Prospective open-label study of add-on and monotherapy topiramate in civilians with chronic nonhallucinatory posttraumatic stress disorder

BACKGROUND: In order to confirm therapeutic effects of topiramate on posttraumatic stress disorder (PTSD) observed in a prior study, a new prospective, open-label study was conducted to examine acute responses in chronic, nonhallucinatory PTSD. METHODS: Thirty-three consecutive newly recruited civilian adult outpatients (mean age 46 years, 85% female) with DSM-IV-diagnosed chronic PTSD, excluding those with concurrent auditory or visual hallucinations, received topiramate either as monotherapy (n = 5) or augmentation (n = 28). The primary measure was a change in the PTSD Checklist-Civilian Version (PCL-C) score from baseline to 4 weeks, with response defined as a ≥ 30% reduction of PTSD symptoms. RESULTS: For those taking the PCL-C at both baseline and week 4 (n = 30), total symptoms declined by 49% at week 4 (paired t-test, P < 0.001) with similar subscale reductions for reexperiencing, avoidance/numbing, and hyperarousal symptoms. The response rate at week 4 was 77%. Age, sex, bipolar comorbidity, age at onset of PTSD, duration of symptoms, severity of baseline PCL-C score, and monotherapy versus add-on medication administration did not predict reduction in PTSD symptoms. Median time to full response was 9 days and median dosage was 50 mg/day. CONCLUSIONS: Promising open-label findings in a new sample converge with findings of a previous study. The use of topiramate for treatment of chronic PTSD, at least in civilians, warrants controlled clinical trials

Introduction: Interrogating the 'everyday' politics of emotions in international relations

The focus on the everyday in this Special Issue reveals different kinds of emotional practices, their political effects and their political contestation within both micro- and macro-politics in international relations. The articles in this Special Issue address the everyday negotiation of emotions, shifting between the reproduction of hegemonic structures of feelings and emancipation from them. In other words, the everyday politics of emotions allows an exploration of who gets to express emotions, what emotions are perceived as (il)legitimate or (un)desirable, how emotions are circulated and under what circumstances. Consequently, we identify two thematic strands which emerge as central to an interrogation of ‘everyday’ emotions in international relations and which run through each of the contributions: first, an exploration of the relationship between individual and collective emotions and, second, a focus on the role of embodiment within emotions research and its relationship with the dynamics and structures of power

Topiramate in the treatment of compulsive sexual behavior: case report

BACKGROUND: Among the multiple mechanisms of action of topiramate, AMPA/kainate antagonism may be particularly interesting for the treatment of disorders characterized by conditioned cognitive and behavioral cue reactivity. CASE PRESENTATION: We report the case of a patient consulting primarily for obesity and cue triggered snacking, who responded well on topiramate at doses up to 50 mg. Coincidentally he reported on an improvement of compulsive nonparaphilic sexual behaviors (consumption of prostitution), which was also strongly triggered by environmental cues. Both addictive behaviors (snacking and consumption of prostitution) reoccurred after discontinuation of topiramate and again responded reintroduction of the drug. CONCLUSION: The present case report of topiramate's effect on comorbid obesity and nonparaphilic addiction could be interpreted as a further indication that topiramate acts on the common pathway underlying conditioned behaviors and seems to be a treatment of behavioral disorders associated with environmental cues

A randomized, double-blind, placebo-controlled trial to assess the efficacy of topiramate in the treatment of post-traumatic stress disorder

