Mental Health

NALTREXONE PROMISING FOR TREATING KLEPTOMANIA

Administrator — Sat, 30 May 2009 17:48:49 +0000

Last Updated: 2009-04-14 11:16:27 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The opiate antagonist naltrexone, commonly used to treat alcoholism and drug addiction, reduces stealing urges and behavior in kleptomania, according to study results published in the April 1st issue of Biological Psychiatry.

"Kleptomania appears to share many phenomenological similarities to substance use disorders: urges or cravings, tolerances, withdrawal, repeated unsuccessful attempts to cut back or stop, and impairment in areas of life functioning," Dr. Jon E. Grant and colleagues of the University of Minnesota School of Medicine, Minneapolis, point out.

"Opioid antagonists have been hypothesized to influence dopamine neurotransmission in the nucleus accumbens and linked motivational neurocircuitry, dampening stealing-related excitement and cravings," they note.

In an 8-week, double-blind, placebo-controlled trial, the researchers examined the efficacy and tolerability of naltrexone in 25 adults with kleptomania who were randomly assigned to naltrexone or...

PARKINSON'S PATIENTS ON DOPAMINE AGONISTS MAY DEVELOP PATHOLOGIC BEHAVIORS

Administrator — Sat, 30 May 2009 17:48:25 +0000

Last Updated: 2009-04-13 11:18:48 -0400 (Reuters Health)

NEW YORK (Reuters Health) - About one in five patients taking a therapeutic dose of a dopamine agonist for treatment of Parkinson disease may develop new-onset compulsive gambling or hypersexuality, according to a study of patients treated at the Mayo Clinic in Rochester, Minnesota.

By contrast, these behaviors were not seen in untreated patients, those taking subtherapeutic dopamine agonist doses, or those taking carbidopa/levodopa alone.

"Physicians who care for patients taking these drugs should recognize the potential of the drugs to induce pathologic syndromes that sometimes masquerade as primary psychiatric disease," Dr. J. Michael Bostwick and co-authors caution in the April issue of Mayo Clinic Proceedings.

Their study was designed to more accurately determine the prevalence of this treatment complication than has been estimated by specialty referral clinics, by limiting their study cohort to patients in...

WOMEN'S LOW SEX DRIVE TIED TO POOR QUALITY OF LIFE

Administrator — Sat, 30 May 2009 17:48:04 +0000

Last Updated: 2009-02-04 14:19:03 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Postmenopausal women who have hypoactive sexual desire disorder (HSDD) - a low level of sexual desire -- have a worse health-related quality of life than their counterparts who are happy with their sex lives, according to a new study.

In fact, the researchers say, HSDD can cause in impairments in well-being on par with those seen in chronic diseases such as diabetes, hypertension, osteoarthritis and asthma.

HSDD, the "persistent lack of sexual desire causing 'marked stress or interpersonal difficulties,'" is included in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, which lists and defines mental illnesses widely accepted by the psychiatric establishment.

But questions remain about whether HSDD is a real problem for women or "represents a disorder that has become 'medicalised' because of its pharmaceutical market...

ANTIPSYCHOTICS USEFUL IN PSYCHIATRIC EMERGENCIES, STUDY CONFIRMS

Administrator — Sat, 30 May 2009 17:47:43 +0000

" Last Updated: 2008-08-15 9:38:43 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Immediate control of aggressive and impulsive behavior in psychiatric emergencies can be achieved through administration of antipsychotic medications, findings from an observational study indicate, confirming the validity of current medication practices.

Dr. Stefan Wilhelm and two colleagues from the medical department of Lilly Deutschland GmbH, Bad Homburg, Germany evaluated the short-term effectiveness and tolerability of atypical and typical antipsychotic medications in the emergency treatment of acutely agitated adult patients.

Treatment over the first 5 days was classified according to whether olanzapine, risperidone, or haloperidol was administered, with or without benzodiazepine co-medication.

In the open-access online journal BMC Psychiatry, the investigators report that "clear improvements" in agitation and aggression scores were noted in all treatment groups within the short observation period (5 days).

Most of the 558...

INFORMATION FOR HEALTHCARE PROFESSIONALS: ANTIPSYCHOTICS

Administrator — Sat, 30 May 2009 17:47:12 +0000

FDA is notifying healthcare professionals that both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis.

