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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Perospirone is a recently developed atypical antipsychotic with potent serotonin 5-HT2 and dopamine D2 antagonist activity. Other atypical antipsychotics including risperidone, quetiapine and olanzapine have been widely used for treatment, not only for schizophrenia symptoms but also for delirium, because of their low potential to induce extrapyramidal disturbances. In the present study the effectiveness and safety of perospirone in patients with delirium are described. Thirty-eight patients with DSM-IV delirium were given open-label perospirone. To evaluate the usefulness of perospirone, scores from 13 severity items of the Delirium Rating Scale-Revised-98 were assessed. Data were gathered from October 2003 to September 2004. Perospirone was effective in 86.8% (33/38) of patients, and the effect appeared within several days (5.1 +/- 4.9 days). The initial dose was 6.5 +/- 3.7 mg/day and maximum dose of perospirone was 10.0 +/- 5.3 mg/day. There were no serious adverse effects. However, increased fatigue (15.2%), sleepiness (6.1%), akathisia (3.0%) and a decline in blood pressure (3.0%) were observed. It is proposed that perospirone may be another safe and effective atypical antipsychotic drug for the treatment of delirium symptoms in hospitalized patients. This is a preliminary open trial, and further randomized double-blind placebo-controlled tests are needed.
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PMID:Perospirone in the treatment of patients with delirium. 1723 41

This article updates a 1990 review of the effects of tobacco abstinence by reviewing (a) which symptoms are valid indicators of tobacco abstinence and (b) the time course of tobacco abstinence symptoms. The author searched several databases to locate more than 3,500 citations on tobacco abstinence effects between 1990 and 2004; 120 of these were used in this review. Data collection and interpretation were based solely on the author's subjective judgments. For brevity, the review does not evaluate craving, hunger, performance, and several other possible outcomes as withdrawal symptoms. Anger, anxiety, depression, difficulty concentrating, impatience, insomnia, and restlessness are valid withdrawal symptoms that peak within the first week and last 2-4 weeks. Constipation, cough, dizziness, increased dreaming, and mouth ulcers may be abstinence effects. Drowsiness, fatigue, and several physical symptoms are not abstinence effects. In conclusion, no major changes are suggested for DSM-IV criteria for tobacco/nicotine withdrawal, but some deletions are suggested for ICD-10 criteria. Future studies need to investigate several possible new symptoms of withdrawal and to define more clearly the time course of symptoms.
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PMID:Effects of abstinence from tobacco: valid symptoms and time course. 1736 63

Dentists often treat patients who may be suffering from comorbid mental disorders without paying attention to their symptoms. This leads to a delay in starting the treatment of mental disorders and to inappropriate dental treatments for physical symptoms originating from mental disorders. In the present study, the ways in which dentists can easily detect mental disorders in dental patients with occlusion-related problems were examined. Fifty-three patients who visited the Occlusion Clinic of Kanagawa Dental College were interviewed by a psychiatrist and a dentist specialized in psychosomatic medicine. Thirty-five patients (66.0%) were diagnosed as having DSM-IV Axis I disorders. The demographic and psychological factors that correlate with the presence of mental disorders are duration of chief complaint, number of clinics and hospitals visited for the current symptom, total score of the General Health Questionnaire (GHQ), the scores of the anxiety and insomnia and social dysfunction subscales in the GHQ and the scores of the confusion-bewilderment and fatigue-inertia subscales in the Profile of Mood States (POMS). A logistic regression analysis indicated that number of clinics and hospitals visited markedly correlated with cormobidity of a mental disorder. This information may be useful for screening mental disorder patients. Dental patients having comorbid mental disorders should be treated both odontologically and psychologically.
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PMID:Detecting mental disorders in dental patients with occlusion-related problems. 1747 1

Depression with atypical features is characterized by mood reactivity and 2 or more symptoms of vegetative reversal (including overeating, oversleeping, severe fatigue or leaden paralysis, and a history of rejection sensitivity). Another important feature of atypical depression is its preferential response to monoamine oxidase inhibitor (MAOI) treatment, especially phenelzine, relative to tricyclic antidepressants (TCAs). The efficacy of newer agents relative to MAOIs and TCAs is unclear. This presentation reviews currently available treatments for DSM-IV depression with atypical features, focusing specifically on placebo-controlled trials. Although phenelzine shows the most efficacy in this population, treatment with TCAs, selective serotonin reuptake inhibitors, cognitive-behavioral therapy, MAOIs other than phenelzine, and other agents are discussed. Following this presentation is a discussion on the treatment of depression with atypical features by experts in this subject area.
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PMID:Treating DSM-IV depression with atypical features. 1747

