Clozapine versus...


Clozapine versus other atypical antipsychotics for schizophrenia (>> click to go to the journal's website)
Cochrane Reviews, 12/01/10
Asenjo Lobos C et al. – Clozapine was somewhat more efficacious than zotepine. Also, inefficacy of treatment led more frequently to leaving the studies early in the risperidone group suggesting a certain higher efficacy of clozapine. The principal drawback of clozapine were its adverse effects which lead to significantly higher numbers of participants leaving the studies early compared to olanzapine and risperidone. Clozapine was associated with more sedation and hypersalivation than olanzapine, quetiapine and risperidone and with more seizures than olanzapine and risperidone. There was a higher incidence of white blood cell decrease in clozapine groups than olanzapine and more weight gain than in risperidone groups. On the other hand clozapine produced fewer movement disorder than risperidone and less prolactin increase than olanzapine, quetiapine and zotepine.





Presynaptic Dopamine in Schizophrenia (>> click to go to the journal's website)
CNS Neuroscience & Therapeutics, 01/10/11
Miyake N et al. – Excessive striatal presynaptic dopamine is linked to the emergence of acute psychotic symptoms and to their response to treatment in schizophrenia. Understanding the etiology of this dysregulation and its consequences on the rest of the circuitry is important for future drug development.







The Role of Beta-Blockers as First-Line Therapy in Hypertension (>> click to go to the journal's website)
Current Atherosclerosis Reports, 01/07/11
De Caterina AR et al. – Thee available evidence does not support the use of beta–blockers (BBs) as first–line drugs in the treatment of uncomplicated hypertension. It remains to be determined whether newer BBs, such as nebivolol and carvedilol, will be more effective than older compounds in improving cardiovascular prognosis.






Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review (>> click to go to the journal's website)
Journal of General Internal Medicine, 01/10/11
Trivedi RB et al. – Review demonstrates the utility of psychotherapy in managing treatment resistant depression. However, evidence is sparse and results are mixed. Given that quality trials are lacking, rigorous clinical trials are recommended to guide practice. In the interim, primary care providers should consider psychotherapy when treating patients with treatment resistant depression.






Beta-Blockers in Hypertension (>> click to go to the journal's website)
The American Journal of Cardiology, 12/13/10
Ram CVS – Much of the unfavorable data revealed in the recent meta–analyses were gleaned from studies involving nonvasodilating, traditional (beta) blockers, such as atenolol. However, findings with traditional (beta) blockers may not be extrapolated to other members of the class, particularly those agents with vasodilatory activity. Vasodilatory (beta) blockers (i.e., carvedilol and nebivolol) reduce blood pressure in large part through reducing systemic vascular resistance rather than by decreasing cardiac output, as is observed with traditional (beta) blockers. It is time for a reexamination of the clinical evidence for the use of (beta) blockers in hypertension, recognizing that there are patients for whom (beta) blockers, particularly those with vasodilatory actions, are an appropriate treatment option.






The effect of low-dose spironolactone on resistant hypertension (>> click to go to the journal's website)
Journal of the American Society of Hypertension, 12/23/10
Engbaek M et al. – The objective was to estimate the effect of addition of low–dose spironolactone to previous antihypertensive therapy in patients with resistant hypertension. Patients had 25 to 50 mg of spironolactone once daily added to the treatment of hypertension that was uncontrolled despite previous treatment with three classes of antihypertensive drugs. The effect on blood pressure was estimated by office measurements together with serum potassium and adverse effects. Low–dose spironolactone is highly effective when added to previous treatment of patients with resistant hypertension.






The Role of Benzodiazepines in the Treatment of Anxiety Disorders (>> click to go to the journal's website)
Psychiatric Annals, 12/16/10
Macaluso M et al. – Since the patent of chlordiazepoxide nearly 50 years ago, benzodiazepines are one of the most widely prescribed psychotropic medications worldwide. As a class, benzodiazepines share the following properties: anxiolytic, hypnotic, sedative, anticonvulsant, amnestic, and muscle relaxant. These effects are mediated through agonist activity at GABA–A receptors, where endogenous GABA binding has inhibitory effects.






Treatment of trigeminal neuralgia: role of radiofrequency ablation (>> click to go to the journal's website)
Journal of Pain Research, 01/03/11
Emril DR et al. – Trigeminal neuralgia (TN) is a neuropathic pain condition affecting the face. It has a significant impact on the quality of life and physical function of patients. Evidence suggests that the likely etiology is vascular compression of the trigeminal nerve leading to focal demyelination and aberrant neural discharge. Secondary causes such as multiple sclerosis or brain tumors can also produce symptomatic TN. Treatment must be individualized to each patient. Carbamazepine remains the drug of choice in the first–line treatment of TN.






Antipsychotic Occupancy of Dopamine Receptors in Schizophrenia (>> click to go to the journal's website)
CNS Neuroscience & Therapeutics, 01/03/11

Nord M et al. – The positron emission tomography (PET)–defined interval for optimal antipsychotic drug treatment has been implemented in the evolvement of dose recommendations for classical as well as more recently developed drugs. Another consistent finding is lower D2–occupancy during treatment with the prototype atypical antipsychotic clozapine. The mechanism of action(MoA) of clozapine remains to be fully understood and may include nondopaminergic mechanisms. A general limitation is that currently available PET–radioligands are not selective for any of the five dopamine receptor subtypes. Current attempts at developing such ligands may provide the tools required to refine further the MoA of antipsychotic drugs.

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