FDA

Download File

EVIDENCE LACKING TO SUPPORT MANY OFF-LABEL USES OF ATYPICAL ANTIPSYCHOTICS

Administrator — Sat, 30 May 2009 17:46:32 +0000

Some newer antipsychotic medications approved to treat schizophrenia and bipolar disorder are being prescribed to millions of Americans for depression, dementia, and other psychiatric disorders without strong evidence that such off-label uses are effective, according to a new analysis by the Department of Health & Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ).

The federally funded comparative effectiveness review of these drugs-called atypical antipsychotics-identified the medications' potential for serious side effects while pointing to an "urgent need" for more research into new treatments for the growing population of dementia patients who display severe agitation.

"This report emphasizes the importance of understanding the risks and benefits of different medicines," said AHRQ Director Carolyn M. Clancy, M.D. "Caution is necessary in the off-label use of atypical antipsychotics, especially when used in the elderly and when the evidence for effectiveness is not good."

Atypical antipsychotics are second-generation medicines...

MEDICATIONS

Administrator — Sat, 30 May 2009 17:46:07 +0000

A detailed booklet by the NIMH that describes mental disorders and the medications for treating them, and includes a comprehensive list of medications. It is designed to help mental health patients and their families understand how and why medications can be used as part of the treatment of mental health problems.

NIMH

Download File

TREATMENT RESEARCH IN MENTAL ILLNESS

Administrator — Sat, 30 May 2009 17:45:46 +0000

Improving the Nation-s Public Mental Health Care through NIMH Funded Interventions Research

By National Advisory Mental Health Council-s Workgroup on Clinical Trials

Based on its review, the Workgroup strongly endorsed the important role of the NIMH in fostering treatment research in mental disorders ranging from facilitating treatment development to evaluating the efficacy, safety and effectiveness of treatments, to providing an essential complement to the extensive treatment research efforts of the pharmaceutical industry.

NIMH

Download File

OVERVIEW OF TREATMENT

Administrator — Sat, 30 May 2009 17:45:00 +0000

Introduction to Range of Treatments

Mental disorders are treatable. In fact, for most mental disorders, there is generally not just one but a range of treatments of proven efficacy. Most treatments fall under two general categories, psychosocial and pharmacological.

This section of the Surgeon General's Report examines the types of barriers that prevent people from seeking help. But the chapter first covers some general points about psychological and pharmacological therapies. It also discusses why therapies that work so well in research settings do not work as well in practice.

SAMHSA

Download File

Magic bullets for insomnia?

Fri, 29 May 2009 08:51:45 +0000

Patients' use and experiences of newer (Z drugs) versus older (benzodiazepine) hypnotics for sleep problems in primary care.

By Siriwardena A.N., Qureshi M.Z., Dyas J.V., Middleton H., Orner R.

BACKGROUND: Little is known about patients' perceptions of newer hypnotics. AIM: To investigate use, experience, and perceptions of Z drug and benzodiazepine hypnotics in the community.

DESIGN OF STUDY: Cross-sectional survey of general practice patients who had received at least one prescription for a Z drug or benzodiazepine in the previous 6 months.

SETTING: Lincolnshire, UK. METHOD: Self-administered postal questionnaire.

RESULTS: Of 1600 surveys posted, 935 (58.4%) responses were received, of which 705 (75.4%) were from patients taking drugs for insomnia. Of those 705 patients, 87.9% (n = 620) were first prescribed a hypnotic by their GP, and 94.9% (n...

Maternal use of antipsychotics in early pregnancy and delivery outcome

Fri, 29 May 2009 08:50:54 +0000

By Reis M., Kallen B.

The effect of various antipsychotics during pregnancy has repeatedly been studied, but for most atypical antipsychotics, only little information is available. We identified from the Swedish Medical Birth Register 2908 women who had reported the use of any antipsychotic or lithium in early pregnancy and studied malformation rates with data also from the Register of Congenital Malformations and the Hospital Discharge Register. Comparisons were made with all births (n = 958,729) after adjustment for some confounders. Risks were expressed as odds ratios (ORs).Most women had used dixyrazine or prochlorperazine mainly because of nausea and vomiting in early pregnancy. Seventy-nine women had used lithium, and these outcomes are reported separately. Hence, the main analysis was restricted to 570 women (576 infants) using other antipsychotics. There was a statistically significant increase in the risk for a congenital malformation-after exclusion of some common and minor...