Drug-related social role impairments and social maladaptation are referenced explicitly in the case definitions for drug dependence within DSM-IV-TR. Nonetheless, cases of drug dependence without this type of secondary consequence have been observed in recent epidemiological studies. When an 'impairment/maladaptation gating' approach has been taken during recent large-scale psychiatric surveys (for example, to reduce participant fatigue or burden), the net effect may include (a) a reduced number of identified drug dependence cases and (b) biases in the estimates of association linked to the occurrence of drug dependence. In this report, we probe these issues with respect to cannabis dependence, making use of data from the cross-sectional United States National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a household survey of 43,093 adults aged 18 years and over. In this process, we shed light on actual impact of the gating approach mentioned above. Specifically, when we simulated a social impairment/maladaptation 'gated' assessment of cannabis dependence, the end result was a very modest reduction in the estimated prevalence of cannabis dependence. It suggested that for every 10 000 general population survey respondents there would be no more than 12 cases of cannabis dependence without the above-referenced impairments/maladaptations. Patterns of association linking suspected background characteristics to the prevalence of cannabis dependence were not appreciably different when the 'gated' and 'ungated' approaches were applied. In summary, there are reasons to take the ungated approach in detailed research on cannabis use and dependence. Nevertheless, in panoramic mental health surveys, the inefficiency of an 'ungated' approach must be balanced against the anticipated yield of cannabis dependence cases who lack social role impairments or socially maladaptive behaviours.
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PMID:Assessing cannabis dependence in community surveys: methodological issues. 1762 84

Social role impairment and other forms of maladaptation are referenced explicitly in the case definitions for the drug use disorders within DSM-IV-TR, but there is continuing debate about whether and how to include these manifestations of 'clinical significance' in diagnostic criteria and assessment protocols. When a 'gated' approach (based on impairment or other maladaptation) has been taken during recent large scale psychiatric surveys with coverage of drug dependence (e.g. to reduce participant fatigue or burden), the net effect may include (a) a reduced number of identified cases, and (b) biases in the estimates of association linked to the occurrence of drug dependence. In this report focused on alcohol dependence, we probe these issues, making use of data from the cross-sectional US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a household survey with 44,093 adult participants. NESARC alcohol dependence assessments were 'ungated', but allowed simulation of a 'gated' approach; the end result was a robust decrement in the estimated prevalence of this condition. Nonetheless, patterns of association linking suspected background characteristics to prevalence of alcohol dependence were not appreciably different when the gated and ungated estimates were contrasted. In summary, there are reasons to take the ungated approach in detailed research on alcohol use and dependence. Nevertheless, in panoramic mental health surveys, the inefficiency of an ungated approach must be balanced against the anticipated yield of cases who have experienced alcohol dependence without alcohol related social role impairments or other maladaptation, particularly when the dependence syndromes without these consequences are sometimes thought to lack clinical significance.
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PMID:Case ascertainment of alcohol dependence in general population surveys: 'gated' versus 'ungated' approaches. 1770 72

This multicenter study estimated the prevalence of major depressive disorder (MDD) among emergency department patients in Latin America. To identify patients with MDD, we used a combination of DSM IV- criteria interview and a questionnaire screen including the center for Epidemiological Studies Depression Scale. We analyzed data from consecutive adult patients from hospitals in Argentina, Brazil, Chile, Colombia, and Mexico and described the demographic and health status differences between MDD and non-MDD patients. Prevalence of MDD ranges from 23.0 to 35.0%. The estimates are based on a total of 1,835 patients aged 18 years and over, with response rates of 83.0%. Compared to non-MDD patients, MDD patients were more likely to be middle-aged, female, smokers, of lower socioeconomic status, and to report a diagnosis of asthma or arthritis/rheumatism. Multivariate analysis identified a lower level of education, smoking, and self-reported anxiety, chronic fatigue, and back problems to be independently associated with MDD. Our data suggest that the prevalence of MDD is elevated among emergency department patients in Latin American countries. The integration of depression screening into routine emergency care merits serious consideration, especially if such screening can be linked to psychiatric treatment.
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PMID:A multicenter study of major depressive disorder among emergency department patients in Latin-American countries. 1797 40

