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Il trattamento del disturbo ossessivo-compulsivo: Farmaci, psicoterapia o trattamento integrato?
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Olanzapine or lamotrigine addition to lithium in remitted bipolar disorder patients with anxiety disorder comorbidity: a randomized, single-blind, pilot study
No full textOBJECTIVE: The aim of the present randomized, single-blind, pilot study was to assess the efficacy of the addition of a second mood stabilizer, either olanzapine or lamotrigine, to lithium in patients with remitted bipolar disorder and comorbid anxiety disorder. METHOD: Adult DSM-IV bipolar disorder patients with a current anxiety disorder and a Hamilton Rating Scale for Anxiety (HAM-A) score of 12 or higher, in remission from an affective episode for at least 2 months while on lithium maintenance treatment, were randomly assigned to receive 12 weeks of single-blind olanzapine 5 to 10 mg/day (N = 24) or lamotrigine 50 to 200 mg/day (N = 23) addition to lithium. The primary outcome measure was the HAM-A; secondary outcome measures were the Clinical Global Impressions-Severity of Illness scale and the Global Assessment of Functioning (GAF) scale. Data were collected from July 2005 to February 2007. RESULTS: Twenty-two patients in the olanzapine and 18 in the lamotrigine group completed the trial. Mean +/- SD final doses of olanzapine and lamotrigine were, respectively, 7.7 +/- 4.2 mg/day and 96.7 +/- 46.7 mg/day in the intent-to-treat sample (N = 47). Both olanzapine and lamotrigine were effective in reducing HAM-A scores from baseline to endpoint (paired t test for completers: t = 11.361, df = 21, p < .001 for olanzapine and t = 6.301, df = 17, p < .001 for lamotrigine). Both drugs were also effective on the secondary outcome measures. Olanzapine was more effective than lamotrigine at weeks 6 and 12 with a last-observation-carried-forward analysis on all 3 outcome measures, while such differences disappeared on the HAM-A and GAF at week 12 with the visit-wise analysis. CONCLUSIONS: The addition of a second mood stabilizer (olanzapine or lamotrigine) to lithium is effective in reducing anxiety symptoms in bipolar disorder patients with a co-occurring anxiety disorder
Management of treatment resistant obsessive-compulsive disorder. Algorithms for pharmacotherapy
No full textTreatment resistant OCD subjects, defined as those patients who undergo an adequate trial of SRI (clomipramine or SSRI) and do not respond or show unsatisfactory results, account for 40-50% of all patients. Once the appropriateness of the trial has been assessed, several options exist for the clinicians. If clomipramine or citalopram have been used, an appropriate strategy consists in giving the same drug intravenously. Double-blind studies exist on the efficacy of clomipramine IV, while data are missing for citalopram. Another option that should be considered first, although data are scarce, is the addition of a cognitive behavioral therapy, when available, in the forms of exposure and response prevention. When such options are not suitable or available, augmentation of the ongoing SRI with another compound represents the preferable strategy. Double-blind, placebo-controlled studies have shown the efficacy of adding pindolol (7.5 mg/d), risperidone (2 mg/d) and olanzapine (5-10 mg/d). Other agents have been proposed, but data emerging from double-blind studies were negative or contradictory. Another option available is switching from CMI to SSRI, or vice versa, or from SSRI to SSRI. Data regarding such treatment strategy, however, are highly preliminary, based on a couple of open label reports and on studies performed in treatment resistant depression. An unresolved question is whether augmentation should be preferred to switching. No data exist in OCD; a practical approach would suggest augmentation first, considering that response should be obtained faster than by switching compound. When all the available and effective strategies prove uneffective, clinicians should consider switching the patient to other compounds in monotherapy, such as venlafaxine, sumatriptan, inositol, although research is strongly needed before conclusions on the efficacy of such compounds can be drawn
La stabilità temporale dei sintomi ossessivo-compulsivi in un campione di pazienti con DOC
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Sleep disturbance in obsessive-compulsive disorder
No full textIntroduction: Obsessive-Compulsive Disorder (OCD) is a common, chronic disorder which results in marked distress and impairment of social and occupational functioning. Sleep disturbance often accompanies mental disorders, but there have been few studies of sleep disturbance in OCD. These have produced contradictory findings, with some reporting sleep disruption, and others a normal sleep pattern. The aim of the present study is to examine sleep patterns in OCD, to establish the frequency of the different types of insomnia (early, middle and late insomnia) in a sample of patients with OCD. The study also intends to determine whether the presence of a comorbid mood disorder influence frequency and type of insomnia. Methods: all patients with a primary diagnosis of OCD (according to DSM-IV criteria) consecutively referred to the Mood and Anxiety Disorder Unit, Department of Neuroscience, University of Turin, from January 2003 to June 2008, were recruited. Frequency and severity of the different types of insomnia were evaluated on the basis of the Hamilton Depression Rating Scale (HDRS) specific items score (item 4-5-6). A statistical comparison between OCD patients with and without insomnia was performed to examine whether there was any difference in clinical features. Then a statistical comparison between patients with and without depressive comorbidity was performed to examine whether there was any difference in prevalence and type of insomnia. Results: The sample included 315 OCD patients. More than a half of the sample suffered from any type of insomnia. The most frequent type of insomnia was early insomnia (about 44,8%). We didn't find a positive correlation between the severity measured with total Y-BOCS score or obsessions and compulsions sub-score clinical and socio-demographic features and insomnia. The presence of any comorbid depressive disorder increased the frequency of insomnia. Conclusions: Insomnia, especially the early one, is a common symptom in OCD patients with or without comorbid depressive disorders. Late insomnia is typical of OCD with comorbid major depression. © 2010 Nova Science Publishers, Inc. All rights reserved
Quality of life of relatives of patients with obsessive-compulsive disorder: relation to family accomodation and other socio-demographic and clinical characteristics
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