatment, and to 22 healthy subjects of similar age, sex and intellectual level. In the first assessment, the OCD group performed worse on some tests of memory, speed of information processing and executive functions, this being similar to the cognitive dysfunction described in adult patients. After treatment the cognitive profile of the OCD group was normalized, and many of the significant differences present in the first assessment disappeared. Children and adolescents did not show the stability in cognitive dysfunction described in studies with adults. Six months of effective treatment normalized cognitive performance in young patients, who showed an important response to treatment.
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Affiliation(s)
- Susana Andrés
- Department of Child and Adolescent Psychiatry and Psychology, Institute Clinic of Neurosciences, Hospital Clinic, C/Villarroel, 170, 08036 Barcelona, Spain.
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48
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Sharma H. Psychogenic excoriation responding to fluoxetine: a case report. J Indian Med Assoc 2008; 106:245-262. [PMID: 18828345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Compulsive skin picking, 'acne excoriee', neurotic (psychogenic) excoriation, dermatotillomania, occurring in 2% dermatology patients mostly in women, is a result of excessive scratching, picking, gouging or squeezing of the skin using teeth, tweezers, nail files, pins and knives, etc. The lesions are usually found on face and also on upper limbs and upper back, areas patients can easily reach. They may occur in absence or in response to skin pathology or sensation of itching. A young female patient attended OPD with the complaints of multiple excoriated lesions over the face, arms and forearms. The diagnosis was psychogenic excoriation which is an uncommon psychodermatological condition. She was treated with fluoxetine and behaviour therapy. The patient recovered fully with above treatment at the end of 3 months. Psychogenic excoriation is an uncommon psychodermatological condition which responds well to selective serotonin reuptake inhibitors and behaviour therapy (habit reversal training).
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Affiliation(s)
- Himanshu Sharma
- Department of Psychiatry, PS Medical College and SK Hospital, Karamsad 388325
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49
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Ulloa RE, Nicolini H, Avila M, Fernández-Guasti A. Randomized controlled pilot study of quetiapine in the treatment of adolescent conduct disorder. J Child Adolesc Psychopharmacol 2008; 18:140-56. [PMID: 17343556 DOI: 10.1089/cap.2006.0007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether quetiapine is superior to placebo in the treatment of adolescents with conduct disorder. METHODS This was a 7-week, randomized, double-blind, placebo-controlled pilot study with two parallel arms. Nine youths were randomly assigned to receive quetiapine, and 10 youths were randomly assigned to receive placebo. Patients were assessed weekly throughout the trial. Quetiapine was dosed twice daily, and medications could be titrated flexibly through the end of study week 5. The dose was fixed for the final 2 weeks of the study. The primary outcome measures were the clinician-assessed Clinical Global Impressions-Severity (CGI-S) and-Improvement (CGI-I) scales. Secondary outcome measures included parent-assessed quality of life, the overt aggression scale (OAS), and the conduct problems subscale of the Conners' Parent Rating Scale (CPRS-CP). RESULTS The final mean dose of quetiapine was 294 +/- 78 mg/day (range 200-600 mg/day). Quetiapine was superior to placebo on all clinician-assessed measures and on the parent-assessed quality of life rating scale. No differences were found on the parent-completed OAS and CPRS-CP. Quetiapine was well tolerated. One patient randomized to quetiapine developed akathisia, requiring medication discontinuation. No other extrapyramidal side effects occurred in patients receiving active drug. CONCLUSIONS This methodologically controlled pilot study provides data that quetiapine may have efficacy in the treatment of adolescents with conduct disorder. Because of the preliminary nature of the study, further research with larger samples is needed to confirm these findings.
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Affiliation(s)
- Rosa-Elena Ulloa
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Mexico City, Mexico.
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50
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Mercado MG, Kimmer SL, Holman JR, Wanserski G, Lo V. Clinical inquiries. What's the best drug treatment for premature ejaculation? J Fam Pract 2008; 57:192-194. [PMID: 18321459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Michael G Mercado
- Department of Family Medicine, Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
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