A Review of Pharmacologic Treatment for Compulsive Buying Disorder

At present, no treatment recommendations can be made for compulsive buying disorder. Recent studies have found evidence for the efficacy of psychotherapeutic options, but less is known regarding the best pharmacologic treatment. The purpose of this review is to present and analyze the available published evidence on the pharmacological treatment of compulsive buying disorder. To achieve this, we conducted a review of studies focusing on the pharmacological treatment of compulsive buying by searching the PubMed/MEDLINE database. Selection criteria were applied, and 21 studies were identified. Pharmacological classes reported included antidepressants, mood stabilizers, opioid antagonists, second-generation antipsychotics, and N-methyl-D-aspartate receptor antagonists. We found only placebo-controlled trials for fluvoxamine; none showed effectiveness against placebo. Three open-label trials reported clinical improvement with citalopram; one was followed by a double-blind discontinuation. Escitalopram was effective in an open-label trial but did not show efficacy in the double-blind phase. Memantine was identified as effective in a pilot open-label study. Fluoxetine, bupropion, nortriptyline, clomipramine, topiramate and naltrexone were only reported to be effective in clinical cases. According to the available literature, there is no evidence to propose a specific pharmacologic agent for compulsive buying disorder. Future research is required for a better understanding of both pathogenesis and treatment of this disorder.info:eu-repo/semantics/publishedVersio

Relationship of Paroxysmal Atrial Tachyarrhythmias to Volume Overload

BACKGROUND: Clinical experience suggests that atrial tachyarrhythmias (ATs) are a frequent comorbidity in heart failure patients with left ventricular systolic dysfunction and that volume overload may increase AT susceptibility. However, substantiating this apparent relationship in free-living patients is difficult. Recently, certain implantable cardioverter-defibrillators provide, by measuring transpulmonary electric bioimpedance, an index of intrathoracic fluid status (OptiVol index [OI]). The goal of this study was to determine whether periods of greater intrathoracic fluid congestion (as detected by OI) correspond with increased AT event frequency. METHODS AND RESULTS: This analysis retrospectively assessed the relation between AT events and OI estimate of volume overload in patients with left ventricular systolic dysfunction and OI-capable implantable cardioverter-defibrillators. OI values were stratified into 3 levels: group 1, \u3c40; group 2, 40 to 60; and group 3, \u3e60. An OI threshold-crossing event was defined as OI \u3e or = 60, a value previously associated with clinically significant volume overload. Findings in 59 patients (mean left ventricular ejection fraction, 24%) with 225 follow-up visits (mean, 3.8 visits per patient) were evaluated. AT prevalence was 73%. AT frequency (percent of patients visits with at least 1 episode of AT since previous device interrogation) was greater in group 3 versus group 1 (P=0.0342). Finally, in terms of temporal sequence, AT episodes preceded OI threshold-crossing event in 43% of incidences, followed threshold-crossing event in 29%, and was simultaneous or indeterminate in the remainder. CONCLUSIONS: These findings not only support the view that worsening pulmonary congestion is associated with increased AT frequency in patients with left ventricular dysfunction but also suggest that AT events may be responsible for triggering episodic pulmonary congestion more often than previously suspected

Culture bound syndromes- a cross-sectional study from India

IntroductionSociocultural factors profoundly influence and determine every aspect of psychiatric disorder. The term culture bound syndrome refers to psychopathological entities that are not mere variants of well recognized psychiatric disorder, have a geographically defined prevalence, and are largely determined, at least in their symptoms by the beliefs and assumptions prevalent in the native culture. Dhat syndrome, possession syndrome, Koro, Ascetic syndrome, Gilhari syndrome are some of the frequently reported culture bound syndromes from Indian subcontinent.ObjectivesTo assess the prevalence rates and psychiatric co morbidities in patients affected by Dhat syndrome, possession syndrome, Koro, Ascetic syndrome, Gilhari syndrome.Methods50 subjects of either sex affected by at least one of the following culture bound syndromes - Dhat syndrome, possession syndrome, Koro, Ascetic syndrome, Gilhari syndrome were recruited on consecutive basis from the patients attending psychiatry outpatients department of a tertiary care hospital in Delhi, India. The selected subjects were assessed for respective prevalence rates and co morbidity profile in patients affected with above listed culture bound syndromes.ResultsOf 50 cases of culture bound syndromes seen in psychiatry OPD, Dhat syndrome was most common (80%), followed by Possession syndrome (14%), Ascetic syndrome (2%), Gilhari syndrome (2%), Koro (2%). Depression was the most common associated psychiatric disorder.ConclusionsCulture bound syndromes exhibit significant psychiatric co morbidity, this study calls for careful evaluation of these patients psychologically to detect and treat the associated psychiatric co morbidity appropriately.</jats:sec

A study on comorbidities, knowledge and attitudes among patients of dhat syndrome

IntroductionDhat syndrome is a commonly recognized clinical entity in Indian culture. It consists of vague somatic symptoms (fatigue, weakness, anxiety, loss of appetite, guilt, etc.) and at times sexual dysfunction (impotence or premature ejaculation), which the patient attributes to the passing of semen (Dhat) in urine as a direct consequence of his excessive indulgence in masturbation or sexual intercourse.ObjectivesTo assess medical and psychiatric co-morbidities and prevalent knowledge and attitudes among patients of Dhat syndrome.MethodsA cross-sectional study of 50 consecutive male patients with Dhat syndrome attending psychosexual clinic of a tertiary care hospital in Delhi was performed to ascertain co-morbid psychiatric and medical disorders and the prevalent knowledge and attitudes of subjects towards Dhat syndrome and its management.ResultsThe commonest associated psychiatric illness was neurotic depression followed by anxiety neurosis. The commonest associated medical illness was urinary tract infections (UTI) followed by sexually transmitted diseases (STDs). Majority of subjects believed Dhat to be semen; that Dhat syndrome causes both physical and mental weakness and; that health tonics are required for successful management of Dhat syndrome. More than half of the subjects believed that masturbation causes Dhat syndrome. The study reveals a change in knowledge and attitudes of patients affected with Dhat syndrome in the last decade.ConclusionsDhat syndrome exhibits significant medical and psychiatric co-morbidity. The findings of this study need to be further evaluated in the immigrant population.</jats:sec