Depression is a common psychiatric disorder, characterized by a persistent lowering of mood, loss of interest in routine activities and diminished ability to experience pleasure. There are several depression classification systems and diagnostic tools based on clinical symptoms, i.e. the International Classification of Diseases (ICD-10), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the Hamilton Depression Rating Scale, the Montgomery-Asberg Scale and Beck's Depression Inventory. Depression frequently occurs in patients with heart failure, as similar pathophysiological mechanisms of neurohormonal activation, arrhythmia, inflammation and hypercoagulation are present in both these diseases. Prognosis in patients with depression is also affected by insufficient cooperation between a patient and his doctor as regards the lifestyle and medication intake of a patient. Depression is usually accompanied by remission and relapse periods which might be related to the current heart failure status of a patient and despite intensive medical treatment they may recur. Depression is often difficult to diagnose or even left undiagnosed and thus untreated, because its symptoms: fatigue, apathy and decreased exercise tolerance, are common in the general population. Furthermore, safety and efficacy of antidepressant therapy in patients with cardiovascular diseases are not well established. Evidence from clinical trials evaluating the influence of depression behavioral and pharmacological treatment on morbidity and mortality in patients with heart failure is also limited. Taking into account that depression affects prognosis in patients with variety of disorders and common pathological mechanisms present both in depression and heart failure, screening tests for depression should be considered not only in patients with diagnosed heart failure but also those at risk of heart failure development.
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PMID:Is depression a problem in patients with chronic heart failure? 1840 73

To evaluate acute onset of anxiolytic activity using a dental anxiety model, 89 patients were randomised to double-blind single dose pregabalin 150 mg, alprazolam 0.5 mg or placebo 4 h before a scheduled dental procedure. A Dental Anxiety Total score >12 (moderate-to-severe) without meeting Diagnostic and Statistical Manual of Mental Disorders (Fourth edition) (DSM-IV) anxiety disorder criteria was required. Efficacy and safety, assessed 2, 2.5, 3, 3.5 and 4 h postdose, included 100 mm Visual Analogue Scale for Anxiety (VAS-Anxiety; primary outcome), 100 mm VAS-Sedation and Time-to-Onset of Action Scale (TOAS), a patient-rated anti-anxiety drug-benefit scale (no [0] to full benefit [10]). Mixed model analysis found significantly greater VAS-A improvement slopes for pregabalin (t = -2.47; P = 0.014) and alprazolam (t = -2.39; P = 0.018). There was a significant improvement versus placebo in the TOAS from 2 h through endpoint in alprazolam patients and from 3 h onward in pregabalin patients. Pregabalin produced significantly greater increases in VAS-Sedation versus placebo from 2.5 h through 4 h (2 h onward for alprazolam). Notably, there was a higher correlation between TOAS and VAS-Sedation (r = +0.58) than VAS-Anxiety (r = -0.50) on Spearman's analysis. The majority of Adverse Effects (AEs) were mild, and the most frequent for pregabalin, alprazolam, and placebo, respectively, were fatigue (N = 7, 7, 3), dizziness (N = 6, 3, 3), attention disturbance (N = 3, 1, 0), somnolence (N = 3, 0, 0), feeling abnormal (N = 0, 2, 0) and balance disorder (N = 0, 2, 0). These results suggest that onset of clinically meaningful anxiolytic effect after single-dose pregabalin occurs within the first 3-4 h. Additional research is needed to determine whether anxiolytic effect occurs in generalized anxiety disorder populations by day 1 or within 3-4 h post-first dose.
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PMID:Early onset anxiolytic efficacy after a single dose of pregabalin: double-blind, placebo- and active-comparator controlled evaluation using a dental anxiety model. 1863 90

The efficacy, safety and tolerability of bupropion XR and venlafaxine XR was assessed and compared with placebo in adult outpatients with major depressive disorder (MDD). Adults meeting DSM-IV criteria for MDD with a minimum Hamilton Depression Rating Scale (HAMD) 17-Item total score of > or =18 were randomized to eight weeks of double-blind treatment with either bupropion XR (150 mg/day), venlafaxine XR (75 mg/day) or placebo. At the end of the fourth week of treatment, a dosage increase to bupropion XR 300 mg/day or venlafaxine XR 150 mg/day was allowed if, in the opinion of the investigator, response was inadequate. The primary efficacy endpoint was mean change from baseline at week 8 in the Montgomery-Asberg Depression Rating Scale (MADRS) total score last observation carried forward (LOCF). Mean changes from baseline at week 8 (LOCF) in MADRS total score were statistically significant for bupropion XR and venlafaxine XR patients compared to the placebo group: -16.0 for bupropion XR (P = 0.006 vs placebo), -17.1 for venlafaxine XR (P < 0.001 vs placebo) and -13.5 for placebo. Secondary outcomes (including CGI-S, HAM-A, MEI, Q-LES-Q-SF, responder and remitter analyses) also improved significantly for both active treatment groups compared with placebo. The most frequently reported adverse events were dry mouth and insomnia for bupropion XR, and nausea, hyperhidrosis, fatigue, and insomnia for venlafaxine XR. In this double-blind, placebo-controlled trial, bupropion XR at doses up to 300 mg/day and venlafaxine XR at doses up to 150 mg/day demonstrated comparable antidepressant efficacy.
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PMID:Eight-week, placebo-controlled, double-blind comparison of the antidepressant efficacy and tolerability of bupropion XR and venlafaxine XR. 1863 95


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