Escitalopram tolerability as mono- versus augmentative therapy in patients with affective disorders : a naturalistic study

BACKGROUND: Escitalopram is a selective serotonin reuptake inhibitor, widely used in the treatment of affective disorders. The purpose of this study was to examine its safety and tolerability, as mono- versus augmentative therapy, in a group of patients with affective disorders. MATERIALS AND METHODS: The sample consisted of 131 patients suffering from different affective disorders, including major depressive disorder, bipolar disorder, and generalized anxiety disorder, who received escitalopram for at least 4 weeks. Data were analyzed on the basis of mono- versus augmentative therapy, as well as age, gender, mean daily dosage, and patterns of combination therapy. RESULTS: Sixty-seven (51.1%) patients were treated with monotherapy (mean dose of 11.76 mg/day) and 64 (48.9%) with augmentative escitalopram (mean dose of 12.81 mg/day). The mean duration of escitalopram treatment was 14 months. The most frequently combined compounds were: other antidepressants (36.5%), mood stabilizers (33.4%), and atypical antipsychotics (30.1%). Side effects were reported in 5.3% of the total sample and the most common were insomnia (2.3%), nausea (2.3%), and dizziness (0.8%). No significant difference, in terms of tolerability, in mono- versus augmentative therapy groups was found. In addition, neither age nor gender was significantly correlated with a greater presence of side effects. Finally, no significant correlation between dosage and side effects was observed. CONCLUSION: Over a 14-month observation period, escitalopram, either as monotherapy or an augmentative treatment, was found to be well tolerated in a large sample of patients with affective disorders, with an overall low rate of side effects

Duration of untreated illness and duration of illness in anxiety disorders : assessment and influence on outcome

Anxiety disorders are disabling and generally chronic conditions, with a lifetime prevalence of 15-20% in the general population. These disorders are usually associated with early onset and often remain untreated for several years with important consequences on patients' functioning and quality of life. From this perspective, recent literature has considered duration of illness (DI) and duration of untreated illness (DUI), two important variables influencing outcome in many psychiatric conditions including anxiety disorders. The DUI has been defined as the interval between the onset of a specific psychiatric disorder and the subsequent administration of the first adequate pharmacological treatment given at standard dosages and for an adequate period of time in compliant subjects. The DI can be defined as the time elapsing between the onset of a psychiatric disorder and the recovery from the illness. The two variables are likely interrelated, with a longer DUI being a major contributor to a longer DI. A significant body of evidence has shown that prolonged DI and DUI are associated with structural and functional brain abnormalities as well as with poor treatment response, particularly in schizophrenia. More recently, an increasing number of studies have been pointing toward a similar conclusion in affective disorders. As a consequence, the assessment of the latency to treatment (DUI) may represent one of the first steps in order to plan early interventions and reduce the overall DI. The present chapter highlights the role of the DI and latency to treatment in anxiety disorders, focusing on epidemiologic, neuropathological, clinical and prognostic issues

Differences in latency to first pharmacological treatment duration of untreated illness in anxiety disorders : a study on patients with panic disorder, generalized anxiety disorder and obsessive-compulsive disorder

Aim The latency to first pharmacological treatment (duration of untreated illness or \u2018DUI\u2019) is supposed to play a major role in terms of outcome in psychotic conditions. Interest in the field of affective disorders and, in particular, of duration of untreated anxiety, has been recently registered as well. However, a preliminary epidemiologic investigation of the phenomenon is necessary. The present study was aimed to investigate and compare age at onset, age at first pharmacological treatment and DUI in a sample of patients affected by different anxiety disorders. DUI was defined as the interval between the onset of the specific anxiety disorder and the administration of the first adequate pharmacological treatment in compliant subjects. Methods Study sample included 350 patients, of both sexes, with a DSM-IV-TR diagnosis of panic disorder (n\u2009=\u2009138), generalized anxiety disorder (n\u2009=\u2009127) and obsessive\u2013compulsive disorder (n\u2009=\u200985). Results Panic disorder was associated with the shortest DUI (39.5 months), whereas obsessive\u2013compulsive disorder was associated with the longest latency to treatment (94.5 months) (F\u2009=\u200913.333; P\u2009<\u20090.0001). Patients with generalized anxiety disorder showed a mean DUI of 81.6 months. Conclusion Present results indicate that patients with different anxiety disorders may wait for years (from 3 up to 8) before receiving a first adequate pharmacological treatment. Differences in terms of age at onset, age at the first pharmacological treatment and, ultimately, in DUI in specific anxiety disorders may depend on multiple clinical and environmental factors. Latency to non-pharmacological interventions (e.g. psychoeducation and different forms of psychotherapy) needs to be addressed and correlated with DUI in future studies

