Prevalence of the catatonic syndrome in an acute inpatient sample

OBJECTIVE: In this exploratory open label study we investigated the prevalence of catatonia in an acute psychiatric inpatient population. In addition, differences in symptom presentation of catatonia depending on the underlying psychiatric illness were investigated.METHODS: 130 patients were assessed with the Bush-Francis Catatonia Rating Scale (BFCRS), the Positive and Negative Syndrome Scale (PANSS), the Young Mania Rating Scale (YMRS) and the Simpson-Angus Scale (SAS). A factor analysis was conducted in order to generate 6 catatonic symptom clusters. Composite scores based on this principal component analysis were calculated. RESULTS: When focusing on the first 14 items of the BFCRS, 101 patients (77.7%) had at least 1 symptom scoring 1 or higher, whereas 66 patients (50.8%) had at least 2 symptoms. Interestingly, when focusing on the DSM-5 criteria of catatonia, 22 patients (16.9%) could be considered for this diagnosis. Furthermore, different symptom profiles were found, depending on the underlying psychopathology. Psychotic symptomatology correlated strongly with excitement symptomatology (r=.528,p<.001) and to a lesser degree with the stereotypy/mannerisms symptom cluster (r=.289; p=.001) and the echo/perseveration symptom cluster (r=.185;p=.035). Similarly, manic symptomatology correlated strongly with the excitement symptom cluster (r=.596;p<.001) and to a lesser extent with the stereotypy/mannerisms symptom cluster (r=.277;p=.001).CONCLUSION: There was a high prevalence of catatonic symptomatology. Depending on the criteria being used, we noticed an important difference in exact prevalence, which makes it clear that we need clear-cut criteria. Another important finding is the fact that the catatonic presentation may vary depending on the underlying pathology, although an unambiguous delineation between these catatonic presentations cannot be made. Future research is needed to determine diagnostical criteria of catatonia which are clinically relevant

Evaluation of vilazodone for the treatment of depressive and anxiety disorders

ABSTRACTIntroduction: Major Depressive Disorder (MDD) and General Anxiety Disorder (GAD) significantlycontribute to the global burden of disease. Vilazodone, a combined serotonin reuptake inhibitor and5-HT1A partial agonist, is an approved therapy for the treatment of MDD and which has been furtherinvestigated for GAD.Areas covered: This article covers the pharmacokinetics and pharmacodynamics of vilazodone andprovides an evaluation of the clinical usefulness of vilazodone for the treatment of MDD and anxietydisorders. A literature search was performed using PubMed/MEDLINE, Web of Science and the CochraneLibrary.Expert opinion: Studies have shown that vilazodone is significantly superior to placebo. However,vilazodone cannot as yet be recommended as a first-line treatment option for MDD as it is unclearwhether the drug’s dual mechanism of action provides greater efficacy than prevailing treatmentoptions. Moreover, more phase IV studies are needed to establish its efficacy and long-term safety inlarger and more diverse populations. Although vilazodone may have an additional advantage for thetreatment of anxiety symptoms in MDD, here also additional studies are required to confirm its efficacyover and above SSRI alternatives and other antidepressant treatments. Therefore, presently, vilazodoneshould be considered as a second- or third-line treatment option for MDD and GAD.</p

Symptom profile and clinical course of inpatients with unipolar versus bipolar depression

Background:Although differences in symptom profiles and outcome between depressive patients with an underlying major depressive disorder (MDD) and bipolar depression (BD) have been reported, studies with sequential short-interval assessments in a real-life inpatient setting are scarce.Objectives:To examine potential differences in symptom profile and course of depressive symptomatology in depressive inpatients with underlying MDD and BD.Methods:A cohort of 276 consecutive inpatients with MDD (n= 224) or BD (n= 52) was followed during their hospitalization using routine outcome monitoring (ROM), which included a structured diagnostic interview at baseline (Mini-International Neuropsychiatric Interview Plus [MINI-Plus]) and repeated 17-item Hamilton Depression Rating Scale every 2 weeks. MDD and BD were compared regarding their symptom profiles and time to response and remission. Furthermore, the concordance between the MINI-Plus and clinical diagnosis was analyzed.Results:Patients were on average 52 and 47 years old in the MDD and BD group, respectively, and 66 versus 64% were female. Compared to patients with BD, patients with MDD scored higher on weight loss (p= 0.02), whereas the BD group showed a higher long-term likelihood of response (hazard ratio = 1.93, 95% confidence interval 1.16-3.20,pfor interaction with time = 0.04). Although the same association was seen for remission, the interaction with time was not significant (p= 0.48). Efficiency between the MINI-Plus and clinical diagnosis of BD was high (0.90), suggesting that the MINI-Plus is an adequate ROM diagnostic tool.Conclusions:In routine clinical inpatient care, minor differences in the symptom profile and the course of depressive symptomatology may be helpful in distinguishing MDD and BD, particularly when using sequential ROM assessments.Stress-related psychiatric disorders across the life spa