Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obsessive-compulsive disorder is a chronic psychiatric illness, affecting up to 3% of the general population, to the middle of 60-th it was supposed to be untreatable. Antidepressant pharmacotherapy is one of the treatment alternatives today. We compared efficacy and safety of citalopram versus clomipramine (serotoninergic antidepressants) in 6 weeks in double blind therapy of obsessive-compulsive disorder. The second objective was to compare prolactin response to a fenfluramine challenge test before the treatment of patients and after 6 weeks of the treatment. In a sample of 14 patients we confirmed significant therapeutic response after 3 weeks of pharmacotherapy, better in obsession than in compulsion. We found low level of adverse effects in the first week of therapy--dry mouth, anxiety, nausea, somnolence, tremor, and sexual adverse events. There were no changes in the laboratory, test EEG, and ECG examinations. Fenfluramine challenge test showed statistically significant decrease of prolactin levels 1 hour after administration of fenfluramine. It was not observed after six weeks of the therapy. Statistically significant negative correlation between prolactin plasma levels at the 6th hour after administration of fenfluramine and obsession item of YBOC Scale was showed after the 3rd and 6th week of the therapy. The correlation was not observed for compulsion item YBOC Scale. Side effects observed during and after the challenge test were anxiety and nervousness and gastrointestinal problems, lasted from 1 hour to 10 hours. These preliminary result could support the idea, that obsessions and compulsions have not necessary the same biological background. The challenge paradigm appears to be a possible way to clarify the pathogenesis of OCD. Our study will continue.
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PMID:Fenfluramine challenge test in obsessive-compulsive disorder--first results. 948 83

Pure akinesia is a disorder characterized by profound freezing in the absence of rigidity or tremor that is not improved by levodopa therapy. We report two cases of pure akinesia who developed obsessive-compulsive-disorder- (OCD-) like behavior during their illness. Although the pathophysiological mechanism underlying freezing is unclear, the coexistence of pure akinesia and OCD-like behavior suggests that both symptoms have a common pathological basis in these two cases, presumably damage to the pallidum.
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PMID:Obsessive-compulsive-like behavioral changes in pure akinesia. 1134 16

Deep brain stimulation (DBS) has been approved by the FDA for use in the treatment of Parkinson's disease, essential tremor, and dystonia. Case reports and case series have reported significant psychiatric side effects in some individuals. The goal of this meta-analysis is to characterize the risks and benefits of DBS and to assess its possible use within the psychiatric setting. A search was conducted on PubMed, EBSCO, and PsycInfo in January 2006 that covered the time period 1 Jan 1996-30 Dec 2005. All identified articles were reviewed and those describing adverse events were further examined with a structured instrument. The initial searches yielded 2667 citations; 808 articles met inclusion criteria for the meta-analysis; 98.2% of studies that specifically assessed motor function reported some level of improvement. Most reported side effects were device or procedure related (e.g., infection and lead fracture). The prevalence of depression was 2-4%, mania 0.9-1.7%, emotional changes 0.1-0.2%, and the prevalence of suicidal ideation/suicide attempt was 0.3-0.7%. The completed suicide rate was 0.16-0.32%. In conclusion, DBS is an effective treatment for Parkinson's disease, dystonia, and essential tremor, and case reports suggest that major depression and OCD may also respond to DBS. Reported rates of depression, cognitive impairment, mania, and behavior change are low, but there is a high rate of suicide in patients treated with DBS, particularly with thalamic and GPi stimulation. Because of the high suicide rate, patients should be prescreened for suicide risk prior to DBS surgery. Additionally, patients should be monitored closely for suicidal behavior post-operatively.
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PMID:Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: A meta-analysis of ten years' experience. 1858 79

Stereotypic movements are repetitive, rhythmic, fixed, patterned in form, amplitude, and localization, but purposeless (e.g., hand shaking, waving, body rocking, head nodding). They are commonly seen in children; both in normal children (primary stereotypy) and in individuals with additional behavioral or neurological signs and symptoms (secondary stereotypy). They should be differentiated from compulsions (OCD), tics (tic disorders), trichotillomania, skin picking disorder, or the direct physiological effect of a substance. There is increasing evidence to support a neurobiological mechanism. Response to behavioral and pharmacological therapies is variable.
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PMID:Stereotypic movement disorders. 2149 12

The specific effect of DBS at high frequency, discovered during a VIM thalamotomy, was extended to the older targets of ablative neurosurgery such as the pallidum, for tremor in Parkinson's disease (PD), dyskinesias, essential tremor, as well as the internal capsule to treat psychiatric disorders (OCD). A second wave of targets came from basic research, enabled by the low morbidity, reversibility, and adaptability of DBS. This was the case for the subthalamic nucleus (STN) which improves the triad of dopaminergic symptoms, and the pedunculopontine nucleus (PPN) for gait disorders in PD. The new concepts of the role of basal ganglia in psychiatric disorders indicate the subgenual cortex CG 25 for severe resistant depression, the accumbens nucleus for depression, anorexia nervosa, and addiction, and the thalamus intralaminar nuclei for minimally conscious states. Serendipity and a scientific approach have provided several instances where targets have produced unexpected effects (such as STN in OCD), as well as limbic effects observed during attempts at VMH stimulation for obesity: this might offer a novel way to treat mild cognitive impairment, or memory deficits reported in Alzheimer's disease. While these might provide solutions for as yet unsolved problems, attention must be paid to ethical considerations.
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PMID:New targets for DBS. 2216 37

High-frequency deep brain stimulation (HF-DBS) has become a widely used therapeutic method in the field of movement disorders for the treatment of Parkinson's disease, essential tremor or dystonia. New targets and indications are under evaluation in several other conditions such as cluster headache, obesity, epilepsy or psychiatric diseases (depression, OCD). However, the mechanisms of action of HF-DBS remain poorly understood. Herein we present a review of the literature and our current view of the question. The first part deals with the effects of stimulation itself on the different parts of the neuron and tries to answer the question of what is actually stimulated by DBS (cell bodies, dendrites or axons). The second part is devoted to the ortho- and antidromic effects of the stimulation. The third part more specifically focuses on the case of subthalamic nucleus stimulation. The target axons in the subthalamic area are discussed in the light of recent optogenetic studies. In conclusion, HF-DBS leads to a kind of functional deafferentation of the stimulated structure and to the modulation of cortical activity (both ortho and antidromically). Which effects are relevant to the therapeutic effects of DBS is still unclear. Further investigations are required especially regarding the corticosubthalamic pathways.
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PMID:[Mechanisms of action of high-frequency deep brain stimulation. A review of the literature and current concepts]. 2246 40