Un approccio dimensionale al disturbo di personalit\ue0 borderline

Background: Borderline Personality Disorder (BPD) is one of the most prevalent personality disorders affecting approximately 1-2% of the general population in the U.S., with an incidence up to 20% in psychiatric settings. Complex interactions between genetic, neurobiological and environmental factors are involved in the pathogenesis of BPD, resulting in core dimensional symptoms such as emotional dysregulation, impulse dyscontrol, aggression, cognitive dysfunctions and dissociative states. Comorbidity with other mental disorders is frequent in BPD, particularly for mood and anxiety disorders, psychotic spectrum disorders, other personality disorders and substance abuse/dependence. Suicidal ideation is frequently experienced by BPD subjects as well, and almost 10% of affected patients who have committed suicide by adulthood. As a consequence, BPD patients are high utilizers of health care resources and the correct clinical management of this disorder represents a challenge for psychiatrists. The aim of the present review is to provide a dimensional approach to BPD with specific emphasis to neuropsychological and biological findings in BPD and their relation to clinical aspects such as comorbidity patterns and treatment issues. Methods: Review of existing literature, through search of relevant papers in the major medical and psychological data bases. Results: Neurobiological studies have shown that symptoms and behaviors of BPD are partly associated with alterations in basic neurocognitive processes, involving glutamatergic, dopaminergic and serotoninergic systems. In addition, neuroimaging studies in BPD patients indicated differences in the volume and activity of specific brain regions related to emotion and impulse control, such as the prefrontal cortex, cingulate cortex, amygdala and hippocampus (Table I). As for other mental disorders, genetic vulnerability and environmental factors play a critical role for the development of these neuropsychobiological alterations and, ultimately, to the development of BPD. Nevertheless, a multiple concomitant involvement of different neurobiological circuits in BPD is supposed to produce specific cognitive dysfunctions and results in heterogeneous symptom dimensions that may be targeted with specific treatment interventions including different forms of psychotherapy and the combination of pharmacological agents. Conclusion: In the light of the complex neuropsychobiological aspects underlying the pathophysiology of BPD, a dimensional approach including the use of different spectrum models and a comprehensive investigation of the main comorbidity patterns and symptom dimensions, seems not only of academic interest but, particularly, of great clinical importance in order to orient clinicians to the most appropriate treatment choice (Table III)

Fiscal consolidation in developed and emerging economies

The debate regarding fiscal policy has given support to the formulation of an economic policy based on control of indebtedness and in persecution of public savings, acting as important support for the economic growth. This paper presents evidence that counter acts this theory of expansionary austerity. A set of panel data regressions is estimated – through Driscoll & Kraay’s, FGLS, panel corrected standard errors, and SUR estimators and the causality test approach proposed by Kónya (2006) – in search of robust inference related to the main determinants that encompasses the fiscal framework. Our conclusion is that the empirical evidence - using a set of 20 developed economies and other of 24 emerging economies - suggests that identical economic policies for different countries might conduce to results that are opposite to the desired outcome. Notwithstanding the adverse effects associated to explosive debt path, the search for “fiscal space” should be determined essentially by a pro-growth agenda. This is particularly important for the emerging economies facing the transition path challenges

Tolerability and use in co-administration of pregabalin in affective patients : a 6-month prospective naturalistic study

OBJECTIVE: The aims of the present study were to investigate the main demographic and clinical characteristics, comorbidity patterns, use in association and tolerability of pregabalin in a sample of patients with affective disorders, and to compare demographic and clinical variables of the groups divided, according to the treatment pregabalin was associated with. METHODS: One hundred and fourteen consecutive outpatients, with anxiety and/or depressive disorders with or without comorbidity, were started on pregabalin, assessed and interviewed and their demographic data, associated therapy, tolerability and side effects collected over an observational period of 6 months. RESULTS: The most frequent primary diagnoses were mood disorders (49.1%) and generalized anxiety disorder (21.9%). The most commonly associated treatments were antidepressants (66.7%) and mood stabilizers (15.8%). The most frequent side effects were sedation (3.4%), dizziness (0.9%), nausea (0.9%), diarrhea (0.9%), cough (0.9%) and peripheral edema (0.9%). When patients were divided according to the co-treatments, subgroups differed in terms of prescription of benzodiazepines (\u3c7(2) = 15.25, df = 6, p = 0.013, phi = 0.37), with the most frequent use of these molecules in patients co-treated with tricyclic antidepressants and minor use in the selective serotonin reuptake inhibitors group. CONCLUSIONS:Differences in the co-administration of benzodiazepines might suggest a stronger anxiolytic effect when pregabalin is combined with specific psychotropic drugs (e.g., SSRIs)