Textbook of Psychiatry First Edition, Draft 2

This multi-authored collaborative textbook on psychiatry, originally created on Wikibooks, discusses a range of psychiatric disorders, including psychotic, mood and and anxiety disorders, amongst many others. It covers other aspects of psychiatric care such as diagnosis, neurobiology, psychopharmacology, treatment methods, and dealing with agitated or violent patients

O que nossos pacientes querem e necessitam saber sobre transtorno de ansiedade generalizada?

Pessoas com transtorno de ansiedade generalizada geralmente não procuram tratamento e, se o fazem, é mais devido aos sintomas somáticos (tensão muscular, insônia) ou a uma depressão secundária do que por causa da característica central do transtorno de ansiedade generalizada: preocupação. O aspecto da preocupação torna-se aparente quando se propõe que o paciente tome uma medicação ansiolítica. O clínico terá então que estar preparado para responder a muitas perguntas sobre os riscos e benefícios potenciais de tal medicação. Esses pacientes tendem a ter uma atitude cética, por terem obtido informações em websites que apresentam afirmações que não têm nenhum embasamento científico ou alegações distorcidas, equivocadas e infundadas. Quais são as perguntas freqüentes que os pacientes preocupados colocam ao clínico antes de aceitarem a farmacoterapia ansiolítica? Tendo atendido a pacientes ansiosos em meu consultório por 25 anos, e tendo realizado vários ensaios clínicos com ansiolíticos, reuni neste artigo, em linguagem simples, as respostas baseadas em evidências a essas perguntas

Establishing non-inferiority in treatment trials in psychiatry - guidelines from an Expert Consensus Meeting

Comparing the efficacy of different treatments in psychiatry is difficult for many reasons, even when they are investigated in `head-to-head' studies. A consensus meeting was, therefore, held to produce best practice guidelines for such studies. This article presents the conclusions of this consensus and illustrates it using published data in the field of antidepressant treatment of generalized anxiety disorder

Efficacy of venlafaxine extended release in major depressive disorder patients : effect of baseline anxiety symptom severity

Effects of baseline anxiety on the efficacy of venlafaxine extended release versus placebo were examined in a post hoc pooled subgroup analysis of 1573 patients enrolled in eight short-term studies of major depressive disorder. Anxiety subgroups were defined based on baseline 17-item Hamilton Rating Scale for Depression Item 10 score <3 (low) versus >= 3 (high). Change from baseline to final visit in Montgomery-Asberg Depression Rating Scale total score and Montgomery-Asberg Depression Rating Scale response and remission rates were analyzed. Change from baseline in Montgomery-Asberg Depression Rating Scale total score and response and remission rates was significantly greater for venlafaxine extended release versus placebo in both low and high anxiety subgroups (all P < 0.0001). A statistically significant baseline anxiety by treatment interaction was observed for Montgomery-Asberg Depression Rating Scale total score only (P = 0.0152). The adjusted mean change from baseline in Montgomery-Asberg Depression Rating Scale total score was significantly greater in the high anxiety subgroup versus low anxiety subgroup for patients treated with venlafaxine extended release (-6.27 versus -3.89; P = 0.0440) but not placebo. These results support the efficacy of venlafaxine extended release for major depressive disorder treatment in patients with anxiety symptoms. Copyright (C) 2019 The Author(s). Published by Wolters Kluwer Health, Inc

A possible association between panic disorder and a polymorphism in the preproghrelin gene

The aim of the study was to investigate whether polymorphisms in the preproghrelin gene are associated with anxiety disorders, such as panic disorder, in humans. Panic disorder is a severe anxiety disorder, characterized by sudden attacks of intense fear or anxiety in combination with somatic symptoms. The preproghrelin gene codes for two gut-derived circulating peptides that have been linked to anxiety-like behaviour in rodents: ghrelin (an orexigenic, pro-obesity hormone) and obestatin. In the present study, we genotyped three missense mutations in the preproghrelin gene in 215 patients suffering from panic disorder and in 451 controls. The A allele of the rs4684677 polymorphism was significantly associated with panic disorder, while there were no significant associations with the two other polymorphisms studied. We conclude that the rs4684677 (Gln90Leu) polymorphism in the preproghrelin gene may be associated with increased risk of panic disorder. It will be important to confirm these findings in additional panic disorder patient groups.Funding Agencies|Swedish Research Council for Medicine|2009-S266|European Commission|FP7-HEALTH-2009-241592FP7-KBBE-2009-3-245009FP7-KBBE-2010-4-266408|FOU/ALF Goteborg|ALFGBG-138741|Swedish Foundation for Strategic Research|A305-188|</p

A possible association between panic disorder and a polymorphism in the preproghrelin gene

The aim of the study was to investigate whether polymorphisms in the preproghrelin gene are associated with anxiety disorders, such as panic disorder, in humans. Panic disorder is a severe anxiety disorder, characterized by sudden attacks of intense fear or anxiety in combination with somatic symptoms. The preproghrelin gene codes for two gut-derived circulating peptides that have been linked to anxiety-like behaviour in rodents: ghrelin (an orexigenic, pro-obesity hormone) and obestatin. In the present study, we genotyped three missense mutations in the preproghrelin gene in 215 patients suffering from panic disorder and in 451 controls. The A allele of the rs4684677 polymorphism was significantly associated with panic disorder, while there were no significant associations with the two other polymorphisms studied. We conclude that the rs4684677 (Gln90Leu) polymorphism in the preproghrelin gene may be associated with increased risk of panic disorder. It will be important to confirm these findings in additional panic disorder patient groups.Funding Agencies|Swedish Research Council for Medicine|2009-S266|European Commission|FP7-HEALTH-2009-241592FP7-KBBE-2009-3-245009FP7-KBBE-2010-4-266408|FOU/ALF Goteborg|ALFGBG-138741|Swedish Foundation for Strategic Research|A305-188|</p