Adjunctive quetiapine for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: A meta-analysis of randomised controlled treatment trials

Small studies have shown positive effects from adding a variety of antipsychotic agents in patients with obsessive–compulsive disorder who are unresponsive to treatment with serotonin reuptake inhibitors. The evidence, however, is contradictory. This paper reports a meta-analysis of existing double-blind randomized placebo-controlled studies looking at the addition of the second-generation antipsychotic quetiapine in such cases. Three studies fulfilled the inclusion criteria. Altogether 102 individuals were subjected to analysis using Review Manager (4.2.7). The results showed evidence of efficacy for adjunctive quetiapine (< 400 mg/day) on the primary efficacy criterion, measured as changes from baseline in total Yale–Brown Obsessive Compulsive Scale scores (P = 0.008), the clinical significance of which was limited by between-study heterogeneity. The mechanism underlying the effect may involve serotonin and/or dopamine neurotransmission

Predictors of distress and anxiety during pregnancy

Objective: There is a high incidence of distressing psychological symptoms including anxiety in pregnancy. Nevertheless, predictors of distress and anxiety during pregnancy have not been well characterized. We determined whether temperament and character, trait anxiety, resilience, and social support predicted distress and anxiety symptoms in pregnancy.Method: Pregnant women (n=105) with low risk singleton pregnancies were recruited from Midwife Obstetric Units. Assessments of distress (usingthe K-10) and anxiety (using the Spielberger State Inventory) were undertaken in trimester 2 and 3. Measures of temperament and character, trait anxiety, resilience and social support were undertaken at the same time points. Regression analyses were used to determine predictors of distress and anxiety at each trimester.Results: Predictors of distress and anxiety were lower selfdirectedness,higher harm avoidance, higher trait anxiety, lower resilience, and lower social support, at each time point.Conclusion: Understanding predictors of distress and anxiety in pregnancy may be useful in developing interventions for addressing such symptoms, as well as perhaps in preventing potential sequelae such as anxiety and mood disorders.Keywords: Distress; Anxiety; Self-directedness; Harm avoidance; Resilience; Social suppor

Olfactory reference syndrome in DSM-V

LetterThe original publication is available at http://www.samj.org.zaTo the Editor: We read with interest Dr A Lawrence’s recent SAMJ case report of a young man who presented with persistent preoccupation with personal body odour in the absence of any physical abnormalitiesPublishers’ Versio

Collaborative care for the detection and management of depression among adults with hypertension in South Africa: study protocol for the PRIME-SA randomised controlled trial

Background: The high co-morbidity of mental disorders, particularly depression, with non-communicable diseases (NCDs) such as cardiovascular disease (CVD), is concerning given the rising burden of NCDs globally, and the role depression plays in confounding prevention and treatment of NCDs. The objective of this randomised control trial (RCT) is to determine the real-world effectiveness of strengthened depression identification and management on depression outcomes in hypertensive patients attending primary health care (PHC) facilities in South Africa (SA). Methods/design: The study design is a pragmatic, two-arm, parallel-cluster RCT, the unit of randomisation being the clinics, with outcomes being measured for individual participants. The 20 largest eligible clinics from one district in the North West Province are enrolled in the trial. Equal numbers of hypertensive patients (n = 50) identified as having depression using the Patient Health Questionnaire (PHQ-9) are enrolled from each clinic, making up a total of 1000 participants with 500 in each arm. The nurse clinicians in the control facilities receive the standard training in Primary Care 101 (PC101), a clinical decision support tool for integrated chronic care that includes guidelines for hypertension and depression care. Referral pathways available include referrals to PHC physicians, clinical or counselling psychologists and outpatient psychiatric and psychological services. In the intervention clinics, this training is supplemented with strengthened training in the depression components of PC101 as well as training in clinical communication skills for nurse-led chronic care. Referral pathways are strengthened through the introduction of a facility-based behavioural health counsellor, trained to provide structured manualised counselling for depression and adherence counselling for all chronic conditions. The primary outcome is defined as at least 50% reduction in PHQ-9 score measured at 6 months. Discussion: This trial should provide evidence of the real world effectiveness of strengtheneddepression identification and collaborative management on health outcomes of hypertensive patients withcomorbid depression attending PHC facilities in South Africa

Consultation liaison psychiatry in Africa - essential service or unaffordable luxury?

[No abstract available

Pharmacotherapy of obsessive-compulsive disorder: Experience with the selective serotonin reuptake inhibitors

Since the introduction of the selective serotonin reuptake inhibitors (SSRIs) a decade ago, they have become first-line agents in the treatment of obsessive-compulsive disorder (OCD). Numerous clinical trials have confirmed their efficacy, and established their superior risk-benefit ratio in comparison with clomipramine, a non-selective serotonin reuptake inhibitor. Relatively higher doses and longer duration of treatment may be necessary to effect a response in OCD, with long-term treatment being required to maintain therapeutic gains. Despite the advances represented by the SSRIs, treatment resistance remains a problem. While no one solution exists, various strategies, including pharmacotherapy augmentation, look promising. (C) 2000 Lippincott Williams and Wilkins.Conference Pape