<p>Abstract</p> <p>Background</p> <p>Topiramate might be effective in the treatment of posttraumatic stress disorder (PTSD) because of its antikindling effect and its action in both inhibitory and excitatory neurotransmitters. Open-label studies and few controlled trials have suggested that this anticonvulsant may have therapeutic potential in PTSD. This 12-week randomized, double-blind, placebo-controlled clinical trial will compare the efficacy of topiramate with placebo and study the tolerability of topiramate in the treatment of PTSD.</p> <p>Methods and design</p> <p>Seventy-two adult outpatients with DSM-IV-diagnosed PTSD will be recruited from the violence program of Federal University of São Paulo Hospital (UNIFESP). After informed consent, screening, and a one week period of wash out, subjects will be randomized to either placebo or topiramate for 12 weeks. The primary efficacy endpoint will be the change in the Clinician-administered PTSD scale (CAPS) total score from baseline to the final visit at 12 weeks.</p> <p>Discussion</p> <p>The development of treatments for PTSD is challenging due to the complexity of the symptoms and psychiatric comorbidities. The selective serotonin reuptake inhibitors (SSRIs) are the mainstream treatment for PTSD, but many patients do not have a satisfactory response to antidepressants. Although there are limited clinical studies available to assess the efficacy of topiramate for PTSD, the findings of prior trials suggest this anticonvulsant may be promising in the management of these patients.</p> <p>Trial Registration</p> <p>NCT 00725920</p

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

Introduction : narcissism, melancholia and the subject of community.

Sigmund Freud’s twin papers, ‘On Narcissism: An Introduction’ (1914) and ‘Mourning and Melancholia’ (1917 [1915]), take as their formative concern the difficulty of setting apart the ‘inner’ and the ‘outer’ worlds, and of preserving a stable image of a boundaried self. Whilst it is true that the term narcissism especially has come to be deployed in ways that seem foreign to the complexities of Freud’s 1914 paper (by its reduction to a personality disorder or its use as a broad-brush cultural diagnosis), we suggest in this introductory chapter that neither narcissism nor melancholia can be thought about today without expressing some debt to Freudian metapsychology. However, whereas Freud was most evidently concerned to describe the structure of ego-formation, subsequent commentators have preferred to emphasize the cultural and normative dimensions of these terms. Accordingly, we consider the respective discursive histories of narcissism and melancholia and find that although they have been put to work in very different ways they remain grounded by a shared concern with mechanisms of relation and identification. Indeed, this shared concern is the basis upon which they’ve been most productively reanimated in recent years: the rise of melancholia as a critical aid to the study of cultural displacement and dispossession, and the determined redemption of narcissism from its pejorative characterization as fundamentally anti-social. We argue that what is most noteworthy in this post-Freudian literature is the increasing relevance of metapsychology to social and political theory. The language of psychoanalysis, extrapolated from the clinic, permits a detailed examination of the boundaries which construct and challenge the terms of social solidarity. Specifically, this takes place though careful reading of the complex practices of (dis)identification at the heart of ego-formation (at both individual and group levels), and the associated mechanisms of defence, for example: introjection, incorporation, projective-identification, and splitting. By recognising the complexity of how communities get made, and connecting this with recent literature on counter publics and the commons, we demonstrate that Freud’s frameworks of narcissism and melancholia remain essential for any contemporary understanding of political association

Valproate in the treatment of PTSD: systematic review and meta analysis

Objective: Anticonvulsants are used in clinical practice for the treatment of PTSD. However, a systematic investigation of their effects in the treatment of PTSD is currently lacking from the literature. Our aim is to review and appraise the evidence for the use of the anticonvulsant valproate for the treatment of PTSD. Methods: We performed a systematic review and meta-analysis of the literature where valproate was used for the treatment of PTSD. Studies of treatment of PTSD with valproate were located using a search protocol which was applied to the electronic databases CINAHL, EMBASE, MEDLINE and PSYCHINFO. A search of the National PTSD Centre Pilots Database and of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) were also conducted. Findings: We only found one single-blinded study, four open-label studies and three case reports. These data do not allow for robust conclusions because of the design of the studies which are of limited patient number and open to bias. However, the studies reported that valproate was generally effective for the treatment of symptoms of PTSD by reducing hyperarousal, improving irritability and anger outbursts and improving mood. Conclusions: The limited evidence base suggests that valproate can be effective as a monotherapy for the treatment of both PTSD and mood symptoms, A double blind controlled study should be the next step to robustly study the efficacy of valproate on the treatment of PTSD