Paroxetine for patients with undifferentiated somatoform disorder:

Fri, 29 May 2009 08:50:10 +0000

A prospective, open-label, 8-week pilot study

By Han C., Marks D.M., Pae C.-U., Lee B.H., Ko Y.-H., Masand P.S., Patkar A.A., Jung I.-K.

Background: Forty-eight percent of somatic symptoms encountered in the primary care setting are medically unexplained. Such symptoms have been associated with negative impact on quality of life and with functional impairment.

Objective: The aim of this study was to assess the potential utility and tolerability of paroxetine for the treatment of undifferentiated somatoform disorder (USD), using the 15-item Patient Health Questionnaire (PHQ-15) to assess the severity of somatic symptoms.

Methods: A prospective, open-label, 8-week pilot study of paroxetine was conducted in outpatients with USD. Data were collected at baseline and at weeks 1, 2, 4, and 8. The primary measure was the mean change in PHQ-15 total score from baseline...

Role of mirtazapine in the treatment of antipsychotic-induced akathisia

Fri, 29 May 2009 08:49:08 +0000

By Hieber R., Dellenbaugh T., Nelson L.A.

OBJECTIVE: To evaluate the role of mirtazapine in the treatment of antipsychotic-induced akathisia.

DATA SOURCES: MEDLINE (1966-February 2008) and PsycINFO (1967-February 2008) were searched using the terms akathisia and mirtazapine. A bibliographic search was conducted as well.

STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the search were evaluated. All primary literature was included in the review.

DATA SYNTHESIS: Antipsychotic-induced akathisia can be difficult to manage and may respond to mirtazapine based on its antagonist activity at the serotonin 5-HT (2A)/5-HT(2C) receptors. Three case reports (N = 9 pts.), 1 placebo-controlled trial (N = 26), and 1 placebo- and propranotol-controlled study (N = 90) that evaluated mirtazapine tor antipsychotic-induced akathisia have been published. Mirtazapine demonstrated a response rate of 53.8% compared with a 7.7% response rate...

The Search for Medications to Treat Stimulant Dependence

Fri, 29 May 2009 08:47:35 +0000

Research review on pharmacological treatments for stimulant dependence that might help patients initiate abstinence or avoid relapse.

NIDA

Download File

Ketamine Aggravates Symptoms of Acute Stress Disorder in a Naturalistic Sample of Accident Victims

Fri, 29 May 2009 08:47:05 +0000

By Scho¨nenberg M.; Reichwald U.; Domes G.; Badke A.; Hautzinger M.

The glutamatergic N-methyl-D-aspartate receptor antagonist ketamine produces transient dissociative states and alters cognitive functioning in healthy humans, thus resembling the core symptoms of acute and chronic post-traumatic stress disorder (PTSD). First evidence exists that the common use of the analgesic and sedative properties of ketamine during emergency care correlates with sustained symptoms of PTSD in accident victims. The aim of the present study was to examine whether ketamine administration after moderate accidental trauma modulates dissociation and other symptoms of acute stress disorder (ASD) in the direct aftermath of the event. Accident victims were screened within the third day after admission to hospital for symptoms of ASD (Peritraumatic Dissociative Experiences Questionnaire, ASD Scale) and prior stressful life events (Traumatic Life Events Questionnaire). Subjects had received a single or fractionated dose of either racemic ketamine (n...

A prospective study of glycaemic status in anti-psychotic-treated patients

Fri, 29 May 2009 08:46:13 +0000

By Mackin P., Bishop D., Watkinson H.M., Ferrier I.N.

Anti-psychotic drugs, particularly the second generation, or 'atypical' agents, have been implicated in the development of metabolic dysfunction such as diabetes mellitus. There is a paucity of longitudinal data on the natural history of glucose homeostasis in anti-psychotic-treated patients, and there are no universally accepted strategies for managing worsening glycaemic control in this population. Notwithstanding, several guidelines recommend switching to a 'lower risk' agent if patients develop worsening glycaemic control during anti-psychotic treatment. We prospectively followed a cohort of 106 anti-psychotic-treated patients from across the diagnostic spectrum, and investigated changes in glycaemic status. Between baseline and follow-up assessment (mean follow-up time, 599.3 [SD (plus or minus) 235.4] days glycaemic status was unchanged in 78 (86.7%) patients; 5 (5.6%) reverted from impaired fasting glucose (IFG) to normoglycaemia in the absence of any pharmacological or lifestyle intervention and all were...

