Psychostimulants in the Treatment of Depressive Disorders

Despite antidepressant therapy of appropriate trial duration and dose optimization, 50-60% of depressed patients have an adequate treatment response, whereas only 35-40% achieve remission. Psychostimulants have been suggested as potential candidates to promote acceleration of response and to alleviate residual symptoms of depression. Nowadays, clinicians often consider the off-label use of stimulants or stimulant alternatives as adjunctive antidepressants. In this review study, we reviewed the available literature on the efficacy of these agents for treatment of refractory unipolar and bipolar depression. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2015; 7(3.000): 304-318

OKB hastalarında düşük dereceli inflamasyonla klinik ve sosyodemografik özelliklerin ilişkisi

Amaç: Son yıllarda inflamasyonun obsesif kompulsif bozuklukluğun (OKB) etyolojisindeki rolüne ilişkin kanıtlar artmaktadır. Bildiğimiz kadarıyla, OKB'li olgularda C-reaktif protein (CRP) ile klinik ve demografik özellikleri arasındaki ilişkiyi araştırmış herhangi bir çalışma yoktur. Bu çalışmada OKB'li olgularda CRP düzeyleri ile psikopatolojik ve demografik değişkenler arasındaki ilişkiyi değerlendirmeyi amaçladık. Yöntem: OKB tanısı konmuş ardışık 98 ayaktan hasta ayrıntılı olarak değerlendirildi. Inflamasyon göstergesi olarak değerlendirme sırasında bakılan CRP sonuçları hastaların bilgisayar kayıtlarından araştırıldı. Rutin olarak bakılan tetkiklerinde CRP kesme değeri 3 mg/dl olarak kabul edilerek (3 olan hastalar yüksek CRP; 3 olan hastalar normal CRP grubu) iki grup karşılaştırıldı. Bulgular: Elli sekiz hasta (%59.2) normal CRP, 40 hasta (%40.8) yüksek CRP olarak sınıflandırıldı. Yüksek CRP düzeyi grubunun iç görü düzeyleri anlamlı olarak diğer gruba göre daha kötüydü. Yüksek CRP grubundaki hastaların normal olan gruba göre anlamlı olarak daha yüksek oranda intihar girişimi, OKB için pozitif aile öyküsü olduğu ve daha erken hastalık başlangıç yaşına sahip oldukları bulundu. Lojistik regresyon analizinde üç değişkenin hastaların yüksek CRP grubunda olma riskini anlamlı yordadığı saptandı: İç görü düzeyleri, hastalığın başlangıç yaşı, OKB aile öyküsü. Sonuç: Bulgularımız OKB'li olgularda düşük dereceli inflamasyonla iç görünün, hastalık başlangıç yaşının, intiharın ve OKB için pozitif aile öyküsünün ilişkisine işaret etmektedir. Gelecek çalışmalarda CRP düzeyinde uzunlamasına dönemdeki değişimlerin, OKB'de psikopatoloji ile ilişkisinin araştırılması hastalığınObjective: To our knowledge, no study has specifically examined the relationship between C-reactive protein CRP levels and clinical features in patients with obsessive compulsive disorder (OCD), even though inflammation plays a role in the etiology of OCD. The aim of this study was to assess the associations between CRP levels and psychopathological and demographic variables in OCD. Methods: Ninety-eight consecutive outpatients with a diagnosis of OCD underwent a detailed clinical assessment for OCD. The study also utilized a cross-sectional patients' records design for obtaining CRP levels. Two groups of patients were compared by CRP levels at the cutoff of 3 mg/dl (high vs. normal). Results: Patients with high CRP levels exhibited worse insight, had earlier age of illness onset, higher rates of previous suicide attempts and positive family history for OCD compared to subjects with normal CRP levels. The logistic regression included three predictive variables for CRP status in patients with OCD (a) YBOCS-insight scores (b) age at onset and (c) family history of OCD. Conclusion: Our data indicates a significant association between inflammation and some clinical features in OCD. Future studies should prospectively examine longitudinal changes in CRP and its' association with clinical and demographic features

Brexpiprazole: A partial dopamine agonist for the treatment of schizophrenia

PubMed ID: 28828976Background: Schizophrenia is a chronic and debilitating mental disorder that affects the patient’s and their family’s life. The disease remains a complicated disorder that is challenging to treat, despite there being a large antipsychotic armamentarium. Brexpiprazole acts both as a partial agonist at the serotonin 5-HT1A and dopamine D2 receptors and as an antagonist at the serotonin 5- HT2A and noradrenaline alpha1B and alpha2C receptors, all with similar potency. This balanced receptor profile may produce promising antipsychotic effects on positive, negative and cognitive symptoms in schizophrenia with minimal adverse effects. Methods: This review summarizes the pharmacodynamics and pharmacokinetic profile of brexpiprazole and the clinical trial information pertaining to its effectiveness and safety and tolerability, discusses its best clinical use, and compares its clinical profile to those of other widely used antipsychotic agents. Results: Brexpiprazole demonstrated significant clinical efficacy and had good safety and tolerability in well-designed trials with patients with schizophrenia. This agent may be a useful treatment alternative. Conclusion: However, it will be valuable to consider a long-term observational study that includes an active comparator, especially other second-generation antipsychotics (SGAs), to further evaluate the efficacy and safety of brexpiprazole in the treatment of schizophrenia. © 2018 Bentham Science Publishers

