MDLinx - Recent Articles

Efficacy of frovatriptan in the acute treatment of menstrually related migraine: analysis of a double-blind, randomized, cross-over, multicenter, Italian, comparative study versus rizatriptan
The Journal of Headache and Pain, 08/17/11
Savi L et al. – These results need to be confirmed by randomized, double–blind, prospective, large clinical trials. Methods
  • A multicenter, randomized, double blind, cross–over study.
  • Each patient received frovatriptan 2.5 mg or rizatriptan 10 mg in a randomized sequence: after treating 3 episodes of migraine in not more than 3 months with the first treatment, the patient had to switch to the other treatment.
  • Menstrually related migraine was defined according to the criteria listed in the Appendix of the last IHS Classification of Headache disorders.
  • 99 out of the 125 patients included in the intention–to–treat analysis of the main study were of a female gender: 93 had regular menstrual cycles and were, thus, included in this analysis.
Results
  • A total of 49 attacks classified as menstrually related migraine were treated with frovatriptan and 59 with rizatriptan.
  • Rate of pain relief at 2 h was 58% for frovatriptan and 64% for rizatriptan (p = NS), while rate of pain free at 2 h was 31 and 34% (p = NS), respectively.
  • At 24 h, 67 and 81% of frovatriptan–treated, and 61 and 74% of rizatriptan–treated patients were pain free and had pain relief, respectively (p = NS).
  • Recurrence at 24 h was significantly (p < 0.01) lower with frovatriptan (10 vs. 32% rizatriptan).
  • Frovatriptan was as effective as rizatriptan in the immediate treatment of menstrually related migraine attacks while showing a favorable sustained effect with a lower rate of migraine recurrence.

 

 

 

 

The endocannabinoid system in anxiety, fear memory and habituation
Journal of Psychopharmacology, 08/19/11
Ruehle S et al. – In fear memory paradigms, the endocannabinoid system (ECS) is mostly involved in the two opposing processes of reconsolidation and extinction of the fear memory. Whereas ECS activation deteriorates reconsolidation, proper extinction depends on intact cannabinoid type 1 (CB1) receptor signalling. Thus, both for anxiety and fear memory processing, endocannabinoid signalling may ensure an appropriate reaction to stressful events. Therefore, the ECS can be considered as a regulatory buffer system for emotional response

 

 

 

 

Treatment of severe borderline personality disorder with clozapine
Indian Journal of Psychiatry, 11/02/10
Vohra AK – Patients with borderline personality disorder (BPD) show significant impairment in the domain of interpersonal and social functioning and may use the resources of health and social services extensively, with little beneficial outcome. At present there are no clear guidelines in literature for the use of pharmacotherapy in the management of BPD. According to the scanty literature available in the form of case reports and small studies, clozapine has been demonstrated to be effective in the management of BPD.

 

 

 

 

Oral versus depot antipsychotic drugs for schizophrenia--A critical systematic review and meta-analysis of randomised long-term trials
Schizophrenia Research, 02/08/11
Leucht C et al. – Non–adherence is a major problem in the treatment of schizophrenia. Depot antipsychotic drugs are thought to reduce relapse rates by improving adherence, but a systematic review of long–term studies in outpatients is not available. Depot antipsychotic drugs significantly reduced relapse. Due to a number of methodological problems in the single trials the evidence is, nonetheless, subject to possible bias.

 

 

 

 

 

Treatment-Refractory Generalized Anxiety Disorder
Psychiatric Annals, 02/21/11
Starcevic V et al. – It has been reported that about half of patients with generalized anxiety disorder (GAD) do not respond adequately to standard pharmacological treatments, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and imipramine, with or without a benzodiazepine.

 

 

 

 

 

Clinical potential of lurasidone in the management of schizophrenia
Therapeutics and Clinical Risk Management, 06/29/11

Samalin L et al. - The efficacy of lurasidone with regard to cognitive functions and depressive symptoms seems good, but requires further work. Lurasidone differs from the other second-generation antipsychotics by having a good tolerability profile, in particular for cardiometabolic tolerability. However, it seems to have a significant although moderate link with the occurrence of akathisia, extrapyramidal symptoms, and hyperprolactinemia at the start of treatment. This tolerance profile greatly broadens the scope of second-generation antipsychotics and so supports the view of some authors that the term ?second-generation antipsychotic? is now outdated.
  • Lurasidone is a new second-generation antipsychotic approved in October 2010 by the Food and Drug Administration for the treatment of schizophrenia.
  • Like other second-generation antipsychotics, lurasidone is a powerful antagonist of D2 dopamine and 5HT2A serotonin receptors, but differs from the other second-generation antipsychotics in its action profile for certain receptors.
  • Lurasidone is the second-generation antipsychotic with the greatest affinity for 5HT7 receptors and has a high affinity for 5HT1A serotonin receptors, compatible with favorable effects on cognitive function and an antidepressant action.
  • By contrast, lurasidone has a low affinity for α1 and α2C-adrenergic and 5HT2C serotonin receptors, and no affinity for histaminergic H1 or muscarinic M1 receptors, suggesting a better tolerability profile than the other second-generation antipsychotics.
  • Lurasidone has demonstrated its efficacy in several short-term trials in acute schizophrenia, promptly and significantly reducing total Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores compared with placebo.
  • Several long-term studies are in progress to assess its efficacy in the maintenance treatment of schizophrenic patients.