Clozapine-induced myocarditis after long-term treatment:

Fri, 29 May 2009 08:44:56 +0000

Case presentation and clinical perspectives

By Lang U.E., Willbring M., Von Golitschek R., Schmeisser A., Matschke K., Tugtekin S.M.

Anti-psychotic drugs, particularly the second generation, or 'atypical' agents, have been implicated in the development of metabolic dysfunction such as diabetes mellitus. There is a paucity of longitudinal data on the natural history of glucose homeostasis in anti-psychotic-treated patients, and there are no universally accepted strategies for managing worsening glycaemic control in this population. Notwithstanding, several guidelines recommend switching to a 'lower risk' agent if patients develop worsening glycaemic control during anti-psychotic treatment. We prospectively followed a cohort of 106 anti-psychotic-treated patients from across the diagnostic spectrum, and investigated changes in glycaemic status. Between baseline and follow-up assessment (mean follow-up time, 599.3 [SD (plus or minus) 235.4] days glycaemic status was unchanged in 78 (86.7%) patients; 5 (5.6%) reverted from impaired fasting...

Early onset of antipsychotic response in the treatment of acutely agitated patients with ...

Fri, 29 May 2009 08:43:57 +0000

By Agid O., Kapur S., Warrington L., Loebel A., Siu C.

Objective: While the efficacy of antipsychotic medications for the treatment of psychosis is generally established, the speed of onset of antipsychotic action remains controversial. The objective of this study was to evaluate the early response (within the first 24 h) in psychosis with ziprasidone IM treatment, and to determine whether this early effect is distinct from a reduction in agitation symptoms.

Methods: In a 24-h, double-blind study, hospitalized patients with psychotic disorder and acute agitation were randomized to treatment with fixed doses of IM ziprasidone: 2 mg (N = 38) or 20 mg (N = 41). Efficacy assessments were based on the PANSS positive subscale and PANSS early psychosis factor score (conceptual disorganization, hallucinatory behavior, and unusual thought content) at 4 and 24 h.

Results: Ziprasidone IM demonstrated...

Indiplon: A nonbenzodiazepine sedative-hypnotic for the treatment of insomnia

Fri, 29 May 2009 08:43:09 +0000

By Marrs J.C.

OBJECTIVE: To review the pharmacology, pharmacokinetics, pharmacodynamics, efficacy data, and adverse effects of indiplon in the treatment of transient and chronic insomnia in adult and geriatric patients.

DATA SOURCES: A literature search was conducted using MEDLINE (1966-May 2008), International Pharmaceutical Abstracts (1970-May 2008), and Cochrane database (2007) for the key words indiplon or NBI-34060. References cited in the articles were reviewed for additional information. Abstract data were included only in the absence of significant published data.

STUDY SELECTION AND DATA EXTRACTION: English-language literature reporting animal and human clinical studies was reviewed to evaluate data on the pharmacology, pharmacokinetics, pharmacodynamics, efficacy, and adverse effects of indiplon. Clinical trials selected for inclusion were limited to those with human subjects, with the accepted inclusion of pharmacology data in animals.

DATA SYNTHESIS: Indiplon is a nonbenzodiazepine...

Metabolic and hormonal side effects in children and adolescents treated with second-generation ...

Fri, 29 May 2009 08:42:23 +0000

By Fraguas D., Merchan-Naranjo J., Laita P., Parellada M., Moreno D., Ruiz-Sancho A., Cifuentes A., Giraldez M., Arango C.

Objective: The aim of this study was to evaluate metabolic and hormonal side effects in children and adolescents after 6 months of treatment with 3 different second-generation antipsychotics (SGAs).

Method: 66 children and adolescents (44 male [66.7%], mean (plus or minus) SD age=15.2 (plus or minus) 2.9 years) treated for 6 months with risperidone (N = 22), olanzapine (N = 20), or quetiapine (N = 24) composed the study sample. 34 patients (51.5%) suffered from schizophrenia or other psychosis (according to DSM-IV criteria). Patients were consecutively attending different programs from March 2005 to October 2006. Prior to enrollment in the study, patients were either antipsycholie-naive (37.9%, N = 25) or had been taking an antipsychotic drug for fewer than 30 days. Significant weight gain...