Relation of quality of life with clinical and demographic features in patients with obsessive-compulsive disorder: The effect of insight and suicidality

Objective: Obsessive-compulsive disorder (OCD) may affect the quality of life (QOL), family relations, professional performance, and relationships of the individual in many other areas. The evidence has emphasized the relevance of examining QOL as a critical outcome in mental health studies. This study aimed to examine possible effects of clinical and demographic features including insight and suicidality on the QOL in patients with OCD. Method: The sample of this study consists of 80 patients diagnosed with OCD according to DSM-IV and 80 healthy volunteers. A sociodemographic and clinical data form and the World Health Organization Quality of Life brief form-Turkish version (WHOQOOL-BREF-TR) were administered to the participants. In addition, the patient group was assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Hamilton Depression Rating Scale (HAM-D). Insight was evaluated by using the insight item of Y-BOCS and the Overvalued Ideas Scale (OVIS). Results: The average scores for the physical health, psychological health, and social relationship domains of WHOQOOL-BREFTR were lower in the patient group; however, there was no significant difference in the environmental health domain between the two groups. Negative correlations were found between the severity of the disease, age at illness onset and QOL subdomains. Besides, a history of suicide attempt had a statistically significant effect on all subscales of quality of life. Insight had no significant effect on any QOL subscale. Conclusion: This study shows that the quality of life is affected in OCD and this is partly related to the severity of the disease and suicidality but not to insight. Considering the effects of quality of life in both the treatment and follow-up of this patient group, the importance of identifying the factors affecting the quality of life will be better understood in OCD patients. Further large-scale longitudinal studies are needed to clarify this issue. © 2019 Yerkure Tanitim ve Yayincilik Hizmetleri A.S.. All rights reserved

The connections among suicidal behavior, lipid profile and low-grade inflammation in patients with major depressive disorder: a specific relationship with the neutrophil-to-lymphocyte ratio

PubMed ID: 28800269Objectives: The role of inflammation and lipid metabolism in the pathophysiology of suicidal behavior has received particular attention in recent years. The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a new and more reliable indicator of low-grade inflammation. NLR has been found to be altered in major depressive disorder (MDD) and has been related to various factors, including chronic stress and impulsivity that were previously reported to be related to suicidal behavior. We aimed to explore the roles of NLR, C-reactive protein (CRP) and serum lipid levels on suicidal behavior in patients with MDD. Methods: The study group consisted of 139 inpatients diagnosed with MDD [37 suicide attempters (SA); 102 suicide non-attempters (NSA)], 50 healthy controls and matched according to age, gender and education. NLR, PLR, CRP and lipid values were obtained from digital inpatient records. Results: CRP levels and NLR were substantially higher in patients with SA than in subjects with NSA and healthy comparison subjects after adjusting the confounding factors. The logistic regression included two predictive variables for suicide status in patients with depressive disorder (A) previous suicidal history; (B) NLR. Conclusions: This is the first study suggesting that NLR may be a trait marker for suicidal vulnerability via a relationship between NLR and a recent suicide attempt in depressed inpatients. Future prospective studies are needed to determine the exact roles of NLR, and other inflammatory markers on suicidality in MDD. © 2017 The Nordic Psychiatric Association

Neurological Soft Signs and Clinical Features of Tic-Related Obsessive-Compulsive Disorder Indicate a Unique Subtype

PubMed ID: 31688495Tic-related obsessive-compulsive disorder (OCD) may be a unique OCD subtype. This study examined whether neurological soft signs (NSSs) of patients with tic-related and tic-free OCD enable discrimination of these subgroups. We used the Neurological Evaluation Scale to assess 32 patients with tic-related and 94 with tic-free OCD, as well as 84 controls. Most patients with tic-related OCD were male, with earlier illness onset and poorer insight scores than those of patients with tic-free OCD. Patients with tic-related OCD had poorer motor coordination, sensory integration, and motor sequencing than did tic-free patients. Logistic regression using NSS subscale scores predicted tic-related OCD. Patients with tic-related OCD displayed greater neurodevelopmental abnormalities than did tic-free patients. NSSs of the former group suggest the need to separate this subgroup. Our results also support the newly introduced tic-related specifier in the fifth edition of the Diagnostic and statistical manual of mental disorders. © Wolters Kluwer Health, Inc. All rights reserved