1,721,365 research outputs found
Switching from serotonin reuptake inhibitors to agomelatine in patients with refractory obsessive-compulsive disorder: a 3 month follow-up case series
Full text linkAbstract Background Serotonin reuptake inhibitors (SRIs) currently represent the cornerstone of obsessive-compulsive disorder (OCD) pharmacotherapy. However, OCD is characterized by high rates of partial and/or absent response to standard, recommended treatments, often prompting pharmacological and non-pharmacological augmentation or switching of strategies. Agomelatine, a novel melatonin agonist and selective serotonin antagonist (MASSA) antidepressant approved for major depressive disorder (MDD) has recently been additionally proposed as a treatment for anxiety disorders such as social anxiety disorder (SAD) and panic disorder (PD), but not yet OCD. Nonetheless, agomelatine may have a role in the management of OCD, essentially due to its anxiolytic 5-hydroxytryptamine (HT)2C blockade action, while melatonin (MT)1 and MT2 modulation might contribute to circadian rhythm restoration if impaired. Methods This case series reports the outcome of six patients with or without comorbid mood and/or other anxiety disorders who were treated with SRIs at adequate doses for at least 8 weeks, showing partial or no response. Patients were then switched to agomelatine 50 mg/day, and followed up for 12 weeks. Results Three out of six patients, in particular those with relevant circadian rhythm subjective impairment, showed a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score reduction of ≥35%. No relevant side effects were observed, but initial, transient, self-remitting dizziness in one patient and weight gain in another were seen. Conclusions Although clinical confounding factors (subthreshold bipolarity and eventually the presence of impaired circadian rhythms) and methodological boundaries (lack of control and neurophysiological recording, tiny sample size and short follow-up) limit the validity of this preliminary observation, it does indicate agomelatine may have a role in some SRI-refractory OCD cases, thus prompting the validity of investigation by further controlled studies, even for drug-naïve OCD patients.</p
Catatonia: a narrative review
No full textCatatonic syndromes involve a complex mixture of motor, behavioral, and systemic manifestations that are derived from unclear mechanisms. What is clear is that neurotransmitters, such as dopamine (DA), gamma-aminobutyric acid (GABA), and glutamate (GLU), are of major importance in the pathogenesis of catatonia and Neuroleptic Malignant Syndrome (NMS) and that serotonin (5-hydroxytryptamine [5-HT]) is crucial to the development of Serotonin Syndrome (SS). As medications with potent effects on modulation of monoamines proliferate, the diagnosis and management of these complex disorders become even more important. Without question, these syndromes have signs, symptoms and treatments that overlap, thus, considering the symptomatological load and the associated clinical burden (including potentially life-threatening conditions), the need for a better knowledge of the hypothesized biological mechanisms and pharmacological management is imperative. Although the search for a unique, conclusive approach to the management of catatonia is futile, stating the heterogeneity of the clinical pictures and the wide range of effective treatment choices (including non-pharmacological interventions), clinicians should not disregard an accurate, critical therapeutic approach to such a relevant, yet often disregarded, topic. The aim of this narrative review is to provide both clinicians and pharmacologists with a narrative, panoramic review on catatonia and associated clinical pictures, focusing on its general pharmacological management
Beyond monoamines towards the development of novel antidepressants
No full textObjective: Herein, a concise review is presented on the current and most promising antidepressant pharmacological agents for management of depression. Materials and methods: A PubMed search (1966 - February 2012) was performed using the following keywords or their combination: "depression"; "major depressive disorder": "antidepressants"; "novel antidepressant targets"; "monoamine"; "novel antidepressants". Additional literature sources, including most authoritative and updated edited books or pamphlets were examined accordingly. Results: All relevant literature sources written in English were evaluated giving priority to RCTs and meta-analyses. At present, the pharmacological management of depression appears is characterized by a wide variety of different augmentation or switching approaches (Fig. 1). Nonetheless, response rates remain substantially unsatisfactory, thus prompting for the development of novel agents with different mechanisms of action. Conclusions: Shifting the interest for novel antidepressant drugs beyond the monoaminergic modulation represents (Tables I-III) an intriguing opportunity to enhance response rates of depression, although other issues, including revision of current nosological boundaries, should also be considered
Obsessive-compulsive disorder with bipolar diathesis following isotretinoin therapy remitting upon treatment with olanzapine and fluvoxamine
Full text linkMichele FornaroDepartment of Neuroscience, Section of Psychiatry, University of Genoa, Genoa, ItalyAbstract: Isotretinoin, a drug used for moderate to severe acne, has been repeatedly associated with various psychiatric complications, although a definitive causal relationship has not been established to date. This case report describes a 25-year-old male who developed obsessive-compulsive disorder at the age of 23 years following isotretinoin treatment for acne (10&ndash;20 mg/day) since the age of 16 years. Although standard treatment for obsessive-compulsive disorder caused mood swings, the combination of fluvoxamine 300 mg/day and olanzapine 15 mg/day significantly improves the clinical picture. Although rare, severe adulthood psychiatric complications may occur following isotretinoin treatment, requiring management which is individually tailored to the patient.Keywords: isotretinoin, obsessive-compulsive disorder, olanzapine, fluvoxamine, treatmen
Current nosology of treatment resistant depression: a controversy resistant to revision
Full text linkTreatment-Resistant Depression (TRD) represents a source of ongoing clinical and nosological controversy and confusion. While no univocal consensus on its definition and specific correlation with major mood disorders has been reached to date, a progressively greater number of evidences tend to suggest a revision of current clinical nosology. Since a better assessment of TRD should be considered mandatory in order to achieve the most appropriate clinical management, this narrative review aims to briefly present current most accepted definitions of the phenomenon, speculating on its putative bipolar diathesis for some of the cases originally assessed as unipolar depression
Adherence to Chronic Therapies in Psychiatry: From Treatment to Cure.The Relevance of Therapeutic Relationship
Full text linkCorso Enable (Bristol Myers Squibb) - “Come evitare l’eccessiva sedazione per ottimizzare gli esiti del trattamento del disturbo bipolare”, La Spezia il 24 marzo 2011.
No full textSuggerimenti clinici per impiego preferenziale aripiprazol
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