 

 

 

 

Valproate v. lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study
British Journal of Psychiatry, 07/27/11
Kessing LV et al. ? In daily clinical practice, treatment with lithium seems in general to be superior to treatment with valproate. Methods
  • An observational cohort study with linkage of nationwide registers of all people with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed valproate or lithium in Denmark during a period from 1995 to 2006.
Results
  • A total of 4268 participants were included among whom 719 received valproate and 3549 received lithium subsequent to the diagnosis of bipolar disorder.
  • The rate of switch/add on to the opposite drug (lithium or valproate), antidepressants, antipsychotics or anticonvulsants (other than valproate) was increased for valproate compared with lithium (hazard ratio (HR) = 1.86, 95% CI 1.59?2.16).
  • The rate of psychiatric hospital admissions was increased for valproate v. lithium (HR = 1.33, 95% CI 1.18–1.48) and regardless of the type of episode leading to a hospital admission (depressive or manic/mixed).
  • Similarly, for participants with a depressive index episode, a manic index episode and a mixed index episode, the overall rate of hospital admissions was significantly increased for valproate compared with lithium.

 

 

 

 

Benzodiazepine Use Among Patients With Schizophrenia in Taiwan: A Nationwide Population-Based Survey
Psychiatric Services, 08/10/11
Wu CS et al. – The study showed that benzodiazepine use was highly prevalent among patients with schizophrenia in Taiwan and that a substantial proportion of users (62.9%) were long–term users. Because long–term use was associated with longer duration of illness and with use of concomitant psychotropic medications, long–term users may be at higher risk of neurocognitive side effects caused by benzodiazepines and interactions with other psychotropic medications. Therefore, this group should be closely monitored for drug–drug interactions and the benefits and risks of benzodiazepine use.

 

 

 

 

What is the optimal dose of escitalopram for the treatment of obsessive-compulsive disorder? A naturalistic open-label study
International Clinical Psychopharmacology, 08/11/11
Shim G et al. ? These results imply that doses less than or equal to 40 mg/day ESC are sufficient for symptomatic improvement with good tolerability for most patients. Very high doses of ESC, on the other hand, can be considered for patients with inadequate therapeutic responses to the administration of 40 mg/day ESC. Methods
  • Explored efficacy and tolerability of very high doses (maximum dose of >40 mg/day), high doses (maximum dose of 25?40 mg/day), and standard doses (maximum dose of &le20 mg/day) of escitalopram (ESC) as an anti-obsessive?compulsive disorder treatment in a naturalistic clinical setting
  • Reviewed medical records of all patients with OCD (n=246) who had taken ESC between May 2006 and September 2009, and assigned Clinical Global Impression (CGI) scores
  • Of total sample, 24.4, 38.2, and 37.4% patients received very high, high, and standard doses of ESC, and the mean daily maximum doses of ESC were 57.3�12.0 mg, 33.9�5.4 mg, and 13.4�5.8 mg
Results
  • CGI-Severity scores in each group decreased significantly after treatment with ESC, as evidenced by response rates (i.e. CGI-Improvement scores of 1 or 2) of 46.3, 43.2, and 26.2%

 

 

 

 

What is the optimal dose of escitalopram for the treatment of obsessive-compulsive disorder? A naturalistic open-label study
International Clinical Psychopharmacology, 08/11/11
Shim G et al. ? These results imply that doses less than or equal to 40 mg/day ESC are sufficient for symptomatic improvement with good tolerability for most patients. Very high doses of ESC, on the other hand, can be considered for patients with inadequate therapeutic responses to the administration of 40 mg/day ESC. Methods
  • Explored efficacy and tolerability of very high doses (maximum dose of >40 mg/day), high doses (maximum dose of 25?40 mg/day), and standard doses (maximum dose of &le20 mg/day) of escitalopram (ESC) as an anti-obsessive?compulsive disorder treatment in a naturalistic clinical setting
  • Reviewed medical records of all patients with OCD (n=246) who had taken ESC between May 2006 and September 2009, and assigned Clinical Global Impression (CGI) scores
  • Of total sample, 24.4, 38.2, and 37.4% patients received very high, high, and standard doses of ESC, and the mean daily maximum doses of ESC were 57.3�12.0 mg, 33.9�5.4 mg, and 13.4�5.8 mg
Results
  • CGI-Severity scores in each group decreased significantly after treatment with ESC, as evidenced by response rates (i.e. CGI-Improvement scores of 1 or 2) of 46.3, 43.2, and 26.2%

 

 

 

 

Efficacy of pregabalin in preventing relapse in patients with generalized social anxiety disorder: results of a double-blind, placebo-controlled 26-week study
International Clinical Psychopharmacology, 08/16/11
Greist JH et al. – The results of this study suggest that pregabalin (450 mg/day) is safe, well tolerated, and has significant relapse–prevention efficacy over 26 weeks in patients with social anxiety disorder (SAD) who responded to an initial course of the pregabalin treatment.

 

 

 

 

Tolerability profile of aripiprazole in patients with Tourette syndrome
Journal of Psychopharmacology, 08/16/11
Cavanna AE et al. – The discontinuation rate of 20.7% suggests that aripiprazole is safe and reasonably well tolerated for use in TS. The prevalence of adverse effects appears to increase with treatment duration.

 

 

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